Identifying Pre-hypertensives in the Community: At Risk Approach for Prevention of Hypertension

Introduction: Pre-hypertension is a borderline health state of increased blood pressure (BP) that falls short of the measurable parameters at which surveillance and/or therapy would be required. The approach of identifying people “At Risk” of developing hypertension can be more cost-effective and feasible for applying lifestyle interventions. Objectives: The objective of the present study is to find the prevalence of pre-hypertensives and associated bio-socio-demographic factors Materials and Methods: A cross-sectional study was conducted among 1946 participants aged 19 years and more in the Doiwala block of Dehradun, Uttarakhand. Multistage sampling was used to arrive at desired sample size. A pre-validated, structured questionnaire was used for data collection. The questionnaire included information on the socio-demographic profile (age, sex, education etc.), awareness about hypertension and its associated risk factors. Statistical Analysis: The chi-square test was used to compare proportions and draw inferences. Results: 958 (49.2%) study participants out of a total 1946 were found to be pre-hypertensives. A statistically significant association was found between pre-hypertension and factors such as male gender, age, education, occupation and waist-hip ratio. (p<0.05) Conclusion: It is recommended that identification on the pre-hypertensive group and subjecting them to lifestyle modification could be a fruitful strategy for preventing them from becoming hypertensive.

COVID-19 Vaccination status among Health care workers diagnosed with COVID-19 in a tertiary care institute of Uttarakhand: A Cross-sectional Study

Background: Vaccines are considered as the one of the main pillars in halting and ending the presently on-going coronavirus disease (COVID-19 disease) pandemic which has spread globally since it was first detected in Wuhan, China in December 2019. In the absence of specific therapy, infection prevention practices and mass vaccination remains the mainstay in controlling the disease. Objectives: Objective of the study was to assess COVID-19 vaccination status, socio-demographic and clinical profile among healthcare workers diagnosed with COVID-19. Methodology: A cross-sectional survey from 1st March 2021 to 30th June 2021 among healthcare workers who were diagnosed with COVID-19 in a tertiary care institute of Uttarakhand, India was conducted, and universal sampling was used. Institutional Ethics Committee approved this study. Results: Total 662 healthcare workers were diagnosed with COVID-19. 429 (64.8%) of these COVID-19 diagnosed healthcare workers had received either single (129,30%) or both dose (300,70%) of COVID-19 vaccine while remaining 233 (35.2%) belonged to non-vaccinated group. History of exposure to COVID-19 positive patients was higher in vaccinated (66.4%) than in non-vaccinated group (55%) (p = 0.004). Hospitalisation was found to be higher among non-vaccinated (5.6%) than vaccinated group (2.3%) (p = 0.029). Conclusions: This study concludes that being vaccinated against COVID-19 disease provides protection against severe infection and reduces the need for hospitalization.

Revisiting POSHAN Abhiyan with special Emphasis on Stunting

The Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan or National Nutrition Mission was launched by the Government of India on March 8, 2018 in the Jhunjhunia District of Rajasthan. POSHAN Abhiyan is India’s flagship programme to improve nutritional outcomes by convergence, targeted approach and use of appropriate technology. To strengthen nutritional content, delivery, outreach, and outcomes, Government has merged the Supplementary Nutrition Programme and Poshan Abhiyan to launch Mission POSHAN 2.0. As India formulates POSHAN Abhiyaan 2.0, the use of the stunting metric to measure the effect of current interventions needs to be reconsidered. It has been emphasized that the stunting metric, due to its sensitivity to maternal height, cannot accurately assess the extent of the current under-nutrition burden. Among the target indicators identified in POSHAN Abhiyaan, stunting is least indicative of current nutrition-specific and nutrition-sensitive conditions.

