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Introduction: The Integrated Child Development Services (ICDS) Scheme, the largest program for promotion of maternal and child health nutrition in India, is operational for more than four decades. Objective: To evaluate Integrated Child Development Services Scheme in Kangpokpi District of Manipur in terms of input, process and outcome indicators. A community-based cross-sectional studyMethod: was conducted at a tribal hilly district of Kangpokpi in Manipur. The study included ICDS staff and beneficiaries of 35 randomly selected Anganwadi Centres (AWCs). Data related to ICDS was collected by using interview schedules and checklists. The descriptive data were expressed in terms of mean, standard deviation and percentage. Association between important background characteristics and Anganwadi centre attendance was analysed using chi-square test. Ethical clearance was obtained from the institutional Ethic Committee of JNIMS, Imphal before conducting the study (study period: May 2018 to April 2021) Input indicators: The study found that 86% anganwadi centres were run inResults: anganwadi worker’s own house. Two-thirds of the anganwadi workers (65.7%) were found to have separate toilet and 22.9% had separate kitchen. Process indicators: Even though the proportions of beneficiaries accessing services from anganwadi centres were high, the number of days Supplementary Nutrition (SN) was provided in a month was comparatively low (mean: 2.97 and SD: 0.618 for under-6 children and mean: 1 and SD: 0.000 days for adolescent girls, pregnant women and lactating mother in a month) due to frequent interruption of supplementary nutrition supply. There was no supplementary nutrition stock in 74.3% of the anganwadi centres on the day of visit. Outcome indicators: Regarding the nutritional status 90% of Under-6 children were found to be normal, 9% underweight and 0.6% severely underweight. The Integrated Child Development Services Programme in the study area wasConclusion: found to have several short-comings both in terms of inputs and process. There were not only inadequate facilities and infrastructure, but the anganwadi centres also lacked essential equipment like weighing machines and medicine kits, rendering a vital activity like growth monitoring to be almost completely absent. Supervisory visits were far below satisfactory.
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Background: In spite of the weak health care delivery system, the Infant Mortality Rate (IMR) of the state of Manipur as reported in the Sample Registration System Bulletins has been consistently very low (≈11 per 1,000 live births) for the last five years or so. This warranted a study to re-affirm it and also to explore the important reasons of why and how the IMR could be brought down to very low levels. Objectives: The study objectives were to make an estimate of IMR in the Rural Field Practice Area (RFPA) of JN Institute of Medical Sciences, Manipur and also to assess the important infant-care practices starting from before the child is born till infancy. Methods: A community-based cross-sectional study was done in the RFPA of JNIMS during Sept-Oct 2018. Using a pre-tested semi-structured and semi-open interview schedule that had sections on socio-demographic profile, details of infant deaths and infant-care practices starting from ante-natal visits, information were collected from a scientifically calculated sample size of 150 women who had live births in the last one year prior to the study, immaterial of the survival status of the infant. Data collected were analysed and presented by using descriptive statistics. Results: Not even a single infant died in the last one year. Better infant care practices were seen in the study area when compared to the latest NFHS-4 Report for the state of Manipur. Some of these important better practices were pregnant women having ≥ 3 ANC visits (98%), institutional delivery rate (94%), conducting home deliveries by skilled health personnel (22.2%), exclusive breastfeeding rate (77.3%) and proportion of infants aged 6-12 months adequately fed (35%). Conclusion: The estimated IMR in the study area was zero. The better infant-care practices prevailing in the study area might have averted infant deaths.
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Unguided FNAC may be the only option left for accurate diagnosis of malignant lesions in the lung in resource poor settings. The present study was done with the aim of assessing the accuracy and utility of unguided transthoracic fine needle aspiration cytology in the diagnosis of lung cancer. Methods: An interventional study was taken up in the Department of Respiratory Medicine, JN Institute of Medical Sciences, Imphal. All patients admitted in the IPD with suspected malignant lung lesions during the period July 2017-Dec 2018 was included. After obtaining prior informed written consent fine needle aspiration was done from the dullest area on chest wall by using a lumbar puncture needle under local anaesthesia. The slides prepared thereafter were alcohol-fixed and sent to the Department of Pathology, JNIMS for cytological examination. The patients were observed closely after the intervention to detect any complications. Results: Completed data sets could be obtained from 20 study subjects. Unguided fine needle aspiration cytology had a diagnostic yield of 75% for detecting malignant lesions in the lung. Only minor post-procedure complications were encountered in 10% of the patients. Conclusion: The unguided trans-thoracic fine needle aspiration cytology has many merits. It is rapid, safe, accurate and cost-effective for the diagnosis of intra-thoracic peripheral lesions. It can also be used as an outdoor procedure even in peripheral health centres in properly selected cases.
