A cross-sectional e-survey to map clinical practice of electrocardiogram use as a screening tool in outpatient department: India office electrocardiogram e-survey

Background:Early detection of electrocardiogram (ECG) abnormalities in high risk cardiovascular patients with routine ECG screening is the need of the hour. The aim of the e-survey was to understand the use of ECG in high risk cardio-metabolically deranged patients at outpatient departments (OPDs) by Indian physicians.Methods:A cross-sectional India office ECG (IOECG) e-survey was conducted using Google form questionnaire from November 2021 to December 2021 among Indian physicians. Survey results were collected and analysed using Google form survey tool.Results:We received total of 1863 responses. The results of the survey showed that while 90% of physicians agreed to the necessity of doing 12 lead ECG of cardio-metabolically deranged patients, only 61% of all physicians could perform ECG screening in less than 40% of high risk cardio-metabolic patients mainly, due to several practical challenges. Among physicians, 40.2% physicians believed that 12 lead ECG was too time consuming, 35.8% physicians believed that the unavailability of ECG device was common reason while 27.5% physicians believed that there was a lack of trained staff. Majority of physicians (69.7%) agreed to use point of care ECG device which can be a solution for more screening of such patients whether symptomatic or asymptomatic. According to the survey, 88.7% physicians would appreciate if a portable handheld ECG device was made available to facilitate screening in their practice.Conclusions:There is a need of the portable handheld ECG device which helps physicians to screen large number of cardio-metabolically deranged patients in their busy OPDs.

Maturation timing and fetal bovine serum concentration for developmental potential of sheep oocytes in vitro.

The success of in vitro embryo production (IVEP) in animals has improved over time, employing a variety of culture media. Here, we assessed the maturation timing and developmental potential of sheep oocytes in vitro at different concentrations of fetal bovine serum (FBS). Cumulus oocyte complexes (COCs) were aspirated from follicles (2-6 mm) of sheep ovaries collected from local slaughter house. COCs were randomly divided into two groups and matured at 38.5°C, 5% CO2 for 24 h (Group I) and 27 h (Group II). Oocytes cultured for 27 h showed significantly (P <0.05) more maturation than those cultured for 24 h (82 vs. 76%) followed by more cleavage (35 vs. 30%), morula (53 vs. 39%) and blastocyst (17 vs. 11%) percentage. In the second experiment, oocytes were randomly divided into two groups and matured with 10% FBS (Group I) and 20% FBS (Group II) for 27 h supplemented with pyruvate, glutamine, LH, FSH and estradiol. After maturation, oocytes were fertilized by fresh semen for 18 h. Presumptive zygotes in both the groups were again divided into two groups and cultured in 10 and 20% FBS during post fertilization period, respectively. Different FBS concentration in maturation medium did not influence maturation percentage (82 vs. 79%) significantly. Out of culture groups, presumptive zygotes matured in 20% FBS and cultured in 20% FBS during post fertilization period showed significant increase in cleavage percentage (44 vs. 39, 35 and 27%) as compared to other groups but subsequent development to morula (55 vs. 53, 43 and 40%) and blastocyst (20 vs. 17, 16 and 15%) percentage were more in the group matured in 10% FBS and cultured in 20% FBS during post fertilization period.

Utilization of and barriers to public sector tuberculosis services in India.

BACKGROUND: Tuberculosis control in India still faces many challenges related to the provision of services under the Directly Observed Treatment, Short-course (DOTS) strategy. We assessed the utilization of and barriers to the Revised National Tuberculosis Control Programme (RNTCP) services based on DOTS in 4 states of India, and recommend actions to optimize utilization of the RNTCP services. METHODS: Two districts each in 4 states with more than 50% of the population covered under the RNTCP in 2002, representing diverse levels of general health indicators, were selected. Sex-disaggregated data on patients who reported to the RNTCP facilities for the diagnosis and treatment of tuberculosis in 2002 were reviewed from the laboratory and tuberculosis registers to assess the utilization of these services. Data on barriers to utilization of the RNTCP services were collected through interviews of 4310 patients with tuberculosis who were 16 years of age or older. RESULTS: A total of 83,099 patients had reported for the diagnosis of tuberculosis in the study areas, of whom 29,279 were women (35.2%). The proportion of sputum-positive diagnosis was lower in women (10.8% [95% CI 10.5%-11.1%]) than men (17% [95% CI 16.7%-17.3%]). For the treatment of tuberculosis, 21592 patients were registered in the study areas; 6789 were women (31.4%). Among new smear-positive tuberculosis patients, 79.9% of women (95% CI 78.4%-81.4%) and 74.4% of men (95% CI 73.4%-75.4%) were cured. Multivariate analysis revealed that the odds of not completing the process of diagnosis of tuberculosis were significantly higher for patients > 50 years of age, those who were never married or married currently, those with symptoms for < or = 15 days, those who had gone alone for diagnosis, and those who were not informed about a suspicion of tuberculosis by the health personnel at the time of diagnosis. Among the reasons for not completing the process of diagnosis of tuberculosis, health provider-related barriers were cited most frequently (45.9%), followed by improvement in symptoms. Health provider-related barriers were also cited most frequently (40.4%) by those who had completed the process of diagnosis but did not start treatment in the RNTCP facility. On multivariate analysis, the odds of not completing the treatment of tuberculosis were significantly higher for men, those who were ever married, those who were not informed that tuberculosis was curable, those who were not informed of the duration of treatment at the time of starting treatment, those who were dissatisfied with the DOTS provider, and those who had health facility staff as the DOTS provider compared with those who had an anganwadi/health worker. Medicine-related barriers were cited most frequently by patients who had defaulted in the intensive (37.1%) or continuation (23.1%) phase of treatment. CONCLUSION: Of the persons utilizing the RNTCP services, about one-third are women. The health services-related factors indicated in the multivariate analysis for less than optimal utilization of the RNTCP services, and the health provider-related and treatment-related barriers to utilization of the RNTCP services at various levels cited by the patients suggest the need to adopt a patient-centred approach to improve utilization of the RNTCP services.

Deaths due to road traffic crashed in Hyderabad city in India: need for strengthening surveillance.

BACKGROUND: Road traffic crashes are an important cause of death and disability in India. Reliable and accurate data are necessary to plan strategies to reduce death and disability due to road traffic crashes. We assessed the utility of the available data on deaths due to road traffic crashes for road crash surveillance for a major metropolitan city of southern India. METHODS: We analysed the Department of Police database on deaths due to road traffic crashes for 2002 in Hyderabad, southern India and collected data from a leading newspaper for the same information using a standardized format. RESULTS: A total of 3039 cases of road traffic crashes were recorded in the police database for 2002, including 400 cases (13.2%) in which 411 people were killed. In the same year, 316 cases of road traffic crashes resulting in 353 deaths were reported in the newspaper. The majority of those who died due to these crashes were males. Seventy per cent of those killed were between 16 and 49 years of age. Pedestrians and riders of two-wheelers were the most vulnerable. Collision with a vehicle caused 86.4% of all crashes and 60% of the victims died before reaching a hospital. The available data were not comprehensive enough to provide a thorough basis for planning intervention strategies to reduce fatalities due to road crashes. CONCLUSION: Despite the gaps in reporting of fatalities in road traffic crashes in these data sources, they provide insights into the magnitude and nature of deaths resulting from such crashes in Hyderabad. The available data have limitations and there is a need for strengthening the road traffic crash surveillance system to have reliable, accurate and adequate data on road traffic crashes and the resulting fatalities and injuries. These could then form the basis for planning effective intervention strategies to improve road safety.