Challenges faced by clients of RBSK: A mixed method study from Uttarakhand, India

Background- Rashtriya Bal Swasthya Karyakram was launched in 2013, to reduce mortality and morbidity in children due to prevalent birth defects, diseases, deficiencies, and developmental delays. The strategy employed is early detection and management of health conditions. Mobile health teams (MHTs) and District early intervention centers (DEIC) are set up for screening, management, and referral of beneficiaries. Methodology – A concurrent mixed method study was conducted in Uttarakhand for exploring challenges faced by clients and to assess client satisfaction regarding services provided under the program. Caregivers of beneficiaries were interviewed telephonically about the challenges they faced while availing the facilities. Result- It was found that out of 41 caregivers of beneficiaries, 13 (31.7%) faced challenges while availing the services, and 2 (4.87%) were dissatisfied with the services. Challenges faced by caregivers were out-ofpocket expenditure on transportation, food and stay, long time in referral and unavailability of beds, unavailability of medicines, and failed treatment. Conclusion- The majority of the caregivers were satisfied with the referral and treatment provided. RBSK provides free-of-cost treatment to children but the indirect cost that the caregivers have to pay for travel, stay and multiple visits pose a challenge for utilization of the services.

Addressing obesity among females: The need for focused strategies in National programmes

Prevalence of obesity is increasing in both developed and developing countries. India is also facing a double burden of malnutrition as already existing malnutrition and increasing prevalence of obesity. Evidence suggests that prevalence of obesity is more in women as compared to men due to consumption of pre-packed energy-dense food, hormonal change during pregnancy and menopause. Obese females are more prone to life style diseases and abdominal obesity increases the risk of metabolic syndrome and is strongly related to poly cystic ovarian syndrome (PCOS). Obesity’s impact can be seen in the life cycle of women. It not only impacts the physical health of women but on her psychological, social, reproductive and social well-being which hampers her overall health. To address obesity various programmes and interventions have already been formulated by the Government of India. Need is to address the issue of obesity at every stage of women’s life cycle and this can be done by adding some interventions in already existing programmes.

One Virus! But Different Masks in Different Countries for Protection Against it! How to Choose?

COVID -19 is causing plenty of deaths in India as well as globally andmany of them are health care workers (HCWs).As per data given by IMA 744 MBBS doctors have been died due to Covid–19 till 4 February 20213.As this disease transmitted between person to person by respiratory droplets hence mask hygiene is very important effective preventive measure for HCWs. In market due to high demand, much different type of masks is available with different specifications. Some of them are from Indian origin and many of them are procured from foreign. Many of them are not effective to safeguard health care workers against COVID 19 infection2. Hence this paper will discuss different country specific standards of masks in relation to SARS COV-2 as well as home based disinfection method of masks. In market many masks are available and most of them are sub-standard and making falsely claim of N95. Most of them are not able to protect Health Care Workers from the infection of SARS COV-2. Hence in this paper will examine different countries specific standard of mask with respect to size of SARS COV-2. US standard N95 masks will give desire level of protection against SARS COV-2. Conclusion:NIOSH certified N95 or N99 or N100 mask should be given priority over other counties N95 equivalent masks. Chinese masks GB2626-2006 are least recommended among all other countries N95 equivalent masks6.

Diagnostic dilemma of cognitive decline in a young female: considering congenital rubella, depressive disorder, and moyamoya disease

We report a case of a 20-year-old young female patient from North India presenting with headache, decline in scholastic performance, irritability, and low mood, and having a history of hemiparesis, who had rubella infection in her antenatal period, who was investigated and diagnosed as persistent depressive disorder (PDD) with left-sided hemiparesis in remission with moyamoya disease (MMD) based on history, examination, and relevant investigation (magnetic resonance imaging [MRI] brain/magnetic resonance [MR] angiogram). We highlight the difficulties we faced in attributing whether the cognitive decline was due to congenital rubella, PDD, MMD, or a combination of any of these three diagnoses.

