Self-medication and its associated factors in Amdanga block of West Bengal

Background: The WHO defines the use of medications without prior medical consultation regarding indication, dosage and duration of treatment as self-medication. The practice is a global problem. Aims and Objectives: The study was conducted to describe the care seeking behavior of rural self-medicators living in Amdanga Block of West Bengal and to assess the belief in medicines by the self-medicators. Material & Methods: A descriptive cross-sectional study was conducted by interviewing with a pretested semi-structured questionnaire on 665 self-medicators out of 1740 adults who were interviewed in 80 villages of Amdanga Block, West Bengal. A three-stage sampling method was used to reach the study population. A three month recall on self-medication practice was considered operationalizing the “pull” and “push” factors of self-medicators using a Pshycho-social framework. The variables were Socio-demographic factors, Care Seeking Behaviors, Health System related factors, Belief in Medicines according to the framework. Results: The prevalence of self-medication was found to be 38.2%. 63% of the study subjects were female and 56.3% had a literacy status of middle school and above. 54.4% relied on their old prescription for self-medication. 68.7% had an initial choice to consult a doctor but later self-medicated of whom 53.2% changed their choice due to monetary and transport issues while 38.5% thought of self-medication considering their disease was mild in nature. Conclusion: Awareness and health education can link rural subjects with primary care facility and right decisions on care can be provided.

COVID Vaccine Hesitancy among the Tribal Population and Its Determinants: A Community-Based Study at Berhampore Block of Murshidabad District, West Bengal

Background: On January 16, 2021, India rolled out the COVID vaccination drive. A successful and effective vaccination campaign requires much more than the availability of a safe and effective vaccine. This includes identifying vulnerable populations with lower vaccine confidence and identifying the drivers of vaccine hesitancy. Objective: This study aims to find out vaccine hesitancy among the tribal population regarding COVID‑19 vaccination. Methods: It was an observational descriptive cross‑sectional study, conducted at Manindranagar and Hatinagar gram panchayat of Berhampore Block of Murshidabad district, West Bengal, from June 2021–November 2021, among tribal people aged >18 years. A total of 198 tribal people were selected by applying the probability proportional to size sampling method. Participants were interviewed using predesigned, pretested, and semi‑structured schedules. Potential predictors of hesitancy were investigated using the multivariate logistic regression model. Results: Vaccine hesitancy was present among 36.9% of the study participants. Fear of side effects (78.1%) was the most common reason of vaccine hesitancy. Only 30.8% of them received at least one dose of vaccine. Vaccine hesitancy was associated with decreased family income in the last 1 year (adjusted odds ratio [AOR] = 8.23), knowledge regarding vaccine (AOR = 0.41), adherence to COVID‑appropriate behavior (AOR = 0.45), and trust on the local health‑care worker (AOR = 0.32). Conclusion: Vaccine hesitancy among the tribal population is driven by a lack of knowledge and awareness. Their economic status, attitudes toward the health system, and accessibility factors may also play a major role in vaccine hesitancy. Extensive information, education, and communication activity, more involvement of health‑care workers in the awareness campaign, and establishment of vaccination centers in tribal villages may be helpful.

Factors Influencing Contribution of Geriatric Persons in the Society: A Glance from a Rural Area of West Bengal

Background: To facilitate healthy aging in India, it is important not only to acknowledge older people’s contribution but also to understand their perception regarding their impact in the society along with society’s attitude toward them. Objectives: This study aims to assess their self‑perceived contribution in the society and the factors related with their contribution. Methods: It was an observational, descriptive, cross‑sectional study, conducted at Amdanga block of North 24 Parganas district, West Bengal, during July 2021–June 2022. A total 0f 384 geriatrics were interviewed by the house‑to‑house survey with the help of a predesigned, pretested and semi‑structured schedule. Potential predictors of contribution were investigated using the multivariate logistic regression model. Results: 78.9% of participants had contribution in the society. 85.9% were taking care of family members when they were sick. 93.2% were sharing their opinion with the family members. 86.5% were participating in various social works. 79.1% were suffering from at least one physical health problem. With increase in the number of health problems, chances of good contribution decreases. In case of self‑perceived contribution in the society family type, employment, physical health and social participation are influencing the most. Conclusion: Elderly people are taking care of not only family members, but even relatives and neighbors also. They are sharing their knowledge and experience with family members and in the society. They are also contributing financially. Employment and proper health‑care infrastructure for geriatric may be helpful to maximize their contribution.

