Background: Low birth weight (LBW) is an important risk factor for childhood morbidity and mortality, consequently an important public health concern. Aim: This study aims to identify significant socio-economic and nutritional determinants associated with LBW in India. Materials and Methods: Data from 2005 to 2006 National Family Health Survey-3 (NFHS-3) of India was analyzed. A total of 20,946 women (15-49 years) who gave birth at least once 5 years preceding the NFHS-3 were included in this study. Infant's LBW (<2500 grams) as outcome variable was examined in association with all independent predictors as infant's sex, maternal household wealth status, caste, age, education, body mass index (BMI), stature, anemia level, parity, inter-pregnancy interval, antenatal care received, and living place. Results: Almost 20% of the infants were born with LBW. Mother's low education level, BMI <18.5, short stature (height <145 centimeters) and lack of antenatal visits (<4 visits) were significant predictors of LBW. Male gender has a protective effect against LBW. Conclusion: Maternal education, nutritional status and antenatal care received are key determinants that need to be addressed to reduce prevalence of LBW in India. Continue implementation of multifaceted health promotion interventions are needed to address these factors effectively.

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Background: No studies have addressed the "fit but fat" paradigm using accelerometry data. Aim: The study was to determine if 1) higher levels of accelerometer-determined physical activity are favorably associated with biomarkers in overweight or obese persons (objective 1); and 2) overweight or obese individuals who are sufficiently active have better or similar biomarker levels than normal weight persons who are not sufficiently active (objective 2). Materials and Methods: Data from the 2003-2006 National Health and Nutrition Examination Survey were analyzed and included 5,146 participants aged 20-85 years. Results: Regarding objective 1, obese active individuals had more favorable waist circumference, C-reactive protein, white blood cells, and neutrophil levels when compared to obese inactive individuals; similar results were found for overweight adults. Regarding objective 2, there were no significant differences between normal weight inactive individuals and overweight active individuals for nearly all biomarkers. Similarly, there were no significant differences between normal weight inactive individuals and obese active individuals for white blood cells, neutrophils, low-density lipoprotein cholesterol, total cholesterol, triglycerides, glucose, or homocysteine. Conclusions: Physical activity has a protective effect on biomarkers in normal, overweight, and obese individuals, and overweight (not obese) active individuals have a similar cardiovascular profile than normal weight inactive individuals.

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Context: Lung tumors are very heterogeneous histological entities. Pulmonary sarcomatoid carcinoma is a subset of tumors characterized by specific histological features. Their poor prognosis compared to other lung tumors is due to limited responses to different types of chemotherapy. Case Report: We report two patients with sarcomatoid tumors: A 53-year-old woman and a 46-year-old man who presented respiratory symptoms: Dyspnea, cough, associated with a deterioration of general condition. Conclusion: Pulmonary sarcomatoid carcinomas remained an unexplored entity, despite their poor prognosis. Based on these cases, we will discuss the histological and immunohistochemical features of these tumors, as well as report their responses to different chemotherapy regimens used in the course of treatment.

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Background: With the increasing rate of oral diseases, the global necessity of effective and economical products for its prevention and treatment has intensified. Aim: This study was to compare the effectiveness of two oral hygiene aids: Chewing stick and manual toothbrush, for plaque removal and gingival health after one month of a randomized clinical trial. Materials and Methods: Dental students (age 18-22 years) of a public sector dental hospital were recruited. Sample size was determined using the American Dental Association guidelines. Participants were randomized into two interventional groups and provided with either chewing sticks or toothbrushes. Pre- and post-intervention examinations were executed by two blind and calibrated examiners using plaque and gingival dental indices. Statistical analysis included descriptive statistics, paired t-test, and two sample independent t-tests. Results: Fifty subjects were recruited with mean age 20 ± 0.66 years (80% were females and 20% were males). Except for the mean plaque scores of toothbrush users (which increased at post-intervention examination), all other scores showed reduction. In contrast to the final mean gingival scores, a significant difference (P = < 0.0001) in the final mean plaque score was observed for the two respective interventional groups. Conclusion: Chewing stick has revealed parallel and at times greater mechanical and chemical cleansing of oral tissues as compared to a toothbrush.

