Abstract: The present paper studied the impact of educational inequality on child mortality in the states of southern region of India during the period 1991 to 2019. The study applied the Gini coefficient technique to investigate the education inequality in each state of the region. The paper observed the highest educational inequality in Andhra Pradesh while the lowest in Kerala among the states. However, such educational inequality is highest in the rural areas as compared to the urban areas in each state. The improvement of the average years of schooling contributed to the reduction of education inequality in the region. The study observed that the reduction of education inequality leads to the growth of per capita NSDP in each state of the region. Similarly, the expansion of education sector leads to reduction of child mortality rate in each state of the region.
Key words: Gini Coefficient, Educational Inequality, Rural-Urban Inequality, Child Mortality.

Abstract: Introduction: The assessment of growth is essential during preschool age, more particularly in pediatric neurological examination, where measurement of the head circumference plays a vital role. Head circumference (HC) is a simple and non-invasive anthropometric measure. Also known as the frontal occipital circumference, HC has been cautiously used to assess the frequencies of undernutrition among preschool children. Material & Methods: The current study was done on 782 preschool children (boys= 384, girls = 398) aged 24-60 months ICDS beneficiaries of Jalpaiguri by using WHO (2007) recommended cut-off points for head circumference for age. Statistical analyses were also done to determine age and sex variations in Head Circumference. Results: Age combined rates of Head Circumference based moderate undernutrition for boys was 21.87 % and for girls was 25.37 %. Age-combined severe undernutrition among boys and girls were 5.72% and 6.53 %, respectively. The higher percentage of malnourished girls was seen in the previous study done on Midnapore and Bangalkot and a higher percentage of malnourished boys was seen than the Midnapore children. The present study reveals Girls were more affected by moderate and severe undernutrition compared to boys. Conclusion: Head Circumference is an indicator of brain development so initiative should be taken for regular monitoring of ICDS beneficiaries to improve the nutritional condition of preschool children.
Key words: Anthropometry, Head Circumference, HC for Z score, Undernutrition, Preschool children, Age and sex variation

Abstract: Background: Healthcare expenditure plays a crucial role in determining the quality and accessibility of healthcare services within a country. The Indian government has made efforts to improve healthcare infrastructure and services for which, they need fiscal space through government revenue and expenditure account. Objectives: The present study tries to examine the impact of macroeconomic factors such as economic growth, revenue and expenditure account, internal debt, and deficit on public health expenditure for the North Eastern states of India from 1990-91 to 2019-20. Methods: The trends of the variables and sigma convergence analysis have been employed to check the movement of the states over time. Further, the vector error correction model has been used to examine the long- and short-run impact of the macroeconomic variables on public healthcare expenditure. Results:The study observed that an increase in total social sector expenditure and revenue receipts also has favourable impact on the growth of public health expenditure for the North Eastern states in both the long run and short-run.
Key words: Public Health Expenditure, North East India, Panel Vector Error Correction Model

Abstract: Rising in the rates of C-section deliveries worldwide is a major public health concern. According to WHO, C-section rate continues to rise globally, accounting for more than 1 in 5(21%) childbirths. There is lack of evidence supporting the maternal and neonatal benefits with the increasing C-section rates. Robson’s Ten Group Classification system (RTGCS) serves as an initial structure with which caesarean section rates can be analyzed and allow us to bring changes in clinical practice. The objective of the current study was to audit C-section rate using Robson’s Ten Group Classification System in our tertiary care hospital, and to identify the main contributors of each subgroup to overall C-section rate. This was a cross-sectional study conducted at out tertiary care center, Karpaga Vinayaga Institute of Medical Sciences and Research Centre (KIMS&RC), Madhuranthagam, Tamil Nadu, India during the period of January 2019 to December 2021. The study was conducted by reviewing the hospital record for analyzing the C-sections performed during the above-mentioned period. The study population include the pregnant women who underwent C-sections in our hospital during the specified period. The 401 women who underwent C-section were classified in Robson’s Ten group classification system, 45% women in Group 5 and it contributed to the maximum number of the total C-section rates. The second highest contributor was Group 1 and Group 2 contributing to 41% of the overall C-section rates. The Robson’s Ten group classification system provides a useful framework for auditing C-section rates. Regular audits and standardization of indication of C-section will help in reducing the C-section rate in future.
Key words: Cesarean section rate, Audit, LSCS, Robson’s Ten Group classification, Labour.

