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   Table of Contents - Current issue
Dec 2020
Volume 9 | Issue 12
Page Nos. 5827-6298

Online since Thursday, December 31, 2020

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Comparison between two different successful approaches to COVID-19 pandemic in India (Dharavi versus Kerala) Highly accessed article p. 5827
Rahul K Pal, Gitismita Naik, Vinay Rathore, Kamal K Sahu, Raman Kumar
Various factors interplay when it comes to successful containment of pandemic. In last one year, we have witnessed various countries formulating and practicing their own unique ways to tackle coronavirus. We have seen the most developed countries failing terribly and unable to slow the COVID-19 spread, but at the same time also endorsed the comparatively less resourceful countries outperforming in terms of reduced disease morbidity and mortality. Current review is about two regions from India (Dharavi and Kerala) who were different in their approach as compared to rest of the country and were able to keep the COVID-19 cases to the minimum.
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Considerations in evaluating the thyroid gland in a primary care setting Highly accessed article p. 5833
Jose Humphreys
The evaluation of the thyroid can be a very involved process. A misinterpretation of the results of a thyroid function test can lead to serious complexities in a patient's management and outcome. The nuances in diagnostic approaches necessitates that standardized protocols for assessing thyroid function are established. A number of factors may impact how the thyroid functions and these factors must be considered when interpreting the results of a thyroid function test. Unfortunately, many clinicians only observe a cursory analysis of thyroid function. Primary care physicians, in particular, must be aware of these practice deficiencies and hopefully increase the detection of thyroid anomalies with greater accuracy at this first level of clinical contact.
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A step towards real-time implementation of GDM guidelines in India: Review of Gaps in RCH Programme Highly accessed article p. 5837
Surabhi Mishra, Chythra R Rao, Ajeet Singh Bhadoria, Raman Kumar, Pradeep Aggarwal, Shaili Vyas, Sudip Bhattacharya
Gestational Diabetes Mellitus (GDM) risks the affected mother-child duos not only with respect to adverse perinatal outcomes but also for chronic diseases later in life. Therefore, in 2014, the Government of India (GoI) mandated universal GDM screening for all pregnant women as a part of essential obstetric care within the Reproductive and Child Health (RCH) programme. Later in 2018, the domain experts from GoI envisaged pan India implementation of GDM screening services within its RCH framework by 2023. As Uttarakhand—a hilly, EAG state of north India—would also be part of this nation-wide drive; prior identification of RCH services coverage in the State assumes paramount importance, as it reflects probable executability of GDM screening services within its delivery platform. Therefore, the present review aims to assess the readiness of Uttarakhand maternal health functionary system in view of GDM national guidelines implementation at both state and district levels. In this regard, freely accessible, full-text GoI documents pertaining to GDM implementation guidelines and maternal health program of India and Uttarakhand available in public domain in English language were reviewed. The present review favors the pilot implementation in district Dehradun prior to implementing in all districts of the state. It may, however, require overall improvement in maternal health programmatic services in all parts of the State for much efficient service delivery. Effective implementation of GDM guidelines requires urgent correction in the background performance of RCH program.
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Colour coding-based client segmentation approach: A neglected yet powerful tool to tackle non communicable diseases in high burden and low resource setting countries- A primary care approach Highly accessed article p. 5846
Sudip Bhattacharya, Om Prakash Bera, Dhananjay Kumar Singh, Md Mahbub Hossain, Shailesh Tripathi, Sandeep Boora, Amarjeet Singh
Health systems in low- and middle-income countries like India continue to struggle with the overwhelming burden of noncommunicable diseases (NCDs) alongside the coexistence of multiple medical conditions. Such cases are challenging to diagnose and treat, especially in places where electronic health records are not readily available. In such contexts, using colour coding system for recording health conditions may ensure optimal documentation, effective patient-provider communication, adherence to treatment and follow up, quality of health services, and an overall improvement in health systems performance for NCDs. Colour coding is a common tool used in several service industries including public health programmes locally and globally. Despite such promising aspects, colour coding is not widely used for NCDs in health services organizations, which necessitates a translation of evidence from other sectors and the adoption of innovative and evidence-based approaches to promote the use of colour coding for better addressing NCD epidemic.
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Unmasking N95 for COVID-19 health-care workers in India Highly accessed article p. 5850
Mrinal Barua, Subodh Kumar, Vivek Mishra, Aroop Mohanty, Hari S Joshi
A general term N95 Mask has been widely used by all including the health care personnel. It has been use incorrectly by all and it should be replaced with the term filtering facepiece respirator. There are two types of respirators being used in the world. One is the industrial type whereas the other one is the medical surgical one. The medical surgical masks are an intermediate product between the industrial and the triple layer medical mask. Many other equivalent products like KN95 masks are also available in the market. There is an urgent need of certification because this is the only way quality face masks can be provided to the public in these difficult times of COVID-19. This is essential because of the entry of many counterfeit and uncertified respirators have entered the market.
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Strengthening public healthcare systems in India; Learning lessons in COVID-19 pandemic p. 5853
Suneela Garg, Nidhi Bhatnagar, M Meghachandra Singh, Amod Borle, Sunil K Raina, Raman Kumar, Sagar Galwankar
COVID-19 pandemic has involved nations and incapacitated the health systems globally. The pandemic preparedness has been tested with immense losses. Universal health coverage is needed more than ever to recuperate from the effects of the current pandemic. Post pandemic, many lessons need to be learnt especially for developing economies like India where public healthcare system is grossly inadequate to take care of health needs of citizens. World Health Organization's framework of six health system building blocks was utilized to study the lessons learnt and actionable points in the post pandemic period. Participation in Global Health Security Alliance has to be stepped up with involvement in Joint external evaluation and development of epidemiological core capacities. National Health Security Action Plan needs to drafted and available for health emergences. Ayushman Bharat scheme should incorporate elements to address surge capacity at the time of health emergencies and measures to deliver care at the time of pandemic. Technology through telemedicine, m-health, and digital platforms or apps should contribute to trainings, supervision, and facilitation of healthcare delivery at remote locations. Open data sharing policies should be developed for the practice of evidence-based public health. Public healthcare system and health manpower trained in epidemiology should be given a boost to have system readiness to respond in case of future pandemics.
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'How COVID 19 imposed a new normal outlook in reproductive health care of patients, research, teaching and assessment'- Perspective of a Gynecologist p. 5858
Charu Sharma, Pratibha Singh, Shashank Shekhar, Manisha Jhirwal, Navdeep K Ghuman, Meenakshi Gothwal, Garima Yadav, Priyanka Kathuria
With the frequently changing guidelines on Pregnancy care, management of obstetric patients remains a major challenge during COVID-19 Pandemic. The department of Obstetrics and Gynecology had a huge responsibility to provide respectable maternity care to all women irrespective of their virologic status and at the same time protect the frontline warriors dealing with patient care during the COVID-19 pandemic. We would like to share our perspective regarding the challenges faced and the solutions sought for, in both patient care and teaching and research.
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Primary health care and family physicians provide frontline care to the dermatology patients during the era of COVID-19: Recommendations and future directions p. 5862
Badr Al-Khateeb
COVID-19 has affected those disciplines where close contact is required and where there is no need for urgent care such as the field of dermatology. Due to the contagious nature of the virus, front line health care workers such as family health care physicians and primary health care doctors are using personal protective measures (PPE), which might result in skin disorders. In addition, social distancing has also resulted in the compromise of teaching and learning mainly bedside teaching in the dermatology wards. Moreover, there is also uncertainty about the guidelines different to be followed by primary health care and family physicians while assessing patients of dermatology. We aim to provide an overview of how COVID-19 has affected the primary health care workers and physicians. We have highlighted the challenges faced by the family health care physicians from the perspective of dermatology along with recommendations and future directions for family health care physicians. Results reveal that wearing PPE measures might be challenging for primary health care workers and family physicians as it can cause facial inflammatory papules, acne rosacea, seborrheic dermatitis, and facial itching. They cannot escape encounter with the patients, and they need to be careful by undertaking some precautionary measures while taking care of the patients in general with a specific focus on COVID-19. COVID-19 has also affected all teaching and learning in the field of dermatology. However, academic institutions can use digital tools such as zoom or skype to continue learning dermatology during the crisis of COVID-19.
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A general overview of mucocele of appendix p. 5867
Mahendra Pratap Singh
Mucocele of the appendix is a very rare disease entity that often discovered incidentally during surgery. It can result from both non-neoplastic and neoplastic lesions and histopathological examination is needed for confirmation. Failure to make an early preoperative diagnosis may results in its rapture and spillage of mucin contents into the peritoneal cavity leading to a disastrous complication of pseudomyxoma peritonei (PMP) that has a very bad prognosis. A clear pathological terminology and management strategies of appendiceal mucocele (AM) is lacking. This literature review aims to derive detailed information related to clinical significance of AM to avoid complication of PMP and plan appropriately during surgery according to the current evidence. The relevant articles from scientific databases such as Medline, PubMed, Google Scholar were searched and extracted using the keywords “mucocele appendix” “cystadenoma&%#8221;. Data based on epidemiology, clinical manifestations, complications, pathology, diagnostic work up and management were analyzed and summarized. A meticulous surgical excision is the mainstay of treatment and open surgical approach is still preferred over laparoscopy. Preoperative diagnosis of AM is very imperative as it may harbour neoplasm and can be made utilising the imaging tools like computed tomography and ultrasonography. Primary care physicians can have a crucial role in making early detection and timely referral for appropriate management in order to avoid complications. After appendectomy, 5-year survival rate for the simple AM is 91%-100% but it reduces to 25% for the malignant AM.
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Access, utilization, perceived quality, and satisfaction with health services at Mohalla (Community) Clinics of Delhi, India p. 5872
Chandrakant Lahariya
The first Mohalla or Community clinic was set up in July 2015 in Delhi, India. Four hundred and eighty such clinics were set up in Delhi, since then. This review was conducted to synthesize evidence on access, utilization, functioning, and performance of Mohalla clinics. A desk review of secondary data from published research papers and reports was conducted initially from February–May 2020 and updated in August 2020. Eleven studies were included in the final analysis. Studies have documented that more than half to two-third of beneficiaries at these clinics were women, elderly, poor, and with school education up to primary level. One-third to two-third of all beneficiaries had come to the government primary care facility for the first time. A majority who attended clinics lived within 10 min of walking distances. There was high rate of satisfaction (around 90%) with overall services, doctor–patient interaction time and the people were willing to return for future health needs. Most beneficiaries received consultations, medicines, and diagnostics at no cost. A few challenges such as dispensing of medicines for shorter duration, lack of awareness about the exact location of the clinics, and services available among target beneficiaries, and the incomplete records maintenance and reporting system at facilities were identified. Mohalla Clinics of Delhi ensured continuity of primary care and laboratory services during COVID-19 pandemic in 2020. In summary, Mohalla Clinics have made primary care accessible and affordable to under-served population (thus, addressed inequities) and brought attention of policy makers on strengthening and investing on health services. The external evaluations and assessments on the performance of these clinics, with robust methodology are needed. The services through these clinics should be expanded to deliver comprehensive package of primary healthcare with inclusion of preventive, promotive, community outreach, and other public health services.
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Understanding the emerging and reemerging terminologies amid the COVID-19 pandemic p. 5881
Madhu Kumari Upadhyay, Khan Amir Maroof
Coronavirus disease (COVID-19) has been declared as a Public Health Emergency of International Concern by the World Health Organization (WHO). During this phase of the health crisis posed by the COVID-19 pandemic, news in print, electronic as well as the social media is abuzz with several emerging and reemerging terminologies. Some of them, such as “social distancing,” “infodemic,” “flattening the curve,” “quarantine,” “cluster containment,” and others were not in routine use but have suddenly reemerged and become the key toward understanding the disease and its prevention. Many of these terms have been a part of public health strategies used for centuries for containment of the spread of infectious diseases. These terms span across social, epidemiological, and administrative contexts concerning the COVID-19 pandemic. Our article aims to present a better understanding of the meaning and origin of these terms and their application in the context of the current pandemic based on a review of the available literature such as chapters from textbooks, published guidelines of the WHO and Centre for Disease Control and Prevention (CDC) and published articles in journals and newspapers through a comprehensive search of the electronic database in English.
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One health approach and COVID-19: A perspective p. 5888
Pooja Jorwal, Swati Bharadwaj, Pankaj Jorwal
One Health is a well-recognized concept; however, it has been at the fringe of most operational health policies rather than being the central theme. Although, global experts and policy makers have agreed on this theory, the transition from a vision to practical application is inconspicuous. COVID-19 pandemic has caused massive damage to the world economy and continues to peril human lives everywhere. Ignorance of the principles of One Health approach in the current health care system has proved to be the Achilles heel of our health policy. Social distancing, lockdown, and hand hygiene are short-term preventive measures imposed by nations worldwide but are difficult to sustain in the long run. Thus, it is long overdue that we change our unidimensional approach regarding the control and prevention of diseases. A rational practice of the One Health strategy should be our utmost priority to control the ongoing grave situation. The purpose of this article is to bring the attention of healthcare professionals and researchers toward the One Health paradigm for the betterment of public health while combating COVID-19 and to prepare for future emergence of infectious diseases. Our assessment for this review is based on the philosophy and views shared by recent publications on the One Health approach which emphasizes an integrated, multisectoral, and holistic concept (animal health-human health-environmental factors) and promotes a transdisciplinary-integrated tactic for disease prevention and control.
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Multidimensional impact of COVID-19 pandemic in India—Challenges and future direction p. 5892
Rajesh Kumar, Nita Bharti, Saurabh Kumar, Gian Prakash
Direct impact of COVID-19 pandemic on lives is almost well known to the world with gradual reporting of its various systemic effects from almost every country. But this disease doesn't have direct impacts only, it causes collateral damage along with some hidden effects which may or may not be reported now and many will be come in future. India, a developing country, also got affected during this pandemic and now ranks under five in relation to the number of cases being reported till now. Here in this manuscript, various hidden aspects of COVID-19 has been discussed like issues related to healthcare infrastructure, food insecurities, domestic issues, mental and physical health, effect on education, screen time, and its challenges because of new trend of distant education, human resources, effects on labor class, material management, monetary issues, economic and industrial downfall, etc., along with challenges on both side for the Government as well as general public faced during this pandemic. Manuscript has been structured on the basis of concept and design of authors and various information put here on the basis of practical scenario being seen in the community and from various data published on Government sites, published articles from journal as well as media report.
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Medical certification of cause of death during COVID-19 pandemic – a challenging scenario p. 5896
Deepak Juyal, Adarsh Kumar, Shekhar Pal, Shweta Thaledi, Shalabh Jauhari, Vijay Thawani
Death certificate data is used to monitor local, regional and national mortality trend and is helpful in improving public health as well as public safety. Accurate and reliable information about the cause of death in a population is useful for understanding disease burden estimation and trends in the health of populations; moreover, the information provided by such data is vital in terms of public health planning as well. With the continuous upsurge in mortality due to coronavirus disease 19 (COVID-19), mortality analysis could be valuable in addressing the current pandemic and implementing the epidemic control strategies effectively and efficiently. Given that COVID-19 death certification substantially affects the local and national responses towards disease prevention and transmission, the importance of the accuracy and quality of information in these certificates cannot be understated. Hence, accurate death certification related to COVID-19 is vital to understand the extent and progression of the current pandemic.
