Development, validation & pilot testing of a questionnaire to assess healthcare seeking behaviour, healthcare service utilization & out-of-pocket expenditure of Particularly Vulnerable Tribal Groups of Odisha, India

Background & objectives: Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated. Methods: Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q. Results: On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald’s omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively. Interpretation & conclusions: The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.

Causes of late-presenting developmental dislocation of the hip beyond 12 months of age: A pilot study

Background & objectives: Developmental dysplasia of the hip (DDH), when detected early, can usually be managed effectively by simple methods. A delayed diagnosis often makes it a complex condition to treat. Late presentation of DDH is fairly common in developing countries, and there is scarcity of literature regarding the epidemiology and reason for late presentation. Through this study, we attempted to identify the reasons for late presentation of DDH in children more than 12 months of age. Methods: Fifty four children with typical DDH and frank dislocation of hip in whom treatment was delayed for 12 months or more were included. Parents were interviewed with a pre-structured questionnaire and data were collected for analysis with Microsoft Excel 2016 and SPSS version 26. Results: Diagnostic delay was the most common reason for late presentation and was observed in 52 children (96.2%). The mean age at diagnosis was 24.7 months. The mean age at treatment was 37.3 months with a mean delay of 12.5 months from diagnosis and 22.1 months from initial suspicion. Physician-related factors contributed 55.3 per cent, while family and social issues accounted for 44.7 per cent of overall reasons for diagnostic and treatment delays. Interpretation & conclusions: Late presentation of DDH in walking age is common. Physician- and family-related factors accounted for most of these cases. Failure or inadequate hip screening at birth by the attending physician is a common reason for late diagnosis. The family members were unaware about the disorder and developed suspicion once child started walking with an abnormal gait

GLOBAL WARMING AND ITS IMPACT ON THE FISHERIES INDUSTRY

Several social and environmental factors such as industrialization, deforestation, erosion of toxic pollutants have played dominant role in the increase rate of the global warming. This notion has affected the various segments of the planet. Sectors such as Fishery, Firming, and Agroforestry and Forest management sectors have been facing deleterious realities because of the greenhouse emission from the last few decades. In recent times, scientist has become apprehensive about the fact of reducing the negative effects caused by the global warming. Moreover, several studies have circulated various strategies to mitigate the risk factors of greenhouse effects to protect the future of the planate.

Functional annotation of uncharacterized proteins from Fusobacterium nucleatum: identification of virulence factors

Fusobacterium nucleatum is a gram-negative bacteria associated with diverse infections like appendicitis and colorectal cancer. It mainly attacks the epithelial cells in the oral cavity and throat of the infected individual. It has a single circular genome of 2.7 Mb. Many proteins in F. nucleatum genome are listed as “Uncharacterized.” Annotation of these proteins is crucial for obtaining new facts about the pathogen and deciphering the gene regulation, functions, and pathways along with discovery of novel target proteins. In the light of new genomic information, an armoury of bioinformatic tools were used for predicting the physicochemical parameters, domain and motif search, pattern search, and localization of the uncharacterized proteins. The programs such as receiver operating characteristics determine the efficacy of the databases that have been employed for prediction of different parameters at 83.6%. Functions were successfully assigned to 46 uncharacterized proteins which included enzymes, transporter proteins, membrane proteins, binding proteins, etc. Apart from the function prediction, the proteins were also subjected to string analysis to reveal the interacting partners. The annotated proteins were also put through homology-based structure prediction and modeling using Swiss PDB and Phyre2 servers. Two probable virulent factors were also identified which could be investigated further for potential drug-related studies. The assigning of functions to uncharacterized proteins has shown that some of these proteins are important for cell survival inside the host and can act as effective drug targets.

An ethnographic approach to understand cultural perspectives of tribes on branding practice for sick children in Odisha, India

Background & objectives: Traditional beliefs on child healthcare at time lead to potentially harmful practices like branding. However, there is a gap in people’s perceptions, attitudes and beliefs about branding practice. Therefore, the present study was undertaken to document the cultural motivation, ability and opportunity for branding practice in a tribal district of Odisha, India. Methods: Initially, such practices were observed in the tribal community for three months. Then, 18 in-depth interviews were conducted - ten among women having under-five children, and eight among traditional healers. Six focus group discussions were conducted with community health workers as well. The responses were digitally recorded, transcribed and translated and were further used for thematic framework analysis. Results: The primary determinants of branding practice were cultural beliefs compounded with low-health literacy, proximity to conventional care and influence of family and friends. The key driver for branding practices was traditional cultural beliefs on child healthcare decisions and health-seeking behaviours. Opportunities in the health system – availability and quality of health services – frequently drive them to seek healthcare from the system structure and routine health communication improves their ability to make better healthcare decisions. Interpretation & conclusions: Culture significantly affects the conceptualisation of illness and care-seeking pathways in a society. The indigenous community used to consult local traditional healers for their health concerns. While the government has made efforts to increase community health literacy through various platforms and multiple stakeholders’ engagements, the doorstep availability of modern care and health promotion interventions remains critical for meeting the health needs of the indigenous community.