Abstract: The Indian innovation ecosystem is a vibrant space, and India has emerged as the world's third-largest startup economy. Biotechnology, Digital healthcare and Medical devices have emerged as three key sectors in the innovation ecosystem of India. However, there has been no systematic understanding of the evolution and application of healthcare innovations in these sectors and their role in the Indian healthcare system. This study addresses this gap and aims to understand the nature and scope of these innovations in India. The study analysed secondary and primary data (expert interviews) from the above three sectors to create an innovation diffusion framework based on the empirical findings. The application of innovation in the biotechnology sector has resulted in many frugal innovations which have global applicability. Digital innovations have contributed to convenience in access to healthcare and medicines. However, their impact is dependent on supporting infrastructure and digital literacy. Medical device innovations have significantly increased since the launch of the Startup India policy and during the COVID-19 pandemic. However, further research is required to assess the impact of these healthcare innovations towards Universal Health Coverage.
Key words: Health technology, Economic evaluation, Digitalisation, Universal Health Coverage, Ecosystem, Policy, COVID-19.

Abstract: Introduction: Adolescence is a period of psychological and somatic growth and development. Pregnancy and childbirth during this period expose women to medical and cognitive risks. The aim of this study was to determine the prevalence, indications, evolution and factors associated with the risk of caesarean section among adolescent and adult women. Methods: This was a cross-sectional, analytical study conducted at Lubao General Referral Hospital. Data covered the period from 2018 to 2022. Epi Info 7.2.4 and Jamovi 2.3.21 software were used for data analysis. The p-value and Odd ratio were used to determine the association between the variables. Results: Caesarean sections accounted for 15.3% of deliveries (375 out of 2444). The prevalence of caesarean sections was 78.0% (64 out of 82 deliveries) among adolescent women and 13.2% (311 out of 2362 deliveries) among adult women. The risk of caesarean section was 23.44 times higher among adolescents (OR 23.44; [IC95% 13.71-40.09]; p-0.0000). Fetal macrosomia and acute fetal distress were the main indications in both groups. Bone dystocia was found only among adolescents. Occupation (OR 39.04 [CI95% 5.34-285.27]; p=0.0000), being single (OR 43.26 [CI95% 9.54-196.10]; p=0.0000), mechanical dystocia (OR 2.08 [CI95% 1.11-3.87]; p=0.0190) and parity ? three (p=0.0000) were associated with the indication for caesarean section among the adolescents studied. Maternal and early neonatal outcome were not associated with maternal age. Conclusion: Adolescents present a very high risk of caesarean section. Raising parents' awareness of the risks of early marriage, educating girls in favour of sex education in schools, churches and youth clubs, and combating sexual exploitation and abuse and even sexual violence are all solutions that should be considered.
Key words: Caesarean section, Childbirth, Adolescents, Lubao, DRC

Abstract: Background: The study was carried out to evaluate the pulmonary fibrosis cases secondary to Covid-19 pneumonia and it’s relation with inflammatory markers in patients presenting at Indira Gandhi Medical College, Shimla, Himachal Pradesh. Materials and Methods: This was a Prospective Cohort study conducted from 1^st August 2021 to 31^st July 2022 and included 40 RT-PCR confirmed COVID-19 pneumonia patients who completed six months follow up. Demographic and clinical characteristics were recorded. Laboratory and radiological indices including pulmonary fibrosis were collected at admission and at three and six months and analysed using Epi Info version 7 software. Results: Among the totalof 40 patients, 26(65%) were males and 14 females (35%). Majority of patients belonged to age group of 51-60 years (35%). In 15(37.50%) patients, fibrosis was present at 3 months and at 6 months, fibrosis was present in 11 (27.50%) patients. Fibrosis was absent when dexamethasone was administered for a duration of 6.7(±3.94) days at 3 months and at 6 months when it was given for a duration of 7(±3.8) days which was found to be statistically significant (p value = 0.0047,0.009) . At 3 months fibrosis was present in majority of patients with deranged TLC, QCRP, NLR, LDH (40%,38.24%,42.86% and 42.42% respectively) and also D-dimer and ferritin (60% and 46.67% respectively), which was found to be statistically significant while At 6 months fibrosis was present in majority of patients with deranged QCRP, NLR, LDH, D-dimer (29.41%,31.43%,33.3% and 40% respectively) along with ferritin(36.67%), which was significant. Conclusion: Our study concluded that in most of the patients with mild lung involvement at presentation, fibrosis was significantly lower at 3 months and 6 months of follow up in comparison to patients with severe lung involvement and steroids for average duration of 10 days at presentation was significantly associated with improvement in fibrosis.
Key words: Covid-19 Pneumonia, Pulmonary Fibrosis, Inflammatory markers