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Studies regarding clinical profile of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is extremely rare from the north-eastern part of India. This necessitates the present study. Aim: The present study aimed to describe the clinical profile of Acute Exacerbation of COPD (AECOPD) patients admitted in the Department of Respiratory Medicine, JNIMS, Imphal. Methods: The hospital records of all Acute Exacerbations of COPD patients admitted during the period Sept 2015 to Aug 2016 in the IPD of the Department of Respiratory Medicine, JNIMS were recorded retrospectively and analyzed by using descriptive statistics. Results: A total of 100 patients were admitted during the study period of one year. The mean age (SD) of the patients was found to be 71.3 (10.567) years. Female patients outnumbered male patients (M:F=1:1.08). The last quarter of the year (Sept-Dec) showed the least number of patients admitted while remaining months of the year had variable but relatively higher number of patients admitted with a peak in August. Dyspnoea was the commonest symptom which was found in almost all the patients (99%). Co-amoxiclav, Cephalosporin, Macrolide and Fluoroquinolone were the antibiotics most frequently used. In addition to the antibiotics mentioned above, steroids were needed and administered in 74 cases (74%). Methylprednisolone and Hydrocortisone were the main steroidal preparations used. Ventilation support was needed by two (2%) patients. And altogether three patients died during the study period (3%). The period of stay in IPD by all the patients ranged from 2-35 days with a mean (SD) of 8.51 (6.268) days. Conclusion: COPD exacerbation was seen in ageing population of both sexes. Dyspnoea was commonest symptom and mean hospital stay was 8.51 days. Antibiotics and steroid commonly prescribed were Coamoxiclav and methylprednisolone respectively. 3% of study population expired.
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Background: HIV infection/AIDS is becoming a public health hazard globally. Ocular complications of HIV/AIDS are very common and its severity increases as the disease progresses and ultimately leads to blindness. Objective: The purpose of the present study was to determine the prevalence and type of ocular complications in patients with HIV/AIDS. Methods: A cross-sectional study was done on patients with HIV infection/AIDS who attended or referred to eye OPD and also cases from General Medicine ward of JNIMS. A complete ophthalmic evaluation of both anterior and posterior segments was conducted. HIV sero-positivity was established by ELISA and confirmed by Western Blot in all cases. Results: The majority of the patients were in the age group of 21-40yrs. The prevalence of ocular involvement was 47%. The commonest involvement was on posterior segment with HIV retinopathy and cotton wool spots (20%) and CMV retinitis (5%). Anterior segment involvement was 18% with conjunctival micro-vasculopathy being the commonest (8%) and HZO in 5 cases. Conclusion: HIV infection is fairly common in Manipur among the age group of 20-40yrs., IDU being the commonest route of infection. Ocular involvement occurred in 47% of cases and it may be the first manifestation. So, the ophthalmologist must be aware for prompt treatment and prevention of visual disabilities.
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Background: AIDS-related cytomegalovirus (CMV) retinitis is one of the most serious ocular complications in individuals with AIDS. It can progress to blindness, and in some cases, be accompanied by potentially fatal systemic disease.Antiviral compounds including Ganciclovir, Foscarnet and Cidofovir are routinely used in the treatment of CMV infection and disease. However, these agents have a poor oral bioavailability and have the inconvenience and expense of intravenous administration. Aim: The aim of the present study was to evaluate the safety and the effectiveness of oral Valganciclovir in the treatment of CMV retinitis in HIV- infected patients. Methods: A cohort of 12 CMV retinitis patients with HIV was treated with Valganciclovir at the Department of Ophthalmology, JNIMS during the period of Apr 2013 - Mar 2016. The therapy of Valganciclovir was continued until the CMV retinitis was completely inactive, two reports of CD4+ T lymphocyte counts six months apart was > 100 and the patient was on HAART therapy. The clinical profiles of these patients before and after the therapy were compared. Results: On an average the patients received oral Valganciclovir therapy for 9 months. Post- HAART and anti-CMV treatment, Ophthalmology report showed a 1-2 line improvement in Snellens eye chart reading in three patients while among the remaining nine patients, seven had no change in vision and in two patients the eyes went Phthisical and had no perception of light vision (NPL) at the time of last follow up. All the patients had increased CD4 cell counts and remained clinically stable over 8-24 months follow up period. Only minor adverse effects were seen with the treatment. Conclusion: Oral valganciclovir therapy is highly effective for the induction and maintenance of AIDS related CMV retinitis . It’s used significantly improves the quality of life for patients with this disease as it has eliminated the need for chronic intravenous therapy for people with CMV retinitis
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Background: Since the beginning of medical mycology at the turn of the century there has been a continual increase in the discovery of pathogenic fungi. The morbidity and mortality associated with these infections are becoming substantial and is emerging as a public health problem. Determining the rate of infections and determining the emerging pathogen and its potential risk factors will have an important influence on the prevention and control of these fungal diseases. Data regarding these is almost non-existent for the north-eastern part of the country. Aim: The present study was done to study the pattern of fungal infections in the north-eastern India in terms of clinical parameters and required diagnostic techniques. Methods: An observational cross-sectional study was done in which all the patients who attended the Otorhinolaryngology Department of Jawaharlal Nehru Institute of Medical Sciences,Imphal during the period of August 2015 to July 2017 with features suggestive of fungal infections were included. The exclusion criteria consisted of patients suffering from malignancies and receiving radiotherapy or chemotherapy. A detailed history was taken by using a structured, open interview schedule which had sections on socio-demography and case-history. Then, all the patients were given a thorough clinical examination followed by routine laboratory investigations, radiological examination and endoscopic examination wherever indicated. Further, the study subjects underwent mycological investigations. Data collected were analysed and presented descriptively. Results & Conclusion: 80 eligible study-subjects participated in the study (58 ear, 15 throat and 7 nose & PNS cases). Otomycosis was found to be more common in the 2nd to 3rd decades of life (56.9%) and aspergillosis of nose & PNS being more common in the 2nd decade of life (42.85%) whereas oral and oropharyngeal candidiasis was more common in older age-groups (40%). In the overall, there was a male preponderance (M:F=1.15:1). Otomycosis which was mainly due to infection with A. niger had a definite relation with warm and humid climatic condition. A. fumigatus was responsible for majority of nose & PNS infections while C. albicans was the commonest fungus responsible for fungal infection of the throat.