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Background & objectives: Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. Methods: A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. Results: The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen’s kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. Interpretation & conclusions: The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.
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COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO’s emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ?18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India’s COVID-19 vaccination drive
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Background & objectives: Data from the National Clinical Registry for COVID-19 (NCRC) were analyzed with an aim to describe the clinical characteristics, course and outcomes of patients hospitalized with COVID-19 in the third wave of the pandemic and compare them with patients admitted earlier. Methods: The NCRC, launched in September 2020, is a multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized COVID-19 patients were captured in an electronic data portal from 38 hospitals across India. Patients enrolled during December 16, 2021 to January 17, 2022 were considered representative of the third wave of COVID-19 and compared with those registered during November 15 to December 15, 2021, representative of the tail end of the second wave. Results: Between November 15, 2021 and January 17, 2022, 3230 patients were recruited in NCRC. Patients admitted in the third wave were significantly younger than those admitted earlier (46.7±20.5 vs. 54.6±18 yr). The patients admitted in the third wave had a lower requirement of drugs including steroids, interleukin (IL)-6 inhibitors and remdesivir as well as lower oxygen supplementation and mechanical ventilation. They had improved hospital outcomes with significantly lower in-hospital mortality (11.2 vs. 15.1%). The outcomes were better among the fully vaccinated when compared to the unvaccinated or partially vaccinated.Interpretation & conclusions: The pattern of illness and outcomes were observed to be different in the third wave compared to the last wave. Hospitalized patients were younger with fewer comorbidities, decreased symptoms and improved outcomes, with fully vaccinated patients faring better than the unvaccinated and partially vaccinated ones.
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Background: Mental health problem is a major public health issue all over the world including India. In India, mental disorders are the leading contributors to significant morbidity and disability amongst those affected. With changing health pa?erns among Indians, mental behavior and substance use disorders are coming to the forefront in health care delivery systems. Objec?ve: This study was aimed to assess the diagnos?c pa?ern of psychiatric morbidity among the pa?ents a?ending psychiatric outpa?ent department in a private medical college. Methodology: This cross-sec?onal study was carried out in the Department of Psychiatry in Prathima Ins?tute of Medical Sciences located at Karimnagar, Telangana, India. For this study, a total of 442 new subjects a?ending Psychiatry Outpa?ent Department (OPD) from August 2020 to July 2021 were taken. All the informa?on including longitudinal histories of pa?ents was recorded in files and the diagnosis was made following Diagnos?c and Sta?s?cal Manual of Mental Disorders-Fi?h Edi?on (DSM 5). Sociodemographic parameters and family history of mental illness were collected from the record file of the individual pa?ent. Results: In the present study, among the different age groups, the majority (28.05%) of the study subjects were of the age ranging from 21-30 years. The distribu?on according to gender was (62.89%) males and (37.10%) females. The majority of the study subjects belonged to the rural background (69.45%), educated up to 10th standard (28.73%), self-employed (29.86%), married (67.42%), belonged to Hindu religion (85.74%), and with a monthly family income of 5,000 to 10,000 (38.68%). The majority of the study subjects were diagnosed with Major depressive Disorders (28.05%), followed by anxiety disorders (17.87%) and Substance-Related and Addic?ve Disorders (16.96%). Conclusion: This study provides informa?on about the prevalence of psychiatric morbidity among pa?ents a?ending outpa?ent department in a private medical hospital in Northern Telangana. It helps in assessing the pa?ern of psychiatric problems and taking necessary steps to plan for better management of mental health care in the near future.
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Introduction: Femur fractures configure an important publichealth issue and are associated with high mortality taxes andlose of functionality. Study aimed to compare the analgesiceffects of FNB with intravenous (IV) fentanyl prior topositioning for spinal block in patients with fractured femur.Material and Methods: Sixty patients scheduled for fracturedfemur surgery under spinal block. They were grouped as FNBgroup (n=30) and a fentanyl group (n=30). A spinal block wasperformed. Pain scores 15 minutes after analgesia and duringpositioning were recorded. A numeric rating pain scale (0 =no pain, 10 = maximal pain) was used. Additional fentanylrequirement during positioning and satisfaction with patientposition maintained for spinal block (yes = satisfactory, no =not satisfactory) were also recorded.Results: Base line values for Heart Rate (HR), Mean ArterialPressure (MAP) and type of surgery were comparable inboth the groups. We found an insignificant difference in HR(P>0.001) among the groups and a significantly lower MAPin FENT group (P = 0.0090). SpO2 was significantly lower inFENT group (P < 0.001).Conclusion: Femoral nerve block lowers pain and the needfor supplementary analgesia requirement
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Introduction: Cisatracurium unlike atracurium is devoid of histamine-induced cardiovascular effects and this would be thegreatest advantage in replacing atracurium for the facilitation of endotracheal intubation.Aim: The aim of the study was to compare the effectiveness of atracurium 0.5 (2 ED95) mg/kg IV versus two different dosesof cisatracurium, i.e., 0.1 (2 ED95) and 0.15 (3 ED95) mg/kg IV for intubation with regard to onset time for intubation, intubingconditions, duration of blockade, and hemodynamic parameters.Materials and Methods: In this study, 150 patients of the American Society of Anesthesiologists Grades 1 and 2 undergoingelective surgeries under general anesthesia were taken up and divided into three groups of 50 each by computer-generatedrandomization. GroupA received Inj. atracurium besylate 0.5 mg/kg IV, Group B received Inj. cisatracurium besylate 0.1 mg/kg IV,and Group C received Inj. cisatracurium besylate 0.15 mg/kg IV.Results: The three groups were compared regarding the onset of blockade, duration of blockade, condition of intubation,hemodynamic effects, and results analyzed.Conclusion: Cisatracurium 0.15 mg/kg provides excellent intubating conditions with rapid onset of action, with longer durationof action and no significant hemodynamic changes when compared with cisatracurium 0.1 mg/kg and atracurium 0.5 mg/kgand hence cisatracurium 0.15 mg/kg can be used as an ideal non-depolarizing muscle relaxant for intubation.