A Review: Lumpy Skin Disease in Cattle

Lumpy skin disease (LSD) is one of the most economically valuable transboundary and OIE-listed diseases caused by Capripoxvirus in the family Poxviridae. LSD should always be included in the differential diagnosis when cattle exhibit tiny nodules development in the head, neck, udder, rump, perineum, and leg area and elevated body temperature, respiration, and salivation. The economic potential of these diseases is of significant concern, provided that they threaten international trade and could be used as economic bioterrorism agents. Because of the scarcity of reliable vaccinations and the widespread poverty in rural areas, capripoxviruses appear to be spreading more widely. The best treatment for reducing the risk factors for the disease could be strict quarantine, vector control, and prophylactic vaccination. The goal of the current study is to give the information that is currently available on the disease’s various aspects, including its clinicopathology, method of transmission, possible treatments, and diagnostic procedures

Cingulum bundle integrity in schizophrenia with auditory verbal hallucinations: A diffusion tensor imaging tractographic study

Background & objectives: Cingulum bundle (CB) is frequently implicated in schizophrenia; however, its role in specific symptoms of schizophrenia such as auditory verbal hallucinations (AVHs) is less explored. Few studies have reported association between reduced integrity of CB and severity of AVH. Using a symptom-based approach, this diffusion tensor imaging (DTI) tractographic study was aimed to assess and compare the integrity of CB in schizophrenia with AVH, schizophrenia without AVH and healthy controls. Methods: A total of 92 right-handed adult individuals (aged 18-50 yr) were recruited across three study groups. Those with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) diagnosis of schizophrenia with AVH (group I; n=30) were compared to those with DSM-5 schizophrenia without lifetime AVH (group II; n=32) and healthy controls (group III; n=30; screened using Mini International Neuropsychiatric Interview version-7.0.0. and negative family history). Clinical assessments (groups I and II) included scale for assessment of positive symptoms, scale for assessment of negative symptoms, clinical global impression-schizophrenia and psychotic symptom rating scale. All participants underwent DTI, and quantitative tract-based measurements of fractional anisotropy (FA) were obtained for images using DTI studio version-3.0. Results: All groups were comparable for age, gender, education and severity of illness. Group I had significantly lower FA values in the cingulate gyrus (CG) part of the left CB compared to groups II and III. No significant difference was found between groups II and III. Interpretation & conclusions: The findings of this study suggest that the disruption in the left CB appears to be specific for AVH-positive schizophrenia. The finding is, however, preliminary subject to replication in future studies. Further investigations are needed to understand its relevance in the context of AVH-positive schizophrenia.

Delayed presentation of enterocutaneous fistula after tubal ligation: a case report

A 50-year-old woman with a history of tubal ligation nine years earlier, presented with a complaint of discharge from the scar site. She was found to have an enterocutaneous fistula. The patient underwent an exploratory laparoscopy. The tract excised and primary repair of bowel done. A unique feature of the case is the formation of an enterocutaneous fistula after an extremely long latency due to gauze threads, which has not been previously reported in the literature.

Conservative management of an iliopsoas hematoma causing walking difficulty in an elderly patient on anticoagulation therapy: a case report

Spontaneous iliopsoas hematoma is a rare complication in patients suffering from bleeding disorders like hemophilia, Von Willebrand’s disease or those taking blood thinners like aspirin and clopidogrel or anticoagulant medications like warfarin for atrial fibrillation or post-thrombotic status. It can present as severe pain, muscle dysfunction, difficult walking or neurological dysfunction due to compression on femoral nerve or lumbar plexus. A high index of suspicion with early blood and radiological investigations like contrast enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) of the part is immensely helpful in diagnosis and prompt management of such patients. A low hemoglobin or hematocrit level and a high INR is supportive while CECT or MRI of the abdomen and pelvis is confirmatory. Management in a hemodynamically and neurologically stable patient include immediate withdrawl of the anticoagulant, bed rest, infusion of I.V. fluids, vitamin K, fresh frozen plasma and packed red cell transfusion, which ensures complete recovery in most of the cases. However angio-embolization to control ongoing arterial bleeding is lifesaving when feasible or emergent open decompression and bleeding control surgery can save the life or prevent permanent neurological damage to the limb. Decompression of the hematoma by ultrasound or computed tomography guided catheter drainage is helpful alternative in few selected cases. We report an elderly patient on warfarin, who suddenly developed difficulty in walking within hours of a strained defecation, diagnosed to suffer from left iliopsoas hematoma and responded to conservative management with complete resolution of symptoms by 3 weeks.