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Background: There has been an increase in institutional delivery rates in India in the recent years. However, in areas with high institutional delivery rates, most deliveries (>50%) occur in private institutions rather than in government facilities where zero expense delivery services are being provided. Aim: This study aimed to understand, from the community health volunteers' viewpoint, the reasons for underutilization of zero expense delivery services provided in government health facilities. Materials and Methods: Five Focused Group Discussions (FGD) were conducted among Accredited Social Health Activist (ASHAs) of a Primary Health Centre (PHC) in Dayalpur village, Haryana in December 2012. Participants were asked to articulate the possible reasons that they thought were responsible for expectant mothers not choosing to deliver in government health facilities. Verbal informed consent was obtained from all participants. Result: The commonly stated reasons for underutilization of government health facilities for delivery services were lack of quality care, abominable behaviour of hospital staff, poor transportation facilities, and frequent referrals to higher centres. Conclusion: This study reflected the necessity for new policies to make government health facilities friendlier and more easily accessible to clients and to make all government hospitals follow a minimum set of standards for providing quality care.

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Background: Despite low peri-operative mortality after major lower extremity amputation, long-term mortality remains substantial. Metabolic syndrome is increasing in incidence and prevalence at an alarming rate in the USA. Aim: This study was to determine whether metabolic syndrome predicts outcome after major lower extremity amputation. Patients and Methods: A retrospective review of charts between July 2005 and June 2010. Results: Fifty-four patients underwent a total of 60 major lower extremity amputations. Sixty percent underwent below-knee amputation and 40% underwent above-knee amputation. The 30-day mortality was 7% with no difference in level (below-knee amputation, 8%; above-knee amputation, 4%; P = 0.53). The mean follow-up time was 39.7 months. The 5-year survival was 54% in the whole group, and was independent of level of amputation (P = 0.24) or urgency of the procedure (P = 0.51). Survival was significantly decreased by the presence of underlying chronic kidney disease (P = 0.04) but not by other comorbidities (history of myocardial infarction, P = 0.79; metabolic syndrome, P = 0.64; diabetes mellitus, P = 0.56). Conclusion: Metabolic syndrome is not associated with increased risk of adverse outcomes after lower extremity amputation. However, patients with chronic kidney disease constitute a sub-group of patients at higher risk of postoperative long-term mortality and may be a group to target for intervention.

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Background: Subclinical cardiovascular disease is inherent in complications of diabetes mellitus. It occurs before the obvert manifestation of cardiovascular disease complication in diabetes, and involves vasculopathy triad or three major vascular events comprising stasis, endothelial dysfunction, and atherothrombosis. Aim: This study was to examine evidence of vasculopathy triad in prediabetes, biomarkers of stasis, endothelial dysfunction, and atherothrombosis in prediabetes were compared with apparently healthy group. Materials and Methods: Eighty-one participants with results for plasma D-dimer, homocysteine, and whole blood viscosity were selected from a research database. The participants consisted of control (n = 44) and prediabetes (n = 37) based on clinical history and laboratory results. Results: Multivariate analysis shows a significantly higher level of vasculopathy in prediabetes than in the control group (P > 0.0001). Blood viscosity (P < 0.04) and homocysteine (P < 0.03) are significantly higher in prediabetes than in controls. Average levels for plasma D-dimer are also higher in prediabetes than in control, but not statistically significant in this particular analysis. Conclusion: This study suggests a novel application of known idea, vasculopathy triad that could be used for assessment of subclinical cardiovascular disease in prediabetes.

