Swasth Saarthi Abhiyan for public transport drivers, filling fuel at Indraprastha gas limited stations in Delhi and National Capital Region

Background: A public transport driver (Saarthi) if sick thinks twice before taking a day off. The community health department (CHD) of a tertiary care hospital started a ‘Swasth Saarthi (healthy drivers) Abhiyaan’ (SSA) for the public transport drivers (PTDs) for one year. The objectives of the study were to conduct 220 health check-up camps at selected compressed natural gas (CNG) stations in Delhi and National Capital Region; to improve health awareness and early detection of diseases in drivers and getting treated at base hospital.Methods: A cross-sectional study carried out from 15th March 2017 to 14th March 2018 at 36 Indraprastha Gas Limited (IGL) stations for all public transport drivers coming to IGL stations. Health camps conducted were - general health camp at IGL stations, NCD camps at community health department and clinical camps at the base hospital.Results: A total of 408 camps were held in which 14,945 drivers came for health check-up. The PTDs with Eye problems 5981 (40%), over-weight 5315 (35.56%), tobacco/gutka chewing 4687 (31.36%), drinking 3734 (24.98%), smoking 3616 (24.20%), obesity 1655 (11%), hypertension 1433 (9.59%) and diabetes 1057 (7.07%). Health awareness was improved through health education. Surgeries for cataract 20/155 and sleep apnoea 4/122, and de-addiction drugs for 15 drivers of ‘addiction’ were started at base hospital.Conclusions: The health check-up camps under SSA revealed that a large number of public transport drivers are at risk of various health related disorders. Innovative programme like ours is good to reduce “Treatment Gap” and is a step towards achieving Universal “Health for All”.

Effect of Kasni seed preparations on serum glutamic pyruvic transaminase and glutamic oxaloacetic transaminase levels in newly diagnosed patients of type 2 diabetes mellitus.

Background: Kasni (Cichorium intybus L.) reported to play an important role in the effective management of serum liver enzymes SGPT & SGOT in various animal models and this study is extension to newly diagnosed patients of type 2 diabetes mellitus. Methods: Newly diagnosed 90 patients of Type2 DM, age 35-65years, of either sex were divided into 3 groups. In group I only Metformin sustained release once a day and in group II/III 6 grams crude seed powder or 50 ml decoction of crude seed powder was given twice a day for 90 days in combination with Metformin sustained release orally once in a day. Serum liver enzyme levels of SGPT & SGOT were measured at zero, 30th, 60th and 90th day. Results: All the three groups showed a significant reduction in SGPT & SGOT across the four time periods. Post hoc Tukey HSD test shown that there was a significant difference between group I & II (p=0.011) and group I & III (p=0.000) for SGPT and group I & II (p=0.012) and group I & III (p=0.000) for SGOT. Conclusions: The add on therapy with Kasni seed preparations is more effective for the management of altered SGPT and SGOT levels in Type2 diabetes mellitus patients than only oral hypoglycaemic agent in decreasing SGPT & SGOT of selected patients. Among Kasni seed preparation treated groups, decoction was found more effective than crude seed powder.

Relationship between sputum smear grading and smear conversion rate and treatment outcome in the patients of pulmonary tuberculosis undergoing DOTS- A prospective cohort study.

