Healthcare Seeking Behaviour of Hospitalised COVID-19 Patients During Second Wave in Tertiary Care Hospital of Northern India

Background: The Coronavirus Disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people’s perceptions of preventive and curative measures changed. Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients. Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients’ healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview. Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 ± 14.7 years. Self-medication was significantly associated with study subjects’ mortality (p=0.03). Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19.

Correlation between vitamin D deficiency and benign paroxysmal positional vertigo

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo. Vitamin D3 is an indispensable part of bone mineralization and calcium homeostasis. Vitamin D3 also plays a role in BPPV and therefore may offer a therapeutic option. Aim and Objective: This study aims to evaluate the relationship of BPPV with Vitamin D deficiency. Materials and Methods: This observational case–control study was done on 80 subjects out of which 40 were confirmed cases of BPPV patients and 40 were controls. Ear, throat, and nose were examined in all patients. Measurement of Vitamin D3 was done in all subjects. Assessment of quality of life was done using Dizziness Handicap Inventory score (DHI) and Visual Vertigo Analog Scale (VVAS). Results: In our study among cases, 14 patients (35%) had normal Vitamin D levels, Vitamin D deficiency was seen in 15 cases (37.5%) and 11 patients (27.5%) had Vitamin D insufficiency. In control group, 22 patients (55%) had normal Vitamin D levels and 9 patients (22.5%) each had Vitamin D insufficiency and deficiency. Mean of Vitamin D concentration in the case group was 23.78 ± 10.43 and in the control group had 35.99 ± 15.99. The relationship between the two groups was significant (P = 0.001). The mean of body mass index in case and control group was 22.46 ± 2.48 and 23.43 ± 2.38, respectively, with P-value of 0.032 indicating significant relationship statistically. Furthermore, VVAS and DHI scores were higher in cases with deficiency and insufficiency of Vitamin D. Conclusion: The present study shows a significant relationship of reduced concentration of Vitamin D with idiopathic BPPV.

Effects of Corona Pandemic on Global Environment and Economy

The COVID-19 pandemic is draw into concern as the most reproving international fitness tragedy of the century since December 2019, the era of Second World War. A new transmissible respiratory disease comes in existence in Wuhan, Hubei province, China and the World Health Organization named it as COVID-19 (corona virus disease 2019). For the quarter of 2020 the corona virus epidemic has swamp the international locations of the sector and changed the pace, material and nature of our lives. In this evaluation accompanying, we inspect some of the various social, environmental and economic issues influenced by COVID-19. The COVID-19 epidemic has ended in over 4.3 million confirmed instances and over 290,000 deaths globally. The Indian economy as with the global economy, was faced with multiple curtailment too when the pandemic emerged. Advance estimation recommend that the Indian economy is anticipate to witness real GDP augmentation of 9.2 per cent in 2021-22 after reducing in 2020-21. This implicit that overall economic activity has retrieve past the pre-epidemic levels. Social spacing, self-isolation and travel diminution have led to a less staff throughout all capitalism or economic sectors, and because of that many jobs to be bygone. Schools have closed down, and there is requirement for artefacts and products has reduced. In contrast, there requirement for medical essentials has significantly increases. In reaction to this global epidemic, we summarize the effect of COVID-19 on socio-economic condition on individual factors of the world economy and environment.

The Health and Wellness Benefits of Traditional Postnatal Practice (TPC) on Postnatal Mothers: A Systematic Review

@#Introduction: Postnatal is a transition process for the mother back to her non-pregnancy state and involves the changes in hormones level. During the postnatal period, many health issues need to be addressed for both mother and newborn. One of the upsetting health issues for the mother due to the increasing trend is postnatal depression and if it is not identified and treated early, it may cause further complicated problems not only to the mother but also to the baby, family, and local community. With this issue, the Ministry of Health Malaysia has taken a few initiatives to encourage the postnatal mother to also practice the non-medical approaches or traditional postnatal care (TPC) as a self-care for the prevention of postnatal depression. Aim: To systematically identify and review studies examining the influence of TPC on postnatal mothers. Design & Data Sources: A systematic search strategy on the research trend for the period between the years 2013 to 2020 through the Scopus database, Science Direct, and PubMed database. Methods: This review has identified 7 journal articles based on the preferred reporting items for the systematic reviews (PRISMA) framework. Results: There are many methods of TPC, such as traditional postnatal body massage, herbal consumption, herbal bath, body steaming, and body wrapping based on own culture and beliefs. Besides the TPC preparation and techniques, some studies also describe the effects of TPC on a mother’s health and wellness. Conclusion: TPC shows encouraging health trends, and it helps to enhance the well-being and good health of postpartum mothers.

