Government General Hospital

Breastfeeding competency is a core professional requirement in midwifery practice and significantly influences maternal and neonatal health outcomes. Despite global recommendations advocating exclusive breastfeeding, gaps persist in practical skill preparation and clinical confidence among midwifery students. Simulation-based training has emerged as an innovative educational strategy; however, its conceptual meaning within breastfeeding competency development remains inadequately defined. This study aimed to clarify the concept of simulation-based training for breastfeeding competency development in midwifery practice using Walker and Avant’s eight-step concept analysis methodology. A systematic literature search was conducted across PubMed, Scopus, CINAHL, and Web of Science databases for studies published between 2000 and 2025. Sixty-four relevant articles were included in the final synthesis. Five defining attributes were identified: structured experiential learning, simulated clinical environment, competency-based evaluation, facilitated reflective debriefing, and clinical transferability. Antecedents included curricular gaps, technological advancement, maternal–infant health priorities, and ethical considerations in clinical training. Consequences encompassed improved psychomotor skills, enhanced clinical confidence, strengthened breastfeeding support practices, and potential improvement in maternal satisfaction and breastfeeding outcomes. An operational definition was developed to guide curriculum design, research standardization, and policy development. Concept clarification supports the integration of simulation-based strategies into competency-based midwifery education to enhance breastfeeding support quality and maternal–newborn health outcomes.

Objectives: This study evaluated psychosocial predictors of relapse and abstinence in alcohol-dependent individuals using standardized psychosocial assessment tools. Methods: A cross-sectional study was conducted among 100 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition–diagnosed alcohol-dependent patients (50 relapse; 50 abstinent). Four validated scales – Coping Behavior Inventory (CBI), Alcohol Abstinence Self-Efficacy Scale (AASES), Multidimensional Scale of Perceived Social Support (MSPSS), and Social Readjustment Rating Scale (SRRS) – were administered. Continuous predictors were standardized (z-scores). A single logistic regression model predicted relapse. Results: Maladaptive coping was the strongest predictor of relapse (odds ratio [OR] = 30.98; 95% confidence interval [CI]: 7.99–120.16; p<0.001). Higher self-efficacy was protective (OR=0.34; 95% CI: 0.16–0.70; p=0.003). Higher perceived social support predicted relapse (OR=3.61; 95% CI: 1.52–8.58; p=0.004). Stress showed borderline significance (OR=2.06; p=0.055). Model fit was strong (Nagelkerke R2=0.54). Conclusion: Coping, self-efficacy, social support, and stress significantly influence relapse risk. Psychosocial interventions enhancing coping and self-efficacy and modifying maladaptive family support may reduce relapse.

Dental age estimation is an integral component of forensic identification and medico-legal investigations. Kvaal’s method, based on the radiographic assessment of regressive dental changes, is widely used in adults; however, its accuracy varies across populations and age groups. To evaluate the accuracy and reliability of Kvaal’s dental age estimation method in an Indian adult population and to assess its performance across different age groups and sexes. A cross-sectional study was conducted at Jawaharlal Nehru Medical College, Belagavi, from August 2023 to August 2024. The study included 200 adults (100 males and 100 females) aged 20–80 years. Digital periapical radiographs of permanent maxillary central incisors were analysed using Kvaal’s method, focusing on pulp-to-tooth measurements reflecting secondary dentin deposition. Estimated ages were compared with chronological ages using descriptive statistics, paired t -tests, intraclass correlation coefficients and Lin’s concordance correlation coefficient. The mean chronological age was 48.7 ± 14.5 years, while the mean estimated age was 46.5 ± 12.3 years, showing an overall underestimation of −2.65 years. Higher accuracy was observed in the 20–50-year age group, with significant underestimation in individuals above 60 years. The Lin’s concordance correlation coefficient demonstrated good agreement overall (0.82), with higher reliability in males (0.84) compared to females (0.81). Kvaal’s method provides reliable age estimation in younger and middle-aged Indian adults but demonstrates reduced accuracy in elderly individuals. Population-specific modifications and integration of advanced imaging and analytical techniques may improve age estimation in older age groups.

Background & objectives Persistent mild inflammation is considered as a main contributor to the altered genesis of polycystic ovary syndrome (PCOS), with numerous studies reporting elevated serum levels of inflammatory markers. This inflammatory state may be attributed to genetic variants, particularly single nucleotide polymorphisms (SNP), that alter cytokine regulation. This study investigated the association of PCOS and inflammatory SNPs including interleukin (IL) such as IL-1β rs1143634, IL-1β rs16944, IL-6 rs1800795, IL-6 rs1800797, IL-6 rs1800796, IL-1RN; and tumour necrosis factor-alpha (TNF-α). Methods A total of 250 women volunteered for the study; of which 100 were diagnosed with PCOS and 150 were healthy controls. Serum levels of IL-6, IL-1β, and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). Genotyping was analysed using polymerase chain reaction (PCR), PCR-restriction fragment length polymorphism (PCR-RFLP), or real-time PCR (RT-PCR). Genotype distributions amid groups were compared using the Chi-square test. Results Women with PCOS exhibited elevated serum levels of IL-1β than those of healthy controls which was considerably significant (P<0.001). The heterozygous genotypes of IL-1RN and IL-6 rs1800796 were seen more frequently in the control group (P=0.02), suggesting a potential inverse association. Interpretation & conclusions SNPs in IL-1 and IL-6 genes may influence susceptibility to PCOS and could confer a protective role in women of South Asian Indian origin.