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Relationship of socio-economic inequality and overweight with non-communicable diseases risk factors: A study on underprivileged population p. 5899
Ashish Kumar Yadav, Mriganka Baruah, Niam Rahman, Joya Ghosh, Susmita Chaudhuri
Background: Out of every five deaths in India three are due to Non-Communicable Diseases (NCDs). Two major modifiable risk factors for NCDs are overweight and socioeconomic inequality. This study assesses the burden of various NCDs risk factors and their relationship with socioeconomic inequality and overweight among the underprivileged population. Aim: To compare the different Non-Communicable Diseases risk factors with socioeconomic inequality and overweight. To evaluate the relationship between socioeconomic inequality and body weight with NCDs. Materials and Methods: A cross-sectional study incorporating 241 random sample of participants was assessed using WHO Stepwise approach to NCD risk factor surveillance. Anthropometric measurements and biochemical analysis of 12 h of fasting venous blood samples were done. Data were analyzed using Stata version 16 and Graph Pad Prism 8, using two-sided significance tests at the 5% significance level. Results: The study finds a 10-fold higher risk of tobacco use (AOR = 10.18, C.I=2.79−37.10) and 5 times higher risk of alcohol use AOR=5.57, C.I=1.25−24.65) among people with poor SES compared to higher SES. A significant correlation was observed between BMI, LDL cholesterol (r=−16.0; P=0.009) and HDL cholesterol (r=18.0; P=0.006) with socioeconomic status. The study finds that for individuals who were overweight the odds of systolic blood pressure (AOR = 2.11, C.I = 1.03−4.31), fasting blood sugar (AOR=3.84, C.I=1.30−11.32), triglyceride level, (AOR=2.20, C.I=1.18−4.09) high-density lipoprotein (AOR=2.63, C.I=1.26−5.46) were significantly higher compared to normal BMI individuals. Conclusion: The study showed that the socioeconomic patterning of the population is significantly associated with NCD risk factors. Obesity was closely linked with several major NCD risk factors.
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Study the effect of increased maternal BMI on foetal outcome: A prospective observational study p. 5906
Nabnita Patnaik
Aim: To study the effect of increased maternal BMI on fetal outcome. Materials and Methods: The present descriptive cross-sectional study entitled was conducted in the Department of Obstetrics and Gynecology. The study includes 100 subjects who have taken antenatal care at the hospital. Descriptive statistics included computation of percentages, means and standard deviations were calculated using SPSS version 20. Results: Mean age was 27.21 years, mean BMI (kg/m2) was 27.49 and mean weight gain was 7.14 kgs. Most common neonatal complication was Low Birth Weight (7%) followed by Meconium Aspiration Syndrome (6%), Sepsis (6%). Neonatal death was observed among 5% subjects and still birth was reported among 4%. Conclusion: Present study confirmed that maternal obesity is associated with an increased risk of neonatal complications like Low Birth Weight, Meconium Aspiration Syndrome and Sepsis.
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A prospective study of catch-up growth among Indian children with celiac disease p. 5909
Madhavi Bharadwaj, Ashish Jain, Anand Prakash Dubey, Avinash Lomash, Seema Kapoor
Objectives: The study was done to investigate the response of the gluten-free diet (GFD) on growth and other biochemical parameters in newly diagnosed children with celiac disease (CD). We also determined the association of Marsh biopsy classification and the response in haematological parameters among the children with GFD over the follow-up time. Methods: A prospective observational study was conducted for 1.5 years where children aged 1–10 years with newly confirmed CD (as per Marsh classification) without pre-existing chronic disease were enrolled. Individual anthropometry, biochemical and haematological parameters were recorded on enrolment and compared with 1, 3 and 6 months (follow-up) after initiating GFD (as per World Health Organization growth charts). Statistical Analysis: The data were entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences version 21.0. A P value of < 0.05 was considered significant. Results: A total of 51 (out of 55) children with CD completed 6-month follow-up. A significant improvement in the growth and biochemical parameters was seen at 6-month follow-up with the GFD (P < 0.05). There was a significantly decreasing Hb (at enrolment and at 3 months) with increasing Marsh biopsy grade—it was significantly less with Marsh 3C and more with Marsh 3A. A significantly better %Hb improvement was seen in children with Marsh biopsy 3C as compared to 3A and 3B (P < 0.05). We found no significant association of Marsh biopsy with Malabsorption, type of anaemia and Serum ferritin levels (P > 0.05). Conclusions: GFD showed significant improvement in the growth and development of the child with a significant reduction in anaemia at 6 months. With increasing grade of Marsh biopsy, the severity of anaemia increases but after the initiation of GFD, such children show significantly better improvement in %Hb over time.
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Smartphone addiction among medical students in Bisha, Saudi Arabia p. 5916
Mohammad S Al-Shahrani
Context: Smartphones are quickly becoming the most pervasive technological device on the planet. Aims: This study aims to assess smartphone addiction and the factors associated with it among medical students. Settings and Design: This study was carried out in Bisha, Saudi Arabia, following a cross-sectional study design. Methods and Material: The data collection tool comprised a self-administered questionnaire. The validated Problematic Use of Mobile Phones (PUMP) scale was used. The PUMP score was calculated by summing up the scores for the individual questions such that higher scores indicate higher levels of addiction. Statistical Analysis Used: Pearson's correlation coefficient was applied to observe the linear relationship between the PUMP scale total score and the quantitative study variables. Results: The mean total PUMP score was 61.55, with a standard deviation of 13.16. The correlation coefficient between daily hours of smartphone usage and total PUMP score was 0.39, with a statistically significant P value (P < 0.0001). The correlation coefficient between smartphone use for games and total PUMP score was 0.19, with a statistically significant P value (P = 0.009). The correlation coefficient between GPA scores and total PUMP scores was -0.21, with a statistically significant P value (P = 0.003). Conclusions: There is a high prevalence of smartphone addiction among medical students in Bisha city. There is a significant positive correlation between daily hours of smartphone usage and total PUMP score. Playing games on smartphones is significantly associated with smartphone addiction. There is a significant negative correlation relation between GPA score and total PUMP score.
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Psychological impact of the COVID-19 pandemic on healthcare workers in India: An observational study p. 5921
Rachna Raj, Soujanya Koyalada, Amit Kumar, Stuti Kumari, Pooja Pani, Nishant , Kishore Kumar Singh
Background: The World Health Organization (WHO) in January 2020 declared outbreak of novel coronavirus disease, COVID-19, an international public health emergency. It was stated that there was high COVID-19 spread risk to various other countries across world. According to WHO in March 2020, COVID-19 was characterized as pandemic. However, this sudden crisis is generating great deal of stress, anxiety, and depression throughout the world. Aim: The aim of this study was to assess the psychological impact and various associated factors during the developing COVID-19 situation among both the healthcare and non-healthcare working professionals in India. Materials and Methods: This was an observation-based cross-sectional study conducted during the lockdown period and following the lifting of the lockdown for a total of 3 months duration. A structured questionnaire was send via the (email) electronic mail system to a target population of 350 people. Out of which 300 responded. The questionnaire was comprised of study variables: (a) Gender; (b) age-group range which was categorized into- (i) Between 30 snf 50 years and (ii) More than 50 years; (c) Presence of any comorbid medical condition; psychological symptoms of- (d) insomnia; (e) anxiety; and (f) depression. Statistical analysis was performed using the Chi-square test for determining significance. Results: Mean ± SD values for age were found to be 35.54 ± 6.09; 33.84 ± 7.87; 32.16 ± 5.89 and 55.76 ± 8.98 for physicians, nurses, technical staff, and non-healthcare professionals while the percentages of male study participants was found to be 37.2%, 15%, 57%, and 65% and female study participants was 62.8%, 85%, 43%, and 35% for the physicians, nursing staff, technicians, and non-healthcare professionals. Depression, insomnia, and anxiety between healthcare and non-healthcare professional workers, demonstrated significant P values of 0.05, 0.03, and 0.02, respectively. Conclusion: The present study has shown a significant psychological impact arising from this crisis.
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Has tax reforms in India been effective in tobacco control: Evidences on affordability of cigarette after introduction of Goods and Service Tax p. 5927
Sarit K Rout, Amrita Parhi
Background: Taxes are the most cost-effective mechanism to deter tobacco consumption. However, the tobacco tax system has not been favorable in India. India introduced Goods and Service Tax (GST) in 2017 to make the tax system uniform. This paper seeks to examine the role of the newly rolled out tax system on cigarette prices and affordability and hence consumption. Methods: We used secondary data from different government publications and conducted simple statistical analysis – to present price changes, affordability of cigarette in pre and post GST regime. Affordability was estimated comparing per capita income with price index of cigarette. Results: The findings suggest that the tax structure has not been simplified with multiple taxes imposed based upon the length of cigarettes. The relative WPI of cigarettes is increasing suggesting higher increase in cigarette prices than general price. Affordability though declined in the initial two years as compared to WPI and per capita income, it remained neutral in the post GST regime. Conclusions: The findings suggest that tax reform should aim at influencing affordability adequately so that it deters consumption of cigarette.
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Effectiveness of back massage on pain relief during first stage of labor in primi mothers admitted at a Tertiary care center p. 5933
Manasi P Pawale, Jyoti A Salunkhe
Background: Labor pain is one of the most severe pains a woman experiences in her life, causing an increase in the anxiety and stress levels. Massage therapy has proven beneficial for relaxation purposes. Aim: To evaluate the effectiveness of back massage in relieving pain during the first stage of labor in primi mothers. Methodology: The study included 40 primipara mothers belonging to the age group 22–25 years, equally divided into 2 groups: Experimental (massage therapy) and control (routine care). The socio-demographic data, labor assessment parameters (cervical dilation, status of fetal membranes, frequency and duration of uterine contractions during the latent and active phase of labor, and the total duration of the first stage of labor), and the level of labor pain (numerical rating pain scale) were recorded. Data analysis was performed by one-way ANOVA and two independent samples t-test (P ≤ 0.05 as significant). Results: During the latent and active phase of labor, majority of the mothers experienced 4–5 contractions in a span of 10 min. During the latent phase of labor, uterine contractions for 20–40 s were exhibited by 90% and 75% mothers in the experimental and control group, respectively; and during active phase, contractions of >40 s were exhibited by 85% mothers in both groups. A significant difference in the post-test pain scores was noted between the 2 groups (P < 0.0001). Conclusion: Our study proved that back massage was effective in reducing pain during the first stage of labor in primipara mothers in comparison to those who were subjected to routine care.
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Preliminary study of prevalence of urolithiasis in North-Eastern city of India p. 5939
Mohammad Shazib Faridi, Khumukchum Somarendra Singh
Introduction: Urinary tract stone is one of the major urological problems globally and has changed significantly in the last few decades. The epidemiology differs according to geography, socioeconomic status, and diet. The primary care physicians are initially consulted rather than urologists because of increase in the prevalence of urolithiasis and saturation of health facilities. Objectives: To study the prevalence of urolithiasis in the urology department of a tertiary care centre, Manipur, India. Methods: A total 621 patients of urolithiasis were studied. After history and physical examination of each patient, urolithiasis was confirmed by X-ray Kidney Ureter Bladder (KUB) or Ultrasound (USG) KUB. Results: The male to female ratio was 1.01:1. 30.8% patients came from Imphal West district. 63.1% of studied population had single stone and commonly seen in the 31–40 years of age, whereas multiple stones (n = 59) were found most commonly in the 41–50 years of age group. The difference of number of stones according to age group was statistically significant (P = 0.000). The most common location of stones was in kidneys (67.4%) and stones in urethra were the least common (P = 0.000). Conclusion: In this preliminary study, we report the prevalence of urolithiasis in Manipur, India. The better understanding of the epidemiology of urolithiasis is important to plan the effective treatment and prevention strategies in general practice. There is a shift in gender distribution of urolithiasis. Aging demographics, number of stones, obesity; all were associated with increased prevalence of urolithiasis.
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Diagnostic accuracy of the postoperative C - reactive protein to albumin ratio in prediction of complications after major abdominal surgery p. 5944
Manish Swarnkar, Ruturaj Pendkar
Introduction: postoperative complications are common after surgery for both benign and malignant disease, and results in infections, extended hospital stay, delayed return to normal status, increased financial burden and long-term morbidity hence early recognition of surgical complications and management is of utmost importance. Aim: To assess the predictive value of C-reactive protein to albumin ratio (CAR) and C-reactive protein (CRP) in determining the post-operative complications following major abdominal surgeries. Methods: this two-year prospective observational study was carried out at acharya vinoba bhave hospital and risk factors for post-operative complications in 100 eligible patients who were undergone major abdominal surgeries were identified using uni and multivariate analysis. Cut Coff values, PPV, sensitivity and specificity of CAR and CRP was analysed by ROC curve. Results: in our study 62% patient developed post-operative complications and CAR on post-op. day three found to be independent risk factor for prediction of post-op. complication and has higher PPV than CRP. CAR cut-off value of 2.16 is associated with more post op complications. Conclusion: From our study it can be hypothesized that patients having CAR value of more than 2.16 on post op day 3 should be monitored carefully for development of complications. So that early intervention could reduce the unwanted sequelae associated with it.
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Clinico-epidemiological characteristics of hospitalized acute encephalitis syndrome children and their correlation with case fatality rate p. 5948
Gitali Kakoti, Bishnu Ram Das
Background: Acute Encephalitis Syndrome (AES) in children contributes considerable morbidity and mortality in endemic region. A study was conducted to see the clinico-epidemiological characteristics of hospitalized AES children and to find out if there is any correlation of clinico-epidemiological factors with case fatality rate (CFR). Methods: This hospital-based observational prospective study was conducted in a tertiary care teaching hospital of Assam, India from 16th May, 2019 to 15th May, 2020. We enrolled clinically diagnosed 140 hospitalized AES children consecutively as per WHO case definition. Cerebrospinal fluid and serum samples were tested for JEV-specific IgM antibodies. Results: Out of 140 AES children 84 (60%) were male and 5–12 years age group had the highest 79 (56.4%) number of cases. Primarily cases were from rural areas 132 (94.3%). In addition to fever, major clinical manifestations were seizures 114 (81.4%), altered sensorium 128 (91.4%), meningeal signs 62 (44.3%), and <8 GCS 42 (30%). CFR was 27.7%. Significantly high CFR was seen among AES children with GCS <8 (P-value 0.0001) and presence of meningeal signs (P-value 0.0007). A higher proportion of non-survivors 55.6% were non JE AES. Monthly incidence of AES/Death showed a peak in the month of July. Conclusion: AES in children is a significant public health problem in the study area with high CFR. Presence of GCS <8 and meningeal irritation are the important predictors of mortality in AES children. Preponderance of non-JE AES case fatality in children warrant further exploration and appropriate public health interventions.