Comparative Analysis of Efficacy and Safety of Gabapentin Vs Amitriptyline in Patients of Peripheral Neuropathic Pain in Case of Diabetes Mellitus

Introduction: Diabetes mellitus frequently leads to development of peripheral neuropathies in almost 30-50% of patients and the most common type of neuropathy associated with this condition is Distal Symmetric Sensorimotor Polyneuropathy (DSPN). Gabapentin and Amitriptyline are two drugs frequently used for the treatment of neuropathic pain associated with type 2 diabetes. Aim of the study: The aim of this study was to compare efficacy and safety of Gabapentin and Amitriptyline in subjects of Type 2 diabetes mellitus with peripheral neuropathic pain. Material and Methods: A prospective, open, randomized, parallel group, comparative study was conducted in 60 patients coming to Department of Medicine, Rajindra Hospital attached to Government Medical College Patiala, to evaluate the efficacy and safety of Gabapentin and Amitriptyline in patients with diabetic peripheral neuropathic pain. The patients fulfilling the inclusion criteria were included in the study after taking written informed consent. The patients were divided into two groups of 30 cases each by simple randomization. Group I patients received Gabapentin 300 mg HS by oral route. Group II patients received Amitriptyline 25 mg HS by oral route. Therapeutic efficacy of both drugs, by using Michigan Neuropathy Screening Instrument (MNSI) was compared at the baseline and at the end of 4 months. Any adverse drug reactions of the respective drug observed in patient were also noted. All the observations thus made were statistically analysed using appropriate tests. Results: Baseline characteristics of the patients in two groups such as age, sex, duration of diabetes were similar (p>0.05). The mean age in group I and group II were 53.40±8.41 years and 57.17±8.55 years, respectively. There was statistically significant reduction in mean MNSI scores in questionnaire part and physical examination part in both the groups. Also, there was statistically significant difference between the two drugs in reducing mean MNSI score. Mean difference between two drugs in reducing MNSI score in history part (0.77±0.16, p<0.01) and physical examination part (0.75±0.19, p<0.01) favoured Gabapentin. No. of adverse drug reactions reported were significantly higher in Amitriptyline group, p value (<0.05) for the difference in ADRs between two drugs was statistically significant. Conclusion: In this study, we concluded that both drugs lead to improvement in signs and symptoms of diabetic neuropathy. Gabapentin was proved to be more efficacious than Amitriptyline. Gabapentin treated patient’s mean MNSI score at the study end point was significantly lower as compared to the Amitriptyline treated patient’s end-point score. Adverse drug reactions reported in our study were mild in both the groups and a significantly higher number of adverse effects were reported in the amitriptyline group. Dizziness and somnolence were two most commonly reported adverse drug reactions.

A Study of Prescribing Pattern in Patients of Hypertension

Introduction: Hypertension is a multi-factorial and complex disease that has both environmental and genetic determinants. It is the single most significant risk factor for heart diseases and kidney diseases. Hypertension is a leading contributor to global burden of morbidity and mortality. It is considered as a silent killer because most of the time it is asymptomatic and goes undetected. Hence, hypertensive patients should be prescribed properly. Objectives: To evaluate the prescribing pattern of anti-hypertensive drugs in patients of hypertension. Material and Methods: This was an observational, cross sectional study conducted over a period of 1 year on hypertensive patients attending the Cardiology out-patient department of Government Medical College and Rajindra Hospital, Patiala and fulfilling the inclusion and exclusion criteria. The prescriptions were evaluated. Results: 22% of prescriptions had monotherapy, amongst which beta-blockers were most commonly prescribed. Majority of prescriptions had two drug therapy (47%), among which ARB+ beta blockers (17%) were most frequently prescribed. Beta blockers +CCB (9%) was the most common Fixed Drug Combination (FDC) prescribed. ARB+beta blockers+diuretics (14%) and ACEI+ARB+beta blockers+diuretics (1%) were most commonly prescribed three drug combinations. Among four drug combinations, only ACEI+ARB+beta blockers+diuretics was prescribed to 1% patients. Hypolipidemic drugs (66%) were maximally co-prescribed. Conclusions: A high trend of polypharmacy was observed in hypertensive patients. So, emphasis is needed to reevaluate the prescribing trends in these patients.

