Bedsore is a curse in disguise: capturing the zeitgeist

Background: Development of a bedsore is always avoidable still its worldwide prevalence fluctuates between 0%-56%. Bedsores are maximally observed in patients who are on long term care, in intensive care, immuno-compromised or on home care.Methods: In a tertiary care center-JK hospital, Bhopal, a longitudinal observational study was done for a duration of 3 years, on all registered in-patients, to understand the trend of bedsore rates on monthly basis.Results: In our study, even though, on yearly basis, average of rates is showing a declining trend in favorable manner yet higher statistical analysis (ANOVA test p value = 0.054) has decrypted the non-significant results.Conclusions: Timely and appropriate prophylactic interventions are needed to overcome the increased bedsore rates. Checklist based surveillance and monitoring should be a pressing priority. Cochrane reviews are also suggestive of incorporation of organizational changes, risk assessment tools, wound care teams and education to reduce the incidence of pressure ulcers.

Feckless practices of bio medical waste management: a conundrum for developing countries

Background: Biomedical waste poses hazard due to two principal reasons: infectivity and toxicity. 75-90% of waste produced by health care facilities is generally non risky but remaining 10-25% is regarded as hazardous with the potential for creating a variety of health problems. Biomedical waste management is an integral part of infection control practices. Virtuoso biomedical waste handling leads to a better environment for medical as well as surgical care patients.Methods: It is a descriptive forward moving study conducted to empower first year MBBS students about biomedical waste management and handling skills to enhance their expertise for future as a competent physician or surgeon and to assess their knowledge gain.Results: Out of 150 students, 131 were present. 68 were males and 63 were females. Mean age was 21.33 with standard deviation of 3.745. Mean marks obtained were 3.09±1.15 (out of 5). ANOVA statistics revealed insignificant p value denoting unambiguous pattern of knowledge gain by all the participants.Conclusions: Empowering medical undergraduates with basic medical skills at an early stage will make them more efficient for future endeavors.

Susceptibility of the Bhopal-methyl isocyanate (MIC)-gas-tragedy survivors and their offspring to COVID-19: What we know, what we dont and what we should? / Suscetibilidade dos sobreviventes da tragédia de Bhopal-isocianato de metila (CIM)-gás e seus filhos ao COVID-19: O que sabemos, o que não sabemos e o que devemos?

Abstract There is credible evidence that the 1984-Bhopal-methyl isocyanate (MIC)-gas-exposed long-term survivors and their offspring born post-exposure are susceptible to infectious/communicable and non-communicable diseases. Bhopal's COVID-19 fatality rate suggests that the MIC-gas tragedy survivors are at higher risk, owing to a weakened immune system and co-morbidities. This situation emboldened us to ponder over what we know, what we don't, and what we should know about their susceptibility to COVID-19. This article aims at answering these three questions that emerge in the minds of public health officials concerning prevention strategies against COVID-19 and health promotion in the Bhopal MIC-affected population (BMAP). Our views and opinions presented in this article will draw attention to prevent and reduce the consequences of COVID-19 in BMAP. From the perspective of COVID-19 prophylaxis, the high-risk individuals from BMAP with co-morbidities need to be identified through a door-to-door visit to the severely gas-affected regions and advised to maintain good respiratory hygiene, regular intake of immune-boosting diet, and follow healthy lifestyle practices.

Resumo Há evidências plausíveis de que os sobreviventes a longo prazo da exposição a gás de 1984 e isocianato de metila (CIM), em Bhopal, e seus filhos nascidos após esse fato estão suscetíveis a doenças infecciosas/transmissíveis e não transmissíveis. A taxa de fatalidade COVID-19 de Bhopal sugere que os sobreviventes da tragédia do gás MIC estão em maior risco, devido a um sistema imunológico enfraquecido e comorbidades. Essa situação nos encorajou a refletir sobre o que sabemos, o que não sabemos e o que devemos saber sobre a suscetibilidade deles ao COVID-19. Este artigo objetiva responder a essas três perguntas que surgem na mente dos funcionários de saúde pública sobre estratégias de prevenção contra o COVID-19 e promoção da saúde na população afetada pelo Bhopal MIC (BMAP). Nossas visões e opiniões apresentadas neste artigo chamam a atenção para prevenir e reduzir as consequências do COVID-19 no BMAP. Da perspectiva da profilaxia com COVID-19, os indivíduos de alto risco do BMAP com condições comórbidas precisam ser identificados por meio de uma visita de porta em porta nas regiões severamente afetadas por gases e aconselhados a manter uma boa higiene respiratória, ingestão regular de dieta que estimule o sistema imunológico e seguir práticas de estilo de vida saudáveis.