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Background: Surgical care has a role in treating a broad spectrum of diseases in the alleviation of human suffering. Upper abdominal surgery included gastrectomy, pancreatectomy, hepatic resection, cholecystectomy and splenectomy. Maximal inspiratory pressure (Pimax) is an important indicator for assessing the strength of inspiratory muscles. Respiratory muscle training devices enhance respiratory muscle strength, endurance and exercise capacity. Pressure Threshold IMT devices are usually handheld devices with a spring load that is impeded with different intensities. Incentive Spirometer is a form of ventilatory training that emphasis sustained maximum inspiration. Therefore, the present study aims to assess the effect of Threshold Inspiratory Muscle Training versus Incentive spirometry in participants with upper abdominal surgeries. Materials and Methods: A prospective cross-sectional comparative study was done with 30 participants with upper abdominal surgeries in the age group of 20 to 65. On Day 1 and after 2 weeks the maximal inspiratory pressure was measured using Hand Held Pressure Manometer Device (Pimax). Group A participants received Threshold Inspiratory Muscle Training (IMT) and Group B participants received Incentive spirometry. The intervention was given for 5 days in a week for 2 weeks. The duration for each session was of 15-30 minutes which also includes rest periods. Data was analyzed using student Paired ‘t’ test and Unpaired ‘t’ test. Result: There was extremely significant difference (p<0.0001) in Maximal Inspiratory Pressure (Pimax) in both the groups but Group A showed slightly more improvement were Threshold Inspiratory Muscle Training (IMT) was given as an intervention after 2 weeks. Conclusion: The study shows extremely significant improvement in Maximal Inspiratory Pressure (PImax) in both the groups. This study concluded that Threshold IMT has more effect than Incentive Spirometry in participants with upper abdominal surgeries.
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Food allergy (FA) is a growing health problem in India and worldwide with notable prevalence in infants when compared with children and adults. Multiple genetic and nutritional factors play an important role in etiology of FA leading to morbidity and mortality. As general practitioners (GPs) and homeopaths are the first persons to be approached by patients with possible FA, the need for evaluating their Knowledge, Attitude and Practices (KAP) towards the same are essential to be studied.A total of 214 participants- 107 GPs with or without specialization in Internal Medicine and 107 homeopaths participated in the study. A validated questionnaire was adopted to assess their KAP. The questionnaire had 31 parameters (demographic details-5, knowledge-21 and attitude and practices-5) regarding symptoms, severity, risk factors, diagnosis and treatment of FA. The score was recorded and results with p-value ≤0.05 were considered statistically significant.A significant difference in the perception of FA was observed between GPs (42.1%) and homeopaths (10.3%) regarding the safety of administering influenza vaccines in children with egg allergy (p=0.003). 80.4% of GPs and 23.3% homeopaths believed that epinephrine is the 1st line choice for treatment of anaphylaxis (p=0.035). 64.5% GPs and 28.1% homeopaths opined that timely administration of epinephrine prevents fatal anaphylaxis which was statistically significant. (p=0.046). However no statistically significant difference (p=0.112) was found between GPs (65.4%) and homeopaths (58.9%) in their opinion regarding the reliability of positive skin prick test or radioallergosorbent test (RAST) as sufficient FA diagnostic tool. The total scores obtained regarding the knowledge in FA and anaphylaxis by GPs and homeopaths was 66.4% and 46.8% respectively which was not found to be statistically significant (p=0.172).Overall knowledge of FA in GPs and homeopaths was comparable with strengths and weakness in each domain. GPs had more precise knowledge than homeopaths, regarding the treatment schedule, in case of anaphylaxis, which in turn reflects the differences in attitude and approach in treating FA among the two groups. Periodic educational programs focused at improving the knowledge regarding food allergy and treatment options is a prerequisite among GPs and homeopaths help them to understand better as well as treat the adverse effects of FA