Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India

Background and objectives: Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods: A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions.Results: In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions: The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes

Non-communicable diseases as a major contributor to deaths in 12 tribal districts in India

Background & objectives: Non-communicable diseases (NCDs) are the leading cause of death in India. Although studies have reported a high prevalence of NCD in tribal populations, there are limited data pertaining mortality due to NCDs. Therefore, in this study we estimated the proportion of deaths due to NCDs among 15 yr and older age group in tribal districts in India. Methods: We conducted a community-based survey in 12 districts (one per State) with more than 50 per cent tribal population. Data were collected using a verbal autopsy tool from the family member of the deceased. The estimated sample size was 452 deaths per district. We obtained the list of deaths for the reference period of one year and updated it during the survey. The cause of death was assigned using the International Classification of Diseases-10 classification and analyzed the proportions of causes of death. The age-standardized death rate (ASRD) was also estimated. Results: We surveyed 5292 deaths among those above 15 years of age. Overall, NCDs accounted for 66 per cent of the deaths, followed by infectious diseases (15%) and injuries (11%). Cardiovascular diseases were the leading cause of death in 10 of the 12 sites. In East Garo Hills (18%) and Lunglei (26%), neoplasms were the leading cause of death. ASRD due to NCD ranged from 426 in Kinnaur to 756 per 100,000 in East Garo Hills. Interpretation & conclusions: The findings of this community-based survey suggested that NCDs were the leading cause of death among the tribal populations in India. It is hence suggested that control of NCDs should be one of the public health priorities for tribal districts in India.

Pure red cell aplasia with malignant thymoma: a rarity.

Pure red cell aplasia sometimes accompanies thymoma. Herein we report a PRCA patient with malignant thymoma. Only two Indian cases of PRCA with malignant thymoma have been reported so far and six cases in the world literature, to the best of our knowledge. This paper describes a malignant thymoma in a 40 year old male who later on developed pure red cell aplasia 7 months after thymectomy.

Inflammatory pseudotumour of the lung : report of a case and review of literature.

A case of unusual benign tumour of the lung is described. The patient presented with a history of prolonged cough with expectoration, and fever with generalised weakness of shorter duration. Radiological examination of the chest revealed a large non-homogeneous opacity with calcification in the left lower zone. Fine needle aspiration cytology (FNAC) was inconclusive. Therefore, surgical exploration and a left lower lobectomy was performed. The diagnosis of inflammatory pseudotumour was made on histopathological examination.

Role of Indian Council of Medical Research (ICMR) in advancement of ophthalmic research.

Blindness accounts for almost 7 million Disability Adjusted Life Years (DALYS). Considering its importance ICMR has been continually conducting research in ophthalmology starting from the first nationwide blindness survey in 1970s till date. In addition ICMR also has mechanisms of sponsoring research by interested individuals which involve adhoc research schemes and fellowships. The details of these mechanisms and some of the results of major ICMR projects are presented. The identified new thrust areas and the coordinators for these are also listed.

Effects of cardiopulmonary bypass on thyroid function.

Alterations in serum concentration of thyroid hormones occur even in euthyroid patients undergoing cardiopulmonary bypass. The purpose of our prospective study was to define the effects of cardiopulmonary bypass on thyroid hormones. Twenty euthyroid patients for mitral valve replacement were included in this study. Heparinised arterial sample for thyroid function tests were obtained before cardiopulmonary bypass (CPB), 30 and 60 minutes after initiation of CPB, immediate post-CPB and 24 hours after termination of CPB. T3, T4 and thyroid stimulating hormone (TSH) were estimated using radioimmunoassay method. There was more than 50% decrease in T3 levels after initiation of CPB and it remained persistently below the physiological range until 24 hours after termination of CPB. T4 and TSH remained within normal limits throughout the study period. These results indicate that CPB simulates the euthyroid sick syndrome as seen in critically ill and burn patients. Whether routine administration of intravenous tri-iodo thyronine is beneficial in the prevention of low cardiac output syndrome seen after CPB remains to be elucidated in future.

Unusual intrapulmonary foreign body: a pencil.

A case of unusual intrapulmonary foreign body in the form of a pencil is described. The penetration occurred following an insignificant fall. The diagnosis was made on CT scan and subsequently surgical removal was undertaken successfully.

Recurrent pneumothorax.

A young man with spontaneous pneumothorax who suffered from fourth recurrence, is being reported. He was treated by surgical pleural abrasion.

Tracheo-bronchial stenosis--report of 3 cases.

Three cases of large airway stenosis of different aetiologies are reported. In the first case, tracheal stenosis occurred after endotracheal intubation. The second case developed bronchial stenosis as a sequelae to pulmonary tuberculosis. The third case had localized stenosis of the left main bronchus for which no cause could be found. The first case responded completely to dilatation while the 2nd case demonstrated only partial response. Third case did not improve significantly with dilatation.

Pulmonary hydatid disease presenting as non-resolving bilateral consolidations.

A 45-year-old female, post menopausal, presented with extensive bilateral radiological opacities in the lungs. Diagnosis of hydatid diseases was confirmed through open lung biopsy. Treatment with albendazole showed striking improvement in clinical symptoms as well as clearing of radiological shadows.