Background: The Smear Conversion Rate (SCR) is an operational indicator for the Directly Observed Treatment Shortcourse (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP) in India. The present study was undertaken to determine the relationship between sputum smear grading and smear conversion rate among the Category I smear positive pulmonary tuberculosis patients undergoing DOTS. Methods: A prospective cohort study was conducted among the Category I smear positive pulmonary tuberculosis patients registered under DOTS at GTB, Karawal Nagar and Shahdara Chest Clinics of Delhi. Sample size for the present study was calculated on the basis of a similar study of a retrospective design conducted at LRS Institute of Tuberculosis and Respiratory diseases New Delhi, India using statistical software Epi Info version 6. Accordingly, a total of 338 sputum smear positive patients with 169 each in the High Positive Cohort (pre-treatment sputum grading 3+) and Low Positive Cohort (pre-treatment sputum grading 2+, 1+ and Scanty) were followed periodically at two months ( end of Intensive Phase) , at three months (after one month extension of Intensive Phase ), at two months of Continuation Phase and then at the end of the treatment to record the sputum AFB result and treatment outcome as per the RNTCP guidelines. Data was analyzed using SPSS Version -15. Results: After two months (end of the intensive phase), SCR was 57.9% (98 of 169) among the High Positive and 71.6% (121 of 169) in the Low positive cohort ( p -0.008). After three months (one month’s extension of intensive phase), cumulative SCR was 85.2%( 144 of 169)) in the High Positive and 92.3%(156 of 169) in the Low Positive cohort (p- 0.03). Cure rate was 82.8%(140 of 169) in the High Positive and 84.6%(143 of 169) in the Low Positive cohort. Default rate was 3% (five of 169) in the High Positive and 5.3% (nine of 169) in the Low Positive cohort. Failure rate was 11.2% (19 of 169) in the High positive and 6.5% in the Low positive Cohort (11 of 169). Only one patient (0.6%) in each High and Low Positive cohort died during course of treatment ( p -0.631). Treatment outcome was further compared among the patients according to their sputum status achieved at two and three months of the treatment after ignoring their initial sputum status. The cure rates for the patients who converted at two months was 90.9% (199 of 219) and for those who did not convert at two months, was 74.3% (84 0f 113) (p -0.000). Similarly, the cure rate for the patients who converted at three months was 84% (68 of 81) and for those who did not convert at three months was 55.2% (16 of 29) (p-0.01). Interpretation: Patients with higher grades of sputum positivity at the beginning of the treatment have significantly lower SCR at the end of intensive phase and even after extending the intensive phase for one month. Hence, they are likely to remain infectious for a longer duration and continue to transmit infection in the community. Therefore, these patients demand to have more stringent self-precautionary measures to break the chain of infection in the community. The SCR at two months and three months as an operational indicator should be given more importance rather than being practised only as a documentation and academic exercise. The patient should be investigated for the possible co-morbid conditions and drug resistance which could be a cause for the persistent sputum smear positivity at two and three months and hence poor treatment outcome.

Determination of molecular mass and partial peptide confirmation of short neurotoxins using chromatographic techniques and reverse phase HPLC.

The aim of present work was to investigate the purification of a novel protein (low molecular weight) from Indian cobra Naja naja by Cation exchange chromatography on CM-Sephadex C-25 and followed by Gelfiltration chromatography on Sephadex G-100. Fraction numbers 26, 27, and 28 were obtained from CM Sephadex C-25. From all the fractions, the protein concentration was calculated and it was applied onto the Sephadex G-100 Gelfiltration chromatography. Fraction No-11 obtained from Sephadex G-100 was used for the determination of molecular weight of the short neurotoxins by SDS-PAGE and Matrix- Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF). This SDS-PAGE is corresponding to the gel filtration chromatography which resolved a thick band of ~6-7 kDa proteins, and the MALDI-TOF resolved 6668.530, 7447.438 and 19928.929 Da. Further, this fraction was selected for preparative HPLC by using C18 column, in which two major peaks (retention time 30.793 and 32.846) were found. The peak with retention time of 30.793 was preferred for molecular mass determination by MALDI-TOF showed a single sharp peak of 6815.471 Da. It was digested with trypsin enzymatic cleavage, which explored approximately 26 peptides and their masses were renowned. The scores of all these 26 peptides were compared with online mascot analysis and BLAST sequence and it did not match with any other peptides and proteins. Among these 26 peptides, since only two peptides score as 886.648 and 943.690 Da were identical with short neurotoxin -1 from Naja oxiana, and short neurotoxin -3 from Naja mossambica. Moreover the 6815.471 Da protein was used for hemolytic activity and it did not induce RBC lysis. All this observations suggested that the newly purified protein is a short neurotoxin. This essential information will support us to find out the structural information of short neurotoxin for its application in anti-venom development, antitumor and also for analgesic effects.

Non-health determinants of health and healthcare in Delhi.