The Distribution of the ABO and Rh (D) Blood Types in Type II Diabetes Mellitus Patients

Introduction: The etiopathogenesis of diabetes mellitus ismulti-factorial & complex and appears to involve interactionsof various immunological, genetic and environmental factors.Positive association with blood groups shows increasedsusceptibility and a negative association shows protectionagainst diabetes mellitus. Present study was conducted to findout a possible association between type II diabetes mellitus(DM) and ABO & Rh blood groups.Material and Methods: The study involved 313 patients whoreported to Haematology Laboratory for blood investigationsover a period of 5 months. On the basis of Random & FastingBlood Sugar levels, we made Group I (Diabetic patients) &Group II (Healthy controls). ABO & Rh blood grouping donefor both the groups.Results: AB & B blood group showed less commonassociation with diabetes mellitus. Diabetes mellitus (DM)were more associated with Blood group A, as compared tocontrols. Blood group O has same distribution among bothgroups. Diabetics has higher percentage than controls hadRh positive blood group (96.55% vs 94.69%), and diabeticsshowed less percentage of Rh negative blood group (3.44%vs 5.3%). Blood group B, AB and O were positive in higherpercentage among diabetics, and it was same in blood group A.Conclusion: According to Results, it has association betweenDM and Rh positive blood groups and between blood groupsB & AB it has negative association.

Sleep quality among medical students in Moradabad, Uttar Pradesh, India

Background: Good quality sleep is necessary for overall health. Especially medical students are more prone to have sleep difficulties and with this context present study was done to assess the sleep quality among medical undergraduate students.Methods: This cross-sectional study was conducted among undergraduate students of a medical college in Moradabad, during April to May 2019. Assessment of sleep quality was done by means of self-administered questionnaire based on sleep quality scale. Data was analysed with help of SPSSv21 and statistical tests used were Welch t-test, Chi square test and logistic regression analysis.Results: Mean age of all 149 students was 20.99±0.91 years and mean sleep quality score of all students was 37.90±9.73. Overall 29.53% students had poor sleep quality scores. 8.7% students always have difficulty in falling asleep and 32.9% students were rarely satisfied with their sleep. Poor sleep quality has not been found to be significantly associated with age, gender, BMI and level of physical activity.Conclusions: Sleep quality vary considerably among medical students and approximately one third of medical students had poor sleep quality. Sleep quality scale used has been found reliable.

Paradise under siege: Healthcare elusive under Kashmir lockdown

The famous poet, Amir Khusro, said of Kashmir: “If there is heaven on earth, it is here, it is here, it is here”. That heaven and crown of India has been under siege now for over four months

Isolated Anterior Dislocation of the Radial Head with Atypical Presentation in an Adult: A Case Report / Luxação anterior isolada da cabeça radial com apresentação atípica em um adulto: Relato de caso

Abstract Isolated anterior dislocation of the radial head is rarely reported. To date, only five cases have been reported in the world literature. In all of these cases, the patients presented with restricted supination-pronation movements of the forearm with maintained elbow flexion-extension. We report an unusual case of isolated anterior radial head dislocation in an 18-year-old male, who presented with maintained supination-pronation movements of the forearm but restricted elbow flexion-extension. Closed reduction was attempted, but it failed. Hence, an open reduction was performed. However, the reduction was unstable due to rupture of the annular ligament. Hence, the repair of the annular ligament was performed, and a radio-ulnar Kirschner wire was passed to maintain the reduction of the proximal radio-ulnar joint, thus keeping the annular ligament stress-free, facilitating its healing. At 12 months of follow-up, the patient had normal elbow function and complete range of motion.

