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Context: Coinfection and superadded infections in patients with coronavirus disease 2019 (COVID-19) has been reported on multiple series. The emerging second wave of the pandemic has come with a lot of changes, especially in developing countries like India. One of such changes is sudden, significant rise in mucormycosis cases. Aims: To find out clinicopathological association of invasive mucormycosis with COVID-19 infection status and immunocompromised state. Settings and Design: A cross-sectional study done at a tertiary care centre. Methods and Material: All cases admitted in the dedicated mucormycosis ward between 1-06-2021 and 15-06-2021 were included in the study. The cases were admitted with suspicion of mucormycosis. The histopathological results were correlated with KOH mount and radiological reports. The clinicopathological association of occurrence of mucormycosis in post-covid and non-COVID patients along with other risk factors. Statistical Analysis Used: Odds ratio, chi square test were used to find the association using MS Excel 2010 and SPSS. Results: Thirty-six (81.82%) cases were of the post-COVID status, and 8 cases were non-COVID status. Out of 36 post-COVID patients, 33 (91.67%) showed evidence of invasive mucormycosis and of 8 non-COVIDpatients, 7 had evidence of mucormycosis (odds ratio = 1.57). Out of the total diagnosed cases of mucormycosis, 21 (52.5%) patients were known cases of diabetes mellitus (DM), and 7 (17.5%) cases of newly diagnosed hyperglycemia. Thirty (75%) patients out of 40 had some form of immunocompromised state. This shows statistically significant association of DM and immunocompromised state with the occurrence of mucormycosis in post-COVID patients (chi square value2 = 6.891, P value = 0.008). Twenty-five patients had the history of steroid use during the treatment of COVID-19. Conclusions: The infection with COVID-19 definitely increases the odds of contracting mucormycosis, but most of the cases had diabetes mellitus. So, it is possible that COVID-19 virus predisposes individuals to invasive fungal infection by precipitating DM.
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Introduction: Globally, COVID-19 have impacted people's quality of life. Machine learning have recently be-come popular for making predictions because of their precision and adaptability in identifying diseases. This study aims to identify significant predictors for daily active cases and to visualise trends in daily active, posi-tive cases, and immunisations. Material and methods: This paper utilized secondary data from Covid-19 health bulletin of Uttarakhand and multiple linear regression as a part of supervised machine learning is performed to analyse dataset. Results: Multiple Linear Regression model is more accurate in terms of greater score of R2 (=0.90)as com-pared to Linear Regression model with R2=0.88. The daily number of positive, cured, deceased cases are signif-icant predictors for daily active cases (p <0.001). Using time series linear regression approach, cumulative number of active cases is forecasted to be 6695 (95% CI: 6259 - 7131) on 93rd day since 18 Sep 2022, if simi-lar trend continues in upcoming 3 weeks in Uttarakhand. Conclusion: Regression models are useful for forecasting COVID-19 instances, which will help governments and health organisations to address this pandemic in future and establish appropriate policies and recom-mendations for regular prevention.
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Background: The prevalence of workplace violence in the healthcare sector is a problem that is frequently ignored and underreported. The performance of healthcare workers who have been the target of violence may suffer, which may have a negative effect on patient satisfaction and health. Aims & Objectives: The purpose of the current study was to determine the prevalence of workplace violence (WPV), risk factors for violence against healthcare workers, and their experiencesregarding the same. Methodology: It was a cross-sectional study conducted on 157 hospital staff at Tertiary Care Medical College of Uttarakhand. Data was gathered using a semi-structured, self-administered questionnaire that was modified from the ILO, ICN, WHO, and PSI. Data were analyzed using SPSS software (version 20). Results: Factors like age, gender, job profile, lesser work experience, night shifts, and fewer staff on duty were found to have a positive association with workplace violence. It was observed that the majority of incidents took place in the ward, and the patient’s relatives were the attacker in most of the cases. It was also seen that the majority of Hospital staff did not get bothered by the incident except by staying super alert while dealing with other patients or their relatives. Conclusion: The study concludes that while caring for patients, Hospital staff are at risk of being victims of aggressive and violent situations. To reduce this problem, strategies like training staff in order to handle such incidents in the future should be brought into practice. Laws should be made stricter & assaulting staff on duty should be made a cognizable offense with serious consequences & heavy penalties. Also, the young budding MBBS students should be trained by incorporating these strategies, laws & policies in the CBME curriculum
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Background: India reports the highest number of cases of tuberculosis (TB) in India. Patients with TB employ negative financial coping mechanisms (dissaving) to make up for the costs of care. Our objec-tives were to explore the dissaving employed and enablers perceived by patients with TB-HIV, patients with TB-diabetes, and program managers of TB. Methods: We conducted qualitative in-depth interviews among eight TB-HIV patients, eight TB-diabetes patients, and seventeen program managers of TB in the Bhavnagar region (western part of India). An in-terview guide focusing on the coping strategies and enablers was used. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis (codes and categories). Results: Borrowing money, taking a loan on interest, selling jewellery, taking up employment by the spouse, and mortgaging assets were the negative financial coping strategies employed by patients with TB-HIV co-infection/ TB-diabetes comorbidity. Free diagnosis, free treatment, accessible health facili-ties, support from health workers, bi-directional screening, and collaborative integration were some of the enablers perceived by patients and program managers. Conclusions: Even in settings with a decentralized “free” model of TB care, patients with co-prevalent TB-HIV/ TB-diabetes employ dissaving to offset the costs of care. The cash transfer scheme for patients with TB should be realigned to meet the financial protection targets of zero catastrophic costs by the year 2030.
