Evaluation of interleukin-33 & sST2 levels in type-2 diabetic mellitus patients with or without metabolic syndrome

Background & objectives: Diabetes mellitus (DM) is characterized by increase in blood glucose levels due to defective insulin secretion or insulin sensitivity. Interleukins (ILs) are known to play an important role in the pathogenesis of DM. The aim of this study was to investigate the serum concentration of IL-33 and its receptor soluble ST2 (sST2) in patients with diabetes and draw a correlation between their serum levels and different standard glycaemic indices of patients affected with type-2 diabetes with or without metabolic syndrome. Methods: Thirty type-2 diabetic individuals and 30 healthy controls were recruited for this study. Serum and plasma were separated by centrifugation of blood for quantitative measurement of IL-33, sST2 and other biochemical parameters. Results: It was observed that serum IL-33 levels were significantly less and sST2 levels were significantly high in type-2 diabetic individuals as compared to healthy controls. A significant correlation between the serum IL-33 concentration and fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels were also found. Additionally, data also elucidated that serum levels of high-density lipoprotein, low-density lipoprotein or triglyceride in type-2 diabetics did not influence the serum levels of IL-33 and sST2, thereby excluding these factors as the major drivers of changes in serum IL-33 and sST2 concentration. Interpretation & conclusions: This study demonstrated alteration in serum levels of IL-33 and sST2 in type-2 diabetic individuals. Further mechanistic studies, focusing on the progression of type-2 diabetes could elucidate the involvement of IL-33 in the cellular acquisition of insulin resistance as observed in type-2 diabetics

COVID-19 pandemic: a narrative review on legislative and regulatory framework in India for disaster and epidemic

Public health legislation plays an important role in the containment of any epidemic or pandemic. During a pandemic, it might be necessary to override the existing laws or (individual) human rights for the containment of the pandemic. The objective of the study is to review the legal framework pertaining to COVID-19 pandemic preparedness in India. This study has been done as an unsystematic narrative review where various legislations were assembled from electronic data base, websites from various legislative and Ministries and discussion with experts. Owing to contain the spread of the novel coronavirus Government of India announced nationwide lockdown on 24th March, 2020.  For proper implementation of lockdown measures various legislative laws belonging to different ministries is required. There are two pioneer acts namely The Epidemic disease act of 1897 and The Disaster management act of 2005. Under these two acts the government has laid down various rules and regulations that have to be followed during lockdown. This article describes the need for the law in a crisis like this and various legislations that have been implemented during lockdown.

Handwashing: a household social vaccine against COVID 19 and multiple communicable diseases

Handwashing is the most cost-effective measure for prevention of a wide spectrum of diseases from respiratory, intestinal, soil transmitted helminthiasis, health-care associated illness to infection with pandemic potential like SARS, MERS and COVID 19. Experts view that handwashing can be the greatest investment in the mankind as it reduces under nutrition, morbidity, mortality and paves way for growth, development, educational attainment of people and thereby achieving healthier communities. Though the evidence of handwashing on health is two centuries old but change in human behaviour seems critical in both developing and developed countries. Hand hygiene is rarely practiced during crucial moments and even rarely soap is used. Therefore emphasis should be given towards a societal shift in behaviour change among children, caretakers and people of all age groups. Every school, community and hospital should be provided with Safe water, Sanitation and adequate Hygiene (WASH) services. Hand hygiene to be given top priority in national health plans by which millions of unnecessary deaths and burden on health care system can be avoided. Nevertheless under the looming threat of the current COVID 19 pandemic, where the exact epidemiology is still evolving and a vaccine doesn’t seem feasible as an immediate measure to control the disease, handwashing should be considered as a ‘social vaccine’ for everyone at every household level.

Operational issues and lessons learned during National Iron Plus Initiative documentation in Eastern India

Anaemia is a condition in which red blood cells have fewer haemoglobin molecules than normal, or fewer red blood cells overall, and thus less ability to carry oxygen to tissues in the body. Nutritional anaemia is a major public health problem in India and is primarily due to iron deficiency. Symptoms of iron deficiency anaemia are primarily non specific and become apparent when there is severe anaemia. The National Iron Plus Initiative (NIPI) is the most ambitious and comprehensive anaemia control programme in the world. The process documentation team conducted 170 interviews in March, April and May 2016 among officials and frontline workers at state, district, block, sector/cluster and field levels and among NIPI beneficiaries in Odisha. To achieve variation in responses and to get full set of information on how NIPI was being implemented, process documentation and survey data were collected in four districts of Odisha– Keonjhar, Jagatsinghpur, Bhadrak and Kalahandi. This review will give an overview about the operational issues encountered during the National Iron Plus Initiative documentation in Odisha.

