Background. The National Family Health Survey-3 (NFHS- 3; 2005-06) reports that the prevalence of low birth-weight babies is 22% in India. This old figure is probably an underestimate as this nationwide survey acquired information on birth-weight of only 34% of babies. We aimed to make a fresh estimate of the proportion of low birth-weight babies. Methods. A systematic search was done through PubMed, Google Scholar, Cochrane Library, Medline, IndMed, Embase, WHO and Biomed Central databases. Studies published from 2004 to 2014 were included. Study quality was assessed using the adapted Mirza and Jenkins checklist. An 'adjustment' of 24% was applied to the published estimates where data were collected through records or through a combination of records and anthropometry. The adjustment was done to account for the heaping of birth-weight data at 2500 g. Metaanalysis using both random and fixed effects model was done to derive an estimate. Results. Nineteen studies with 44 133 subjects were included in the review. The pooled estimate for the prevalence of low birth-weight was 27% (95% CI 24%-30%) and the 'adjusted' pooled prevalence was 31% (95% CI 28%-33%). The prevalence in urban and rural areas was 30% (95% CI 23%- 38%) and 26% (95% CI 22%-30%), respectively. Regionwise estimates revealed that the prevalence at 33% was comparatively higher in eastern regions (95% CI 29%-37%). Conclusion. The pooled prevalence of low birth-weight is higher than that reported by NFHS-3. Updated estimates should be used to guide future interventions and policies.

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Background. There is a dearth of recent data on the relationship between nutritional status and intellectual development among children in India. To determine whether such a relationship exists, we studied children in a rural area of Tamil Nadu. Methods. We stratified villages in Kaniyambadi block, Tamil Nadu, and recruited consecutive children who satisfied the study criteria. We assessed nutritional status by measuring height and weight and recording chronological age, and calculated indices weight-for-age, height-for-age, weight-forheight and their Z scores. We assessed intellectual development using the Indian adaptation of the Vineland Social Maturity Scale. We used a case-control framework to determine the relationship and logistic regression to adjust for common confounders. Results. We recruited 114 children between the ages of 12 and 72 months. Z score means (weight-for-age -1.36; height-for-age -1.42; weight-for-height -0.78) were much less than 0 and indicate undernutrition. Z score standard deviations (weight-for-age 1.04; height-for-age 1.18; weightfor- height 1.06) were within the WHO recommended range for good quality of nutrition data suggesting reduced measurement errors and incorrect reporting of age. The frequency distributions of population Z scores suggest high undernutrition, wasting and medium stunting. A tenth of the population (9.6%) had values to suggest borderline/below average intelligence (social quotient <89). Lower height-forage, height-for-age Z score and weight-for-height Z score were significantly associated with a lower social quotient. These relationships remained statistically significant after adjusting for sex and socioeconomic status using logistic regression. Conclusion. Chronic undernutrition, wasting and stunting and their association with lower intellectual development demand an urgent re-assessment of national food policies and programmes.

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Background. There is little information regarding costs of managing type 1 diabetes mellitus (T1DM) from low- and middle-income countries. We estimated direct costs of T1DM in patients attending a referral diabetes clinic in a governmentfunded hospital in northern India. Methods. We prospectively enrolled 88 consecutive T1DM patients (mean [SD] age 15.3 [8] years) with age at onset <18 years presenting to the endocrine clinic of our institution. Data on direct costs were collected for a 12 months-6 months retrospectively followed by 6 months prospectively. Results. Patients belonged predominantly (77%) to the middle socioeconomic strata (SES); 81% had no access to government subsidy or health insurance. The mean direct cost per patient-year of T1DM was `27 915 (inter-quartile range [IQR] `19 852-32 856), which was 18.6% (7.1%-30.1%) of the total family income. A greater proportion of income was spent by families of lower compared to middle SES (32.6% v. 6.6%, p<0.001). The mean out-of-pocket payment for diabetes care ranged from 2% to 100% (mean 87%) of the total costs. The largest expenditure was on home blood glucose monitoring (40%) and insulin (39.5%). On multivariate analysis, total direct cost was associated with annual family income (β=0.223, p=0.033), frequency of home blood glucose monitoring (β=0.249, p=0.016) and use of analogue insulin (β=0.225, p=0.016). Conclusions. Direct costs of T1DM were high; in proportion to their income the costs were greater in the lower SES. The largest expenditure was on home blood glucose monitoring and insulin. Support for insulin and glucose testing strips for T1DM care is urgently required.