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Knowledge and practice of foot care in patients with diabetes mellitus attending primary care center at Security Forces Hospital, Riyadh, Saudi Arabia: A cross-sectional study p. 5954
Mashail Mohammed AlOwais, Omer A Shido
Introduction and Objectives: Diabetic foot is the most common complication among 50% diabetic patients. Evidence exists that with the self-care, the incidence of foot ulcers and toe amputation can be decreased significantly. Hence, the current study was planned to assess knowledge and foot care practice among diabetic patients attending primary care centre in Saudi Arabia. Methodology: This prospective cross-sectional study was conducted at a Primary Care Center in Security Forces Hospital of Riyadh. Consecutive sampling was used to enrol 350 diabetic patients. Information on demographics, knowledge and practice of footcare was collected through standardized and pre-tested self-administered questionnaire. Data were entered and analysed using SPSS V 22.0 software. Results: Out of 350 patients aged 18 years and more, 170 (46.7%) belonged to age group of 46-60 years; mostly males (n = 185, 53.9%). The foot complications were absent among 57.9% patients, 35.5% having numbness, 4.3% having a history of healed ulcer and 2.3% reported toe amputation. More than 65% patients were certain about their knowledge regarding foot self-care. There was no statistically significant difference in the knowledge among males and females. The practice of self-care of feet was statistically significantly different among males and females regarding self-inspection of feet on regular basis as well as daily moisturizing of their feet. Conclusions: Both knowledge and practice levels were low among diabetic patients which needs to be strengthened through regular counselling sessions. There is a pressing need to spread awareness on this important aspect of morbidity and mortality which can be addressed with minimal resources.
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Assessing the awareness on occupational safety and health hazards among nursing staff of a teaching hospital p. 5961
MS Prajwal, Kanakavalli K Kundury, MJ Sujay
Introduction: Occupational safety and health hazards in healthcare facilities play a significant role in the lives of care providers and also contribute toward quality patient care. Healthcare workforce gets exposed to physical, chemical, biological, and psychological hazards while discharging their duties, thus demanding for proper knowledge and awareness to address the same. Objectives: As nursing staff implement the care process directed by the physicians, the current study conducted at a teaching hospital aimed at assessing their awareness on occupational safety and health hazards. Methodology: A prospective study was conducted on a pilot basis for a period of 3 months in various nursing areas of the hospital. The questionnaire aimed at assessing the awareness of nursing staff on occupational safety and health hazards (5-point scale) was administered on nursing staff (150/170]. Total scores and percentage of responses were computed and the degree of correlation was observed as 0.4 between the participants age, educational qualifications, and total scores. Results: Participant response rate was 88% (150/170). Awareness on occupational safety and health hazards were shown as 43.4%- accidental falls at workplace, 42.7%- complete awareness on latex allergies, 52.7% on dermatitis and respiratory problems, 42% complete aware on accidental fires, 39.4%- burns, 36.7%- electric shocks, 59.4%- complete awareness on biological infections, 54%- respiratory disorders, 48.7%- skin allergies, awareness on usage of PPE to prevent: 67.4%-respiratory problems, 44%- accidental falls; 77.4%- importance of handwashing, 78% - significance of Hepatitis B vaccination, 71.4% - usage of first aid kits in minor accidents, 60%- reporting incidents, and 58%- documentation system for incident reporting. Sum total of scores revealed that 73.3% of the participants were found to be completely aware about all the components of occupational health and safety mentioned in the questionnaire. 22.6%- aware, 3.3%- moderately aware, and < 1% were slightly aware of the same. Conclusions: The study had highlighted the areas that require knowledge enhancement on occupational safety and health hazards which helps in adopting the best practices at workplace.
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Outcome of therapeutic plasma exchange in Myasthenia gravis patients p. 5971
Ashu Dogra, Kaushik Rana, Chirag Rathod, Sanjay Prakash
Aims: The aim of this study was to evaluate the indications, adverse reactions, and outcome of therapeutic plasma exchange (TPE) in myasthenia gravis (MG) patients. Settings and Design: Retrospective Observational study. Methods and Material: A total of 18 patients of MG had undergone 18 cycles and 87 session of TPE at our Institution, a tertiary care center in Western India. It was performed using a single volume plasma exchange with intermittent cell separator (Freseniouscomtec), subclavian central line access, and with alternate day interval. Outcome was assessed shortly after each session and overall outcome at the time of discharge. Results: Total of 68 patients of MG were admitted to Neurology Intensive care unit (ICU) during the study period [January 2016–December 2019]. Out of them, TPE was done in 18 patients. Among the 18 patients, 11 patients had myasthenic crisis and 7 patients had worsening of MG. The mean number of TPE session was 4.2(SD ± 1.2), volume exchange was 2215 ml (SD ± 435); overall incidence of adverse reaction was 33.3%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 72.2% of patients. Conclusions: TPE is cost-effective rapid therapy for myasthenic crisis and progressive myasthenia gravis. It reduces ICU stays and improves outcome.
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Oral health status and related quality of life among elderly tribes in India p. 5976
Sandhya K Neelamana, Chandrasekhar Janakiram, Beena Varma
Introduction: Oral health reflects overall well-being for the elderly population. In elderly people, oral health contributes significantly towards quality of life (QOL). Good health is essential for older people to remain independent and to play a part in family and community life. Epidemiological data on health and its related issues are very important in order to plan for future health care provision. Objectives: To assess the oral health status,treatment needs and oral health related quality of life using GOHAI indexin elderly patients in Kalpetta. Methodology: A cross sectional study was conducted in the elderly patients reporting to the OPD of Amritakripa Hospital, Kalpetta. Oral Health status was assessed by structured proforma and WHO oral health assessment form 2013 which included DMFT score, Periodontal status, Oral Mucosal lesions, Treatment needs etc. Oral health related quality of life was assessed by Geriatric oral health assessment index. Data analysis was done using SPSS version 20 and descriptive status were obtained. Results: The sample consisted of 214 females and 66 males.70.7% of of participants were illiterate. 96.4% of the population(270)were having daily wage <500. 59.3% of population were unaware about oral health problems. Emergency treatment was need in 41.4% of population. On assessing oral health related quality of life, Male population found to have GOHAI score of 26.44 and that for the female population, it was 19.72.GOHAI score was compared for prosthetic status and age also. Considering the psychological parameters, suggest that this group of elderly in Kerala does not regard poor oral health as barriers to social interactions. Conclusion: The oral disease burden is very high in tribes. The prevalence of the tobacco habits is of concern. Education and motivation of these laity is needed to improve their oral health.
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Malnutrition among community dwelling older adults in a rural block area of South India p. 5982
Ragasree Govind, Jayalakshmi Rajeev, Arun N Bhatt
Background: Kerala state has highest proportion of older adults in India. There is paucity of information on burden of malnutrition (under-nutrition) among them in the state. This study aimed to measure prevalence and associated factors of malnutrition among older adults in a rural community of Kerala. Methods: A community based cross-sectional study was conducted in 2018, among randomly selected 245 older persons (age ≥ 60 years) across rural area of Nemom block panchayath in Thiruvananthapuram district of Kerala. Nutritional status was determined by Mini Nutritional Assessment tool. Other components of the interviewer-administered questionnaire were Barthel Index, Geriatric Depression Scale-15, socio-demography, morbidity and substance abuse details. Chi Square test and binary logistic regression were done appropriately. Results: Prevalence of malnutrition was 14.3% (95% CI – 9.9% to 18.7%) and 44.1% (95% CI – 37.9% to 50.3%) were at risk of malnutrition. Older-old (70-79 years), oldest-old (≥80 years), unmarried or widowed, those with chewing and swallowing difficulties, those who screened positive for depression and those who had higher grade of dependency in any activities of daily living were more likely to be malnourished (p < 0.05). Older-old age (aOR – 3.358), depression (aOR – 4.859) and higher grade of dependency in activities of daily living (aOR – 2.940) were the attributes independently associated with malnutrition after adjusting for other factors. Conclusions: The older persons in the rural area of Kerala had high burden of malnutrition. Older-old, dependent and depressed individuals are more likely to be affected.
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Advancing oral health policy for mandatory dental screening before admission into public primary and secondary schools in Lagos, Nigeria p. 5988
Afolabi Oyapero, Temitope Iyadunni Bakare, Titilayo Fausat Goncalves
Background: The oral health of children is a significant public health issue that considerably affects nutritional intake, growth and development, daily learning activities, sleep pattern, self-esteem, and quality of life. In Nigeria, limited progress has been made in reducing the prevalence and burden of oral health problems such as dental caries, Noma, and oral cancer due to absence of national data, inadequate budgetary allocation, dearth of personnel, poor policy framework/implementation, and challenges of care access. Lagos state has a large, diverse population, hampered by illiteracy and poverty, and school-based dental screening is a strategy that can potentially reduce the prevalence of oral diseases among a vulnerable population in resource-poor settings. This document proposes secondary prevention through screening for a significant proportion of children in Lagos State and will be a veritable source of Data for oral Health planning. Proposed Interventions: A draft policy document is proposed for the Ministry of health for legislation mandating a low-cost comprehensive oral health examination to screen every child admitted into Primary or Secondary School in any of the State Government-owned Schools in Lagos State. Each child will receive an oral health education leaflet and a duplicated annual dental screening form in addition to all the other requirements he will provide before being cleared for resumption when the academic year commences. The parents of the child will then be expected to present the form at any of the Lagos State-owned General hospitals for dental screening. The children will receive expedited attention and will not be kept waiting unnecessarily before being attended to. Students who have any form of dental disease will however be required to open a dental card at the clinic and have their treatments done as soon as possible. Except the dental treatment is found to be very expensive, the parents would be firmly encouraged to have the treatment done before the academic year commences and the form can be filled and signed. The school authorities would be notified if the parents cannot bear the cost and the ministry of health would be duly informed. Once the child is examined and found to be free of dental disease, the form can be filled and signed by the attending dental practitioner and duly stamped. A duplicate would be retained in a dedicated file in the dental clinic while the main form will be returned to the school. The schools will keep the forms in a dedicated file and at the end of each admission cycle, a report on the oral health status of the children for each school must be submitted to the Ministries of Education and Health. The preferred format for submission should be an excel spreadsheet containing the biodata and the summary of dental findings and treatment provided as applicable for each child. Evaluation: Short and long term evaluation will be done to assess coverage rate, the number of dental diseases identified, number of treatments done, the satisfaction of parents and children with the services while the cost-benefit analysis of the services will be determined using a combination of qualitative and quantitative methods. The results of these analyses will be utilized to justify further government commitment of resources to this program. Conclusion: Strategies to reduce the burden of disease in developing countries must focus on policy design/implementation and preventive interventions. This proposed policy can help to decrease or eliminate barriers to access. It can also increase the number of children who will receive both preventive and curative oral care and also improve their knowledge of oral health.
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Risk factors for alcohol use relapse after abstinence in patients with alcoholic liver disease p. 5995
AC Arun, Nityashree Ilangovan, Jenish Rajma
Introduction: In patients with alcoholic liver disease, abstinence from alcohol is an important aspect of treatment. Once abstinence is achieved, the challenge is to avoid relapse of alcohol use. This study aims to analyse the significant risk factors for alcohol relapse thereby identifying the patients with high risk for recidivism to have an early social and medical intervention. Methodology: This was an observational and a retrospective type of study. Patients with chronic liver disease and had alcohol use relapse after abstinence were classified into Group A. Patients who did not have relapse after abstinence were classified into Group B. The two groups were compared for various social and personal and disease related factors. Student “t” test was used for raw data and Chi square test was used for consolidated data to find significant difference between variables. Results: Overall nine factors were analysed. The factors which were found to be significant for predicting relapse are quantity of alcohol consumption per week, duration of abstinence, associated smoking, marital status, severity of liver disease (Child-Pugh scoring system). The other factors like age of starting alcohol consumption, duration of alcohol consumption, family history of alcohol intake and MELD score were not statistically significant. Conclusion: This study identifies the risk factors associated with alcohol relapse in patients with alcoholic liver disease. The data from this study can be used to identify individuals who are high risk for relapse and treat them with pharmacological and psychosocial methods to prevent relapse.
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Airway status at arrival to the Emergency department among patients with life threatening emergencies p. 6000
Sanjay Murugan, Anju S Kurien, Kundavaram Paul Prabhakar Abhilash
Background: Despite the improvement in prehospital care in the last decade in India through dedicated ambulance services, airway management is often performed by undertrained or untrained personnel and remains teetering to the edge of collapse. This study aimed at assessing the airway status in critically ill patients at their arrival to the Emergency Department (ED). Methods: This prospective study included all triage priority I patients presenting to the ED during August 2017 and September 2017. Details of their airway status at arrival to the ED was noted. The severity at presentation and outcome of patients brought in ambulances and private vehicles were determined using descriptive analytic statistics and bivariate logistic regression analysis. Results: The study included 450 patients, with a male predominance (65.3%). Only a third (31%) of patients were brought in ambulances with a reminder through various means of transport. Compared to patients brought by private vehicles, patients brought to the ED by ambulances had a higher odds of being hypoxic at ED arrival [OR: 1.63 (95% CI: 1.08–2.46); P value: 0.01] and requiring invasive ventilation on arrival to the ED [OR: 2.36 (95% CI: 1.46–3.80) P value: < 0.001]. Overall, 55.7% (248/450) required hospital admission while 21% (95/450) were discharged stable from the ED after resuscitation and stabilization by the ED team. The overall mortality rate was 11.1% (50/450), with 13.5% (19/144) of those brought by ambulances and 10% (31/309) of those brought by private vehicles succumbing to their illness in the hospital. Conclusion: Private vehicles still remain the predominant mode of prehospital transport though ambulances are used to transport sicker patients. More than half the critically ill patients remained hypoxic on arrival to the ED. Our study clearly highlights the glaring deficiency in airway status at ED arrival and stresses the urgent need to improve prehospital care.
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A study of quality of care of sterilization services in Madhya Pradesh Highly accessed article p. 6005
Surya Bali, Kriti Yadav, Yash Alok
Background: In a country with a high demand for contraception such as India, one of the most common methods is surgical sterilization, which is delivered by two approaches namely the camp approach and the fixed day static approach. The quality of services for sterilization in India for both the approaches has remained questionable. Objectives: This paper seeks to determine the quality of sterilization services at fixed day static centers of Madhya Pradesh. Methods: It was a descriptive observational study done between September 2017-December 2017 in 10 districts of Madhya Pradesh. One District Hospital and 2 Community Health Centers were randomly chosen from each district. The study was carried out using a prestructured, pretested, and prevalidated tool which used the Ona Platform. Results: Two of the facilities conducted more than 30 operations on the day of the visit. In only 18.3% of the cases was the patient informed about all contraception options. The duration between the start of surgery and the signing of consent was less than 2 h in 42% of the patients. The surgical protocol for proper surgical wear was not followed in most cases. Conclusion: The quality of care of sterilization services was found to be substandard in the fixed day static centers. The guidelines for the sterilization services were not being followed, and follow up of the patients was also neglected. Better training of the staff with strict and timely supervision is required for the better quality provision at the fixed day static centers.