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.

Potency dependent activity of homeopathic nanomedicine- classical and quantum electrodynamical approach

The effect of homeopathic medicine on biological and physical system is directly related to its potency [1]. However, from physico-chemical point of view it is difficult to explain this effect at such high dilution, as then the existence of even trace amount of particle is questionable. It has been reported that during the process of potentization, a large amount of mechanical energy gets transferred to the medium due to succussion [2]. This energy in all probability reduces the size of the drug aggregates. The drug then penetrates easily through the membrane barrier, and thereby gives rise to enhanced activity of the medicine. It has been experimentally proved by us and supported by others that indeed a reduction of size of the aggregates takes place with increase in potency [3]. Using five different homeopathic medicines, their sizes at three different potencies have been estimated and a general mathematical expression relating the size of the particle (Y) and the corresponding potency (X) has been derived as follows Y = a X -n. (AU)

Variations in clinical estimates of tumor volume regression parameters and time factor during external radiotherapy in cancer cervix: does it mimic the linear-quadratic model of cell survival?

BACKGROUND: Tumor regression parameters and time factor during external radiotherapy (EXTRT) are of paramount importance. AIMS: To quantify the parameters of tumor regression and time factor during EXTRT in cancer cervix. SETTINGS AND DESIGN: Patients, treated solely with radiotherapy and enrolled for other prospective studies having weekly tumor regressions recorded were considered. MATERIALS AND METHODS: Seventy-seven patients received 50 Gy of EXTRT followed by intracavitary brachytherapy. Loco-regional regressions were assessed clinically and regression fraction (RF) was represented as RF=c + a 1D + a 2 D2 sub - a 3T, with c, D and T as constant, cumulative EXTRT dose and treatment time respectively. STATISTICAL ANALYSIS USED: Step wise linear regression was performed for RF. Scatter plots were fitted using linear-quadratic fit. RESULTS: Coefficients of parameters D, D2 sub and T were computed for various dose intervals, namely 0--20 Gy, 0--30 Gy, 0--40 Gy and 0--50 Gy. At 0--20 Gy and 0--30 Gy, only the coefficient of D2 was significant (P 2 sub and T turned significant (P 2 sub and T showed significance, leading to an estimate of 26 Gy for a1/a2 and 0.96 Gy/day for a3/a1. CONCLUSIONS: As with alpha/beta and gamma/alpha of post-irradiation cell survival curves, a1/a2 and a3/a1 represents the cumulative effect of various radiobiological factors influencing clinical regression of tumor during the course of EXTRT. The dynamic changes in the coefficients of D, D2 sub and T, indicate their relative importance during various phases of EXTRT.

Challenges in the final stage of polio eradication.

India and many other countries of the world have supported the resolution taken by the World Health Organization (WHO) in 1988 to eradicate poliomyelitis globally by the year 2000. At the beginning of 2002, there were 10 countries in the world with endemic transmission. India included in the high transmission area. WHO is preparing guidelines on the program response (both immunization and surveillance) to wild poliovirus isolation from the environment. This technology will be useful in monitoring the disappearance of vaccine virus after ceasing OPV vaccination.

Tumor regression dynamics with external radiotherapy in cancer cervix and its implications.

