Use of Herbal Drugs in Local Health Traditions in Purnagiri Hills, District Champavat, Uttarakhand

The state Uttarakhand is rich with floral and faunal diversity including plants used by local inhabitance to cure health problems. Himalayan region always has been the treasure of herbs from ancient time. Himalayan herbs are highest in quality and potency. There are numbers of side effect are noted using allopathic medicines which leads towards reuse of medicinal plants available locally. Keeping this in view an attempt has been made to enumerate the common medicinal plants used in traditional therapeutic system of Uttarakhand, India. Results reveal that 29 plant species are used for primary healthcare. Purnagiri hills located in Champavat district of Uttarakhand is reservoir for a large number of medicinal herbs during the field survey large number of medicinal plants like Adina cordifolia (Roxb.) Hook. (Rubiaceae), Asparagus adscendence Roxb. (Liliaceae), Artemesia nilgirica (Clarke) Pamp. (Asteraceae), Berberis aristata DC. (Berberiridaceae), Colebrookea oppositefolia Sm. (Lamiaceae), Elephantopus scaber L (Asreraceae), Pinus longifolia Roxb. (Pinaceae), Tamarix gallica L. (Tamaraceae), Urtica dioica L. (Urtecaceae) and many more with their use in local health traditions by local habitants were recorded. One of the serious challenges to biodiversity and ecological functioning is climate change. Climate change and global warming are well known issue that has had an impact on the biodiversity. Second thing over exploitation of Himalayan forest leads these valuable herbs in endangered category. Some of the plants recorded are critically endangered and rare. We have to pay attention towards the conservation, cultivation of these herbs.

A Study to Analyse Covid-19 Outbreak Using Multiple Linear Regression: A Supervised Machine Learning Approach

Introduction: Globally, COVID-19 have impacted people's quality of life. Machine learning have recently be-come popular for making predictions because of their precision and adaptability in identifying diseases. This study aims to identify significant predictors for daily active cases and to visualise trends in daily active, posi-tive cases, and immunisations. Material and methods: This paper utilized secondary data from Covid-19 health bulletin of Uttarakhand and multiple linear regression as a part of supervised machine learning is performed to analyse dataset. Results: Multiple Linear Regression model is more accurate in terms of greater score of R2 (=0.90)as com-pared to Linear Regression model with R2=0.88. The daily number of positive, cured, deceased cases are signif-icant predictors for daily active cases (p <0.001). Using time series linear regression approach, cumulative number of active cases is forecasted to be 6695 (95% CI: 6259 - 7131) on 93rd day since 18 Sep 2022, if simi-lar trend continues in upcoming 3 weeks in Uttarakhand. Conclusion: Regression models are useful for forecasting COVID-19 instances, which will help governments and health organisations to address this pandemic in future and establish appropriate policies and recom-mendations for regular prevention.

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.

Study of Different Evapotranspiration Models under Polyhouse and Open Environment in Tarai Region of Uttarakhand

The average of mean monthly ET0 estimated under polyhouse by FAO PM (benchmark) model was 39.44 mm, but that of the FAO Penman, Hargreaves Stanghellini, Priestley-Taylor and FAO Radiation models were 38.37, 18.18, 37.80, 48.17 and 53.87 mm respectively. Whereas, the average of mean monthly ETo estimated under open environment by FAO PM (benchmark) model was 116.34 mm, but that of the FAO Penman, Hargreaves Stanghellini, Priestley-Taylor and FAO Radiation models were 119.33, 133, 126.41, 113.17 and 117.37 mm respectively. The FAO Penman and Hargreaves model are found to be most and least appropriate models for estimating daily ET0 under polyhouse. Whereas, FAO Radiation and Stanghellini model observed to be most and the least appropriate models in an open environment for estimating daily ET0 under polyhouse for the Pantnagar Tarai condition of Uttarakhand.

A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay

Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care.