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Continuum of care for non-communicable diseases during COVID-19 pandemic in rural India: A mixed methods study Highly accessed article p. 6012
Balaji Gummidi, Oommen John, Vivekanand Jha
Background: COVID-19 pandemic has resulted in disruption to routine health services delivery as strict lockdowns were implemented in India and health workforce redeployed for COVID-19 focused responses. We assess the perceptions about COVID-19, the impact of the lockdown on access to health services and continuum of care for Non-communicable diseases (NCDs) among a cohort of adults in rural India. Methodology: Since 2018, we have been following up a cohort of persons with non-communicable diseases in a high NCD burden region in Srikakulam District of Andhra Pradesh under the STOP CKDu study. We conducted this mixed methods study, administered through a structured telephonic questionnaire and interview to determine the awareness, perceptions and their compliance to ongoing treatment schedules. Results: Overall, 68% of the participants exhibited adequate knowledge of symptoms of COVID-19, while 43% were not aware of the mode of transmission of the virus. In all, 822 (36.1%) participants reported at least one NCD condition. Among them, 115 (14%) missed their follow-up visit, 110 (13.4%) reported facing challenges in medication procurement and 11.6% either developed new complaints or experienced worsening of pre-existing symptoms. A total of 233 (28.5%) used a telemedicine facility and took telephonic advice from (private) physicians. As the access to medicines was restricted due to the lockdown, majority of the respondents were depending on rural medical practitioners (RMPs) for the procurement of medication. Conclusion: Our finding implies the need for the future guidelines on adaptation of telehealth approaches within health systems to maintain the continuum of care, digital health tools to facilitate the patient's appointments including virtual follow-up visits for those with NCDs coupled with regular engagement by frontline healthcare workers at the local levels, evidence informed public health messaging taking into consideration the social and behavioural aspect and uninterrupted essential primary healthcare services.
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Evaluation of knowledge and competency among nurses after a brief suicide prevention educational program: A pilot study p. 6018
Vijay K Saini, Pratibha Gehlawat, Tanu Gupta
Background: Suicide is major public health issue worldwide. The educational interventions in enhancing the knowledge, modifying the attitudes, and raising the competence levels of healthcare professionals to prevent suicides have shown positive results. However, these education programs are under-evaluated, especially in India. Aim: The aim was to evaluate the effect on suicide prevention and management-related knowledge among nursing staff, attitudes, and competence for suicidal patients and their family members. Methods: A brief suicide educational intervention training program was prepared for the study participants. The outcomes of this study were evaluated through a single group pre-test–post-test questionnaire. Result: The mean age of the participants was 28.74 ± 5.73 years. Participants reported significant improvement in their attitude and knowledge about suicide after attending the training program. Conclusion: Empowering primary health care staff including nurses to identify, assess, manage, and refer the suicidal person should be considered as an important step in suicide prevention.
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Top 20 drug − drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients p. 6023
Biswadeep Das, Saravana Kumar Ramasubbu, Barun Kumar, Vikram Singh Rawat
Introduction and Objectives: Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to a greater risk of all-cause and coronary heart disease deaths. We investigated the pattern of utilization of QTc-interval prolonging medications, QT-extending interactions between drugs, and prevalence of QTc-interval prolonging risk factors in elderly patients. Methods: This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to December 31, 2018 employing the pertinent prescriptions. Results: A total of 208 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study period were investigated. 105 (50.5%) patients were males whereas 103 (49.5%) were females in our study. 147 out of 208 patients (70.7%) were using interacting agents with the capacity to produce TdP. 288 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 254 (48.8%), 181 (34.8%), and 62 (12%) interacting medications were identified with known, possible, and conditional risk of TdP, respectively. The common interacting medications belonged to antidepressant (144), proton pump inhibitor (91), antipsychotic (85), anti-nausea (46), antimicrobial (39), and H2 receptor antagonist (15) therapeutic categories. Conclusions: Many geriatric patients were administered drugs and drug combinations with heightened proclivity towards QT-interval prolongation. Therefore, we need to exigently embrace precautionary safety interventions, to be vigilant, and forestall QT-prolongation and TdP in clinical settings. Online evidence-based drug information resources can aid clinicians in choosing drugs for psychiatric patients.
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Injury and its associated factors among residents of an urban slum during the festival month in South India: A community-based survey p. 6041
Vinayagamoorthy Venugopal, Pruthu Thekkur, Kalaiselvi Selvaraj, Swaroop K Sahu
Introduction: Injury morbidity and mortality have been steadily increasing in both developed and developing countries including India. The current study tried to assess the incidence of injury and identify the risk factors associated with injuries during the festival month in a selected urban area in Puducherry. Methods: It is a community-based cross-sectional survey conducted among the residents in the urban field practice area of a medical college in Puducherry. Participants were interviewed using a pretested questionnaire. Information on the incidence of injury and its associated factors were collected. Data were entered in EpiData and analyzed using Stata. Generalized linear models with Poisson distribution were used to identify the risk factors associated with the injuries. Results: Overall, 1380 participants from two selected clusters were interviewed. The incidence rate of injuries was 5.2% (95% CI: 4.0–6.4). In adjusted analysis male (RR 1.96, 95% CI: 1.15–3.37) and student (RR 2.91, 95% CI: 1.13–7.54) were independently associated with having an injury. Most of the injuries were unintentional and accidental. Conclusion: The reported incidence of at least one injury was 52 per 1000 population per month and the majority were accidental in nature. It was higher during the festival week. Public health strategies at the primary healthcare level targeting adult males and school children will be effective in the reduction and prevention of injury.
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Is the medical teacher's mental health neglected? Effects of perceived student attitudes and behaviors on mental health and lifestyle of teachers in a rural university of western Maharashtra in India p. 6046
Anshuman Jain, Mandar Padmakar Baviskar, Sandip Narawne, Rahul Kunkulol
Background: A medical teacher is a practitioner, teacher, trainer, and researcher all at once. There are very few studies assessing stress among medical teachers. With landmark policy changes, disruption and ongoing pandemic, looking at the mental health of medical teachers assumes greater importance. Methods: A cross-sectional study was carried out in the teaching faculty of medical, dental, nursing, and physiotherapy colleges affiliated within a rural medical university in western Maharashtra. A convenience sample of 100 teachers was taken and a self-report questionnaire was used to collect data from the teachers. Stress was measured by the Perceived Stress Scale. Results: Low stress scores (0–13) were seen in 43% of teachers, 55% had moderate stress scores (14–26), and 2% had high stress scores (27–40). Teaching was reported as a stressor by only 8%, whereas administrative work, lifestyle, family responsibilities, finances, patient care, professional jealousy, competition, and frequently changing norms were more commonly reported stressors. The overt focus on entrance test preparation, over-reliance on mobile phones, short attention span, poor listening skills, lack of interpersonal skills, lack of initiative to acquire clinical skills, lack of punctuality, and transactional nature toward learning were some of the perceived faults in the attitude of medical students as reported by the teachers. Conclusion: Teachers are coping with changing trends in technology and attitude of students toward learning and shoulder a multitude of responsibilities while creating doctors and healthcare professionals of the future. Attention needs to be paid to their health.
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Effect of magnification and changes in tobacco pictorial warning on asceticism of tobacco use: An exploratory survey p. 6051
Suresh K Sharma, Prasuna Jelly, Kalpana Thakur, Manoj Gupta
Background: Tobacco usage-related diseases pose serious threat for not only public health but also for country's economy and warning labels are considered as an effective strategy to spread more awareness on tobacco hazards. Aim: The aim of this hospital-based questionnaire survey was to assess the effect of magnified pictorial warning over tobacco products on asceticism of tobacco use and to measure the association of selected tobacco habits variables and asceticism of tobacco use. Materials and Methods: Present exploratory survey based on triangulation method of data collection was conducted among conveniently selected 1,008 tobacco users or smokers attending OPD services at tertiary care center during the year 2018–2019. Quantitative survey data was collected through structured questionnaire and two FGDs were conducted for qualitative information. Data was analyzed using descriptive and inferential statistics. Results: Magnification of health warnings over tobacco packets had impact on tobacco or cigarette consumption to some extent (415; 41.25%); but insisted only one third (383; 38.0%) participants to quit tobacco use. A significant association was observed between awareness about bad effect of tobacco use and attempt of quit tobacco uses (OR 0.29; CI 95%, 0.223–0.390; P = 0.001). Furthermore, significant effect of magnified warning over tobacco products was seen on reduction in tobacco use (OR 0.39; CI 95%, 0.300–0.531; P = 0.001) and quitting the tobacco (OR 0.38; CI 95%, 0.28620.513; P = 0.001). Conclusion: Study results concluded that magnification of pictorial warning is associated with the asceticism of tobacco use to some extent but alone it is not sufficient. Therefore, adjunct intervention of mass public education about bad effect of tobacco use is more essential to augment asceticism of tobacco use.
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Temporal analysis of visceral leishmaniasis between 2000 and 2019 in Ardabil Province, Iran: A time-series study using ARIMA model p. 6061
Vahid Rahmanian, Saied Bokaie, Aliakbar Haghdoost, Mohsen Barooni
Background: Visceral leishmaniasis in human (VLH) also known as kala-azar is a neglected disease of humans that mainly occurs in more than 50 countries mostly located in the Eastern Mediterranean and the Northern America. Objective: The purpose of this study was to determine the temporal patterns and predict of occurrence of VL in Ardabil Province, in northwestern Iran using autoregressive integrated moving average (ARIMA) models. Methods: This descriptive study employed yearly and monthly data of 602 cases of VLH in the province between January 2000 to December 2019, which was provided by the leishmaniasis national surveillance system. The monthly occurrences case constructed the ARIMA model of time-series model. The insignificance of the correlation in the lags of 12, 24 and 36 months, and Chi-square test showed the occurrence of VLH does not have a seasonal pattern. Eleven potential ARIMA models were examined for VLH cases. Finally, the best model was selected with the lower Akaike Information Criteria (AIC) and Bayesian information criterion (BIC) value. Then, the selected model was used to forecast frequency of monthly occurrences case. The forecasting precision was estimated by mean absolute percentage error (MAPE). Data analysis was performed using Stata14 and its package time series analysis. Results: ARIMA (5, 0, 1) model with AIC (25.7) and BIC (43.35) was selected. The MAPE value was 26.89% and the portmanteau test for white noise was (Q = 23.02, P = 0.98) for the residuals of the selected model showed that the data were fully modelled. The total cumulative VLH cases in the next 24 months' in Ardabil province predicted 14 cases (95% CI: 4-54 case). Conclusion: The ARIMA (5, 0, 1) model can be a useful tool to predict VLH cases as early warning system and the results are helpful for policy makers and primary care physicians in the readiness of public health problems before the outbreak of the disease.
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The use of mobile application in primary health care in Saudi Arabia: A cross-sectional study p. 6068
Raghad K Alsalamah, Najla A Almasoud, Jumana A Alghtani, Mohammed A Alrowaily
Background: Technology implantation, for example, smartphone application, in primary health care (PHC) is an approach to enhance healthcare services via availability and convenient access. This study described the factors contributing for not booking an appointment using the mobile application, and why patients visit PHC physicians. Method: This is a cross-sectional study that included 477 participants who visited the PHC physicians. Eligible subjects who present in the patients' waiting area were asked to participate by giving them a self-administered questionnaire. Results: With a total of 477 participants' appointments, 83.5% (N = 398) of them were booked through the mobile application. Out of 398, 54.6% (N = 217) were not booked by the patients themselves. The most common reasons for the visits were follow-up (38.8%), lab/imaging results (34%), and acute complaint (27.3%). Gender, age, and the number of comorbidities the patient has were significantly associated with those who didn't book the appointment by themselves through the mobile application (P-value <0.001). Males were more likely to book for themselves than females. The average age for patients who booked for themselves through the mobile application was significantly low (Mean = 39.4, SD = 14.5). Those who were able to book for themselves had a lower number of comorbidities. Conclusion: Age, gender, and number of comorbidities were significant factors contributing to not to book an appointment/use mobile application by the patients themselves. The mobile application might cause difficulties and influence the appointment booking process. The application should be expanded throughout the country with further modification to meet the patient's needs.
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Local complications of intravenous access – an often underestimated entity p. 6073
Manoj Kr Chaudhary, SK Dhakaita, Rubik Ray, Tridip Dutta Baruah
Context: Obtaining intravenous (IV) access is one of the very frequent invasive procedures performed in hospital care settings. This has several complications some of which are serious in nature. However, the incidence and seriousness of these complications as well as the burden of this complication on patient management are often underestimated. Identification of susceptible patients and the risk factors are important to ensure better outcomes. Aims: The aim of this study was to document the various local complications of intravenous access and to identify the risk factors associated with it. Settings and Design: Prospective observational study with three hundred and one surgical patients. Study duration of 1 year. Methods and Material: Indication of IV access, site, size of IV cannula used, category of personnel involved as well as local complications at access site were documented. Dressing at cannula site were changed every 72 h or earlier. Cannula and site of access were changed in case of any complication. Statistical Analysis Used: Results analysed using SPSS software (IBM Inc). Frequency calculated as average and percentage. Chi-square test used for statistical significance. Relative risk calculated. Results: Females, overweight, diabetics and smokers were found at more risk. Requirement of major surgery, IV access by paramedical personnel, IV access over joints and when kept beyond 3 days were found to have more complications. 5.7% of patients had serious complications requiring surgical intervention. Conclusions: Our study shows that local complications at IV access site are very common with occurrence in more than fifty percent patients. Several risk factors are identified. Not all demographic and clinical risk factors are readily modifiable. However many of the complications can easily be minimized by following basic precautions.
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The impact of the implementation of a clinical decision support system on the quality of healthcare services in a primary care setting p. 6078
Ahmed Sherif Mahmoud, Abdullah Alkhenizan, Mohammed Shafiq, Suad Alsoghayer
Background: In July 2015, King Faisal Hospital Family Medicine clinics (KFH-FMC) successfully implemented a paperless, fully integrated, electronic healthcare system. The aim of this study is to evaluate the impact of moving to a fully integrated electronic medical record system, with clinical decision support (CDS) systems, on the quality of healthcare services in a primary care setting. We aim to evaluate the impact of CDS on clinical outcomes such as screening and diagnosis of breast and colorectal cancers, as well as the management of chronic diseases such as diabetes and hypertension, and the uptake of immunizations. Inclusion and Exclusion Criteria: Our study included all adult patients, over the age of 18, registered in the Family Medicine clinic linked to King Faisal Hospital, seen between January 2012 and December 2018. Design: Retrospective cohort study. Setting: Family Medicine clinics at King Faisal Hospital (KFH-FMC). Materials and Methods: Data were collected retrospectively from the electronic health records of all adult patients above 18 years of age, who were seen in KFH-FMC between January 2012 and December 2018. We analyzed several processes of care and a number of clinical outcomes, comparing results for the three and a half years before CDS implementation with the three and a half years after implementation. Data collected included blood pressure measurements, lipid levels, HbA1c for diabetic patients, screening tests done, including PAP smear, mammogram, fecal occult blood tests, and bone densitometry. Other data included cancer diagnoses and immunizations received. Results: Significant increases were found in adult vaccine uptake ranging from an 11-fold increase in influenza uptake, to a 22-fold increase in pneumococcal 23 uptake. The uptake of all the cancer screening tests increased (FOB 66%, mammogram 33%, PAP smear 16%). Diagnoses of breast and colorectal cancer showed significant increases. Breast cancer diagnoses increased from 2 to 14, and colorectal cancer from 3 to 11. No significant improvement was found in chronic disease outcomes. Discussion: The electronic health record with CDS led to significantly improved uptake of immunizations and screening tests, with earlier diagnoses of breast and colon cancer. Evidence of improvement in chronic disease outcomes is still lacking.