Diagnostic dilemma in catching anaemia early

Anaemia is major health problem in our country and the foremost cause of disability. The non-specific clinical signs together with lack of knowledge among people are a hindrance for people seeking early care for this disease. Palmar pallor in children for diagnosing anaemia is anaemia has shown to have low sensitivity. Laboratory estimation of haemoglobin levels still are the diagnostic modality of choice in most primary care settings. There are numerous methods based on different principles to estimate haemoglobin. Each method has its own merit and demerit and has to be used appropriately based on that. Some methods like Hemoglobin colour scale have shown have good result to replace Sahli's method but more validation is required. HemoCue also can be used for secondary and tertiary care health institution. A strong political commitment and dedication is required for overcoming operational issues in early diagnosis of anaemia.

Public awareness lectures at hospital complex of AIIMS Bhubaneswar: Bridging the gap between people and healthcare professionals

Health communication forms an important link in a doctor patient relationship. Public health awareness lectures are organised across the world to disseminate key messages related to health and to improve the doctor patient interaction. With a plethora of information in this age of social media, which are many a time incomplete and erroneous, it is all the more important that people get the right information based on scientific evidence. In this article we intend to describe our experience of public awareness lectures held at AIIMS Bhubaneswar over the last one year.

Needle stick injury and HIV risk among health care workers in North India.

Objectives: To determine the occurrence of needle stick injuries among various categories of health care workers (HCWs), the causal factors, and the circumstances under which these occur. 2. To explore the possibilities of measures to prevent these through improvement in knowledge, attitude, and practice. Materials and Methods: The study was conducted in two government tertiary level hospitals. Study sample comprised 107 HCWs, providing medical care in two government tertiary level hospitals of Chandigarh. Subjects were enquired about their exposure to needle prick injuries during patient management in the last 6 months and also the action taken following exposure. The statistical tools employed were: ratio, proportions, and other basic methods of data interpretation. Results: The study among 107 HCWs included 27 doctors (25.2%), 68 nurses (63.5%), and 12 paramedics (11.2%), with 87 (81.3%) being females. The prevalence of needle stick injury and exposure to blood was reported by 73 (68.2%) participants. The main factor ascribed for this exposure was heavy patient load (42.5%). The maximum accidents occurred during emergency care (30.1%). Most common action following exposure was cleaning with spirit (46.3%). Only 51 (47.7%) of HCWs admitted following universal precautions. Among those exposed, only 10 (13.7%) persons had undergone HIV testing. Conclusion: Two-thirds of HCWs were exposed to needle stick injuries. Lack of awareness about post-exposure prophylaxis (PEP) was found.

Awareness of emergency contraception among female college students in Chandigarh, India.

SUMMARY: Adolescents and young women are at the greatest risk of unintended pregnancy because they are unlikely to see a family planning provider before or immediately after the sexual activity. Therefore, preventing unintended pregnancy among them is the important concern. Sexually active young women are clients with special needs for contraception. They are eligible to use a variety of the available contraceptives. Introduction of emergency contraception (EC) in the recent past can help them avoid such unintended pregnancies. OBJECTIVE: To investigate the awareness of emergency contraception in female college students. STUDY DESIGN: Cross-sectional, questionnaire-based study. MATERIALS AND METHODS: This study was conducted among college-going undergraduate and graduate female students of Punjab University, Chandigarh. Systematic random sampling was used to select the respondents. RESULTS: Of the 1,017 college students included in the study, 507 (49.9%) knew about different contraceptive methods. Maximum awareness was regarding oral contraceptive pills (239, 47.1%). Only 74 (7.3%) had knowledge about emergency contraceptive pills (ECP). Of them, 10 (14.7%) students knew the correct time for use of ECP and the side effects of ECP were known to 48 (88.9%) respondents. CONCLUSIONS: Awareness about ECP was very low among female college students of Chandigarh, especially regarding correct timing of its use and its side effects. Appropriate awareness programs on EC are needed for them.

Uptake of newer vaccines in Chandigarh.