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Background: By the year 2030, no family with a patient of tuberculosis (TB) is supposed to incur cata-strophic costs. In India, a significant number of people suffer from TB, and many faces catastrophic costs. Our objective was to determine the predictors of catastrophic costs due to TB among co-prevalent TB-HIV and TB-diabetes patients. Methods: We conducted a cross-sectional study among 234 patients co-affected with TB-HIV and 304 patients with TB-diabetes co-prevalence in the Bhavnagar region (western part of India). TB costs was estimated using a validated questionnaire. Multivariable logistic regression was used to determine the significant predictors of catastrophic costs of TB. Results: Four percent of patients in each group incurred catastrophic costs due to TB. Female gender [aOR 6 (1.2-33)], being single [aOR 9 (1.5-52)], low socioeconomic status [aOR 7 (1.2-30)], private con-sultation for TB [aOR 9 (1.5-53)], and hospitalization in first HIV visit [aOR 19 (3-137)] were significant-ly predicted catastrophic costs of TB among patients co-affected with TB-HIV. Among patients with TB-diabetes co-prevalence, hospitalization in first TB visit [aOR 7 (2-29)], and private consultation for TB [aOR 7 (1.6-30)] were the significant predictors. Conclusions: Despite a lower percentage of TB-HIV/ TB-diabetes patients facing catastrophic costs, hospitalization and private care-seeking are the “modifiable” determinants of TB catastrophic costs in our study setting.
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Background: Menopause has become a popular topic of study as life expectancy rises around the world. The average age at menopause in both developed and developing countries ranges from 45 to 53 years. Factors influencing the extent of ovarian follicle reserve dwindling, such as sociodemographic, menstrual, reproductive, and dietary factors. Aim and Objective: The present study aimed to determine the mean age of menopause and to find out the various factors affecting menopause onset. Methods: A community based cross-sectional study conducted in rural and urban areas of District Dehradun for a period of 1 year starting 1st August 2020 to 31st July 2021. Data were collected using multistage stratified random sampling from 211 cases of natural menopause. Chisquare was applied as statistical test of significance and p < 0.05 was considered statistically significant. Results: According to current study, average age menopausal age is 46 years. Variables like sociodemographic characteristics, lifestyle habits, reproductive and menstrual factors were found to have a significant relationship with onset of menopause. Conclusion: Menopause, whether it occurs early or late in life, several factors are responsible for deciding its onset. As a result, it is critical to identify the factors influencing the onset of menopause.
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Background: India is home to the largest number of underweight and stunted children in the world. While several studies have focused on the determinants of child’s nutrition status in India, little attention has been given to the aspect of rural-urban variation in child’s nutritional status. Bearing in mind that around 70% of India’s population resides in the rural area, the study of rural-urban divergence in nutritional status as indicator can be appreciated naturally. Objective: The objective of the study is to compare the feeding practices of children in the initial six months of life in rural and urban setting and to find out any relation between early feeding practices and nutritional status of young children. Materials and Methods: A community-based study was conducted for 2 months in the field practice areas of a tertiary care hospital. Multistage random sampling technique was used for the selection of study subjects. A total of 117 under-five children were studied equally from rural and urban area. A pre-designed pre-tested proforma was used to assess the feeding practices. Stunting and underweight were used to proxy the child nutrition status. Data were evaluated on SPSS version 17. Chi-square test was used to compare the feeding practices and to find out their association with nutritional status in the two areas. Results: Undernutrition was found in children who initiated early artificial feeds, i.e., in the first 6 months of life, were given over diluted milk, were bottle fed, and had inappropriate weaning practices in both the areas. Conclusions: Faulty feeding practices were found in both areas, but some of the parameters were still better in urban areas. Faulty feeding practices were found to be a significant predictor for undernutrition.