Lack of bundled care intervention training program will trip up rates of ventilator associated pneumonia: the contemporary trend

Background: Ventilator associated pneumonia (VAP) is the deadliest hospital acquired infection in many low resource settings of developing countries. For VAP prevention, the concept of bundle of care was defined. Evidence based resources showed it enabled great successes in VAP prevention. It has been observed in clinical practice due to insufficient compliance, there is a need to address related issues in order to define easier-to-apply procedures.Methods: It is a retrospective analytical secondary data based study. It was conducted in a tertiary care hospital of Bhopal city.Results: T value of Mann Whitney/U test was found to be statistically significant and is indicating need of “Bundle Care Intervention” training for the prevention of increase in ventilator associated pneumonia rates in any health care setting.Conclusions: Expanded bevy of options related to infect

A study to assess and develop injection administration skill in medical undergraduates of GMC, Bhopal

Background: Injections are one of the vital route of drug administration in emergency medical practice. WHO has estimated that out of 12 billion injections administered worldwide annually 50% are unsafe and 75% are unnecessary. Despite of humungous efforts medical students still lack the confidence in injecting drugs due to stress for post graduation selection. The objectives of the study were to assess the knowledge of students regarding administration of I.M. and I.V. injections; to make students confident and skilful about administration of I.M. and I.V. injections and to assess the proportion of students who can skilfully administer I.V. and I.M. before and after this intervention.Methods: This was a Quasi experimental study carried out on 150 students of junior final medical students of GMC Bhopal for a period of three months.Results: Out of effective 136 students, 93.4% had ever seen I.M./ I.V. administration. 29.4% have administered I.M. and 16.9% I.V. injection ever. A significant increase in knowledge regarding I.M. and I.V. administration technique is observed following interventional training of the participants. Significant gain in self confidence among the students was perceived.Conclusions: There was a convincing increase in skillful knowledge and self-confidence for parenteral injection technique among medical undergraduates.

CD14 C-159T polymorphism and its association with chronic lung diseases: A pilot study on isocyanate exposed population of Central India.

CONTEXT: CD14 functions as a multifunctional receptor for bacterial cell wall components including endotoxin and lipopolysaccharide and is likely to influence the cytokine profile and subsequent immunoglobulin E production in response to antigen/allergen contact in allergic phenotypes. AIMS: The present study was to investigate genetic polymorphism in CD14 gene - 159C/T, which may be one of the risk factor for increased prevalence of Chronic Lung Diseases in the Central India. SETTINGS AND DESIGN: Survivors of Methyl isocyanates toxicity in Bhopal still suffering from various respiratory ailments were examined. MATERIALS AND METHODS: Polymerase chain reaction-restriction fragment length polymorphism was performed to determine the polymorphism of C-159T. RESULTS: The genotype and allelic frequencies were in Hardy-Weinberg’s equilibrium. Prevalence of CC, CT, and TT were 5.5%, 22.2% and 9.25% respectively in asthmatics; 16.6%, 20.3% and 5.5% respectively in chronic obstructive pulmonary disease (COPD) patients and 5.5%, 14.8% and 1.85 respectively among interstitial lung disorder (ILD) patients; whereas the control cohort with no methyl isocyanate exposure displayed (CC, CT, and TT) cytosine, thymine as 2%, 1.6% and 2% respectively. Increased risk of Asthma among those carrying TT genotype and T allele (odds ratio [OR] =2.61 and 2.02 respectively). CONCLUSION: COPD risk significantly found among those with CC genotype and C allele (OR = 2.81 and 1.50 respectively), whereas ILD risk found significantly among CT genotype and C allele (OR = 1.75 and 1.40 respectively). Therefore, single nucleotide polymorphism (SNP) C-159T polymorphism in CD14 gene might be a risk factor for development of CLD in this population.