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Attitude and practices related to coronavirus disease (COVID-19) pandemic among pregnant women attending family welfare clinic amid Phase-2 lock down p. 6085
Ruqia Quansar, Sabira A Dhkar, Sheikh M Saleem, S Muhammad S. Khan
Background: The antenatal period is an important landmark where the services provided to mothers through antenatal care (ANC) checkups also act as a way for additional interventions influencing maternal and child health. This study aimed to know about the perception and practice among the patients of ANC checkups (ANCs) regarding COVID-19 and what are the implications of it on their routine check-ups. Methods: We conducted this study from 15 April, 2020 to 03 May, 2020, Phase 2 {Country wide lockdown in India}, which was imposed for over 19 days. The sample size was kept open and we used convenient type of sampling and included all those pregnant women who attended the clinic for ANC checkup amid the countrywide lock down. Each patient of ANC checkup was interviewed by the treating doctor using a predesigned structured questionnaire containing questions based on demographic information and the perception and practices regarding corona virus infection. Results: The majority, 66 (79.5%) were in the age group of 26–35 years, 63 (75.9%) were in the second and third trimester of their pregnancy, 72 (86.7%) were from urban areas, 26 (31.3%) and 17 (20.5%) were having education level of bachelor's and higher, respectively. The majority 39 (47%) reported that they are worried that someone they know may have the coronavirus infection and they are unaware about it, 57 (68.7%) feel the nature of the disease as fatal, all ANCs reported that their families are taking initiatives to prevent corona virus infection and they should take extra precautions for corona virus infection, 6 (7.2%) reported that any member of their family has been quarantined during the period, 81 (97.6%) feel that primary precautions like hand washing, social distancing, wearing a face mask, and isolation and quarantine will help in the reduction of infection, 69 (83.1%) choose to report to hospital if any of their close relatives are down with symptoms of corona virus. Conclusion: Our study showed that the respondents had a good attitude, perception, and were following sensible positive practices regarding COVID-19 prevention.
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Impact of temperature and sunshine duration on daily new cases and death due to COVID-19 p. 6091
Swati Thangariyal, Aayushi Rastogi, Arvind Tomar, Ajeet S Bhadoria, Sukriti Baweja
Context: Control of COVID-19 has now become a critical issue for public health. Many ecological factors are proven to influence the transmission and survival of the virus. However, the association between different climatic factors and spread and mortality due to COVID-19 is unknown. Aim: To determine the association of different climatic factors with the spread and mortality due to COVID-19 during January 2020 to May 2020. Methods and Material: The climatic indicators included in the study were duration of sunshine, average minimum temperature, and average maximum temperature, with cumulative confirmed cases, deceased, and recovered cases. The data was performed for 138 different countries of the world, from January 2020 to May 2020. Statistical analysis used: Spearman's correlation analysis was used to assess the correlation between temperature and the spread and mortality of COVID-19 cases. Both univariate and multivariate analysis was performed for cumulative and month-wise analysis, using SPSS software. Results: Average maximum temperature and sunshine duration were significantly associated with COVID-19 confirmed cases, deceased, and recovered. For every 1° increase in average temperature, the confirmed, deceased, and recovered cases decreased by 2047 (P = 0.03), 157 (P = 0.016), and 743 (P = 0.005) individuals. The association remained significant even after adjusting for environmental as well as non-environmental variables. Average sunshine duration was inversely correlated with an increase in daily new cases (r = -2261) and deaths (r = -0.2985). Conclusion: Higher average temperature and longer sunshine duration are strongly associated with COVID-19 cases and deaths in 138 countries.
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Community-based longitudinal follow-up of Stroke patients discharged from a tertiary care center in Central India p. 6102
Sharad Tiwari, Ankur Joshi, Nirendra Rai, Afrah Misbah, Parmeshwar Satpathy
Context: Stroke is a condition that may affect the functionality of a person to a significant degree; however, there is very little data available that speaks about the objective state of a patient from a revalidated scale after the post-stroke event. Aims: To fill the knowledge gap and generate first-hand evidence about the post-stroke events in the community. To study post-stroke well-being of patients discharged from health facility and assess them longitudinally by Relevant Physical Examination, National Institute of Health stroke scale, and Modified Rankin Scale. Methods and Materials: Forty patients who suffered from first episode of stroke were followed in their home longitudinally by Relevant Physical Examination, National Institute of Health (NIH) stroke scale and Modified Rankin Scale. Patients under study were first visited after 2 months of discharge from the hospital set up after which two more follow-up visits were conducted at 2 months interval each. Results: There was an improvement in muscle power, sensation in the upper and lower limb, gait, and posture as well as language and vision in the patients in three subsequent visits. There was no significant difference in the fine movements of the patients. There was a gradual improvement in NIH score and there was a dominant presence of moderate-severe disability among the patients. Conclusions: Quantitative scales largely showed on a primary basis that on the physical dimension of the disease, the effects of Stroke were affecting the functioning of the body at optimum capacity and harmony.
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Utilisation of nutritional support scheme among the patients of tuberculosis: A myth or a truth p. 6109
Jarina Begum, Y Neelima, Syed I Ali, Satyajit Pattnaik, Dhananjaya Sharma
Introduction: Under-nutrition increases the susceptibility to active tuberculosis and delays recovery. Nikshay Poshan Yojana provides a financial incentive of Rs. 500/month for each notified TB patient for a duration until the patient is on anti-TB treatment. Objectives: 1. To find out the utilization of the nutritional support scheme among TB patients. 2. To give evidence-based recommendations. Methods: It is a retrospective cross-sectional study conducted among TB patients. 2 DMC's in each of the 2TU (randomly selected from 12 TUs) were chosen. 83 patients responded to telephonic interview out of all patients registered in the last six months. The demographic details were collected from TB treatment cards and registers and other information by telephonic interview of 10–15 min each conducted over a period of 15–20 days. The quantitative data thus collected was analysed in terms of frequency, percentage and Chi-square test and qualitative data from patients and providers were analysed by thematic analysis. Results: Majority were of 40–60 years of age and were males. A total of 76 patients were aware of the scheme but only 17 patients had received their first instalment after two months in their account. Among the 17 who faced difficulty while getting the money, 13 TB patients spent it on nutrition. Lack of communication, stigma, unawareness, ignorance, illiteracy, multistep approval process and technical issues were few themes that emerged as difficulties encountered while utilisation. Conclusion: There is a large gap between demand and supply chain of services. A majority were unsatisfied and thus the administrative scale up for proper implementation of services and measures to bring down the stigma attached with the disease was recommended.
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Plain lumbosacral X-rays for low back pain: Findings correlate with clinical presentation in primary care settings Highly accessed article p. 6115
Mohammed AlAteeq, Abdelelah A Alseraihi, Abdulaziz A Alhussaini, Sultan A Binhasan, Emad A Ahmari
Background: Low back pain (LBP) is a common disabling condition frequently seen and managed in primary care. LBP is considered to be the most common health problem for which general practitioners order an imaging test. Objective: To correlate radiological findings of plain lumbosacral X-rays with the initial clinical presentation of patients with back pain. Materials and Methods: This is a descriptive cross-sectional retrospective chart review study, conducted for 384 adult patients, with back pain who had plain lumbosacral X-rays, at three primary healthcare centers at King Abdul-Aziz Medical City (KAMC) in Riyadh, Saudi Arabia, in the period from 1 Jan 2017 to 31 Dec 2018. Results: The majority of cases had either normal lumbosacral X-rays (32.8%) or incidental findings that were nonspecific. The most abnormal findings were degenerative changes such as spondylosis (osteophytosis) and narrowing of the intervertebral foraminal space (45.3%). The vast majority of cases of chronic back pain was associated with abnormal findings on a plain lumbosacral X-ray, which constituted most cases with abnormal findings among subjects. Conclusion: Lumbosacral X-ray findings in the vast majority of cases do not correlate with clinical presentation and do not justify routinely ordering imaging studies for nonspecific back pain in a primary care setting.
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Identifying the risk factors for the prevention of hypertensive disorders in pregnancy in a tertiary care hospital: A cross-sectional study p. 6121
Dhananjay Kumar Singh, Nikhil Sinha, Rajeev Kumar, Sudip Bhattacharya, Anita Maurya
Introduction: Hypertensive disorders in pregnancy accounts for maternal morbidity and mortality globally. Aim and Objectives: We conducted this study to know the demographic profile and risk factors pertaining to lifestyle and behavioral aspects for hypertension among the pregnant women. Methodology: It was a hospital-based cross-sectional study. During the routine antenatal checkups, those antenatal cases found hypertensive, were included in the study after taking written consent. A semi-structured questionnaire was prepared and pretested before conducting the actual study. Statistical analysis was done by SPSS (version 17) software. Participants' sociodemographic characteristics were described using descriptive statistics. Results are presented using graphs, tables, mean, percentages, standard deviation, frequency, and significance. Results: We observed that most of the study subjects 110 (48.9%) were educated up to secondary level followed by primary level 47 (20.9%) while 25 (11.1%) of the subjects were illiterate. We also found that 113 (50.2%) of the study subjects consumed additional salt in their diet and 57 (25.3%) of the study subjects had a history of intake of visible fat. Among 225 study subjects, 174 (77.3%) did not consume tobacco in any form. Among the 225 study subjects, 142 (60.9%) did not have a family history of hypertension. It was observed that 121 (53.77%) subjects had normal BMI while 16 (7.11%) subjects were underweight while 51 (22.6%) subjects were pre-obese. A total of 32 (14.22%) subjects were obese class 1 followed by 5 (2.22%) subjects who were obese class 2. It was observed that among 225 study subjects, 155 (68.9%) subjects had mild hypertension while 70 (31.1%) subjects had severe hypertension. Discussion: The scarcity of data regarding hypertension in pregnancy in low and middle income countries despite this, a comparatively high prevalence of hypertension in pregnancy was observed due to behavioral risk factors, which is mostly preventable at the primary care level. Recommendations: It is possible to prevent PIH by eliminating behavioral risk factors through education and counseling to the pregnant ladies, at the primary care level by family physicians or primary care physicians which will reduce maternal mortality to a great extent.
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Correlation between the arm-span and the standing height among males and females of the Khasi tribal population of Meghalaya state of North-Eastern India p. 6125
Amitav Sarma, Bhupen Barman, Gautam C Das, Hiranya Saikia, Ambath D Momin
Introduction: The estimation of relationship between the arm span and the standing height has been an important tool in anthropometric measurements especially in cases where direct measurement of stature is not possible. Objective: To find the relationship between the arm-span and the standing height of both males and females in the population of Khasi tribal population of Meghalaya. Materials and Methods: The study involved 400 numbers (272 males and 128 females) of healthy human volunteer subjects belonging to Khasi tribe of Meghalaya. The standing height and arm-span were measured for each individual and analyzed. Result: Of the 400 healthy volunteers, 272 (68%) were males and 128 (32%) were females with age ranged from 25 to 45 years. Height and arm span in males (159.68 ± 4.12 cm and 166.30 ± 4.27 cm, respectively) werefound to be significantly (p < 0.001) higher than females (149.96 ± 3.04 cm and 155.77 ± 3.13 cm respectively). The Pearson correlation coefficient (r) between height (cm) and arm span (cm) showed significant positive correlation in both male (r = 0.988, P < 0.001) and female (r = 0.991, P < 0.001) study subjects. The regression equation was Height = 1.060 + 0.954 (Arm span); R2 = 0.976; SEE = 0.646 for male. For female subjects the regression equation was found as Height = 0.150 + 0.962 (Arm span); R2 = 0.983; SEE = 0.400. Conclusion: Arm-span can be used as one of the most reliable parameter in both males and females for obtaining the stature of an individual in alternative to the height.
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Simultaneous infection of Hepatitis A and Hepatitis E viruses amongst acute viral hepatitis patients: A hospital-based study from Uttarakhand p. 6130
Deepjyoti Kalita, Manisha Paul, Sangeeta Deka, Gaurav Badoni, Pratima Gupta
Background: Enterically transmitted viral agents like Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are common causes of viral hepatitis in developing countries. Double infections by both agents, as their routes of entry are similar, are common. Overall this is a major health issue for our country. This study was carried out to learn about the seroprevalence of HAV & HEV (and double infections if any) infections in acute viral hepatitis (AVH) cases attending our hospital. Materials and Methods: This is a retrospective cross-sectional study of a 2-years duration carried out in the serology lab of Dept. of Microbiology, AIIMS Rishikesh. Continuously collected samples totaling 617 cases, presenting with Acute Viral Hepatitis was included in the study. Cases with suggestive history were tested for IgM anti-HAV and IgM anti-HEVrespectively. Commercially available ELISA kits were put into use. Standard Statistical Package (SPSS 23) was put to use for statistical analysis. Results: HAV & HEV seroprevalence in AVH cases were found to be 14.7% (91/617) and 28.04% (173/617), respectively. Dual infection of HAV and HEV was found in 5.9% (32/617) of study subjects. The prevalence of HAV and HEV among males were14.2% and 34.26%, respectively while that in female were 15.36% and 21.16%, respectively. Infection was predominantly found in young adults. Distinct seasonal variation was observed, period towards the end of monsoon, and beginning of winter recorded more cases. Both year, most of the positive cases are seen in the months of August and September. Conclusion: The infection rate of HEV is higher than HAV amongst AVH cases. This and relatively high co-infection rate (5.9%) is significant in terms of the need for regular screening of HEV in pregnant women as well as the urgent need to improve hygiene amongst the population. This data will help in future vaccine strategies and sanitation programs in this part of the country.