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Background: Quality of life is a multidimensional concept. Disability has a shattering effect on the quality of life with a predominantly negative effect on “marriage, educational attainment, employment and emotional state” as it jeopardizes personal, family and social life. Assessment of “quality of life” (QOL) in disabled is essential measure to bring “disabled” to core stream of civilization. Aims & Objectives: To assess the “Quality of Life” among disabled and to determine the “association between socio-demographic” factors with the quality of life. Materials & Methods: A “community based Cross-Sectional study” was conducted in rural area of Dehradun district. Multistage random sampling technique was used to enrol 2600 people in age group of 5- 59 years for the study. Semi-structured questionnaire was used to assess the socio-demographic information while WHO-BREF questionnaire was used to assess the QOL. Results: 61(2.3%) people were found to be disabled. Among those disabled individuals 52.5% were males and 47.5 % were females. In Psychological and Environmental domain, (65.6% & 55.7%) of the study participants respectively were partially satisfied, while 60.7% of the disabled persons were dissatisfied in social domain. However, 68.9 % disabled were satisfied in physical domain. Religion was found to be strong determinant for physical, psychological and environmental domain of QOL (p-value= 0.001, 0.032 and 0.047 respectively). Socio-economic status was also found to be significantly associated with psychological domain (p-value=0.000). Conclusion: Very few individuals were found to be disabled in the present study, but religion was strongly affecting the satisfaction level among disabled. Thus, religious issues should be addressed to improve quality of life among disabled persons and there should be a holistic approach for managing disabled person.
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Background: Road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people aged 15–29 years. Each year, almost 400,000 young people under 25 years old are killed in a road traffic crash - about 1049 youngsters every day. Aims and objectives: To find out the prevalence of road safety related health risk behaviours and its determinants amongst young males of District Dehradun. Methodology: It was a cross sectional study conducted over 12 months of duration. The study sample comprised of 1800 male youth aged 15-24years studying in various schools and colleges of District Dehradun. A pre-tested and pre-structured questionnaire (YRBSS) was used. The data was entered and analysed using SPSS-version 20.0. Results: Approximately three-fourth of youth reported never using seat-belt while driving and only 4.4% reported always using helmet whereas 24.0% accepted never use of helmet. Approximately one-fourth of the total 1168 at risk subjects in past 30 days, accepted driving a vehicle while drunk and 39.9% reported use of mobile phones while driving. Personality traits (extrovert, neuroticism and lack of direction) turned out to be the major factor in road safety related health risk behaviour. Conclusion: Although, road safety related health risk was found to be more among urban youth as compared to their rural counterparts, yet it was found alarmingly high for both rural and urban study population.
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Background: Sexual health is an integral part of overall health and well-being and determination of sexuality of the youth is an important milestone in understanding their behavior, associated risks and outcomes. The declining age at puberty and increasing age at marriage has created a longer growing period in which youth may engage in sexual health risk behaviors. This research focuses attention on estimation and involvement of the most dynamic & valuable segment of a nation’s population towards sexual risk behaviors. Aims & objectives: The aim of this study is to find out the prevalence and determinants of sexual health risk behaviors amongst youth in District Dehradun. Material and methods: It was a cross-sectional study conducted over a period of 06 months in rural and urban area of District Dehradun. The study surveyed 1800 male youth aged 15-24 years using a self-administered questionnaire (YRBSS & Big five inventory). After collection, the data was entered using the SPSS software and analyzed using SPSS and Microsoft Excel 2010. Results: Out of 1800 participants, 19% were found to be at risk of sexual health risk behavior and reported having had sex. Out of these 342 at-risk, 43.5% accepted involving in sexual activity even before adulthood, 31% reported having multiple sexual partners and 21.1% accepted not using condoms. Place of residence and personality trait were found to be important determinants of sexual health risk behaviors. Conclusion: Our study documented the high prevalence of sexual risk behavior among male youth of rural and urban area of District Dehradun.
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Purpose: The aim of the study was to present the level of knowledge and practice patterns regarding exposure keratopathy in mechanically ventilated patients among Intensive Care Unit (ICU) nurses in Chhattisgarh state. Methods: A previously validated semi-structured questionnaire was administered in the ICU of six multispecialty hospitals in Chhattisgarh in 2014–2015. Demography included age, gender, level of education, and months of working in ICU. Most of the questions dealt with frequency of eyelid closure assessment, frequency of cleaning of eyes with saline gauze, using a protocol-based approach for eye care, and documentation of ophthalmic complications. Common barriers to delivery of eye care such as shortage of time and too much writing tasks were also inquired. Results: Our study included 120 nurses. They worked for mean 22.9 ± 17.8 months in ICU. Knowledge about high risk of exposure keratopathy in ventilated patient was present in 93% (78%; 95% confidence interval [CI]) nurses. Only six nurses (5%) followed a strict protocol for eye care, 52 nurses (43%) checked for eyelid closure in the ventilated patients, and 58 (48%) cleaned the eyes frequently. Those who were aware of exposure keratopathy checked eyelid closure (73% vs. 48%) and cleaned eyes with saline gauze more frequently (24% vs. 4%). Nurses in cardiac ICU were significantly lesser aware of exposure complications compared to medical ICU nurses (40% reduction in awareness, 95% CI = 0.37–0.98, P = 0.04). Conclusion: Although there is high awareness, practice patterns of ICU nurses were less than desired. Educational initiatives should focus on weaknesses in knowledge and practice noted to improve eye care of patients in ICU.