Health Status of Leprosy Affected People in Rehabilitation Colonies of Uttarakhand

In the post elimination era for leprosy in India, with changing disease epidemiology and controlled incidence rates, now the focus must shift to rehabilitative strategies for leprosy affected persons (LAP) residing in leprosy rehabilitation colonies. For this, firstly it is important to reassess their socioeconomic and health status before making any recommendations. This study has been conducted among 137 LAP residing in 7 such colonies in Uttarakhand, who were interviewed on a predesigned, pretested questionnaire with aims to study the overall health status of LAPs, to assess their awareness about the disease and to assess their access to various health facilities and make recommendation for their rehabilitation. Out of 137 participants, 72% belonged to 41-80 years' age group. 85% of study participants were either illiterate or had less than or equal to primary education. More than half of the participants were engaged in begging. 87% LAPs had disabilities in hands and feet, 28.3% had disability in eyes. 24% participants had BMI <18.5. 13.9% participants had diabetes, 28.5% - Hypertension, and 13.1% had history of Tuberculosis. NGO's hospital/ private clinic is the nearest health facility for 62.8% of LAPs. Although all inhabitants (100%) are getting support from the government in form of land for rehabilitation colonies, disability cards etc., however, 44.53% had not been visited by any government functionary in the last month indicating need for proper supervision. Socioeconomic and health status of LAPs was found to be poor with most being illiterate, disabled, having comorbidities like diabetes mellitus. Strategies should be considered to improve the access to government services and developing collaboration with certain NGO's for strengthening of health infrastructure and administration, disability care and rehabilitation.

Clinico-pathological correlation of patients undergoing keratoplasty for suspected HSV keratitis in tertiary care centre.

Aim: To identify histopathologic features of HSV keratitis and correlate them to their clinical findings following penetrating keratoplasty for suspected HSV keratitis and predict the graft outcome on oral Acyclovir treatment. Material and methods: A clinical study of 20 patients who presented to us with clinical picture suspected of HSV keratitis that underwent penetrating keratoplasty at a teaching hospital situated in rural area of India. Out of 20 patients 18 were primary grafts and in 2 patients repeat penetrating keratoplasty was done following graft failure due to rejection. A detailed review of the histopathology of the excised corneal button was performed to identify associations between clinical data (diseaseactivity, vascularity, graft outcome) and histopathologic data (inflammation, neovascularization, gross). Patients with features of HSV keratitis on histopathology were started on oral prophylactic acyclovir therapy post penetrating keratoplasty. Results: All patients had clinically quiescent disease for atleast 6 months before surgery. The visual outcome was better in 14 patients on oral acyclovir post penetrating keratoplasty in suspected HSV keratitis positive on histopathology including 2 repeat keratoplasty which were not earlier started on oral acyclovir. Histopathology of 12 cases including 2 repeat Penetrating keratoplasty revealed active corneal inflammation with epithelial irregularities along with patchy loss of Bowman’s membrane, infiltration of anterior stroma by lymphocytes, leukocytes and plasma cells. Diffuse fibrosis and neovascularisation of stroma was present which was correlated clinically. No recurrence was seen in these patients on follow up of 1 year. Of the 6 patients without any histopathologic inflammation in their corneas, only 1 experienced an allograft rejection. Conclusion: Histopathological inflammation is a marker for HSV status and its correlation helps in judicious use of acyclovir and reduces the risk of recurrence of HSV keratitis. Oral acyclovir therapy post penetrating keratoplasty acts as adjunct to improve the visual outcome in patients with positive histopathological changes.

Pathology of a H5N1, highly pathogenic avian influenza virus, in two Indian native chicken breeds and a synthetic broiler line.