Resumo A literatura sobre a luxação anterior isolada da cabeça do rádio é escassa, com apenas cinco casos relatados no mundo inteiro até hoje. Em todos esses casos, os pacientes apresentaram movimentos de supinação-pronação restritos do antebraço, e manutenção da flexão-extensão do cotovelo. Os autores apresentam um caso incomum de luxação de cabeça radial anterior isolada em um paciente do sexo masculino de 18 anos, que apresentou movimentos de supinação-pronação no antebraço e restrição na flexão-extensão do cotovelo. A redução fechada foi tentada, mas sem sucesso. Assim, foi feita a redução aberta. No entanto, a redução foi instável devido à ruptura do ligamento anular. Por isso, o reparo do ligamento anular foi realizado, e um fio de Kirschner rádio-ulnar foi inserido para manter a redução da articulação rádio-ulnar proximal, evitando estresse sobre o ligamento anular, facilitando sua cicatrização. Aos 12 meses de acompanhamento, o paciente apresentava função normal do cotovelo e amplitude de movimento completa.

Prevalence and pattern of substance abuse among male adolescents in urban and rural areas of Dehradun

Background: Substance abuse is a serious problem because it is engulfing the younger generation with serious health, social and economic concern. This study was conducted to determine the prevalence of substance abuse among male adolescents and study the habit pattern of substance abusers.Methods: A cross sectional study was conducted among 776 male adolescents residing in urban and rural field practice areas under the department of Community Medicine, through randomly selected house to house visit. Data regarding the current use of alcohol and tobacco was collected in a predesigned and pretested proforma by oral questionnaire method.Results: The prevalence of substance abuse among male adolescents was found to be 22.8% and majority of them used some form of smokeless tobacco, followed by smoking tobacco. Consumption of alcohol or tobacco by adolescents is significantly associated with alcohol or tobacco consumption by their family members.Conclusions: Prevalence of substance abuse was high among the male adolescents and they should be motivated through IEC to give up the habit.

The Naval Stone: A hidden culprit for umbilical abscess

A rarely encountered benign entity, the omphalolith has been endowed several names like omphalo-keratolith, umbilical bolus and naval stone. We hereby discuss two cases of omphalolith who presented with secondary infection and infra-umbilical sepsis.

Health seeking behaviour of women with unwanted pregnancies: a tertiary care centre based study of eastern Uttar Pradesh, India

Background: Termination of an unwanted pregnancy is legal in India. Many women in this region are still not aware about safe abortion services and its consequences. Especially young, economically deprived and those without a supportive male partner are at higher risk of unsafe abortion. There is no clear and established evidence on this issue in our region. In the study, the aim was to explore the health seeking behaviour of women with unwanted pregnancies.Methods: Present cross-sectional study was conducted among 303 patients visiting to obstetrics and gynecology ward of BRD Medical College, Gorakhpur from April 2018 to September 2018. Their socio demographic profile, reasons for current termination of pregnancy and health seeking behaviour was explored.Results: Most common reason given for terminating the current pregnancy was completed family size 65.3%. Unmarried girls with pregnancy were 5.6 % who wanted termination of pregnancy. Majority (67.0%) took medication for termination of pregnancy from nearby medical store without an expert consultation 15.8% of women consulted to a local quack or local dai for termination of pregnancy. 12.9% of women tried a method as advised by family/friends for termination of pregnancy. About 4% of women 1st tried traditional and herbal medicines, drinking tea or juice for termination of pregnancy. Majority of women (84.5%) visited to medical college for management of complications of earlier tried method of termination of pregnancy.Conclusions: Completed family size was found most common reason for termination of pregnancy. Self medication without consultation of authorised doctor was found most common practice of abortion leading to complications.

Ethanol production by Kluyveromyces marxianus HM36338: Optimization of fermentation conditions using response surface methodology

Bioethanol interests researchers as the greener alternative to fossil fuels. Fungal strains play a major role in this process. On the other hand, whey disposal in dairy industry is an issue of environmental concern. The cheese whey is a source of ethanol production. Kluyveromyces marxianus HM363381 is one such fungal strain used in ethanol production from crude whey. Here, we studied the process of ethanol production by the above strain and attempted to optimize the fermentation conditions adopting response surface methodology (RSM). A total of 20 fermentation trials were carried out which were produced from RSM with the central composite design using the three parameters, lactose concentration (5-20%), yeast extract (10-60%) and the inoculum size (5-14%). The experimental results were analyzed using analysis of variance (ANOVA) and lack of fit tests. The best operating conditions were found to be 14.14% (w/v) lactose concentration, 9.44 % inoculum size and 59.67 g/L yeast extract by keeping the other variables at their zero level, under which the strain Kluyveromyces marxianus HM363381 produced 59 g/L of ethanol. The results demonstrated a correlation of the experimental data to the dynamic models with high significant values of R2 and, thus, could be useful for scaling up the ethanol production by fermentation of crude whey.