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Dosimetric comparison of left sided whole breast irradiation with Tangential wedge beam,electron boosted Tangential wedged beam and asymmetric technique p. 6135
Pedram Fadavi, Helaleh Khoshbakht Ahmadi, Ali Asghar Yousefi Diba, Fatemeh Jafari, Mahboobeh Alamolhoda
Background: Irradiation of the adjacent critical structures is inevitable in breast cancer radiotherapy (RT). Our purpose is to assess the dose distribution across the breast tissue and adjacent organs with our institutional asymmetric technique for left-sided breast cancer compared to the standard tangential wedged beam (TWB) and electron-boosted TWB techniques. Materials and Methods: The three RT planning were created for 30 consecutive patients with a focus on proper coverage of the planning target volume (PTV). The irritated doses into the heart, ipsilateral lung, and left anterior descending artery (LAD) were evaluated. Results: No significant difference was found in the mean values of relative PTV irradiated to 47.5 Gy, PTV dose and the volume of PTV, and critical organs between the treatments. The mean dose (Dmean) irradiated to the heart and LAD was lowest with the electron-boosted TWB. The Dmean to the heart was comparable between the TWB and asymmetric RT techniques, while the Dmean to LAD was significantly reduced with asymmetric technique versus TWB. The heart volume receiving ≥25 Gy and the Dmean to the left lung were significantly decreased with the asymmetric technique compared with TWB. The mean relative lung volume irradiated to ≥20 Gy was comparable between all techniques. The mean central lung distance was also significantly increased from 18.03 ± 4.5 cm with asymmetric RT to 37.47 ± 5.6 cm with TWB and to 27.67 ± 3.8 cm with electron-boosted TWB techniques. Conclusion: The asymmetric technique is useful for patients with breast cancer on the left side, having acceptable PTV coverage and considerably reduced cardiopulmonary doses.
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Overview of child sexual and substance abuse among children in Ethiopia p. 6140
Meseret Takele, Tadesse B Haye, Leul D Kitaw, Nardos Uqubay, Ketema B Gebremedhin
Background: Child sexual abuse is common typically concealed while substance abuse is unhidden in their nature of practice globally. Objective: The study aims to express the overview of child sexual and substance abuse among children in Ethiopia. Method: A facility-based cross-sectional study design with simple random sampling method was used to recruit study participants, after the allocation of sample size to the study institutions. Both descriptive and inferential statistics were used to describe the variables and to show the association of factors. Results: A total of 450 children participated in the study. The mean age of the study participants was 13.67. More than 38% of the study participants were of age below the mean age. The majority of 61.3% of the study population were living with their parents. Factors associated with child sexual abuse were sex (AOR = 2.92; 95% CI; 1.84,4.63), alcohol intake (AOR = 2.53; 95% CI; 1.461, 4.36), chewing chat (AOR = 3.84; 95% CI; 1.68, 8.75), cigarette smoking (AOR = 3.83; 95% CI; 1.67-8.81), age (AOR = 4.38 (95% CI: 2.90, 6.62), educational level (AOR = 0.64 (95% CI: 0.44, 0.93), living conditions (AOR = 4.44; 95%CI: 0.73, 26.87), and conflict between parents AOR = 2.50 (95% CI: 1.43, 4.35). Moreover, the age and educational level of the study participants were statistically significant at P < 0.05. Conclusion: The study concluded that a significant proportion of children who participated in the study experienced sexual abuse and/or substance abuse. Therefore, there should be an intrusion to reverse the prevalent children's sexual and/or substance abuse in the country.
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Dental caries status of children receiving Highly active antiretroviral therapy (HAART) - A multicentric cross-sectional study in Tamil Nadu, India p. 6147
G Shanmugavadivel, AR Senthil Eagappan, S Dinesh, A Balatandayoudham, M Sadish, P Prasanna Kumar
Background: Highly active antiretroviral therapy (HAART) has progressively improved the life expectancies in HIV positive children. These antiretroviral drugs could possibly have an influence on the oral health status. Different age groups of children under HAART with caries had implications in approach to dental treatment, which were attempted to be identified in the study. Aims/Objectives: The aim of the study was to assess the caries status among HIV positive children receiving HAART. To characterize the age group with high caries indices and treatment needs. Methods: A cross-sectional study was conducted among 313 HIV infected children aged 3–14 years receiving HAART from various ART centers Tamil Nadu, India. Dental examinations were performed and caries status of primary and permanent dentition was assessed using Decayed, Missing, and Filled teeth (DMFT)/Decayed, Missing, and Filled surface (DMFS) indices. Statistical Analysis: The one way ANOVA with post-hoc Tukey HSD test. Results: The mean deft/DMFT scores were 3.15 ± 2.72/2.07 ± 1.31 and defs/DMFS scores were 7.42 ± 5.90/4.30 ± 2.58. The caries incidence was significantly different across the three age groups compared. DMFT scores of 13 − 14 years age group were significantly higher than in the 3−6 years (P < 0.0000) and 7−12 years (P < 0.0001). Conclusion: A higher caries experience was present among children on HAART as compared to the general population in Tamil Nadu. A significant association with increasing age and DMFT scores was noted. Age groups of 13−14 had high caries prevalence than age groups of 3−6 and 7−12 years in given study population. The individualized treatment approaches based on the age groups is suggested.
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Awareness level of general population regarding keratoconus in Aseer region, Southern of Saudi Arabia p. 6153
Abdulrahman Al-Amri, Ali Saad Alshamrani, Anas Ali Abo Tamraa, Sultan Ali Alqahtani, Khalid Mohammed L. Alotaibi, Khalid Hussein Almutairi
Background: Keratoconus (KC) is a non-inflammatory disease occur to the cornea and cause it to be thin and progressively bulge it into a cone shape which result to blurred vision secondary to irregular astigmatism, frequently eyeglass changing and increase the sensitivity to the bright light, occur usually at second decade of life and stops progressive after fourth decade of life. keratoconus is unknown in aetiology but is a multifactorial disease in causes which divided into genetic and environmental factors, the genetic factors as if patient under ethnic with high prevalence and family history with keratoconus or Atopy. Aim: to assess the general population awareness regarding keratoconus in Aseer region, southern of Saudi Arabia. Methodology: A descriptive cross-sectional approach was used targeting all population in Aseer region. The study was conducted during the period from January 2019 to May 2020. Data were collected using structured questionnaire included person's socio-demographic data, Participants' Participants' awareness regarding KC. The questionnaire was uploaded online using social media platforms. Results: The study included 638 participants who completed the study questionnaire with mean age of 36.8 ± 11.1 years. Exact of 331 (51.9%) of the participants were males. University level of education was reported by 424 participants (66.5%). Fifty-nine participants (9.2%) reported that they had keratoconus. Conclusions & Recommendations: In conclusion, the study revealed that public awareness in Aseer region regarding keratoconus was moderately poor with defect regarding treatment modalities and its consequences.
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Oral health status and treatment needs of children with special health care needs in rural and urban areas of Hyderabad – A cross sectional study p. 6158
B Tapaswi Singh, V Pranitha, KS Dwijendra, G Nagarjuna, Naseemoon Shaik, R Kavya
Aim: The aim of the cross-sectional study was to ascertain the oral health status and treatment needs of special health care need children of age group 3–16 years in rural and urban areas of Hyderabad, Telangana, India. Materials and Method: To assess and compare the caries status, oral health status, oral hygiene measures, diet and treatment needs in rural and urban population. The data collected was processed and analyzed using the SPSS statistical software program. Results: Among 1000 subjects in rural and urban population highly significant difference was observed for Oral hygiene aids (P < 0.003) and for DMFT (P < 0.008) and no significant difference for dmft (P > 0.26). OHIs status showed no difference in primary and permanent in both rural and urban population (P > 1). Filled and missed were in DMFT, dmft was very low even though there were carious tooth in study population. Most of the children in rural and urban population required varied treatment needs like oral prophylaxis, restoration, pulp therapy, crowns and extractions. Conclusion: High prevalence of dental caries and the need for restorative care was noted in these children emphasizing the necessity of change of attitude towards oral health and improved oral care by repeated counselling of parents by primary health care physicians.
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The insulin sharps disposal study: Evaluation of a structured patient education initiative in an urban community health centre in India p. 6164
Kusum V Moray, K Manjunath, AJ Martina Shalini, Ruby Angeline Pricilla.S, Sushil Mathew John, Jasmin Helen Prasad
Context: India has witnessed an increase in people suffering from diabetes mellitus and also those on insulin. The issue of handling used sharps in the community is an area of concern. Aims: Our study aimed to assess the change in knowledge and practise concerning the disposal of used insulin sharps in patients with diabetes, pre- and post-evaluation, a structured, health provider-initiated, patient-centred insulin-use health education (PIHE) Settings and Design: A pre- and post-evaluation study of PIHE set in an urban health centre in south India Methods and Materials: A pre-evaluation study was done on a cross-sectional sample of type II diabetes patients, who visited the urban health centre and were on insulin for at least 1 year. A semi-structured pilot-tested questionnaire was used for the study. For 18 months, PIHE was provided to all insulin users at outpatient contact, after which a post-evaluation study among another cross-sectional sample of patients in the same centre, was done to assess change in knowledge and practise. Statistical Analysis Used: Univariate analysis followed by logistic regression. Results: The participants in the pre- and post-evaluation studies had a mean (SD) age of 54.9 (11.33) years and 57.2 (11.01) years, respectively. The baseline characteristics of gender, socioeconomic status and diabetes duration were similar. There was a statistically significant (P < 0.001) difference in knowledge (19 [19%] to 81 [81%]) and practise (7 [7%] to 73 [73%]) of participants regarding the correct disposal method of used insulin syringes and sharps before and after PIHE. Conclusions: PIHE over an 18-month period for diabetic patients on insulin significantly improved knowledge and practises relating to insulin use and correct disposal of syringes and sharps.
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Study of microbiological and antibiotic sensitivity pattern of ventilator associated pneumonia (VAP) in ICU of a tertiary care hospital in Nepal p. 6171
Deebya R Mishra, Divya S Shah, Niharika Shah, Jagat N Prasad, Pramendra P Gupta, Krishna K Agrawaal
Introduction: Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU) acquired infection among patients receiving mechanical ventilation. Accurate clinical and microbiologic diagnosis of VAP is essential not only for selection of appropriate antimicrobials but also to prevent their misuse. As the organisms and their sensitivity pattern may differ in every ICU, the knowledge of the resident flora and their behaviour should be known for successful treatment. Methods: The study was conducted to evaluate the organisms responsible for VAP and their Antibiotic Sensitivity Pattern for the study setting. A prospective, open, epidemiological clinical study was performed in a tertiary care hospital in Nepal. 100 patients admitted to ICU and Mechanically Ventilated were evaluated about VAP. Clinical Pulmonary Infection Score (CPIS) was used to diagnose VAP. Results: Among 60 patients ventilated for more than 48 hours, 25 (41.6%) developed VAP. The VAP was caused predominantly by Klebsiella pneumonia in 34.5% of cases, followed by Acinetobacter calcoaceticus baumanni in 27.6%, Acinetobacter wolffi and Pseudomonas aeruginosa in 13.8% each and Escheresia coli in 10.3%. The most sensitive antibiotics were Colistin, followed by Polymyxin B and Amikacin with sensitivity rates of 67%, 60% and 58%, respectively. Conclusion: Based on these results, an empiric approach to antibiotic treatment can be made tailored to the specific settings. Given the magnitude of drug resistance and its implicated financial and societal burden, there is an urgent need for broad implementation of Antibiotic Stewardship programs across all health care settings.
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Awareness and attitudes of Saudi parents toward otitis media in children p. 6177
Mohammed Alsuhaibani, Muna Almijmaj, Abdulaziz Almushaigeh, Raghad Alhomidani, Yasser Aldakheel, Aqeel Alaqeel
Background: An ear infection is a common health problem in children. Parents' awareness about otitis media (OM) among children, varies across the world. We aimed to explore parents' knowledge, attitude, and practices toward OM among their children. Methods: A quantitative cross-sectional study was done from May 1, 2020 to June 30, 2020, in Qassim, Saudi Arabia. Results: This study comprised 703 participants; Mothers comprised the majority (77.1%), 43.2% of the participants were aged between 31 and 40 years of age, and 73% of them had Bachelor's degrees or diplomas. More than half of the participants had suboptimal knowledge of OM. Although the result showed that 56% of them had positive attitudes, 86.6% did not view vaccination as a prevention measure of acute OM (AOM). Besides, 81.8% of parents were willing to follow the watchful waiting approach, in case their child had OM. Conclusion: Most of the parents in the Qassim region have inadequate knowledge regarding OM among children. Based on our result findings, we recommend further education programs to enhance the knowledge regarding OM and AOM, among the Qassim population, Saudi Arabia including family members of patients and the healthcare workers.
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Patients concerns about spinal surgery in Hafr Al Batin, Saudi Arabia p. 6183
Zaheer Ahmed Mohammed, Abdulkarim Alhomaidi Almutairi, Abdullah Shafi Almutairi, Asma Waqit Alghamdi, Rawan Abdu Mashhur, Alwaleed Mohammed Alyamani
Background: The aim of the research to study the concerns about spine surgery in patients who attending to neurosurgery clinic in Central Hospital and King Khalid General Hospital in hafar Al-Batin. Objective: The objective is to determine the concern of patients about spine surgery and to detect the reasons of rejection of the surgery with tying to compare the concerns with the social factors and to know the source of their knowledge. Material and Method: A cross-sectional study on sample of 91 from the patients who attending neurosurgery clinic who could be suffering from any spinal diseases such as tumors, degenerative, and trauma. A standardized survey questionnaire distributed manually and responses were collected and analyzed. Results: The majority of the survey respondents were suffering from trauma (48.4%). The satisfaction rate among persons undergone spine surgery was 20.9%. A negative correlation between age and level of education; rejection of spine surgery or exploring for alternative treatment because of risk of surgery was observed. The patient feedback revealed that if advised for spine operation was 46.2% will accept, 29.7% will delay surgery and looking to alternatives, while 23.1% will reject because of concerns. Conclusion: It is recommended that awareness campaigns are required about the importance of spine surgery and to provide the correct information about the complications of spine surgery and finally give more attention to the correct diagnosis.
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Challenges to lifestyle modification of chronic disease patients attending primary health care centers in Riyadh p. 6186
Sulaiman A Alshammari, Abdullah Z AlDhayan, Omar M Saad Al-essa, Majed M Alosaimi, Badr M Al-badr, Anas B Ali, Qusay A Ajlan
Background: The rate of chronic diseases is increasing due to the global pandemic of inactivity and an unhealthy diet. Objective: We aimed to determine the dietary habits, physical activities of the participants, and challenges facing them to adapt to a healthy lifestyle. Methodology: The researchers conducted a cross-sectional study on chronic disease patients attending primary health care centers in Riyadh from January to March 2018. The estimated sample size was 250 patients. The participants completed a self-administered questionnaire. Result: The mean age of the 250 participants was 35.3 years old. The Overweight and obese participants accounted for 67.2% of the sample (mean BMI = 28.0). Two-thirds of the participants depend mainly on rice or pasta for their diet, and 48.4-52.0% eat fruits and vegetables less than three times a week. About 50% of the participants perceived a lack of information, skills, motivation, and family or friends support as a barrier to a healthy diet. Also, (56.4%) of males and (67.8%) of females are physically inactive. Accessibility, cost, and the hot climate were physical activity obstacles in more than 60% of the respondents. Optimal BMI showed a significant association with increased physical activity P = 0.04. Conclusion: Physical inactivity and consuming a non-balanced diet are common. So awareness campaigns of the benefit of a healthy lifestyle besides increasing physical exercise facilities, installing environmental changes, and subsidizing sports gyms would encourage people to be more physically active.