Background: Vitiligo is a chronic depigmenting disorder, often requiring prolonged therapy due to slow and variable repigmentation. Narrowband ultraviolet B (NB-UVB) is an established treatment approach, and interest has grown in combining it with oral antioxidant supplementation to enhance melanocyte recovery and reduce oxidative stress. Aim: To evaluate the efficacy and tolerability of NB-UVB phototherapy combined with oral antioxidants in patients with vitiligo. Methods: This prospective observational study included 50 clinically diagnosed vitiligo patients. All participants received NB-UVB phototherapy three times weekly, along with a daily oral antioxidant regimen, for 24 weeks. Demographic and clinical parameters were recorded. Repigmentation was assessed using the Vitiligo Area Scoring Index (VASI) at baseline, 12 weeks, and 24 weeks. Treatment response was categorized as excellent (>75%), moderate (50–75%), mild (25–49%), or minimal (<25%). Adverse events were documented throughout the study period. Results: The mean age of participants was 28.6 ± 9.4 years, with females comprising 56% of the cohort. Non-segmental vitiligo accounted for 74% of cases. The mean baseline VASI score was 6.8 ± 2.1, which reduced progressively to 4.3 ± 1.9 at 12 weeks and 2.7 ± 1.6 at 24 weeks. Excellent repigmentation was achieved in 28% of patients, moderate in 36%, and mild in 24%, while 12% showed minimal improvement. Facial and truncal lesions responded better compared to acral sites. Treatment was well tolerated, with only mild transient erythema and pruritus reported. Conclusion: NB-UVB combined with oral antioxidants resulted in meaningful repigmentation with good safety and patient acceptance. Recommendations: This combination may be considered as a preferred therapeutic strategy in the routine management of non-segmental vitiligo, especially when aiming for gradual yet sustained repigmentation.

A BSTRACT Background: This study aimed to evaluate the effectiveness and safety of oral emulsion containing milk of magnesia, liquid paraffin, and sodium picosulphate in treating constipation in Indian patients postanorectal surgery. Methods: This was a prospective, multicenter, single-arm, open-label, observational study among patients who underwent surgery for anal fissures, anal fistulas, or hemorrhoids, and were diagnosed with constipation for at least 3 days before the day of surgery. Patients were prescribed oral emulsion of liquid paraffin, milk of magnesia, and sodium picosulfate at a dose of 7.5 mL at bedtime, preferably with water, for 15 days. If the response was found unsatisfactory, the dose was increased to 15 mL. Patients were followed up on day 4 (±2 days) and 15 (±1-day). Results: A total of 80 (male: female, 57:23) patients with a mean ([standard deviation SD]) age of 42.9 (10.1) years were enrolled. Hemorrhoids (42.5%) were the most common diagnosis for which anorectal surgery was performed. The mean (SD) Patient Assessment of Constipation (PAC) Symptoms score declined significantly by −11.0 (5.4) ( P &lt; 0.001) at day 4 and by −22.3 (11.5) ( P &lt; 0.001) at day 15, compared to baseline. Similarly, for PAC quality of life mean (SD) Score declined significantly by −31.6 (23.5) ( P &lt; 0.001) at day 15. The mean (SD) of frequency of spontaneous bowel movements/week increased by 0.4 ± 0.7 ( P &lt; 0.001) at day 4 and by 0.6 (0.8) ( P &lt; 0.001) at day 15 compared to the baseline mean (SD) score of 0.8 (0.7). No adverse events were reported during the study period. Conclusion: Oral Emulsion of Liquid Paraffin, Milk of Magnesia, and Sodium Picosulfate is an effective and well-tolerated treatment of symptoms of constipation in postanorectal surgery patients.

Introduction: Narrow therapeutic index (NTI) drugs have a small margin between effective and toxic doses, so minor changes in blood levels can cause therapeutic failure or toxicity, leading to significant drug-related problems. The study aims to assess drug-related problems (DRPs) linked to NTI drugs at Government General Hospital, Kadapa, by screening prescriptions, classifying DRPs using Pharmaceutical Care Network Europe (PCNE) v9.0, implementing interventions to reduce them, and calculating drug risk ratios to determine each drug’s contribution. Methods: A six-month prospective observational study (June–November 2023) included 110 inpatients prescribed at least one NTI drug. Data from standardized forms and hospital records were analyzed, with DRPs identified using PCNE v9.0, Micromedex, and WHO adverse drug reaction (ADR) scales. Results: Of 110 patients, 48 (43.6%) had DRPs, mainly males (60.4%) aged 31–60 years. Treatment effectiveness issues dominated (74.5%), with major interactions from digoxin, telmisartan, and heparin. Heparin showed the highest drug risk ratio (0.53), indicating significant safety concerns. Discussion: Findings highlight the high DRP risk from multiple NTI drug prescriptions, particularly heparin and digoxin. Results align with existing research and underscore the role of clinical pharmacy in DRP prevention. Drug risk ratio offers a quantitative tool for prioritizing monitoring. Conclusion: In our study, the most common DRPs observed were related to the drug use process. Heparin and digoxin were found to be high-risk drugs, according to study results. Hence, special observation and monitoring from physicians and other health professionals are needed for the prescriptions with NTI drugs.