With only 0.05% of the total area of the country, Delhi is home to 1.34% of India’s population. This creates enormous pressure on natural and man-made resources, and generates situations in which non-health determinants may take precedence over the conventional determinants directly associated with health and healthcare. With the rising advocacy on social determinants of health, several of these factors may rightly seem to be part of the broader territory of healthrelated variables, and in that context, they may be designated as conventional non-medical determinants. We discuss some more visible domains, such as demography, migration and floating population; the physical and biological environment; economic determinants; social determinants; legislation and enforcement, and underscore some less explored yet critical domains of the determinants related to culture, governance and politics. What emerges as a compelling reality is a wide differential in physical environment, urban planning and access to infrastructural inputs between the privileged and marginalized areas of Delhi. Inequities in physical quality of life are so gross that even a value-neutral, official narrative betrays them helplessly. We propose actionable areas to address some of the pressing non-health determinants of health and healthcare.

Impact of Health Education and Condom Distribution on Incidence of RTI/STI among The Newly Married Urban Poor Women in Delhi.

This study was carried out to find out the impact of a specially designed preventive intervention on menstrual and sexual hygiene practices and incidence of RTI/STI among the newly married women. A community based intervention study with controls was conducted in two resettlement colonies of Delhi. Total 74 subjects in intervention group and 71 subjects in the control group were studied. Each subject was followed up for 9 months every three monthly. The intervention package included education about menstrual and sexual hygiene, RTI/STIs and contraceptive usage, and packets of condoms. RTI/STI was diagnosed using syndromic approach. Only 2 and 8 subjects in the intervention and control group respectively used condoms (p>0.05 after adjustment). Practice of washing genitals improved in the intervention group (p<0.05 both with and without adjustment). 19 (25.68%) women in intervention and 22 (30.99%) in the control group (p=0.478) reported RTI/STI symptoms during study period; after adjusting for other variables OR=0.37 (p=0.007). 57.89% of RTI/STI patients consulted doctor in intervention group as compared to 18.18% in control group (p<0.05). Increasing awareness and providing intervention at the very beginning of sexual life of newly married women can modify some of the high risk behaviors and thus reduce the risk of acquiring RTI/STIs.

Reproductive health of newly married women residing in a resettlement colony of Delhi: A longitudinal study.

During the period immediately after marriage, women are neither assessed for their reproductive health nor given any intervention for the same. A community based longitudinal study was done to assess the status of reproductive health of newly married women in which 71 newly married women were followed for 9 months. Mean age at marriage was 20.24 (19.74-20.74) years. 76.06% were anemic. With time, proportion reporting menstrual complaints and RTI symptoms increased significantly (P<0.05). 29 (40.85%) reported menstrual complaints and 22 (30.99%) RTI symptoms. Only 14 (19.72%) subjects used contraceptive methods. 79% conceived within 9 months of marriage. Only 25% pregnancies got registered in first trimester. Reproductive and nutritional status of the newly married women was unsatisfactory.

Clinical & pathological features of acute toxicity due to Cassia occidentalis in vertebrates.

Cassia occidentalis is an annual shrub found in many countries including India. Although bovines and ovines do not eat it, parts of the plant are used in some traditional herbal medicines. Several animal studies have documented that fresh or dried beans are toxic. Ingestion of large amounts by grazing animals has caused serious illness and death. The toxic effects in large animals, rodents and chicken are on skeletal muscles, liver, kidney and heart. The predominant systems involved depend upon the animal species and the dose of the beans consumed. Brain functions are often affected. Gross lesions at necropsy consist of necrosis of skeletal muscle fibres and hepatic centrilobular necrosis; renal tubular necrosis is less frequent. Muscle and liver cell necrosis is reflected in biochemical abnormalities. The median lethal dose (LD 50) is 1 g/kg for mice and rats. Toxicity is attributed to various anthraquinones and their derivatives and alkaloids, but the specific toxins have not been identified. Data on human toxicity are extremely scarce. This review summarizes information available on Cassia toxicity in animals and compares it with toxic features reported in children. The clinical spectrum and histopathology of C. occidentalis poisoning in children resemble those of animal toxicity, affecting mainly hepatic, skeletal muscle and brain tissues. The case-fatality rate in acute severe poisoning is 75-80 per cent in children.

Cassia occidentalis poisoning causes fatal coma in children in western Uttar Pradesh.