In this study, susceptibility to H5N1 virus infection was studied in two Indian native chicken breeds viz. Kadaknath and Aseel (Peela) and an Indian synthetic broiler strain (Synthetic dam line (SDL-IC). Fifty birds from each genetic group were infected intra-nasally with 1000 EID50 of a highly pathogenic avian influenza virus (HPAIV) strain A/chicken/Navapur/India/7972/ 06 (H5N1) and observed for a period of 10 days. Significant differences in severity of clinical signs, gross lesions and time for onset of symptoms were observed. The overall severity of clinical signs and gross lesions was less in SDL-IC broilers as compared to the other two genetic groups. The mortality percentages were 100, 98 and 92% with Mean Death Time (MDT) of 3.12, 5.92 and 6.96 days, respectively for the two native breeds Kadaknath and Aseel (Peela), the and SDL-IC broiler strain. Comparison of histological lesions revealed differences in disease progression among the genetic groups. Vascular lesions such as disseminated intravascular coagulopathy (DIC) were predominant on 3 days post infection (dpi) in Kadaknath, and on 5 and 6 dpi in Aseel (Peela) and SDL-IC broiler. The mean log2 HA titres of the re-isolated virus from various organs of H5N1 AIV infected birds of the three genetic groups ranged from 2.32 (lung, trachea and bursa) to 5.04 (spleen) in Kadaknath; 2.32 (lung) to 6.68 (brain) in Aseel (Peela); and 2.06 (liver) to 7.01 (lungs and kidney) in SDL-IC broiler. These results suggest that the susceptibility to H5N1 highly pathogenic avian influenza virus infection differed among the three breeds; Kadaknath being highest followed by Aseel (Peela) and synthetic SDL-IC broiler.This is possibly the first report on the differences in the susceptibility of the India native breeds to H5N1 virus infection and its severity.

A Controlled Trial of Oral Rifampin in Chronic Plaque Psoriasis.

Group A Streptococcal infection in the throat is responsible for causing initial and recurrent attacks of acute guttate psoriasis (AGP). Up to 70% of these AGP patients go on to develop chronic plaque psoriasis (CPP). We hypothesized that chronic sub-clinical, on-going streptococcal infection might solely be responsible for CPP in a genetically predisposed individual. Rifampin, a useful drug for several types of bacterial infections including Group A Streptococci (GAS) because of its broad spectrum, excellent tissue penetration, low sideeffect profile and its salivary concentrations after oral administration greatly exceeds the minimum inhibitory concentration for most GAS, thus helpful in eradicating pharyngeal carriage of GAS, was considered for long term use in CPP. Fifty patients with moderate to severe CPP were enrolled. Of these 25 were randomly selected to receive rifampin for 36 weeks as a single oral morning dose of 10 mg/kg body weight (approx. patient weighing <50 kg received 450mg per day and patients >50 kg received 600mg per day). Remaining 25 patients received placebo. Rifampin group was further followed-up to one more year. Significant improvement in PASI score was noted from 12 weeks in majority of patients in Rifampin group. Relevant investigations and clinical assessment was done at regular intervals to observe any side effects and check progress of the disease. Data were analyzed statistically using the t-test. As psoriasis is a chronic disorder that waxes and wanes over time, withdrawal of treatments usually is accompanied by relapse of skin manifestations so a follow-up with one year drug-free period was added to verify treatment consistency. Patients tolerated the therapy well.

Insecticide treated nets, antimalarials and child survival in India.

Malaria has been a complex public health problem affecting mainly the poor and the rural communities in India. Insecticide treated nets (ITN) and antimalarials are the two proven interventions for prevention and control of malaria. ITN has been amply demonstrated to be an effective intervention to protect children from malaria, and in preventing deaths due to falciparum malaria. Antimalarials are a therapeutic intervention for management of malaria, and prevention of complications due to Plasmodium falciparum infection. However, implementation of these interventions is fraught with problems of complex and multidimensional nature at the periphery. These can be addressed by optimizing the use of the 2 interventions, the insecticide treated nets and antimalarials, for area specific application and country specific needs, determined by the eco-epidemiological diversity of malaria in India. This article reviews the significant role of ITN in reducing child mortality, and the judicious use of antimalarials in the management of malaria patient, and the problems associated with the use of these interventions in protecting children against malaria in India.

Investigation of an outbreak of chikungunya in Malegaon Municipal areas of Nasik district, Maharashtra (India) and its control.