Effect of socio-economic status & proximity of patient residence to hospital on survival in childhood acute lymphoblastic leukaemia

Background & objectives: Survival in paediatric acute lymphoblastic leukaemia (ALL) in lower/middle income countries continues to lag behind outcomes seen in high-income countries. Socio-economic factors and distance of their residence from the hospital may contribute to this disparity. This study was aimed at identifying the impact of these factors on outcome in childhood ALL. Methods: In this retrospective study, file review of children with ALL was performed. Patients were treated with the modified United Kingdom (UK) ALL-2003 protocol. Details of socio-economic/demographic factors were noted from a web-based patients' database. Modified Kuppuswamy scale was used to classify socio-economic status. Results: A total of 308 patients with a median age of five years (range: 1-13 yr) were studied. Patients belonging to upper, middle and lower SE strata numbered 85 (28%), 68 (22%) and 155 (50%). Nearly one-third of the patients were underweight. There was no treatment abandonment among children whose mothers were graduates. Neutropenic deaths during maintenance therapy were lower in mothers who had passed high school. In patients who survived induction therapy, the five year event-free survival (EFS) of upper SE stratum was significantly better 78.7�9 vs. 59�2 and 58.1�6 per cent in middle and lower strata (P =0.026). Five year overall survival was higher in the higher SE group; being 91.2�5, 78.3�6 and 78.8�9 per cent (P =0.055) in the three strata. Survival was unaffected by a distance of residence from treating centre or rural/urban residence. High-risk and undernourished children had a greater hazard of mortality [1.80 (P =0.015); 1.98 (P =0.027)]. Interpretation & conclusions: Our findings showed that higher socio-economic status contributed to superior EFS in children with ALL who achieved remission. Undernutrition increased the risk of mortality.

An ensemble model for forecasting infectious diseases in India

@#Time series modelling and forecasting plays an important role in various domains. The objective of this paper is to construct a simple average ensemble method to forecast the number of cases for infectious diseases like dengue and typhoid and compare it by applying models for forecasting. In this paper we have also evaluated the correlation between the number of typhoid and dengue cases with the ecological variables. The monthly data of dengue and typhoid cases from 2014 to 2017 were taken from integrated diseases surveillance programme, Government of India. This data was analysed by three models namely support vector regression, neural network and linear regression. The proposed simple average ensemble model was constructed by ensemble of three applied regression models i.e. SVR, NN and LR. We combine the regression models based upon the error metrics such as Mean Square Error, Root Mean Square Error and Mean Absolute Error. It was found that proposed ensemble method performed better in terms of forecast measures. The finding demonstrates that the proposed model outperforms as compared to already available applied models on the basis of forecast accuracy.

Role of S-100 Immunostaining in Differentiation of Borderline Leprosy from Other Granulomatous Diseases of Skin

Leprosy is a chronic granulomatous disease affecting skin, peripheral nerves and other tissues. On histopathology leprosy mimics other infectious and non-infectious lesions like tuberculosis, sarcoidosis and fungal infections, which are also common in our country. In tuberculoid and indeterminate forms, where Acid Fast Bacilli cannot be demonstrated, the diagnosis becomes more difficult. Mycobacterium leprae is the only bacterium which has the ability to infiltrate peripheral nerves leading to Schwann cell disintegration. On routine Hematoxylin and Eosin stains (H&E), the nerve fibers may not be easily identifiable in some cases , hence S-100 immunostaining is used to highlight the nerve elements and to demonstrate and compare the nerve changes in spectrum of leprosy. With widespread use of multi-drug treatment, there has been changes in the profile of disease. The aim of the present study was to observe different patterns of cutaneous nerve involvement in leprosy and to correlate these with the clinical and histopathological findings in currently referred cases for histopathological opinion. The study was conducted in the Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, over a period of 12 months (July 2016 - July 2017) Subjects were recruited from patients presenting in Dermatology OPD. A total 35 consecutive cases with clinical suspicion / diagnosis of leprosy were included in the study. Biopsies were processed and stained by H&E, Fite-Faraco as well as S100 immunostaining. It was observed that on S-100 immunostaining, 43.7% cases showed granulomas infiltrating the dermal nerves whereas these changes could not be demonstrated in 16.6% cases of Borderline leprosy on H&E staining alone. Thus S-100 staining appears to serve as an important tool to diagnose leprosy from other granulomatous diseases of skin even in current scenario of leprosy.