A Retrospective Study: Increase Trend Of Alcoholic Hepatitis Among Garhwali Population Of Uttarakhand

Introduction:Alcohol is the most commonly abused drug worldwide causing liver injury. There is high prevalence of alcohol use in the society particularly in the developed and developing nations. Alcohol affects all systems ranging from central nervous system, cardio-vascular system and genitourinary system. The World Health Organization estimates that there are 140 million people with alcoholism worldwide. In this study, we have focused on alcoholic hepatitis among the Garhwali population of Uttarakhand.Materials & Methods:The study was carried out upon 680 Garhwali subjects, of which 124 patients were suffering from alcoholic hepatitis at the hepatology clinic, during the period from January 2015 to December 2018 at H.N.B. Govt. Base Hospital of Veer Chandra Singh Garhwali Govt. Medical Science & Research Institute, Srinagar, Uttarakhand. Medical laboratory tests and statistical tools were applied.Results:Out of 680 subjects, incidence of alcoholic hepatitis was found 124 (18.2%) cases in this study. There was occurrence of alcoholic hepatitis only among the males and was found highest in the age group between 40-50 years, 69.4% belong to urban class while 30.6% belong to rural class society. It was also found that the incidence of alcoholic hepatitis was highest in the district of Pauri, followed by in the district of Chamoli, Uttarkashi and Tehri in the Garhwal region of Uttarakhand.Discussion/Conclusion:Increase incidence of alcoholic hepatitis seen among the male was mainly due to addiction of alcohol and increased socio-economic conditions of this region. Nowadays, consuming alcohol has also became a symbol of status in the society. We also found that the incidence of alcoholic hepatitis was increasing year after year from 8.9% in 2015 to 45.1% in the year 2018, was really a matter of concern. Mortality and morbidity associated with this disease is matter of serious economic loss to the nation and grief for the society.

Utilization Of Maternal Health Care Services In Uttarakhand: Comparative Study Between Two Divisions: Kumaun And Garhwal

Background: Maternal mortality remains a biggest setback in developing nations like India. Almost 90% of maternal deaths can be prevented by timely intervention, antenatal care acts as an effective tool to reduce both maternal and infant mortality. The objective of this study is to assess the utilization of antenatal care services in two divisions of Uttarakhand: Kumaun and Garhwal.Materials and Methods: The study was carried out using secondary data source i.e. NFHS-4 data of Uttarakhand which is divided into two regions, Garhwal and Kumaun. Statistical test i.e. Z-test is used for the comparison between two regions and within inter districts of Uttarakhand.Result: The results of this study indicates that between the two regions i.e Kumaun has better utilization of maternal health care facilities. Nainital district recorded best and Pithoragarh district recorded the least utilization of ANC services in Kumaun division. In Garhwal division, district Chamoli and Dehradun recorded highest utilization of maternal health care services whereas Rudraprayag and Tehri-Garhwal had discouraging statistics.Conclusion: Uttarakhand has immensely progressed in terms of maternal health in recent times; still there are some key areas that require immediate attention. Certain districts in both Garhwal and Kumaun division need assistance to improve maternal health care seeking behavior amongst the mother and the family. Dissemination of information and benefits regarding the utilization of ANC services should be encouraged to achieve a reduction in maternal mortality.

A study of complications of scrub typhus in a tertiary health care institute of Uttarakhand, India.

Background: Scrub typhus or tsutsugamushi disease is a febrile illness caused by Orientia tsutsugamushi. Uttarakhand State in the northern region of India has been witnessing increased incidence of this fever. There is paucity of data on this topic from this region. The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from scrub typhus in a tertiary health care institute of Uttarakhand, India. Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary health care institute Uttrakhand. The study period was of 1year from December 2012 to November 2013. Patients of 12 years of age or above it who were IgM antibody positive by ELISA technique were included in the study. All such patients underwent detailed clinical examination and investigation. Results: 47 patients were found to be suffering from scrub typhus. The common symptoms noted fever, myalgias, headache, vomiting, diarrhoea, breathlessness, petechiae and jaundice. Common complications noticed were hepatitis (78.7%) acute respiratory distress syndrome (19.2%), thrombocytopenia (46.8%) and acute renal failure (31.9%), Mortality was seen in 3 (6.4%) patients. Conclusions: Scrub typhus is an important cause of mortality and morbidity in Uttarakhand. High index of suspicion, early diagnosis, monitoring of the clinical and laboratory parameters and prompt intervention may help in reducing the mortality.

A study of clinical and laboratory profile of dengue fever in a tertiary care centre of Uttarakhand, India.