Abstract: Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear cleft with non-healing tympanic membrane perforation leading to conductive hearing loss. Surgery is the definitive management. Myringoplasty with or without cortical mastoidectomy is a matter of discussion among the otorhinolaryngologists society. One hypothesis suggests that myringoplasty combined with cortical mastoidectomy in tubotympanic type of chronic suppurative otitis media (CSOM) is useful, whereas another fraction believes that cortical mastoidectomy combined with myringoplasty has no inconsequential effects on the surgical result. Aim: To compare the surgical outcome of chronic suppurative otitis media of tubotympanic type in patients who underwent myringoplasty alone or with cortical mastoidectomy and myringoplasty. Materials and Methods: A retrospective study includes 300 patients with CSOM of tubotympanic type. Preoperative assessments were done including pure tone audiometry. Patients were divided into two groups. Group I underwent myringoplasty alone and Group II underwent cortical mastoidectomy with myringoplasty. At one month postop period, patients were assessed for graft uptake and pure tone audiometry. These values were compared between the two groups. Results: Out of 300 patients the graft uptake was present in 272 patients (90.7%) and graft uptake was absent in 28 patients (9.3%). The significant value is 0.000 which is less than 0.05 at 95% confidence interval. Therefore, there is significant relationship between Pre PTA and Post PTA in group II. Conclusion:There is a statically significant difference in results in both groups. Cortical mastoidectomy with myringoplasty gives better surgical outcomes in graft uptake rate and audiological improvement than myringoplasty alone.
Key words: Graft, Mastoid, Audiogram, Otitis media

Abstract: Objective: To compare sensitivity, specificity, positive predictive value and negative predictive values of three different techniques such as, urine culture, urinary heparin binding protein assay by ELISA and identification of pathogens by multiplex PCR in gestational diabetes mellitus (GDM). Study design:An observational study was conducted in 50 GDM patients. Urine samples were collected and cultured. Antibiotic sensitivity testing was performed by the modified disc diffusion method. Urine heparin binding protein (UHBP) was estimated in the sample by ELISA. DNA was extracted from urine samples and pathogens were identified by multiplex PCR. Results: Prevalence of asymptomatic bacteriuria (ASB) among GDM patients on basis of urine culture was found to be 6%. A significant association was noted between detection of organisms and multiplex PCR findings compared to urine culture (p <0.0001). Median (25% - 75%) value of UHBP levels in urine was noted to be 689 (625, - 863) pg/ml. A significant association was observed between UHBP levels and multiplex PCR findings(p,0.05). No significant association was found between UHBP levels and urine culture. Conclusion: Multiplex PCR was found to be more sensitive and specific compared to Urine culture and estimation of UHBP by ELISA in detecting asymptomatic bacteriuria/ Pyuia. Overall, multiplex PCR appears to have higher sensitivity compared to UHBP measurement and urine culture, making it a promising technique for detecting ASB. However, further research is needed to validate and compare these methods in diverse populations and clinical settings. Moreover, considering the cost, availability, and turnaround time of each technique is essential when choosing the most suitable method for ASB detection.
Key words: Gestational diabetes, urinary tract infection, aymptomatic bacteriuria, multipleX PCR

Abstract: Background: Worldwide, one of the most common abdominal emergencies is appendicitis. Routine histopathological examination of appendectomy samples, is not at all questioned. Aim of the study: Is to identify the results of the routine histopathological examinations of appendectomy specimens and to correlate them with the preoperative imaging tools. Subjects and methods: In a single secondary health care hospital, a retrospective analysis of 365 appendectomies, for patients operated initially for acute appendicitis, was carried out between April 2020 till April 2023. Demographic, imaging and histopathologic data were retrieved from the patients’ medical records. Results: Out of the studied patients, 95.3% were aged between 12-50 years. One third of the cases was females (32.1%). Laparoscopic appendectomy was operated for the majority of them (77%). Leukocytosis was significantly more frequent between those with positive appendicitis histopathologically. Positive appendicitis was reported between 96.4% of the histopathology reports. The most prevalent diagnosis was acute appendicitis, suppurative appendicitis, gangrenous appendicitis and perforation (50.7%, 41.6%, 2.5% and 1.6%; respectively). Negative appendectomy rate was 3.6%. In diagnosing acute appendicitis, Ultrasound (US) imaging had 66.7% accuracy rate while Computerized Tomography (CT) had a rate of 96.9%. Conclusion: It is evident that although histopathological examination is beneficial in acute appendicitis diagnosis, it advantageous in recognizing the unusual pathological findings. Negative appendectomy rate can be reduced by the use of modern diagnostic modalities, CT is advisable.
Key words: Acute appendicitis, Routine histopathology examination, Radiological imaging.

