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Introduction: The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives: To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods: Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results: Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations: The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion: The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis
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The problem of diabetes continues to explode in our country today. India now has the dubious distinction of being called, “the diabetic capital of the world”. Diabetic foot ulcerations & infections are one of the leading causes of mortality & morbidity from diabetes. It is the most expensive complication of diabetes & the leading cause of hospitalization when compared to other complication of diabetes. The number of cases & problems associated with diabetic foot infection have dramatically increased in the recent years. In rural Bengal, the problem is grave as detection and treatment initiation is very late.METHODSA prospective observational study was conducted in Medicine & Surgery OPD and IPD of Bankura Sammilani Medical College for twenty weeks. Baseline characteristic were noted, ulcer classification was done followed by swab culture, debridement and antimicrobial therapy. Then outcome was observed.RESULTSMaximum patients were aged between 38 to 58 years, were male and were Wagner 1-3 classification. From culture report S. aureus was predominant followed by Enterobacteriaceae group and anaerobes. Amoxicillin-clavulanic acid combination was the most effective antibiotic followed by amikacin. Treatment was satisfactory with dressing, debridement and appropriate antibiotic.CONCLUSIONSS. aureus, Enterococcus, Pseudomonas aeruginosa, E. coli & Anaerobes were the most common causes of diabetic foot infections in my study, and were sensitive to the conventional antibiotics indicating that there is no evidence to suggest significant resistance to these antibiotics. Hence, their empirical usage, either oral or injectable (depending on the type of foot ulcer) is justified. Proper education regarding footwear & foot care is strongly recommended in such patients.
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Background: The terms "metabolic syndrome", "insulin resistance syndrome" and "syndrome X" are now used specifically to define a constellation of abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease. It is a state of chronic low grade inflammation with the profound systemic effects. Several organisations gave several criteria to diagnose it. Effective preventive approaches include lifestyle changes, primarily weight loss, diet, and exercise, the appropriate use of pharmacological agents to reduce the specific risk factors.Methods: A cross-sectional study was done to evaluate the co-morbidity profile of patients, with metabolic syndrome and correlate clinical manifestations with specific components or metabolic syndrome, at the OPD of Bankura Sammilani Medical College and Hospitals, West Bengal. American Association of Clinical Endocrinologists criteria were chosen for diagnosis.Results: 100 patients were recruited having type II diabetes mellitus. Most of the patients were male between 20-70 years and maximum was on oral hypoglycemic agent with app 40% patient was without any glycemic control. In comorbidities hypertension was highest, followed by coronary artery disease, hypothyroidism and cerebrovascular accident. Waist-hip ratio was highest in female. All of the patients were having some cardiac risk factor assessed by ECG, echocardiography and thread mill test.Conclusions: The data demonstrates that metabolic syndrome is extremely common among diabetic patients. Frequency was much higher in women than men. Obesity is a key element in causing the metabolic syndrome and this factor was also more common in women.
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Background: Use of fixed dose combination (FDCs) is a double edged sword with scope for irrational prescribing on one hand and improved pharmacotherapy and patient compliance on the other hand. Irrational FDCs are being marketed aggressively and often young prescribers including Post Graduate Trainees fall prey to the lure of FDCs. This was a Knowledge-Attitude-Practice study regarding of FDC use among the resident doctors working at a tertiary care medical college of rural Bengal.Methods: This was a cross-sectional, questionnaire based study including 50 resident doctors who were asked to fill a 10-question questionnaire on FDCs anonymously.Results: Ninety two percent of the study participants were aware of the FDCs. The most commonly perceived advantages were better patient compliance and synergistic effects. Most (96%) cited problems of titrating dosages and problems of more side effects. Only 37.6% knew about the banned FDCs. Preferred FDCs among them were antibiotics (94%), cough syrups (80%) and NSAIDs (68%). Residents of dermatology, orthopaedics, surgery and medicine most commonly prescribed FDCs. Sources of knowledge regarding FDCs were CME (92%), medical representative (76%), colleagues (72%), internet (68%), journals (48%) and textbooks (36%).Conclusions: The study showed that most participants were aware of the FDCs and also aware of the problems with irrational FDC use. Knowledge regarding banned drugs was poor as was the rationality of such combinations. More CMEs and inter department group discussions could be conducted to improve awareness and FDC prescribing practice among young prescribers.
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Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases.
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Informed consent remains an important ethical and legal document ensuring autonomy of the research participants. Objective: The present study was undertaken with the idea to find out the gap in respect to knowledge, attitude and practice in acquiring Informed Consent so that we can improve the procedure of acquiring consent in accordance with the present regulations. Methods: Questionnaire based close ended cross sectional study within 1 week time frame in Bankura Sammilani Medical college involving the resident doctors pursuing their post graduate degrees. Results: Though 83.4% had the knowledge but 68% do not feel necessary to take consent. The major limitation being excessive work load and lack of time. Conclusion: The study revealed that there was lot of lacunae in their knowledge giving rise to improper attitude and practice regarding Informed consent procedure in a research project.
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Background: Rural Bengal has one of the highest snakebite prevalence in India. This prospective observational study was initiated with the motive to analyse the effects and adherence to implementation of the new national snakebite protocol 2016.Methods: Data were collected from the patients admitted with snake bite on a pre-designed and pre tested case study form and analysed with the help of descriptive statistics.Results: A total of 75 patients arrived in the hospital during the study period out which 53 were male (most in the age group of 31-40 years) and majority of them were farmers (26.6%) or housewives (25%). Maximum of them were bitten in the lower limbs (54.6%) and peak time of bite was between 6 am-12 pm (40%). Most of them reached the hospital late, i.e., beyond 2 hours (70.6%). It was found that there were 26 neurotoxic, 16 hemotoxic and 1 neuro-hemotoxic cases and the rest were non-venomous cases. Fifty-one of them received ASV and 4 died. There was 80% adherence in the indication of ASV administration, 73.3% in the ASV dose, 32% in the monitoring after ASV administration, 94.66% in the monitoring 20 WBCT, 100% in adherence to haemodialysis as indicated.Conclusions: The results showed good adherence in all the parameters. Protocol guided treatment has also resulted in rational use of ASV. So, from this study, it was concluded that protocol guided treatment is effective in snakebite management, but its continuous revision and amendments should be considered in future.