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We report a case of neutropenic enterocolitis diagnosed on computerized tomography abdomen in a 56-year-old man having high-grade non-Hodgkin's lymphoma. After appropriate management, the patient recovered completely.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/adverse effects , Doxorubicin/adverse effects , Enterocolitis, Neutropenic/chemically induced , Humans , Lymphoma, Non-Hodgkin/drug therapy , Male , Middle Aged , Prednisone/adverse effects , Tomography, X-Ray Computed , Vincristine/adverse effectsABSTRACT
The coexistence of two different types of benign cartilaginous tumours of bone in the same patient has not been reported in literature. We report a case in which a sixteen-year-old male had a benign chondroblastoma of the proximal left humerus and an osteochondroma of the distal left femur. Both originated at the same time and had a progressive increase in size with growth.
Subject(s)
Adolescent , Arthrodesis/methods , Biopsy, Needle , Bone Neoplasms/diagnosis , Chondroblastoma/diagnosis , Femoral Neoplasms/diagnosis , Humans , Humerus , Immunohistochemistry , Male , Neoplasms, Multiple Primary/diagnosis , Osteochondroma/diagnosis , Prognosis , Tomography, X-Ray ComputedABSTRACT
The possible effects of EMFs on 100 workers were studied by means of structured interview and rating of subjective symptoms. As control 41 sewing machine operators and assembly workers were chosen, interviewed and likewise tested. The present Indian ceiling value of 250 Tesla for the equivalent power density was exceeded in more than 50% of the machines. The highest leakage fields, for EMFs, were found near machines, which gave a high exposure to the hands. Eye irritation complaints were reported by 40% of the workers. The fertility outcome did not show any significant result.
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Adult , Electromagnetic Fields/adverse effects , Eye Diseases/drug therapy , Fertility , Humans , Male , Middle Aged , Occupational Exposure , Occupational Health , WeldingABSTRACT
AIMS: Eye in Plasmodium falciparum malaria are described by various workers all over the world but its prognostic significance is not clear because of conflicting observation by different authors from different regions. No such study is available on Indian adult patients of cerebral malaria. So we want to describe our observations on various eye abnormalities in these patients and study its prognostic significance. METHODOLOGY: Two hundred and fourteen adult (> 14 years) patients of strictly defined cerebral malaria admitted in classified malaria ward in this tertiary level health care station were studies. Detailed ophthalmoscopic examination was done through dilated pupils at the time of admission, daily thereafter, at the time of discharge and at weekly intervals in those with persistent changes at the time of discharge. RESULT: Retinal haemorrhage was found in 25 (11.68%) patients, papilloedema in 17 (7.94%), blurring of disc margins in 25 (11.68%), retinal oedema in six (2.8%), disc pallor in five (2.33%), vitreous haemorrhage and hard exudate in one (0.46%) each and subconjunctival haemorrhage in six (2.8%) patients. The mortality associated with individual finding was not statistically significant except disc pallor. CONCLUSION: None of the above finding except disc pallor (p < 0.05) was associated with statistically significant mortality (p > 0.05); whereas any of the fundus findings as a whole was related to statistically significant mortality (p < 0.05).
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Adolescent , Adult , Aged , Cause of Death , Developing Countries , Eye Infections, Parasitic/diagnosis , Female , Follow-Up Studies , Humans , India , Malaria, Cerebral/diagnosis , Malaria, Falciparum/diagnosis , Male , Middle Aged , Patient Admission , Survival RateABSTRACT
For induction of humoral or cell-mediated immunity, development of synthetic peptide vaccines present a novel approach and a better alternative to conventional vaccines. Construction of synthetic peptides that mimic antigenic sites is the basis of this approach. In this article various methodologies involved in the peptide synthesis are discussed. This is followed by a discussion on the strategies involved in rendering poor or non-immunogenic peptides immunogenic. These include coupling to large carrier proteins, polymeric presentation and incorporation of an identified Th cell epitope into the peptide.