BACKGROUND & OBJECTIVES: An outbreak of chikungunya fever occurred in Malegaon town of Nasik district of Maharashtra state, India during February and March 2006. A total of 4530 fever cases were reported during this period including 1781 cases which were admitted in different hospitals of the town. An entomological and epidemiological investigation was carried out in the affected villages during the outbreak to study the possible causes of the outbreak and to isolate the virus responsible. METHODS: Entomological evaluation was done as per WHO guidelines. Sera samples were collected by venipuncture from clinically suspected chikungunya patients in hospitals and also during house-to-house survey in affected villages. IgM antibodies to dengue virus were detected using IgM capture ELISA (PANBIO) and by "Haemagglutination inhibition test" for detection of antibodies against Chikungunya virus. Acute sera samples were inoculated in cell lines for virus isolation. The isolates were confirmed by RT-PCR. RESULTS: On investigation, it was found that water storage containers like cement tanks, plastic containers or earthen pots placed in front of the individual houses were the potential breeding sites for Aedes aegypti. Entomological survey carried out in the most affected areas revealed high Aedes indices. House, container and breteau indices were found to be 27.2, 16.19 and 35.1, respectively. Out of the 13 acute sera samples collected, virus was isolated in 10 samples. The isolates were confirmed by RT-PCR and sequencing using primers from nsP1 gene of Chikungunya virus (CHIKV, Accession No. EF077609, EF077610). Of the 17 convalescent sera tested, significant level of HI antibodies to CHIKV was detected in five samples. One sample was positive for IgM antibodies against dengue virus. Based on clinico-epidemiological features and laboratory findings, the illness was confirmed to be of chikungunya viral disease. CONCLUSION: Control measures targeting the vector population and personal protective measures against the mosquito bites were instituted. Extensive IEC campaign with the involvement of community and religious leaders helped in containment of the disease.

Impact of different doses of lead on internal organs of quails.

Lead (Pb) is the most ancient poison known to man. In the present study, amount of accumulation of Pb in liver, kidney, ovary and testes of rain quail was studied using different doses of lead. Spectrophotometric analysis of heavy metal treated organs was carried out to determine the amount of metal accumulation in these organs. LD50 value was 4 ppm. Dose of lead was given in three ranges of low, medium and high. It was observed that testes (< or =6.8 x 10(-6)) mgkg(-1)day(-1) and ovary (< or =7.5 x 10(-6)) mgkg(-1)day(-1), accumulated low amount from different doses when given continuously for 21 days. In contrast to this, liver (< or =9.2 x 10(-6)) mgkg(-1)day(-1) and kidney (< or =9.3 x 10(-6)) mgkg(-1)day(-1) accumulated the maximum amount of metal when treated for the same number of days. This study is quite unique and astonishing as the period for intoxication is short (21 days) as compared to the long ones (91 days and above). Our results show that generally metal accumulation is highest in liver, while it is low in gonad.

Entomological indices of Aedes aegypti at some international airports and seaports of southern India--a report.

Entomological surveys were undertaken at some of the international airports/seaports (Bangalore, Calicut, Chennai, Cochin, Thiruvanathapuram and Vishakapatnam) to find out the breeding prevalence of dengue vector mosquito in diverse breeding containers from 1998 to 2004. Three vector indices (House index, Container index and Breateu index) were used to assess the breeding potential at each airport/seaport. International Health Regulations urged national governments to keep all the international airports/seaports and peripheral areas up to 400 meters free from Aedes aegypti mosquitoes. However, surveys revealed high vector indices at all the airports and seaports. Health authorities of airports/seaports need to take cognizance of these facts and develop action plan for appropriate control measures with emphasis on vector surveillance.

First time detection of Japanese encephalitis virus antigen in dry and unpreserved mosquito Culex tritaeniorhynchus Giles, 1901, from Karnal district of Haryana state of India.

Japanese encephalitis virus (JEV) antigen has been detected by antigen capture enzyme linked immunosorbentassay (ELISA) in dry specimens of the mosquito Culex tritaeniorhynchus Giles, 1901, collected from Karnal district of Haryana state in northern India. These mosquitoes were stored in dry condition for 20 months, at room temperature, before processing. The procedure of detecting JEV infection in long time stored, dry vector mosquitoes, has important application in the surveillance of Japanese encephalitis.