Variations in the Number of Pulmonary Veins Draining into Left Atrium and its Clinical Significance

Pulmonary veins, normally two on each side bring oxygenated blood from lungs to left atrium. During early embryonic life, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmonary veins which open into left atrium may vary

Contact sensitisation in adults: a 5-year retrospective review in hospital Kuala Lumpur

Background: The pattern of contact sensitisation should be monitored in order to detect the changing trend of sensitising allergens. We aim to evaluate contact sensitisation in adults suspected to have allergic contact dermatitis. Methods: This is a five-year retrospective review on contact sensitisation in adults patch-tested with the European Standard and extended series between 2011 and 2015 in the Department of Dermatology, Hospital Kuala Lumpur. Results: There were 689 adults (M:F= 1:2.04; mean age 40.5 years) who were patch-tested. The majority (175, 25.4%) were white collar workers and 118 (17.1%) were healthcare workers. The provisional diagnoses of patients included contact dermatitis (80.8%); endogenous eczema (7.9%); hand eczema (3.2%); hand and foot eczema (3.5%); foot eczema (1.4%) and photodermatitis (1.2%). The allergens selected for testing were based on past and present history of exposure. Almost all (688, 99.8%) were patch-tested with the European standard allergens and 466 (67.6%) were tested with the extended series. About three quarter (528, 76.6%) developed at least one positive reaction. The top five most frequent reactions were to nickel sulphate (35.3%); potassium dichromate (16.5%); methylchloroisothiazolinone (12.9%), fragrance mix I (12.6%), and cobalt chloride (10.2%). The commonest sensitisations identified in the extended series were palladium chloride (23/105, 21.9%), stannous chloride (18/85, 21.2%), miconazole (7/44, 15.9%), gold(I)sodium thiosulfate (16/105, 15.2%) and thimerosal (29/202, 14.4%). Conclusion: Contact sensitisation was detected in 76.6% of adults patch-tested. Nickel sulphate was found to be the most frequently sensitising allergen. The rising prevalence of methylchloroisothiazolinone/methylisothiazolinone sensitization poses significant concern.

Relationship of chronic periodontitis and plasma C - reactive protein during pregnancy.

Background: Maternal periodontal disease is a chronic oral infection with local and systemic inflammatory responses and may be associated with adverse pregnancy outcomes. Elevated levels of Creactive protein has been linked to adverse pregnancy outcomes in maternal periodontal disease. Objectives: To assess plasma C-reactive protein levels in pregnant women with chronic periodontitis and in periodontal health and to compare the incidence of preterm delivery in pregnant women having chronic periodontitis and in periodontal health. Materials and Methods: A total of 122 pregnant women aged 18 years and above with gestational age < 26 weeks were recruited and divided into two equal groups (control group, study group) of 61 each. Blood samples were taken from both the groups to determine the serum C-reactive protein. Results: The mean value of C-reactive protein levels in subjects having chronic periodontitis was higher compared to control group i.e., 2.462±0.318 compared to 1.307±0.361 (P<0.001). The incidence of preterm delivery (< 37 weeks) was 82% in the chronic periodontitis group (study group) compared to 3.3% in the control group (P< 0.001). The incidence of low birth weight(<2500g) was 45.9% in chronic periodontitis (study group) compared to 14.8% in the control group (p< 0.001). Conclusion: The findings from the study suggest that periodontal disease in pregnant women is associated with increased C-reactive protein levels in pregnancy. Incidence of preterm delivery and low birth weight infants is higher in pregnant women with chronic periodontitis compared to healthy controls.

An echocardiographic study in patients with non haemorrhagic cerebral infarction to find cardiac abnormalities.