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Mapping fear among doctors manning screening clinics for COVID19. Results from cloud based survey in Eastern parts of India p. 6194
Ravi Ranjan Jha, Raj Kishore Verma, Anupam Kishore, Rishabh Kumar Rana, Rajan Kumar Barnwal, Haribansh Kumar Singh, Dewesh Kumar
Background: As the number of cases of COVID19 from novel corona virus 2019 rises so are the number of deaths ensuing from it. Doctors have been in front in these calamitous times across the world. India has less number of doctors so doctors are overwhelmed with more number of patients to cater. Thereby they are also fearing that they will be exposed much as they often work in limited resource settings. Methods: An on line survey was to include doctors from eastern states in India for measuring the reasons of their fear and suggest possible solutions based on the results achieved thus. After IEC clearance a semi-structured anonymous questionnaire was sent on google forms as links on known to doctors, working in screening OPDs or flu clinics especially for COVID-19. Results: Out of 59 Doctors majority were provided with sanitizers for practicing hand hygiene. Gloves were provided everywhere but masks particularly N95 and Triple Layer surgical masks were not there for all. Training was not given universally. Fear was dependent on age in our sample. Conclusion: Training and strict adherence to infection control measures along with resources can help in removing the fear.
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Evaluating the effectiveness of cardiac arrest resuscitation short course (CARS) for rural physicians of Asia: The Rural Emergency Care Training for Physicians (RECTIFY) project p. 6201
Nedungalaparambil Nisanth Menon, Raman Kumar, Pratyush Kumar, Pramendra Prasad Gupta, Victor Ng, Elena Klusova Noguina, Jobin Jose Maprani
Background: Physicians from resource-constrained rural areas being lone lifesavers pose a unique challenge in resuscitating emergencies like cardiac arrest. Rural Emergency Care Training for Physicians (RECTIFY) was devised as a short course training to equip them to deal with occasional emergencies using minimal gadgets. This study was conceived to assess the effectiveness of the RECTIFY-Cardiac Arrest Resuscitation Short course (CARS) module in improving current knowledge and practice of cardiopulmonary resuscitation (CPR) among interested rural physicians of Asia. Methods: A three-tier observational study was conducted to assess current CPR knowledge with a pretested structured questionnaire and skills using a checklist, followed by a 3-h hands-on training and posttest evaluation using the same study instruments. Data were entered into Microsoft Excel and analyzed using SPSS 13.0. Results: Out of 622 participants, most of the participants (603; 96.9%) were willing to provide CPR despite poor knowledge and skills. Pretest scores averaged 1.5 ± 0.99 and 0.1 ± 0.3 for CPR knowledge and skills, respectively. Posttest scores for CPR knowledge (10.5 ± 1.5) and skills (2.8 ± 1.6) improved significantly (both P = 0.001). Whereas a majority improved upon chest compression skills, appropriate use of sophisticated gadgets like automated external defibrillators (AED) was low (2.4%) despite training. Conclusion: The level of knowledge and skill among participants was poor despite the enthusiasm and positive intent. The impact of RECTIFY-CARS on knowledge and skills among participant physicians was significant and is recommended for implementation by health policymakers in resource-poor rural settings. However, essential gadgets like AED were not impactful which necessitates the use of simpler rural alternatives.
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Prevalence of diabetes mellitus and HIV/AIDS among tuberculosis patients in Kerala p. 6209
Sherin Jacob, Leyanna Susan George, Aleena Joy, Minu Maria Mathew, K Vijayakumar, Anil Kumar, Akhilesh Kunoor
Introduction: It is estimated that 10 million people fall ill with Tuberculosis (TB) every year worldwide. TB continues to be in the top 10 causes of death globally with India being the home to the world's largest number of TB patients. One of the major factors attributing to this is the presence of comorbidities such as Diabetes Mellitus and HIV/AIDS. Aim: The aim of this study was to determine the prevalence of comorbidities such as Diabetes mellitus & HIV/AIDS among the newly diagnosed TB patients in Kerala in 2019 and also to determine the factors associated with it. Materials and Methods: A cross-sectional study was carried out using the secondary data from NIKSHAY portal. There were a total of 16,527 cases of pulmonary and extrapulmonary TB cases reported from 14 districts of Kerala from January to September 2019. Using a checklist, data regarding the age, gender, type of case, Type of patient, site of disease, drug resistance were collected separately for TB patients suffering from Diabetes mellitus and HIV/AIDS. The data was then entered into Excel sheet and was analyzed using SPSS version 23. Results: Out of the total 16,527 study population, most of the patients were elderly above the age of 60 years (28.6%). The prevalence of Diabetes mellitus (22.6%) was higher among TB patients when compared to HIV/AIDS (1.2%). Males in the age group between 50-59 years were found to be significantly associated with TB- Diabetes Mellitus comorbidities. Diabetes was significantly associated with Pulmonary TB patients, while HIV/AIDS was significantly associated with extrapulmonary TB. Conclusion: Both Diabetes Mellitus and HIV/AIDS are comorbidities that have a strong impact on the diagnosis and management of Tuberculosis patients. Therefore, there is an urgent need to prevent these comorbidities from occurring along with the implementation of early diagnosis and appropriate management strategies. This study is of prime importance especially among Primary care Physicians who are treating TB patients on routine basis. They are particularly important in TB control since they are usually the first to meet a TB suspect, before diagnosis occurs. Both HIV/AIDS and Diabetes mellitus are immunocompromised conditions and these comorbidities can affect the treatment outcomes of TB. Primary care physicians are essential in detecting TB suspects and treating them, thus contribute significantly to reducing the burden of TB.
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Impact of the Covid-19 pandemic on the elimination of hepatitis C virus in Duhok, Kurdistan, Iraq: A retrospective cross-sectional study p. 6213
Nawfal R Hussein, Shameran Daniel, Shahram A Mirkhan, Zana Sidiq M. Saleem, Dildar H Musa, Nashwan Ibrahim, Ibrahim A Naqid
Background and Aim: Infection with hepatitis C virus (HCV) is a public health threat worldwide. The World Health Organization aims to eliminate HCV. However, the coronavirus disease (COVID-19) pandemic has led to a severe compromise in health services, and this has halted efforts to eliminate HCV. Herein, we report our experience with the initiative of HCV elimination in Duhok city, Kurdistan Region of Iraq, with a focus on the effect of the COVID-19 pandemic on the HCV elimination plan. Materials and Methods: An anti-HCV antibody test was used to screen subjects. All positive results were then confirmed by reverse-transcription polymerase chain reaction (RT-PCR) testing. All patients with current HCV infection were treated with direct-acting antiviral regimens. Results: During the study period, 459,015 subjects were tested for anti-HCV antibody positivity, with a monthly average of 9,562 tests for HCV. This number dropped to zero during the lockdown period between 1March and 31May 2020. Among the tested samples, 0.29% (1350/459015) tested positive for anti-HCV antibodies. RT-PCR testing of all positive samples revealed that 0.020% (93/459015) were positive. Of the 93 recruited subjects, 3 patients did not complete the treatment course due to the lockdown. All patients who finished the treatment course were cured as determined by sustained virologic response 12 (SVR12) weeks after finishing the treatment course. Conclusion: During the COVID-19 pandemic, reductions in health facility utilisation led to a significant decrease in services offered for HCV screening and treatment. Such a decrease in services has had a negative impact on HCV elimination. An urgent plan is needed to resume the services, and strict follow-up is needed for patients whose treatment was interrupted.
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What influences adherence among HIV patients presenting with first-line antiretroviral therapy failure (ART failure)? A retrospective, cross-sectional study from a private clinic in Nagpur, India p. 6217
Sanjana Chetana Shanmukhappa, Rahul R Abraham, Poorva Huilgol, Rekha Godbole, Ashoojit K Anand, Ramakrishna Prasad, Varsha Shridhar, Milind Bhrushundi
Background: Multiple reports show increasing occurrences of ART failure in India. Despite the fact that a significant volume of outpatient and on-going healthcare occurs in private clinics, there are very few studies on adherence from private clinics in India. Objective: To evaluate the factors influencing adherence to ART in patients with first-line ART failure. Materials and Methods: Data were collected from a convenience sample of 139 individuals diagnosed with clinical, immunological or virologic failure from a private HIV clinic in Nagpur, India. A retrospective cross-sectional study was undertaken and data were statistically analysed. Results: Of the 139 patients, 118 (84.9%) were male and 21 (15.1%) were female. 64 (46%) had received pre-treatment and adherence counselling. 81 (58.3%) were not told about the side effects of ART medications and 65 (46.8%) avoided friends and family. Most common reasons for suboptimal adherence by stopping treatment were high cost, alcoholism, choosing non-allopathic medications and depression. Reasons cited for suboptimal adherence due to missed doses included feeling healthy, depression, forgetfulness and busy schedule. A significant association was found between pre-treatment counselling, adherence counselling and being told the importance of lifelong treatment and decreased occurrence of complete stoppage of treatment. Conclusion: This study brings to light some of the predictors of ART failure. Counselling, having a strong support system as well as early identification and tackling of reasons for suboptimal adherence plays an important role in preventing ART failure.
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Patient-dependent factors for fractures union failure among Riyadh population 2016 p. 6224
Mohammed Aldhafian, Faisal Alotaibi, Azam Alzahrani, Hareth Almajid, Abdullah Alamri, Ahmad Aljandal, Feras Alamri, Fares Alhawas, Amar Fathi M Khalifa
Background: The primary care has an important role to prevent fractures and make sure of complete healing without any complications like a Malunion which arises when a fracture has healed in a non-anatomical position, and a delayed union which defined as a healing time of more than 12 weeks and a non-union which occurs when absence of fracture healing progression on series of radiographs or with no evidence of healing over 10 weeks. Objectives: To identify the proportion of fracture healing failure types and identify Patient-dependent Factors. Methodology: cross sectional study consecutive sampling till completing sample size (90) patients. Data collection tool was Pretested Pre-Coded self-administered questionnaire it was subjected to a probe to test for validity and reliability. Data analyzed Using SPSS P value of less than 0.05 considered as significant results. Chi-square test was the test of significance. Results: From 90 adult male participants, 71% were 35 years of age and above and below 55 years. Our result indicated that the commonest risk factor was smoking in 62.2% of respondents, and 27.8% have Diabetes mellitus. 50% of fractures failure was diagnosed as delayed union while non-union accounts for 40% and malunion for 10%. We've noticed that smokers mostly had delayed union, while diabetic patients had mostly non-union. Conclusion: the study found that the most associating Patient-dependent Factors were cigarettes smoking and Diabetes mellitus, also most fractures failure were diagnosed as delayed union, non-union, and malunion respectively and we can help prevent these complications by controlling DM and stop cigarettes smoking.
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Is there a need to cover all households under health insurance schemes: A cross-sectional study in a rural area of Jammu p. 6228
Bhavna Langer, Rashmi Kumari, Najma Akhtar, Rajiv K Gupta, Muzaffar H Mir, Mudasir Majeed, Mehak T Mir, Sunil K Raina
Background: For tackling unforeseen health expenditure and improving healthcare accessibility in general, it is important that people should not only be aware but also be covered under health insurance schemes. The present study was conducted with the aim to assess the health expenditure, health insurance awareness, and coverage among rural households. Materials and Methods: This was a community-based cross-sectional study carried out in randomly selected families falling under a rural health block in Jammu district of Jammu & Kashmir, Union Territory. A predesigned, pretested, and semistructured questionnaire was used for data collection. Results: A total of 380 families were surveyed, of which 14.5% belonged to the priority household group. Among the priority and nonpriority households, 8.80% and 5.69% of monthly income were spent on health-related activities and 9.91% of household expenditure was on health. A total of 24.32% of priority households had even borrowed money to meet health expenditures. A total of 28.15% families had heard about the Ayushman Bharat scheme. Attitude towards health insurance was positive in both groups. A total of 29.23% of nonpriority households and 14.54% of priority households had health insurance coverage. Conclusion: A significant proportion of household expenditure was health related. The absence of good insurance coverage raises the need for policies and laws to cover all the households under health insurance schemes.
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Dimethylarginines in acute myocardial infarction: Association with lifestyle, sociodemographic, and somatometric factors p. 6234
Varvara-Maria Chalioti, Vassilis G Giannakoulis, Eleni Papoutsi, Aikaterini Megalou, Konstantinos Kritikos, Panagiotis Konstantopoulos, Paraskevi Roussou, Konstantinos Toutouzas, Despina N Perrea
Background: Recent findings associate asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) with the prognosis of acute myocardial infarction (AMI). The purpose of the current study was to associate patients' lifestyle, sociodemographic, and somatometric characteristics with the time course of ADMA and SDMA concentrations in the serum of AMI patients. Patients and Methods: In the serum of 66 AMI patients, ADMA, SDMA, troponin T, and C-reactive protein (CRP) were measured upon hospital admission (<24 h) and on the 3rd day following. Lifestyle, sociodemographic, and somatometric characteristics were obtained through a questionnaire, filled on patient discharge. Results: ADMA concentrations on the 1st day positively correlated with daily reported hours of sleep (+0.497, P < 0.001) and delivery or eating out frequency (+0.285, P = 0.02), whereas it negatively correlated with reported physical condition (-0.304, P = 0.013). A personal history of hypertension indicated higher 1st-day ADMA concentration (1.818 vs 1.568, P = 0.042). Age positively correlated with 1st-day SDMA (+0.320, P = 0.009). All of the biomarker concentrations were reduced on the 3rd day measurements (P < 0.001). Self-reported lifetime minimum BMI positively correlated with either absolute (r = +0.366, P = 0.009) or percentage (r = +0.262, P = 0.045) ADMA reduction. A daily sleep in 5–8-h range was inversely correlated with percentage (-0.410, P = 0.001) or absolute (r = -0.369, P = 0.002) SDMA reduction. Conclusions: Modifiable factors such as BMI, eating habits, physical condition, and sleep seem to affect the baseline levels or time course of ADMA and SDMA in AMI patients. Changes in these factors may affect AMI prognosis by altering dimethylarginine levels.
