Background. Methamphetamine cannot be detected through conventional urine screening tests or other analytical methods in methamphetamine abusers who have not used the drug for some time. In some instances, detection of methamphetamine in fingernails can be a good alternative. We aimed to determine the sensitivity and specificity of the one-step methamphetamine test strip used in the detection of methamphetamine in urine in the detection of methamphetamine in fingernails. Methods. We took 72 fingernail samples, including 60 samples from methamphetamine abusers and 12 samples as controls from their relatives who had no history of methamphetamine use. The liquid–liquid extraction method was used on fingernail samples, and the resultant solution was tested with one-step methamphetamine test strip. We analysed participants’ demographics including age, gender, duration of methamphetamine abuse and strip test results. Results. The mean (SD) age of the participants was 25 (4.33) years. The mean (SD) duration of methamphetamine abuse was 10 (4.5) months. Of the 72 participants, 61 (84.7%) had positive and 11 (15.3%) had negative strip test results. All 60 methamphetamine abusers had positive test results. A positive or negative history of methamphetamine abuse was taken as the gold standard. The sensitivity and specificity of the test was 100% and 91.6%, respectively. Conclusion. Performing liquid–liquid extraction on fingernails and using the strip test for detection of methamphetamine is a simple, inexpensive, rapid and accessible method, and its high sensitivity and specificity make it appropriate for screening. This method may be preferred over other urine and blood methamphetamine detection methods when the patient has not used the drug for a few days.

Background. We aimed to investigate the relationship between cervical length at 37 weeks of pregnancy and the onset of spontaneous labour as well as mode of delivery. Methods. We did a prospective observational study of 126 low-risk pregnant women with cephalic presentation who were not in labour, attending a south Tehran health centre for prenatal care. The length of the cervix was measured using transvaginal ultrasound (10 MHz endovaginal transducer) by a single sonographer at 37 weeks of gestation. The outcomes were the onset of spontaneous labour and the mode of delivery. Results. The mean cervical length was 26.1 mm (range 10-51 mm), with a non-significant difference between nulliparous and parous women (p=0.36). There was a significant association between cervical length and onset of spontaneous labour (r=0.33, p<0.001). When controlled for parity, maternal height and onset of spontaneous labour, cervical length did not predict the mode of delivery (p=0.79). Conclusion. Measurement of cervical length at 37 weeks could predict the onset of spontaneous labour, but it failed to predict the mode of delivery.

Background. Auxiliary nurse midwives (ANMs), who play a pivotal role in the provision of maternal health services including family planning services, must be adequately trained and skilled. Systematic assessment of their training needs helps in determining this adequacy. We did a systematic assessment of the training needs of ANMs in Jharkhand. Methods. We designed a multi-stakeholder study including (i) meeting with government officials and international development partners (n=1 5); (ii) structured observation of health facilities (n=1 7); (iii) review of health management information system data; (iv) interviews with ANMs (n=19); and (v) interviews with contraceptive users (n=31). The data were thematically analysed based on gaps in technical knowledge, skills and practices; communication and counselling; infrastructural gaps; uptake of contraceptives and emerging training needs and approaches. Results. The ANMs lacked knowledge, e.g. in natural contraceptive methods and skills, e.g. counselling and recordkeeping. Gaps in infrastructure further hampered the provision of uninterrupted service. The belief system of the community about contraception was perceived as a barrier. The lacunae in their knowledge and skills could be attributed to systemic issues such as quality of pre-service education, absence or poor implementation of in-service trainings or individual issues such as incompetence or apathy towards the provision of service. Government training to ANMs in family planning was inadequate. Conclusion. Our study found inadequacy in the training of ANMs in family planning. We suggest the need for systemic efforts with the life cycle approach to family planning, a mix of theory and practical training, appropriate duration of training, careful selection of trainers, a confidence-building approach and supportive environment to raise competencies of ANMs to help them manage their health facilities.

Background. The Consolidated Standards of Reporting Trials (CONSORT) statement has been developed to improve the quality of reporting of clinical trials. There is possibly suboptimal adherence to the CONSORT statement in published trials. We evaluated the compliance of randomized controlled trials ( RCTs) published in the Journal of the American Medical Association (JAMA) and British Medical Journal (BMJ) in 2013 to the CONSORT statement 2010. Methods. A PubMed search for RCTs published in JAMA and BMJ for 2013 was done. Scores were assigned to each subitem of CONSORT by one of four authors and disputes were resolved by mutual consensus. The total score for each RCT was calculated and converted to a percentage total score (PTS). Scores were expressed as median (range). The median scores between journals and types of RCTs were compared using the Mann–Whitney U test. Results. There were 97 RCTs (69 in JAMA and 28 in the BMJ) comprising parallel (75), cluster (14) and non-inferiority (8) design studies. The overall median (range) of PTS of all RCTs was 82% (59.4%–97.1 %). JAMA had an overall median (range) PTS of 81.6% (59.4%–97.1 %) and the BMJ 84% (65.2%–92.2%). The difference was not statistically significant (p=0.25). Between trial designs, the highest PTS was seen with parallel (which included parallel, crossover and factorial designs) with a median (range) of 85.1% (68.4%–90.2%) followed by cluster randomized trials 82.8% (65.2%–92.2%) and non-inferiority trials 78.6% (72.7%–85.7%). There was no significant difference between the three trial designs (p=0.48). Conclusion. A wide range in PTS (59.4%–97.1 %) even in high impact journals indicates poor compliance of reported trials with CONSORT.

A 44-year-old woman intentionally ingested a solution of copper sulphate. She had minimal intravascular haemolysis and methemoglobinaemia but developed acute respiratory distress syndrome (ARDS) 4 hours after acute copper sulphate poisoning. This required extracorporeal membrane oxygenation (ECMO) management in the intensive care unit. Subsequently, she improved clinically and was successfully weaned from ECMO. Acute copper sulphate poisoning can cause severe pulmonary toxicity even in the absence of other serious symptoms. Therefore, a physician treating acute copper sulphate poisoning should look out for respiratory symptoms even in the absence of other common symptoms. We suggest early initiation of venovenous ECMO in those with ARDS following copper sulphate poisoning.

Colour vision deficiency (CVD) is a common problem and persons with CVD experience difficulties in daily life, early learning and development, education, choice of careers and work performance. Medical professionals with CVD also report difficulties in everyday tasks, training in medicine and performance of medical duties. However, because of limited evidence, the real impact of CVD on the lives of medical professionals is unclear, especially regarding the practice of medicine by doctors. The nature and severity of CVD, awareness of its impact, personal circumstances and the ability to cope with the deficiency are the major factors that determine the impact of CVD. However, there is a paucity of methodologically sound research on social and psychological aspects of CVD. Currently, early detection, enhancing awareness and offering support are the only proven ways of helping medical professionals with CVD. With the growing emphasis on equality and inclusivity of those with deficiencies, it is desirable to strike a balance between concerns about patient care and the rights of medical professionals with CVD to pursue their careers. Therefore, any future research also needs to focus on psychological aspects of CVD while exploring its impact on a career in medicine.