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Background. There is a dearth of studies on the clinical profile and therapeutic aspects of critically ill obstetric patients from rural areas, especially those requiring tertiary care support and ventilator therapy. Methods. We retrospectively analysed the aetiological, clinical, interventional and outcome-related factors of obstetric patients requiring mechanical ventilation in western India. We analysed factors that influence seeking of antenatal care, pregnancy and its complications, severity assessment score, indications and initiation of mechanical ventilation, multiorgan failure and their correlation with maternal mortality. Results. Of the 6708 obstetric admissions studied, 1112 were of critically ill (16.5%) patients and 200 (17%) of these required mechanical ventilation. Over three-fourths (77%) of patients were from rural areas, 83.5% were referred and 97% had inadequate antenatal care. Severe pregnancy-induced hypertension/eclampsia, massive haemorrhage and sepsis were the common obstetric complications. Pulmonary oedema (32.5%), acute respiratory distress syndrome (ARDS, 14%) and acute lung injury (22.5%) were the three most common indications for mechanical ventilation. In 26% of patients, mechanical ventilation was initiated early based on a worsening cardiorespiratory profile. A sequential organ failure assessment score of >5 on admission and delay in treatment resulted in multi-organ failure and worsening outcome. The maternal mortality ratio was 32.5%, incidence of multi-organ dysfunction syndrome was 71%, and pregnancy loss was 43.5%. The odds ratio for maternal mortality in patients ventilated early was 0.39 as against 5 in those with ARDS. Conclusions. Inadequate antenatal care, delayed referral practices, pregnancy-induced hypertension, obstetric haemorrhage and sepsis remain the major causes of complications in obstetric patients from rural areas. The common indications for mechanical ventilation were pulmonary oedema, ARDS and acute lung injury. Early initiation of mechanical ventilation upon detection of imminent

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Background. The addition of research-oriented medical education (ROME) to the existing curriculum could promote logical thinking, rapid literature search and a better understanding of research methodology. Creation of research temperament could lead to innovations in healthcare. We assessed the perception, awareness and practice of ROME among undergraduate students. Methods. We conducted a cross-sectional survey among 234 students of R.G. Kar Medical College, Kolkata selected by the simple random sampling technique. Data were collected using a pre-designed, pre-tested, validated questionnaire by direct interviews. Results. The mean (SD) perception score was 44.2 (5.03). Students from outside West Bengal (p=0.05), women (p=0.03) and students whose parents were doctors (p=0.01) had significantly higher scores. Students in the second and fourth semesters had a better perception than those in the sixth and eighth semesters. Awareness of research fellowships granted to undergraduate students such as the Indian Council of Medical Research-Short-term studentship (ICMR-STS) was low among the second semester students (13.9%), but more than half (59.3%) of the students in the eighth semester were aware (difference across semesters, p<0.001). Awareness about journals, conferences and 'research bodies promoting student research' was low. Students in the senior semesters spent more time on research (6th semester 72.2% and 8th semester 88.9%) than those in the junior semesters (2nd: 66.7% and 4th: 77.8%; difference across semesters, p=0.03). About 3% of students participated in extracurricular research and/or had presented work at a conference. Conclusion. There is a good perception about the need for research but a lack of awareness of the why and how, as well as hardly any practice of ROME among medical students of this medical college.

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We report a case of dystrophic calcification presenting as soft cystic swelling in a patient with juvenile dermatomyositis. A 15-year-old boy with lumbosacral cystic swelling, which was considered a cold abscess clinically, was evaluated for nonresponse to antitubercular therapy. The cystic swelling had liquefied calcium with a well circumscribed calcified wall on imaging, which was subsequently excised.

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There is little information on the use of electroconvulsive therapy (ECT) in the presence of glaucoma. An elderly man with known severe depression underwent surgery for cataract and glaucoma in the left eye. His depression worsened in the postoperative period and he required two sessions of ECT within 2 months of the surgery. There were no ophthalmic complications or adverse events associated with ECT and he responded well to treatment.

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The Government at Fort St George determined that a school for instructing and training candidates towards the titles of 'apothecary' was necessary to improve medical help to people in the 1830s. This led to the establishment of the medical school in Madras (presently Chennai) in 1835. The school got renamed as the Madras Medical College in 1850. From 1835, the Madras Medical School offered formal training to personnel to be called either 'apothecaries' or 'dressers' under the superintendence of William Mortimer, who was assisted by George Harding in teaching at the school. Apothecary D'Beaux and Dresser P. S. Muthuswami Mudaliar were subordinate assistants. These apothecaries were recruited essentially under the Subordinate Medical Service of Madras, which was established in 1812 and included non-commissioned medical servants. The Madras apothecaries launched the Madras Apothecaries Society in 1864, which aimed at promoting and advancing medical science and knowledge. This society existed until 1871. Formal training of apothecaries ceased in Madras by the later decades of the 19th century, although informal training continued, especially for army cadets and women. Establishment of medical schools in Royapuram (which developed as the Stanley Medical College and Hospital), Tanjavur and Madurai, in the early decades of the 20th century and the 'branch' of Madras Medical College in Calicut during the Second World War changed the complexion of training of medical personnel immensely in pre- 1947 Madras Presidency. The Royapuram and other Medical Schools in Madras trained medical practitioners granting the title 'Licensed Medical Practitioner' (LMP). Whether the apothecary-dresser training at the 'old' Madras Medical College had a role to play in these developments remains to be verified.

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