OBJECTIVE: To ascertain the uptake of newer vaccines in Chandigarh. METHODS: Uptake of newer vaccines was ascertained in under five children through house to house survey during Jan 2004-Sep 2005 in sector 44 of Chandigarh. RESULTS: Of 1031 children of the total urban population, More than 40% got immunized with newer vaccines. Maximum coverage was seen for Hepatitis B 461 (44.7%) for 3 doses followed by immunization against Hib 287(27.8%). MMR vaccine coverage was 285 (27.6%). For typhoid and varicella coverage was less. More than 50% children got immunization from private sector. CONCLUSION: The newer vaccines are available in the market and being used by the people especially being catered by the private sector.

Immunization status in children.

OBJECTIVE: Recent studies and surveys are observing a declining trend of routine immunization coverage and fully immunized children in India are reported to be 38%. A rapid assessment technique was used on National Immunization Day (PPI) to assess the immunization status among children in the age group of 12-23 months covering urban, rural and slum areas in UT, Chandigarh. METHODS: The study covered 796 children in proportion of their distribution in urban, rural and slum areas. RESULTS: Evaluation recorded fully immunized children as 72.23%, partially immunized as 22.99% and unimmunized as 4.64%. Only 58.66% children in urban slums were fully immunized. The overall coverage for various vaccines was BCG: 93.09%, DPT1/OPV1: 93.97%, DPT2/OPV2: 90.57%, DPT3/OPV3: 85.92% and measles: 76%. No sex-wise difference was noticed in the study. CONCLUSION: Efforts must be made to strengthen routine immunization programme especially in the underprivileged groups and areas such as slum in cities so that target of universal coverage can be achieved as envisaged at national level.

An intervention study to enhance AIDS awareness among underprivileged population in Chandigarh.

BACKGROUND: It is estimated that 4 million persons are suffering from HIV infection/AIDS in India. A family health awareness campaign (FHAC) has been implemented under the National AIDS Control Programme (NACP) to scale up HIV/AIDS awareness in vulnerable groups. METHODS: A community based study was conducted in April 2001 to find the impact of FHAC and IEC activities in 12 villages and slums with a population of 1-1.5 lakhs in Chandigarh. Information was collected from 643 persons in the age group of 15-49 years, 323 in the pre-intervention phase and 320 in the post-intervention phase. RESULTS: Awareness about AIDS increased from 58.2% to 70% (p The major sources of information were the mass media and friends. Knowledge regarding the mode of spread also increased after the campaign. Knowledge regarding prevention of AIDS by using condoms increased from 42% to 61.2%; having a single partner, from 59% to 72.3%; using safe blood, from 14.9% to 29%; and sterile needles/syringes, from 18.1% to 33.9%. Over 90% of respondents consider AIDS a dangerous disease. CONCLUSION: Community based intervention such as FHAC and IEC activities were successful in enhancing the awareness among underprivileged groups. Since a large section of the population still remained unaware, regular efforts must be made to achieve universal awareness about AIDS.

Outbreak of measles amongst vaccinated children in a slum of Chandigarh.

BACKGROUND: An outbreak of measles was reported from a slum, UT, Chandigarh in April 2003. Similar outbreak was also reported in less than three years from the same and adjoining areas. The present study was conducted to investigate and assess various epidemiological features associated with measles outbreak. MATERIAL AND METHODS: Three cases of measles were admitted in Dept. of Paediatrics, Govt. Medical College & Hospital, Chandigarh and were reported to the Dept. of Community Medicine for an outbreak investigation. A trained team investigated the slum having a population of 25,000 and studied various features associated with epidemic between the period of April 22 to May 10, 2003. RESULTS: The study covered 484 houses having 1130 children. Among the children who developed measles 32.76% were vaccinated ones. In them attack rate was 3%. Attack rate in vaccinated children went on increasing as age increased. An overall attack rate of 5.13% (Peak incidence 6% in 1-4 years age group) was recorded. Among measles cases, one-fifth had post measles complications. As much as 32.76% children with measles had received measles vaccination in the past. Therefore something more than immunization by single dose of vaccine is required. Measles was reported to be higher amongst the children without Vitamin A supplementation (P < 0.001). CONCLUSION: There is need to store vaccine properly and to strengthen routine immunization coverage, Vitamin A supplementation and health infrastructure in underprivileged population. Serological studies among vaccinated children against measles should be undertaken to explore the possibility of second dose of measles in older children.