Background: Dengue is an important cause of mortality and morbidity in India. Many recent studies have shown varied clinical manifestations from different geographical locations. There is paucity of data on this topic from this region. The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from dengue in a tertiary care centre of Uttarakhand, India. Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary care hospital of Uttrakhand. The study period was of 1 year from July 2012 to June 2013. Patients of 12 years of age or above it who were antigen positive or antibody positive were included in the study. All such patients who were admitted in the hospital underwent detailed clinical examination and investigation. Results: Dengue infection was identified in 140 patients. Thrombocytopenia was the commonest hematological abnormality. Splenomegaly, hepatomegaly, and hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted. Mortality was seen in 5 (3.6%) patients. Encephalitis, shock and ARDS were associated with high mortality and poor outcome. Conclusions: Dengue is an important cause of mortality and morbidity in Uttarakhand. High index of suspicion, early diagnosis, monitoring of the clinical and laboratory parameters and prompt intervention may help in reducing the mortality.

Prevalence of Rheumatic Fever and Rheumatic Heart Disease Among School Children.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns in the developing countries like India. A total number of 10330 school children were examined clinically for evidence of acute rheumatic fever and rheumatic heart disease . Those suffering with the disease were subjected to electrocardiographic, rontgenographic and echocardiographic examination. Prevalence of acute rheumatic fever and rheumatic heart disease was found to be 0.87 per 1000.

Complications of vivax malaria in Uttarakhand, India.

Background: Malaria is an important cause of mortality and morbidity in India. Many recent studies have shown that vivax malaria which was once thought to be a benign condition has emerged in a more virulent form causing many cases of severe malaria and life threatening complications. There is paucity of data on this topic from this region. Objective: The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from vivax malaria. The study has also tried to find out severe malaria associated with P. vivax infection. Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary care hospital of Uttarakhand. The study period was of two years, from September 2011 to August 2013. Patients of 18 years of age or above it who were smear positive or antigen positive were included in the study. All such patients who were admitted in the hospital underwent detailed clinical examination and investigation. Results: Plasmodium vivax infection was identified in 140 patients. Splenomegaly, hepatomegaly, and hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted. Severe malaria was observed in 63(45.0%). Thrombocytopenia was the commonest hematological abnormality. Mortality was seen in 9(6.4%) patients. Cerebral malaria, shock and ARDS were associated with high mortality and poor outcome. Conclusion: Vivax malaria may cause life threatening complications. The complications of vivax malaria are similar to those which have been traditionally described with falciparum malaria.

Comparative Analysis of the Distribution of Various Subtypes of Lymphoid Malignancies in Uttarakhand with other Regions in India.

Lymphoid malignancies (LM) form an umbrella term comprising both Hodgkin Disease (HD) and Non Hodgkin Lymphoma (NHL). A number of studies conducted in India and worldwide suggests that the disease exhibits similar pattern with contrasting regional variations. Examining regional variations is important as it may provide an insight to the etiological factor and pathogenesis of the disease. Aim: The aim of our study was to investigate the current pattern of lymphoid malignancies both HD and NHL in Uttarakhand and subsequently compare the results with other regions. Materials and Methods: We analyzed 116 cases of Lymphoid Malignancies that were reviewed over a period of 18 months. Both HD and NHL were diagnosed morphologically and then Immunohistochemistry (IHC) using CD3, CD15, CD20, CD30, and CD45 was employed to further subtype disease according to current WHO classification. Results: The lymphoid malignancies were further subdivided into HD and NHL. Nodular Sclerosis (NS) was the dominant subtype of HD in Uttarakhand (48.78%) and was comparable with results from other regions. Statistical analysis regarding distribution of various subtypes of HD in Uttarakhand and its comparison with three distinct geographical regions also showed p value < 0.241832 which was not statistically significant. However, amongst NHL Diffuse Large B cell Lymphoma (DLBCL) (54.66%) was the commonest subtype. Besides, a significant number of cases of Anaplastic Large Cell Lymphoma (12%) were also observed. Furthermore, statistical analysis showed that the distribution of various subtypes of NHL in Uttarakhand when compared to three distinct geographical regions was statistically significant (P value < 0.002808). Conclusion: Geographic differences in the incidence and histologic subtypes of Lymphomas do exist.

Human trichinosis in remotes of Uttarakhand, India.