Abstract: Objectives: Primary colo-rectal adenocarcinoma is one of the common malignancies the world-over. Metastasis to colo-rectum is uncommon. We aim to study the clinical and histological features of a few cases of metastatic carcinoma from stomach, with an emphasis on immunohistochemistry to help us distinguish these tumours from colonic primary. Methods: Data from the laboratory information system was retrieved and biopsies/ resection specimen, taken from colon or rectum, with a diagnosis of metastatic adenocarcinoma from stomach with immunohistochemical studies supporting the same were included. Results: Previous history of carcinoma stomach is an essential part in diagnosing metastases to colo-rectum. Clues to diagnosis on histopathology include expanded lamina by bland looking/ signet ring cells with a relatively preserved colonic glandular mucosa. Useful panel of immunohistochemical stains include cytokeratin (CK) 7 and 20, epithelial membrane antigen (EMA) and CDX2. Conclusion: In a colonic biopsy with a relatively normal mucosa and signet ring cells in the lamina, the possibility of metastatic signet ring cell carcinoma from stomach should also be considered. Clinical history and imaging can be useful to correlate the findings. A small immunohistochemistry (IHC) panel with a minimum of 4 markers (CK7/20, CDX2 and EMA) serves as a valuable adjunct to confirm the same.
Key words: Metastases, Adenocarcinoma, Signet ring, Stomach, Colon.

Abstract: The term “collision tumor” is described as the coexistence of two or more histologically distinct neoplastic morphologies separated by normal tissue in the same organ. Collision phenomenon involving two and more neoplasms of the thyroid gland is a rare entity. A 54 year old female presented with a diffuse large swelling of thyroid gland increasing in size over a period of 20 years. Clinicoradiological examination reveal heterogenous enhancing lesion involving bilateral neck up to skull base. Patient underwent total thyroidectomy with central compartment clearance and bilateral selective neck node dissections. On histopathology, collision tumors with components of five histologically different entities were identified, including hurtle cell adenoma, well differentiated tumor of uncertain malignant potential, papillary thyroid carcinoma-classical variant, follicular variant of papillary thyroid carcinoma and primary squamous cell carcinoma of thyroid within different lobes of thyroid. To the best of our knowledge, this is the first documentation of a collision tumor with five histologically different entities within a single thyroid gland.
Key words: Collision tumors, Follicular variant of Papillary Thyroid Carcinoma, Hurtle cell adenoma, Primary Squamous Cell carcinoma, Papillary Thyroid Carcinoma, Well-differentiated tumour of uncertain malignant potential.

Abstract: Uterine perforation is a rare and one of the most serious complication following Cu IUCD insertion. Here we are presenting a case of Cu IUCD perforation and expulsion though anus. This case emphasises that ultrasonography is not enough for the investigation of missing IUCD thread. X ray may be added to find out IUCD if no IUCD is visible in the uterine cavity.
Key words: Uterus, Perforation, IUCD

Abstract: Partial or complete finger amputations as a result of trauma, tumor, surgeries, or due to congenital anomalies are few of the most commonly confronted forms of partial hand loss. Prosthetic rehabilitation often offers predictable esthetic results although function cannot be completely restored. This case report outlines a low-cost and easy method to rehabilitate a partially amputated finger with a silicone finger prosthesis using a custom-made ring assembly as a retentive aid.
Key words: Amputated finger, Finger prosthesis, Retentive aid

Abstract: Hybrid tumours are defined as two or more neoplasms which are sharply demarcated and possess distinct histologic, molecular and prognostic features occurring in one organ. The incidence of hybrid tumour in the parotid gland is low, accounting for 0.1% of the tumours. These lesions pose significant challenge to the cytopathologist, as the needle may pass through both the lesions, with smears showing representation from both, misleading the cytopathologist. Herein, we report a cytologic dilemma encountered in case of a hybrid tumour of parotid gland comprising of epithelial myoepithelial carcinoma and Warthin’s tumour which was misinterpreted as mucoepidermoid carcinoma with pleomorphic adenoma at cytology.
Key words: Collision tumours, Epithelial-myoepithelial carcinoma, Warthin’s tumour, Pathological findings, FNAC.

Abstract: With merely 300 cases reported in the literature, Grynfelt-Lesshaft hernia is an extremely rare condition. This hernia was identified in a 39-year-old male patient, and is presented due to its rarity.
Key words: Grynfelt-Lesshaft hernia; lumbar hernia; lumbar triangles; cough impulse, strangulation