Association of microsatellite instability and chronic obstructive pulmonary disorder in isocyanate-exposed population of Bhopal.

Context: Survivors of the Bhopal gas disaster still suffer from various respiratory ailments. We examined the effects of exposures among a cross-section of current residents suffering from COPD by ISSR-PCR. Aims: Molecular screening of the gas-affected population of Bhopal with COPD for microsatellite instability due to exposure of MIC. Settings and Design: The isocyanate-exposed population of Bhopal city suffering from chronic obstructive pulmonary disorder. Materials and Methods: Inter-(SSR) analysis was used to characterize microsatellite instability in 52 MIC victims of Bhopal, suffering from COPD using (CA) 8 RG and (CA) 8 R[Y-Q] primer. Statistical Analysis Used: Association analyses were performed using regression analysis. Results: The study on the MIC-affected population in Bhopal showed weak association between microsatellite instability and age (r = + 0.37); exposure distance from site (r = −0.44); and smoking status(r = + 0.12); while regression analysis of the above parameters displayed supporting evidence. Conclusions: The high prevalence of smoking coupled with aging and poor living habits threatens, to further increase COPD incidences among this population, highlighting the need for enhanced screening efforts.

A pragmatic & translational approach of human biomonitoring to methyl isocyanate exposure in Bhopal.

Human biomonitoring has evolved beyond margins to ascertain exposure-response relationship in environmental associated human diseases. As occupational ailments continue to dominate global concerns, biomonitoring strategies have evolved better in terms of evaluating health risks associated with systemic uptake from chronic (long-term) environment exposures. Even though contributions of acute toxic exposures (short-term) towards initiation of disease processes have been gradually recognized, a comprehensive approach delineating mechanistic insights of such an implication remains elusive. Molecular biomonitoring in a strictly selected defined surviving cohort of the infamous Bhopal gas tragedy “as a model”, could provide an unparallel opportunity to discern the long standing implications of acute exposures. Besides comprehending clinical significance of isocyanate toxicity, the results might provide a framework for understanding the molecular repercussions pertaining to a host of other such acute environmental exposures. The investigative strategy might also be helpful in identification of biomarkers with potential for translational research.

Retrospective analysis of lung function abnormalities of Bhopal gas tragedy affected population.

Background & objectives: A large numbers of subjects were exposed to the aerosol of methyl isocyanate (MIC) during Bhopal gas disaster and lung was one of the most commonly affected organs. The aim of the present study was to analyze retrospectively the lung function abnormalities among the surviving MIC exposed population (gas victims) and to compare it with the non-MIC exposed (non gas exposed) population. Methods: The spirometry data of both gas victims and non gas exposed population who attended the Bhopal Memorial Hospital & Research Centre for evaluation of their respiratory complaints from August 2001 to December 2009, were retrospectively evaluated and compared. Results: A total 4782 gas victims and 1190 non gas exposed individuals performed spirometry during the study period. Among the gas victims, obstructive pattern was the commonest (50.8%) spirometric abnormality followed by restrictive pattern (13.3%). The increased relative risk of developing restrictive abnormality among gas victims was observed in 20-29 yr age group only (adjusted relative risk: 2.94, P<0.001). Male gas victims were more affected by severe airflow obstruction than females and the overall increased relative risk (1.33 to 1.45, P<0.001) of developing obstructive pattern among gas victims was observed. Interpretation & conclusions: The present study showed that the relative risk for pulmonary function abnormalities in gas victims was significantly more among those who were young at the time of disaster. Increased smoking habit among gas victims might have played an additive effect on predominance of obstructive pattern in spirometry.