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Knowledge and attitude towards hydrocephalus among healthcare providers and the general population in Saudi Arabia p. 6240
Yusuf Alshehri, Iman Salem, Zeyad Alamri, Ammar Alharbi, Abdulrahman Alshehri, Ahmed Alqurashi, Ahmad Alsaeedi, Abdulrahman Alotaibi, Abdulrahman Jafar Sabbagh
Background: Hydrocephalus is a worldwide disorder characterized by abnormal flow or rarely excessive production of cerebrospinal fluid, leading to the widening of the cerebral ventricles system due to the accumulation of the cerebrospinal fluid in the brain. Previous researches have shown that knowledge about the disorder is limited among healthcare providers and the population, affecting attitudes toward patients, as well as patient outcomes. Aim: To investigate healthcare providers and population's knowledge and attitudes towards hydrocephalus in Saudi Arabia. Methodology: A descriptive cross-sectional study was conducted through an electronic questionnaire. The survey was self-constructed in Arabic and English by the research team and inspired by other awareness questionnaires and validated before use by three experts. Results: There were 444 participants in this study, aged between 17 and 73 years with a mean age of 32.60 ± 10.98. Most of the participants were from the general population (74.8%). More than half of the participants had a bachelor's degree (60.1%). 38.4% of healthcare providers had negative knowledge while 61.6% had positive knowledge. In addition, 82.5% of the general population had negative knowledge, although 17.5% had positive knowledge. Moreover, it was observed that 17.0% of the healthcare providers had a bad attitude while 83.0% had a good attitude. In addition, 60.2% of the general population had a bad attitude, whereas 39.8% had a good attitude. Conclusion: This study revealed that the level of knowledge and attitude towards hydrocephalus among healthcare providers was good on both aspects, while it was poor among the general population.
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Sleep pattern and dozing chance among university students p. 6249
Abdullah A Aljasem, Waseem M Alsahafi, Ahmad A Aljubour, Ahmed A Alobaid, Abdullah A Binsaeed, Mohammed S Alshamoosi, Rsheed A Alsadoon, Yaser A Alasmari, Amar F M Khalifa
Background: Sleep is defined as a naturally occurring state of the body within a relatively inhibited sensory activity, reduced metabolic rate and decreased interaction with the surrounding. Impaired sleep affects students' productivity, this area is not fully covered in the literature. Objectives: To assess sleep patterns and dozing chance among university students. Methods: Institutional based cross-sectional study, a sample of 145 male university students from Almaarefa University aged between 19 and 27 years old, chosen randomly. A self-administered questionnaire developed specifically for this study after consulting literature and epidemiologist. It includes data about the Epworth Sleepiness scale and GPA. Data were analyzed using (SPSS, version 22.0) and (P values of ≤0.05) considered significant. The consent was obtained before data collection. Results: The majority of respondents (62, 1%) reported sleeping time of 5-8 hours per night. To fall asleep at night 13, 1% of participants indicated needing soporific. Overall, only 36, 6% of students showed good sleep behaviors. Among respondents (44, 1%) had moderate chances of dozing and 2, 8% had high chances of dozing, There was no significant statistical relationship between academic performance and bedtime (P-value = 0,231). Conclusion: The majority of respondents had poor sleep quality and moderate to high dosing chance, also, most of the participants go to bed after midnight. In addition, one fifth of participants reported sleeping less than 8 hour per day.
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Differences in knowledge about contraception among Saudi males and females at tertiary hospitals in Riyadh p. 6254
Maysoon S Aladham, Hafiza Turkistany, Nazish Masud, Faisal O Alaqeel, Rawan H Alharbi, Lujain H Aljbli, Arwa A Alharisi, May M Alotaibie, Aryaf M Almotairi, Alanoud H Alassaf
Context: Family planning is a voluntary practice that individuals engage in to control the number of children for promoting the health and development of countries. The aim is to evaluate the level of contraceptive knowledge in Saudi males and females in Riyadh at King Abdul-Aziz Medical City (KAMC) and King Abdullah Specialist Children's Hospital (KASCH). Methods: A cross-sectional questionnaire-based study conducted among educated, under educated, single, married Saudi males and females (n = 385), and aged (20 to 65) years old. Healthcare providers and participants underwent permanent sterilization were excluded. Results: Approximately half of the participants were aware about contraceptive methods. More males (n = 132, 70%) were significantly aware compared to females (n = 110, 56%) (P-value <0.001). The most commonly used contraceptive methods were oral contraceptive pills, male condom, and intrauterine device (69%, 34%, 22%, respectively). A significant difference was noted for the used and preferred contraceptive method, which was condom for male and oral contraceptive pills in female (P-value < 0.001). Healthcare provider was the main source of information and women significantly consult healthcare provider more than men 47% vs 32%, (χ2 = 9.23, P value = 0.002). Side effects were reported as a main reason for discontinuation 61% (n = 120) of females and 52% (n = 98) in males, respectively. Logistic regression indicated a significant association of contraceptive knowledge with age and parity. Conclusions: Regardless of educational level, high levels of awareness were identified in both genders. Oral contraceptive pills were reported as the most used, safest, and preferred method.
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Trends and clinico-epidemiological profile of COVID-19 patients at a designated COVID-19 hospital in Delhi, North India p. 6261
Banke Lal Sherwal, Namrata Makkar, Ajeet Jain, Vikas Dogra, Shaleen Prasad, Ashish Sachan, Ragi Jain, Aarti Gupta, Smita Gulati, Sonali Bhattar, Mona Bargotya
Background: The coronavirus disease (COVID-19) presents across a spectrum of signs and symptoms and shows clinico-epidemiological predilections (elderly, those with comorbidities). Delhi is among the highest burden states in India. Objectives: To report the case detection trends and clinico-epidemiological profile of patients tested positive at a designated COVID-19 hospital in Delhi in Northern India. Methods: Using an observational (descriptive design) we analyzed data from the electronic medical records of the hospital. All individuals testing positive for SARS-CoV-2 RNA using reverse transcription polymerase chain reaction (RT-PCR) between 17th March and 07th May 2020 (both dates inclusive) were included. Case detection trend (7-day moving averages) was plotted. Clinico-epidemiological profile of patients was summarized statistically. Results: Total 308 positive cases were enrolled in this study. The median age of participants was 48 years (09–95 years) men (47.9 ± 16.4 years) and women (43.5 ± 14.0 years). Men to women ratio was 3.4:1 with a statistically significant difference (P < 0.001). During the study timeframe, 166 (54.0%) patients had an outcome: 11 (6.6%; 95% CI: 3.4–11.6) expired and 155 recovered (recovery rate: 93.4%; 95% CI: 88.5–96.7). Chance of death was significantly associated with the higher age group (P = 0.005). The commonest clinical symptoms noted were fever (38.9%) and cough (38.6%). Majority (56.6%) had mild to moderate symptoms, 12.6% had severe symptoms and the remaining were asymptomatic (30.8%). 31 patients (26.05%) needed ICU care. Total 119 patients (38.6%) had various preexisting comorbidities, most commonly diabetes mellitus (35.0%) and hypertension (34.0%). However, the comorbidities were not associated with age (P = 1.000). Conclusion: Triangulation of data and careful analysis of trends in designated COVID-19 hospitals and other institutional settings may help inform surge preparedness and care provisioning. Stringent containment strategies must continue as the pandemic is intensifying.
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Characteristics and outcomes of 231 COVID-19 cases admitted at a tertiary facility in India: An observational cohort study p. 6267
Rohit Kumar, Bisakh Bhattacharya, Ved Prakash Meena, Anivita Aggarwal, Manasi Tripathi, Manish Soneja, Ankit Mittal, Komal Singh, Nishkarsh Gupta, Rakesh Kumar Garg, Brajesh Kumar Ratre, Balbir Kumar, Shweta Arun Bhopale, Pavan Tiwari, Ankit Verma, Sushma Bhatnagar, Anant Mohan, Naveet Wig, Randeep Guleria
Background: Ongoing pandemic because of COVID-19 has spread across countries, with varied clinical features and severity. Awareness of clinical course among asymptomatic and symptomatology in symptomatic cases is essential for patients' management as well as optimal utilization of health services (in resource limited settings) based on clinical status and risk factors. This study aimed to describe the clinical characteristics and outcomes of patients admitted with COVID-19 illness in the initial phase of the pandemic in India. Methods: It was an observational study. Patients aged 18 years or more, with confirmed SARS-CoV-2 infection, asymptomatic or mildly ill, were included. Patients with moderate-severe disease at admission or incomplete clinical symptomatology records were excluded. Data regarding demography, comorbidities, clinical features and course, treatment, results of SARS-CoV-2 RT-PCR, chest radiographs, and laboratory parameters were obtained retrospectively from hospital records. The outcome was noted in terms of course, patients discharged, still admitted (at the time of the study), or death. Results: Out of 231 cases, most were males (78.3%) with a mean age of 39.8 years. Comorbidities were present in 21.2% of patients, diabetes mellitus and hypertension being the most common. The most common symptoms were dry cough (81, 35%), fever (64, 27.7%), sore throat (36, 15.6%); asymptomatic infection noted in 108 (46.8%) patients. The presence of comorbidities was an independent predictor of symptomatic disease (OR-2.66; 95%CI 1.08–6.53, P = 0·03). None of the patients progressed to moderate-severe COVID-19, and there were no deaths. Conclusions: A large proportion of patients remained asymptomatic whereas those with comorbidities were more likely to be symptomatic. Most with mild disease had a stable disease course, barring few complication in those with comorbidities. The pandemic continues to grow as large number of asymptomatic cases may go undiagnosed.
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Horner syndrome with transient visual impairment p. 6273
Frank A Orlando, Maria Elisa Lupi
A 57-year-old female presented with headache, miosis, and ptosis diagnosed as Horner syndrome (HS). After delaying the recommended diagnostic imaging, she experienced transient, unilateral visual impairment in bright light. The patient was subsequently determined to have a spontaneous internal carotid artery dissection (ICAD) and secondary retinal ischemia with minimal cardiovascular risk factors and no history of preceding trauma. She wore dark glasses, received gabapentin for pain control, and was anticoagulated for a total of 4 months at which time the ICAD resolved despite a residual blepharoptosis and anisocoria.
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Ventriculoperitoneal shunt presenting as umbilical CSF fistula p. 6276
Meenakshi Yeola (Pate), Kushagra Singh
An umbilical cerebrospinal fluid (CSF) fistula following a ventriculoperitoneal (VP) shunt is an extremely rare complication. The shunt can get blocked and infected and present as purulent umbilical discharge. We report an 11-month-old female infant who presented with recurrent purulent umbilical discharge, 6 months after VP shunt operation for hydrocephalus. After relevant investigations, she underwent exploratory laparotomy which revealed an umbilical CSF fistula with a blocked VP shunt. VP shunt removal was done with excision of the fistulous tract. The post-op period was uneventful and umbilical discharge ceased. She is further planned for endoscopic third ventriculostomy. Umbilical discharge in a neonate may be due to several pathologies. The family physician is the first point of contact in the majority of the cases before they seek a specialist. Hence, recurrent umbilical discharge not responding to conservative management must be evaluated carefully, referred promptly, and the underlying pathology to be treated.
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Recurrent mucormycosis – Better understanding of treatment and management p. 6279
Karthika Panneerselvam, M Sathish Kumar, Karthikeyan , A Mathan Mohan
Mucormycosis is a rare opportunistic, aggressive, fatal fungal infection. The fungal organisms are ubiquitous and easily affect immunocompromised patients. It is spread on inhalation, inoculation and wound contamination and is more common in diabetic and other immunocompromised individuals in a population. The clinical and radiological features of Mucormycosis can overlap with other conditions for which a thorough diagnosis should be made. The rate of recurrence in Mucormycosis cases is high. This article reports one such case in which recurrence occurred twice and was controlled only with resection. The main aim of this article is to emphasize the importance of practicing aggressive resection and also on regular follow up of the patient after surgical management. Knowledge on different diagnostic and treatment methods, availability of newer drugs and regular follow up can greatly help in the management and recurrence of Mucormycosis even in immunocompromised patients in a population where diabetes is more common and mortality of rhino cerebral form is high.
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Duloxetine-induced hyponatraemia in a patient with hypocortisolaemia p. 6282
Mayuko Ikeguchi, Tetsuro Koide, Yasuhiro Hotta, Kumiko Ito
Duloxetine-induced hyponatraemia is a known adverse effect that can lead to potentially life-threatening complications. In addition, hypocortisolaemia is associated with the development of hyponatraemia. Here, we report a case of severe hyponatraemia rapidly presenting after duloxetine treatment in a patient with hypocortisolaemia. A 75-year-old man administered hydrocortisone for the treatment of hypocortisolaemia induced by a Rathke's cleft cyst was admitted for anorexia 3 days after the initiation of duloxetine therapy. Laboratory findings showed severe hyponatraemia, hypo-osmolality, concentrated urine, and increased urine sodium. Because the syndrome of inappropriate antidiuretic hormone was diagnosed, duloxetine was ceased. Following admission to the hospital, endocrinological analyses revealed mild hypocortisolaemia, possibly due to low adherence to hydrocortisone replacement therapy. By the sixth day after admission, the patient's hyponatraemia, serum osmolality, and urine osmolality had improved. This case suggests that health-care physicians should be aware of the possibility of duloxetine-related hyponatraemia, particularly in patients with hypocortisolaemia.
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Dengue fever presenting with severe myositis—An unusual presentation p. 6285
Kartika Gulati, Rachna Pasi, Alpa Gupta, Kumar Satish Ravi
Dengue fever is an arbovirus (dengue virus DEN) disease caused by bite of mosquitoes, affecting people worldwide but is frequently seen as pandemic in Latin America and Asian countries. Among children it has been the most frequent reason for hospitalization and mortality. Symptoms range from subclinical disease to severe flu-like illness including myalgias. Dengue commonly presents as myalgia but myositis and/or elevated serum creatine phosphokinase (CPK) is rarely witnessed in dengue fever. Therefore, we present a case of dengue fever presenting as myositis: muscle weakness with raised creatine phosphokinase (CPK).
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Coexistence of disseminated tuberculosis and peripheral deep vein thrombosis in a child with newly diagnosed celiac disease: A rare entity p. 6288
Shuchi Mehra, Kapil Bhalla, Poonam Dalal, Ashish Gupta, Deepak Nehra
Some case reports have been published suggesting association of celiac disease (CD) with tuberculosis (TB) and with deep vein thrombosis (DVT) but mostly in adult populations and in different patients. We report a 13-year-old girl recently diagnosed with CD presented to pediatric emergency at a tertiary teaching hospital in north India with complaints of generalized weakness, pain and swelling over left lower limb that subsequently was diagnosed to have disseminated TB and left lower limb DVT. She was treated with course of anti-tubercular drugs, short-term anticoagulant therapy, and gluten free diet with positive outcomes over next 3 months. To the best of authors' knowledge, no previous reports have yet suggested a coexistence of disseminated TB and peripheral deep vein thrombosis and CD in one single pediatric patient.
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Sharpening of medical undergraduates' minds under COVID-19 crisis p. 6291
Sabita Yograj
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Research in medicine: Perspective of a medical student p. 6293
Nuthan Bhat
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Our data may be misleading and underestimating COVID-19 mortality figures p. 6295
Harish Gupta, Sudhir K Verma, Medhavi Gautam, Nitu Nigam
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Comparison between trained specialist and medical student in performing neurological assessment of high-risk infant by Hammersmith infant neurological examination (HINE) p. 6297
Kusum Lata, Prateek Jindal, Anjali Verma, Kanchan Dochania, Rishabh Batra
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