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Context: Amyloidosis is a disease of extracellular deposition of misfolded proteinaceous subunits, which could be systemic or localized disease. Though hepatic amyloidosis was not uncommon in autopsy series, most cases of hepatic amyloidosis were asymptomatic. Ascites, jaundice, portal hypertension, and gastrointestinal bleeding from esophageal varices were reported in literature. Case report: A 42-year-old man with end-stage renal disease on hemodialysis and recent small bowel obstruction presented with chronic abdominal pain. Computed tomography of abdomen and pelvis showed extensive loculated ascites and multiple small bowel loops tethered to adhesions and hepatomegaly. Finally, hepatic venography and liver biopsy confirmed hepatic amyloidosis with portal hypertension. The patient was waiting for liver transplant for definite treatment. Conclusion: We report a rare case of hepatic amyloidosis with prior small bowel obstruction presented with extensive loculated ascites and multiple small bowel loops tethered to adhesions.

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Context: Eosinophilic myocarditis is a rare cause of myocarditis. It is manifested histopathologically by diffuse or focal myocardial inflammation with eosinophilic infiltration, often in association with peripheral blood eosinophilia. Patients infected with Human Immunodeficiency Virus (HIV), especially those with lower CD4 counts, can occasionally have hyperimmunoglobulinemia E (Hyper IgE) and eosinophilia. Case Report: We report a case of a 29-year-old patient with Acquired Immunodeficiency Syndrome (AIDS) who had a persistent elevation of eosinophil counts and elevated IgE levels for a year prior to admission. He was presented to our emergency department with chest pain and laboratory tests revealed peripheral blood eosinophilia and elevated troponins. Coronary angiogram showed nonobstructive coronary artery disease. He then underwent cardiac magnetic resonance imaging which was consistent with an infiltrative myocarditis. After being put on steroid therapy, his peripheral eosinophilia resolved and his cardiac symptoms improved. Conclusion: Our case highlights that eosinophilia and Hyper IgE in HIV patients has the potential to contribute to end-organ damage.

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Background: The outreach of YouTube may have a dramatic role in the widespread dissemination of knowledge on implantable cardioverter devices (ICD). Aims: This study was designed to review and analyze the information available on YouTube pertaining to implantable cardiac devices such as implantable cardioverter defibrillators (ICDs) and pacemakers. Materials and Methods: YouTube was queried for the terms "ICD", "Implantable Cardioverter Defibrillator", and "Pacemaker". The videos were reviewed and categorized as according to content; number of views and "likes" or "dislikes" was recorded by two separate observers. Results: Of the 55 videos reviewed, 18 of the videos were categorized as patient education, 12 were advertisements, 8 were intraoperative videos documenting the device implantation procedures, 7 of the videos were produced to document personal patient experiences, and 4 were categorized as documentation of a public event. 3 were intended to educate health care workers. The remaining 3 were intended to raise public awareness about sudden cardiac death. The videos portraying intraoperative procedures generated the most "likes" or "dislikes" per view. Conclusion: While YouTube provides a logical platform for delivery of health information, the information on this platform is not regulated. Initiative by reputed authorities and posting accurate information in such platform can be a great aid in public education regarding device therapy.

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Background: Little is known about how parental gender equality early in their children lives can influence daughters' decision to use contraceptive pills. Aim: The study aimed at exploring whether maternal working time and paternity leave in Sweden during the first two years of their daughters' lives is associated with the use of oral contraceptives when they are adolescents or young adults. Materials and Methods: The study population was selected from a cohort of all Swedish fathers and mothers who had their first child together between 1988 and 1989 (n = 57,520 family units). Multivariate logistic regression was used to estimate the association. Results: Mothers' longer working time was mildly associated with daughters' oral contraceptive pill use, though no clear trend was observed. Longer paternity leave periods (>30 days) were not associated with use of oral contraceptives among their daughters, but 1-30 day periods showed a mild positive association. Conclusion: For maternal working time, there seems to be an association, but trends by working hours are not clear. There is no clear association between paternity leave during the first two years of their daughters' life and the use of oral contraceptives when they are adolescents and young adults.

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