BACKGROUND: To study the external radiotherapy (EXTRT) regression patterns in cancer of the cervix. AIMS: Evaluate EXTRT tumor regression doses (TRD) for 50% (TRD50), 80% response (TRD80), normalized dose response gradient (g50) and slope (slope50) with clinical outcome. SETTINGS AND DESIGN: Patients, treated solely with radiotherapy and enrolled for other prospective studies having weekly tumor regressions recorded were considered. MATERIAL AND METHODS: Seventy-seven patients received 50Gy of EXTRT at 2 Gy/fraction followed by 18Gy of high-dose rate intracavitary brachytherapy at 6 Gy/fraction. Loco-regional regressions were assessed clinically at weekly intervals during EXTRT to generate EXTRT dose-response curves. STATISTICAL ANALYSIS USED: Student's t test, logistic regression, Kaplan Meier and Cox's proportional hazard model. Scatter plots were fitted using cubic fit. RESULTS: Age (P=0.052) and absence or presence of gross residual tumor (AGRT and PGRT respectively) following EXTRT (P<0.001) were the only determinants for complete response (CR) at 1 month following completion of radiotherapy. EXTRT tumor regression sigmoid curves obtained for various patient characteristics differed only for those with AGRT and PGRT with differences in TRD50, (P<0.001); TRD80 (P<0.001) and slope50 (P=0.001). Response status to EXTRT was a prognosticator for loco-regional disease free survival (LDFS) (AGRT vs. PGRT; P=0.046). On multivariate analysis, both TRD50 and TRD80 emerged as significant predictors for tumor status at end of EXTRT while TRD80 was the sole determinant of LDFS. CONCLUSION: Extent of tumor regression to EXTRT is an important predictor for treatment outcome in cancer cervix as evident from TRD50 and TRD80 values of EXTRT tumor regression curves.

Summated chemotherapy dose-intensity versus loco-regional response in locally advanced breast cancer: its possible implications.

BACKGROUND: Summated dose-intensity (SDI) of chemotherapy regimen could influence the outcome in malignancies. AIMS: To evaluate the implication of SDI and identify key drugs for loco-regional response in locally advanced breast cancer (LABC). Settings and design: This retrospective study was based on audit of records of LABC patients who had received neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS: Actual unit dose-intensity (UDI) of each drug and corresponding SDI of every doxorubicin (n=116 cycles) or non-doxorubicin (n=110 cycles) based NACT received by 42 patients of LABC were summated. Cumulative dose-intensity (CDI) for individual drugs and cumulative SDI (CSDI) for the entire course of NACT were estimated and correlated with quantum of primary tumor, axillary and supraclavicular nodal responses. STATISTICAL ANALYSIS USED: Two-sided chi-square, t-test, step-wise regression was used. RESULTS: Dose-response curve between CSDI and corresponding responses for both primary and lymph nodes were sigmoid in shape for both doxorubicin or non-doxorubicin based NACT. Curves were best fitted using a cubic fit for all patients (r2 = 0.82, 0.84 and 0.93 for primary tumor, axillary and supraclavicular lymph nodes respectively). CSDI emerged as an important prognosticators for both primary (P<0.001) and nodal (P<0.001) responses. Individually, CDI of 5-fluorouracil for primary (P<0.001), CDIs of doxorubicin (P<0.001) and methotrexate (P=0.006) for axillary nodes and CDI of cyclophosphamide (P=0.001) for supraclavicular nodes were significant. CONCLUSIONS: Loco-regional responses in LABC are dependent on CSDI of NACT regimen. Drugs for high-dose intensification protocols could be identified and chosen based on the impact of CDI of individual drugs in NACT.

Torture in the eyes of a medicologist.

Usual torture victims examined by doctors do not have any physical evidence but careful history concerning the method of torture and their effect may provide important evidence. Psychological assessment is very important and will invariably reveal torture. The injury if present to be evaluated against the history and documented as common clinical documentation. Proper documentation is the best campaign of a doctor against torture.

Cardiovascular effects of yellow oleander ingestion.