Background: Strokes are a major cause of morbidity and mortality worldwide. Majority are due to ischemic cerebral infarction. Ischemia may result from occlusion of blood vessels due to a disease process intrinsic to carotid and intracranial vessels or may relate to coexisting heart diseases, predisposing to embolic phenomenon. Objective: Echocardiographic study in patients with cerebrovascular accident, confirmed to be of non hemorrhagic nature on CT scan/MRI, for evidence of potential cardiac abnormalities as a predisposing cause for the vascular event. Material and Methods: An observational study was conducted in department of medicine, GNDH, Amritsar. 50 patients of ischemic stroke were taken and 2D transthoracic echocardiography was done to find potential cardioembolic abnormalities. Results: 76% of patients had echocardiographic abnormalities and 42% had potential cardioembolic abnormalities, out of which most common were ventricular wall hypokinesia, calcific aortic valve, rheumatic heart disease and dilated cardiomyopathy. The prevalence was almost similar in different age groups and both the sexes. Conclusion: Prevalence of potential cardioembolic abnormalities is high (42%) in ischemic stroke patients and 2D echocardiography is therefore recommended in the management and secondary prevention of cardioembolic stroke, which has a higher mortality and more chances of recurrence than atherothrombotic type of ischemic stroke.

Community-acquired bacteremia in Paediatrics: Epidemiology, aetiology and patterns of antimicrobial resistance in a tertiary care centre, Malaysia

bacteremia continues to be one of the major causes of morbidity and mortality despite the existence of numerous antimicrobial agents. this study aimed to provide a Malaysian perspective on paediatric community-acquired bacteraemia based on the documentation of epidemiology and antimicrobial profile of the isolated pathogens.

Reproductive risk factors associated with breast carcinoma in a tertiary care hospital of north India: A case-control study.

Context: Worldwide, breast cancer is the most common cancer among women. In India and other developing countries, breast carcinoma ranks second only to cervical carcinoma among women. But the incidence of breast cancer is on the rise and may become number one cancer in females in near future. Aims: (1) To find out the magnitude of reproductive risk factors of carcinoma breast among the study subjects; and (2) to find out the association of reproductive risk factors with breast carcinoma. Materials and Methods: The study was done in the wards of General Surgery and Oncosurgery from August 2009-July 2010 in a tertiary care institute. A total of 128 histopathologically confirmed cases of breast cancer those came in this duration were considered. Equal controls were selected by simple random sampling by lottery method. The controls were matched for age with a range of ± 2 years. The subjects were interviewed using a pre-tested questionnaire. Written informed consent was taken from study subjects before starting the interview. Statistical Analysis Used: Chi-square test, odds ratio with 95% confidence interval, and t test. Results: The age group of the cases was 25-78 years, whereas that of the controls was 24-79 years. The difference among cases and controls regarding age at marriage, age at menarche, age at menopause, age at first pregnancy, and number of children was statistically significant. Continuous variables of the study population were analyzed by independent t tests, in which age at menarche and age at first pregnancy were found statistically significant. Conclusions: Information, education, and communication activities regarding risk factors and breast self-examination should be imparted to the women to create awareness about this fatal disease.

Prevalence of high--risk human papillomavirus infections in women with benign cervical cytology: a hospital based study from North India.

INTRODUCTION: Cervical cancer is the commonest cancer among Indian women. High-risk human papillomavirus (HPV) detection holds the potential to be used as a tool to identify women, at risk for subsequent development of cervical cancer. There is a pressing need for identifying prevalence of asymptomatic cervical HPV infection in the local population. OBJECTIVE: To determine the prevalence of high-risk HPV DNA in women with benign cervical cytology. MATERIALS AND METHODS: Women visiting the gynecology outpatient with varied complaints were subjected to Pap smear. Four hundred and seventy two samples were subjected to polymerase chain reaction, using consensus primers for low and high-risk HPV (types 6, 11, 16, 18, 31 and 33). The samples that were positive for HPV DNA were subsequently assessed for high-risk consensus primers, types 16, 18, 31 and 33 as well as for HPV type 16 and 18. RESULTS: One hundred and seventy four (36.8%) women tested positive for HPV DNA. Thirty nine (8.2%) of the entire cohort tested positive for high-risk HPV. Fifteen samples were positive for type 16, 22 for type 18 and two for both types 16 and 18. A statistically higher prevalence of high-risk HPV was observed in poorly educated and rural groups. No association of HPV prevalence was noted with age, parity and age at marriage. CONCLUSION: The study generates epidemiological data of prevalence of sub-clinical HPV in the women visiting a tertiary care institute as well as peripheral health centres. The data generated will be useful for laying guidelines for mass screening of HPV, treatment and prophylaxis in the local population.

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.