We investigated cases of the annual seasonal outbreaks of acute hepato-myo-encephalopathy in young children in western Uttar Pradesh for causal association with Cassia occidentalis poisoning, by a prospective survey in 2006. During September-October homes of 10 consecutive cases were visited and history of eating Cassia beans was obtained in all. Nine children died within 4-5 days. There appears to be an etiological association between consumption of Cassia occidentalis beans and acute hepato-myo-encephalopathy.

Cassia occidentalis poisoning as the probable cause of hepatomyoencephalopathy in children in western Uttar Pradesh.

BACKGROUND & OBJECTIVE: Recurrent annual outbreaks of acute encephalopathy illness affecting young children have been reported for several years in many districts of western Uttar Pradesh (UP). Our earlier investigations over three consecutive years (2002-2005) proved that these outbreaks were due to a fatal multi-system disease (hepatomyoencephalopathy syndrome) probably caused by some phytotoxin and not due to viral encephalitis as believed so far. We conducted a case-control study to investigate the risk, if any, from various environmental factors and also to identify the putative toxic plant responsible for development of this syndrome. METHODS: Eighteen cases with acute hepatomyoencephalopathy syndrome admitted in 2005 in a secondary care paediatric hospital of Bijnor district of western UP were included in the study. Three age-matched controls were selected for each case. A semi-structured questionnaire was developed and applied to all 18 cases and 54 controls. All interviews were conducted within one week of discharge or death of each case. Quantitative data were analyzed using the relevant established statistical tests. RESULTS: Parents of 8 (44.4%) cases gave a definite history of their children eating beans of Cassia occidentalis weed before falling ill, compared with 3 (5.6% controls), the odds ratio being 12.9 (95% CI 2.6-88.8, P<0.001). History of pica was the other associated factor with the disease, odds ratio 5.20 (95% CI 1.4-19.5, P<0.01). No other factor was found significantly associated with the disease. INTERPRETATION & CONCLUSION: Consumption of C. occidentalis beans probably caused these outbreaks, described earlier as hepatomyoencephalopathy syndrome. Public education has the potential to prevent future outbreaks.

Recurrent annual outbreaks of a hepato-myo-encephalopathy syndrome in children in western Uttar Pradesh, India.

BACKGROUND & OBJECTIVE: Outbreaks of an acute encephalopathy syndrome affecting children, with high case-fatality, have been reported in western Uttar Pradesh, India for the last many years.We investigated these cases in Bijnor district and present our findings. METHODS: Fifty five children aged 2-10 yr hospitalized from 2003 to 2005 in Bijnor, Uttar Pradesh, with features of acute encephalopathy were selected by defined clinical criteria. Various laboratory investigations were performed. RESULTS: The disease had peak incidence in early winter months. Previously healthy, 2-4 yr old rural children (mean age-3.78 yr) of very low socio-economic background were most vulnerable. Almost all had vomiting preceding unconsciousness and a majority had mild fever and abnormal behaviour/agitation. Abnormal posture of trunk and limbs were distinctive features. Fluctuation of blood pressure was seen in three-quarter cases. Serum aminotransferases, creatine phosphokinase and lactic dehydrogenase levels were found markedly raised virtually in all cases in whom the tests were performed. Serum glucose was found low (<50 mg/dl) in 47.3 per cent cases at presentation. Cerebrospinal fluid (CSF) was under normal or low pressure and without pleocytosis in all cases. No microorganism could be isolated from serum, CSF, urine and visceral specimens. Neuroimaging performed in two cases was also normal. Liver biopsy performed in 21 cases showed acute hepatotoxic injury in all with marked hydropic change and perivenular necrosis. Tibial muscle biopsy done in 8 cases showed focal necrosis while brain biopsy taken in 2 cases had mild spongiosis with focal gliosis. Forty two children succumbed to their illness (case fatality 76.4%), most within 72 h of presentation. Survivors did not show any neurological deficit. INTERPRETATION & CONCLUSION: Our findings showed that the outbreaks were due to a multi-system disease with toxic injury to liver, muscles and brain (hepato-myo-encephalopathy) and not due to viral encephalitis as believed so far. The cause remains unknown but several features suggest the possibility of phytotoxin-induced pathology.