Yellow oleander (Thevetia neriifolia) is a commonly grown tree found widely in Eastern India. The seeds of yellow oleander are highly poisonous and contain three glycosides--thevetin, thevetoxin and peruvoside. Yellow oleander seed ingestion is usually with suicidal intent in Eastern India. Manifestations range from mild to potentially fatal. It has significant cardiovascular effects with varying rhythm abnormalities. Effects of yellow oleander seed ingestion (YOI) were studied in 300 patients from 1986 to 1990 at BS Medical College, Bankura. Majority i.e., 246 (82%) were females and 226 (75.33%) were young in the age group 11-20 years. Most reported for treatment 6 to 8 hours after ingestion of seeds. The number of seeds swallowed varied from half to fifteen. Two hundred and ninety-two (97.33%) ingested seeds in the crushed form; 156 (52%) were asymptomatic, 92 (30.66%) had vomiting and 36 (12%) had palpitation. In electrocardiogram (ECG), 138 (46%) revealed varying types of arrhythmias including sinus bradycardia in 68 cases (49.27%). Ischaemic changes were present in 118 cases (39.33%). Number of seeds ingested did not bear any relationship with ECG changes in YOI. All 14 cases of death were autopsied. Subendocardial and perivascular haemorrhage with focal myocardial oedema was present in all. Median hospital stay was 5 days (range 2 to 24). During discharge, 256 (85.33%) had normal ECG, 14 (4.66%) had sinus bradycardia and 16 (5.33%) demonstrated ischaemic changes.

Some host factors and seasonal variations in the fatal road traffic accidents occurring in eastern suburban Calcutta.

An extensive study of road traffic accident cases occurring within eastern suburban Calcutta during April 1992 to March 1993 was done. Of which 276 fatal cases having minimum medical aids were taken into consideration to avoid erroneous interpretation. Male pedestrians of age group of 50 years and above were mostly involved during the time period of 5 A.M. to 12 Noon. Fatal Accidents mostly occurred during winter and on the broader roads (Highways) and in majority of cases victims were at fault.

Humoral immunity response in malignancies with special reference to the effect of radiotherapy.

In view of the variability in the findings recorded by different authors in the level of immunoglobulins in patients suffering from malignancies, a study on 34 cases of six types of malignancies treated with radiotherapy (telecobalt and telecesium) was carried out to record the humoral response and also to compare the response during radiotherapy and after radiotherapy in these cases. Serum of 20 age-matched normal volunteers served as normal control. The study recorded that the pretherapy levels of IgA and IgG were raised in most of the cases; but the IgM was decreased than that of the control level. This is probably due to the fact that the selective clones of cells producing different types of immunoglobulins are responding to the malignancies in different ways. The midtherapy level of all immunoglobulins showed the value lower than the pretherapy level, but recovery was observed in the post-therapy period with all immunoglobulins in all the cases irrespective of the histological types of malignancies. It was also apparent from this study that the post-therapy gain in the level of immunoglobulins over midtherapy level was more pronounced in cases having telecobalt therapy. Assessment of humoral response in 25 patients suffering from squamous cell carcinoma of different grades revealed that the midtherapy fall and subsequent post-therapy gain had no definite correlation with grading.

Role of sublingual administration of tablet buprenorphine hydrochloride on relief of labour pain.

Tablet buprenorphine hydrochloride when administered to 34 primigravida women sublingually in a dose of 6 micrograms/kg body weight during the first stage of labour, the analgesic action started 30 minutes after administration of drug and the analgesic action increased gradually and reached its peak level 3 hours after administration of drug. Analgesic action continued throughout the first stage of labour when the duration after administration of drug was 9 hours. In one case maximum analgesic action did not persist after 9 hours. The average time of delivery was 5.88 hours having cervical dilatation of 3.1 (+/- 0.13) cm and the progress of labour was not delayed by the drug. There was no cardiorespiratory depression of the subjects. None complained of nausea or vomiting. There was no change in foetal heart rate and Apgar scoring of neonates revealed the average value of 9.71 at 1 minute and 9.94 at 5 minutes.

Role of nicotinic acid as modulator of liposomal microviscosity.

Using the fluorescent probe 1,6-diphenyl-1,3,5 hexatriene, we have investigated the effect of nicotinic acid, a derivative of the toxic alkaloid nicotine, on the fluidity profile and activation energy of diffusion in the liposomal system of several lipids. We have also studied how the fluidizing property of nicotinic acid affects the intermediate fluid condition induced by cholesterol in these liposomal systems.