Trichinosis is a parasitic zoonosis caused by ingestion of infected meat containing larvae of Trichinella, more prevalent in developing countries. Although infection with Trichinella is globally distributed, it has been documented only rarely in India. The reports are available where Trichinella larvae were found from animals in India but, to our knowledge, only one human case has been reported from India (Punjab), so far. This is the first report of small multiple outbreaks of human trichinosis in India (2009-2011). Epidemiological, clinical, and laboratory findings of trichinosis patients belonging to remote areas of Uttarakhand were analyzed retrospectively and prospectively. Patients belonged to remote areas of Garhwal, Uttarakhand, 77.78% were male, and 22.22% were female. The age of patients ranged from 9-55 yrs. History of eating meat of wild boar was given by all (100%). The signs and symptoms of the patients varied even after intake of same diet, and included generalized weakness/malaise, myalgia, fever, gastrointestinal symptoms, facial/periorbital edema, subconjunctival hemorrhages, retinal hemorrhages, muscle atrophy, and dyspnea. Laboratory investigations revealed eosinophilia, leukocytosis, creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT) elevation in 100%, 88.89%, 50% and 16.67%, respectively. Muscle biopsies revealed larvae in 27.78%. One patient expired while others improved. The prevalence of trichinosis is likely to be underestimated. The aim of this study is to emphasize on the magnitude of the problem, to educate people, especially in the affected areas about this health hazard and help implementation of epidemiological studies and preventive measures.

Age of menarche in girls of Uttarakhand.

Menarche is a physiological and developmental phenomenon significant in the life of a female. It occurs between the ages of 10 to 16 years. Study suggests that menarche tends to appear earlier in life as the social, nutritional and economic condition of society improves. There is paucity of information about menarchial age in hilly regions of Uttarakhand. Therefore, this research was undertaken to determine age of menarche and its variation with geographical, seasonal and nutritional status. This study was carried out through a questionnaire in 450 girl students between age 17-26 years at Uttarakhand Forest Hospital Trust, Medical College, Haldwani, India. The mean age of onset of menarche was 13.6 (+ 1.1) years. The monthly occurrence of menarche had peaks in May-June. The mean menarchial age of girls belonging to plain area was 13.18+ 1.31 years, which showed significantly earlier onset as compared to girls from hilly area (14.21 + 1.46 years). In hilly areas girls having vegetarian diet had significantly higher age of menarche (14.60 + 1.33 years), compared to girls having non-vegetarian diet (14.09 + 1.56 years). Therefore altitude, season and nutritional status have bearing on the mean menarchial age in girls of Uttarakhand.

Biosocial Correlates of Nutrition and Chronic Energy Deficiency among Adult Females of two Ecological Zones in Madhya Pradesh and Uttarakhand, India

The paper aims to draw out biosocial correlates of nutrition through body mass index (BMI) and chronic energy deficiency (CED). The findings are based on cross-sectional data of 446 women aged 18-60 years from six different endogamous groups of two ecological zones. The mean age of studied women varied from 31 to 36 years. The mean age at menarche was found to be 14.50±1.32 years. Similarly mean age at menopause was found to be 46.22±4.00 years. The mean of reproductive life span varied from 27 to 35 years. Average number of pregnancies per women was 4.44±2.52, average foetal loss was 0.11, children surviving per women was 3.61, whereas average child loss per women was found to be 0.62 and average family size was 9.51. Variations in mean BMI kg/m2 between populations ranged between 18.56 and 20.71. Prevalence of CED was highest among the Brahmin women of Uttarakhand (58.3%) followed by Ahirwar of Madhya Pradesh (47.1%). Incidence of CED was found lowest among Brahmin women of Madhya Pradesh (24.0%). Linear regression coefficient (b ± standard error) of BMI on Cormic Index for these women was 33.1 ± 8.1 (t=4.0, p=0.001), and correlation coefficient (R) was 0.189. Out of 6 anthropometric variables considered for regression analysis, 5, namely weight, hip circumference, waist circumference, mid arm circumference and sitting height showed significant correlations with BMI. Significant differences in sitting height and Cormic Index of women from the hills and plains indicate the role of ecology in shaping its habitants. Out of 9 demographic variables, only age of respondent and family size were found to have a significant impact on low BMI status. The present study postulates that the nutritional status of women has improved over the last decades.