Effect of COVID-19 Lockdown on Lifestyle Habits and Self-Care Practices of Diabetic and Hypertensive Patients in Rural Shimla and Udaipur – Findings from the HealthRise India program

Background: COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self?care practices are not only associated with less severe COVID?19 infections but also with a high recovery rate. Objectives: This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur. Methods: A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year. Results: Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID?19 pandemic. During COVID?19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001). Conclusion: Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.

Foreign bodies in upper aero-digestive tract: a clinical study.

Background: Foreign-body ingestion and aspiration are common childhood adverse events, hence are commonest causes of morbidity and mortality in infants and children worldwide. Aim of current study was to identify the patients with foreign-body ingestion and aspiration, develop a suitable algorithm for their management and study various complications following their removal. Methods: The present study was carried out in G.R. medical college, Gwalior, M. P. during last one year on hundred patients diagnosed as case of foreign-body in upper aero-digestive tract on the basis of history, examination and investigations. Results: Foreign-bodies in upper aero-digestive tract were seen mostly in children less than 10 years of age (91%). The youngest was 8 months old and the oldest 48 years. Coins were the most common foreign-bodies in oesophagus (90%) while whistle in the upper airway (40%). Right bronchus is the commonest site of impaction in the airway (50%), while cricopharynx is most common in the oesophagus (95.55%). Patients with oesophageal foreign bodies presented mostly with the chief complaint of foreign body sensation (63.4%) in the throat whereas those with airway foreign body presented mostly with dyspnoea and choking sensation (60%). Pooling of saliva was most commonly seen in patients with oesophageal foreign bodies (43.3%). Tachypnoea was the most common sign in cases of tracheabronchial foreign bodies (80%). Positive radiological evidence was present in 88% of upper aero-digestive foreignbodies. Only 2.2% cases showed complications following oesophagoscopy. Tracheo-bronchial foreign-bodies were removed by emergency bronchoscopy. 20% cases had complications post-operatively. Conclusion: Early detection by meticulous history, imaging modality & prompt management remains basis for favourable outcome and prevents fatal complications.

Stem cell therapy: A novel & futuristic treatment modality for disaster injuries.

Stem cell therapy hold the potential to meet the demand for transplant cells/tissues needed for treating damages resulting from both natural and man-made disasters. Pluripotency makes embryonic stem cells and induced pluripotent stem cells ideal for use, but their teratogenic character is a major hindrance. Therapeutic benefits of bone marrow transplantation are well known but characterizing the potentialities of haematopoietic and mesenchymal cells is essential. Haematopoietic stem cells (HSCs) have been used for treating both haematopoietic and non-haematopoietic disorders. Ease of isolation, in vitro expansion, and hypoimmunogenecity have brought mesenchymal stem cells (MSCs) into limelight. Though differentiation of MSCs into tissue-specific cells has been reported, differentiation-independent mechanisms seem to play a more significant role in tissue repair which need to be addressed further. The safety and feasibility of MSCs have been demonstrated in clinical trials, and their use in combination with HSC for radiation injury treatment seems to have extended benefit. Therefore, using stem cells for treatment of disaster injuries along with the conventional medical practice would likely accelerate the repair process and improve the quality of life of the victim.

Botulinum toxin: Bioweapon & magic drug.

Botulinum neurotoxins, causative agents of botulism in humans, are produced by Clostridium botulinum, an anaerobic spore-former Gram positive bacillus. Botulinum neurotoxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons. A single gram of crystalline toxin, evenly dispersed and inhaled, can kill more than one million people. The basis of the phenomenal potency of botulinum toxin is enzymatic; the toxin is a zinc proteinase that cleaves neuronal vesicle associated proteins responsible for acetylcholine release into the neuromuscular junction. As a military or terrorist weapon, botulinum toxin could be disseminated via aerosol or by contamination of water or food supplies, causing widespread casualties. A fascinating aspect of botulinum toxin research in recent years has been development of the most potent toxin into a molecule of significant therapeutic utility. It is the first biological toxin which is licensed for treatment of human diseases. In the late 1980s, Canada approved use of the toxin to treat strabismus, in 2001 in the removal of facial wrinkles and in 2002, the FDA in the United States followed suit. The present review focuses on both warfare potential and medical uses of botulinum neurotoxin.