Self-care practices among known type 2 diabetic patients in Haldwani, India: a community based cross-sectional study

Background: The prevalence of diabetes worldwide is expected to rise to 9.9% by 2045 and with this rising prevalence raises the need for good self-care practices by patients themselves, which play a key role in effective management and prevention of complications.Methods: Present community-based cross-sectional study was conducted among 168 type 2 diabetes mellitus patients by interviewing them using a structured questionnaire assessing their self-care practices using summary of diabetes self-care activities (SDSCA) scale. Different domains were diet, exercise, blood glucose monitoring, medication compliance, foot care and smoking and responses were graded according to number of days in previous week a particular self-care activity of a domain was followed. Data analysis was done with help of SPSS version 21.Results: Mean age of diabetic patients in this study subjects was 54.37±13.24 years. 43.45% respondents have poor self-care practice scores. Bivariate analysis showed that self-care practices were significantly poorer among the diabetic patients less than 60 years of age, residing in rural area, either illiterate or studied till primary/intermediate, had diabetes for less than a year and were taking treatment from public health facilities. Poor self-care practices were insignificantly related with gender, marital status, occupation, monthly family income, type of family, food habits, hypertension as comorbidity, family history, BMI and mode of diagnosis. Multivariate analysis indicates that age, education and duration of diabetes are significant predictors for self-care practices.Conclusions: Self-care practices among diabetic patients were poor among 43.45% patients and there is a need for improving them across all assessed domains.

Apical Vertebral Column Resection with Sagittal Rotation and Controlled Anterior Opening and Posterior Closing Maneuver for the Treatment of Severe Post-Tubercular Kyphosis: Case Series and Literature Review

STUDY DESIGN: Retrospective case series. PURPOSE: Describe the technique and evaluate the outcome of apical vertebral column resection (VCR) with sagittal rotation and anterior opening and posterior closing (AOPC) maneuver for correction of severe post-tubercular kyphosis (PTK). OVERVIEW OF LITERATURE: The surgical procedures described for the correction of PTK are VCR, pedicle subtraction osteotomy, transpedicular decancellation osteotomy, and closing-opening osteotomy. METHODS: We retrospectively evaluated 21 patients who had been operated on with single stage apical VCR with AOPC maneuver. Radiographs were obtained before surgery and at regular follow-up intervals. These were used to calculate the angle of kyphosis. Back pain was rated using the Visual Analog Scale (VAS) and neurological status was graded using Frankel grading. Radiological outcome was assessed by the improvement in the angle of kyphosis and fusion following surgery. Neurological status was assessed using Frankel grading. RESULTS: The study included eight males and 13 females with a mean age of 21.9 and average follow-up time of 30.4 months. The average number of vertebral bodies destroyed was 2.57. Kyphosis was improved from a mean of 68.42°±13.23° preoperative to 8.71°±4.58° postoperative. The average correction achieved was 87.10%. Preoperative VAS score improved from a mean of 6.38±0.92 preoperative to 1.38±0.49 postoperative. No patients had any sign of neurological deterioration. Seven out of eight patients with a preoperative neurological deficit improved following surgery. Two patients developed superficial wound maceration, one had persistent postoperative hypotension, and the other developed hemothorax. All patients recovered fully without a need for additional surgery. CONCLUSIONS: Single stage simultaneous anterior column lengthening and posterior column shortening is an effective method for surgical correction of severe PTK.

Concurrent hepatitis B and autoimmune hepatitis a rare presentation of acute liver failure: a case report

Acute liver failure with concurrent Hepatitis b and autoimmune hepatitis is an extremely rare case. We report a 25 year female presenting to our emergency with fatigue and somnolence, distention of abdomen, jaundice, melena and increased hair loss leading to alopecia. Physical examination revealed jaundice, an enlarged liver, ascites and tenderness of upper right abdomen. Laboratory tests revealed an increased level, bilirubin, GGT, increased INR and prothrombin time with elevated IgG levels, and the presence of anti-smooth muscle antibodies, Anti-nuclear antibodies and HBV infection markers. The patient was diagnosed with liver failure resulting from chronic active hepatitis B with an autoimmune component. The treatment consisted of steroids, azathioprine, vitamin K, low-protein diet and lactulose enemas. After undergoing a molecular test (HBV DNA 3.23 × 10 IU/mL and HBeAg reactive), the treatment was modified by adding tenofovir disoproxil fumarate. After one month the patient was discharged in good clinical condition, with the recommendation of continued tenofovir disoproxil fumarate and prednisone. In subsequent follow-ups, no clinical deterioration or abnormal biochemical liver function test results were found.