Assessment of patients satisfaction with mobile medical clinics in the two districts of north Bengal, India

Background: Patient satisfaction is an important indicator to measure the quality of healthcare services and plays a crucial role in enhancing the quality of health service delivery. The aim of the study was to assess the patient’s satisfaction level with the quality of health care delivered at the mobile medical clinics (MMC) in two districts of north Bengal, India. Methods: A cross-sectional survey was done using a purposive sampling method, and total of 294 samples were recruited. A questionnaire (PSQ-18) was used to assess the patient satisfaction level. Chi-square tests were used for categorical variables. F-test and t-test were used for mean differences between the variables. Linear regression analysis was done to examine the linear effect of social factors on patient satisfaction. Results: The present study shows that overall satisfaction was 74.04%, with a mean value of 3.702. In the Jalpaiguri district, 27.5% of patients are highly satisfied, whereas 17.0% are in Alipurduar. Alipurduar district has a higher low satisfaction rating (39.7%) than Jalpaiguri district (19.7%), and a district-wise significant association was found (p<0.001). Overall satisfaction level effects by occupation (p<0.001), population and socio economic status (p<0.05). Conclusions: Policymakers may consider that MMCs could be an effective strategy to improve primary health care in remote, underserved areas where there are no public health care facilities.

Technological Breakthrough for Large Scale Bioconversion of Coir Pith towards Sustainable Soil Health Management and Development of Source Point Methane Abatement Model

Coir pith, a byproduct of coir industry, continues to be dumped as a waste in India, because despite its utility being claimed in different applications, an efficient and adoptable technology for its safe utilization is yet unavailable. Due to high lignin content and high C:N ratio, coir pith when left untreated can take decades to decompose, which not only leads to environmental pollution but most importantly methane emission, thereby contributing to climate change. However, once composted, coir pith can transform into an effective soil rejuvenator, considering its utility towards amelioration of especially marginal/ agriculturally degraded soil and improvement of soil productivity. But so far, there is no available composting technology in this respect which is practically feasible, economically viable and socially acceptable. Under IBM-IORF Sustainability project (2022-23) at Mandya, Karnataka, an effort was initiated utilizing Novcom Composting Technology, towards bioconversion of coir pith into safe, mature and qualitative compost for sustainable soil management, especially looking at the stony red soils of the area which are erosion prone, and have a poor productive potential. Periodical study of Novcom coir pith compost samples on 0, 10, 20 and 30 days confirmed effective degradation as demonstrated by the rapid decline of C:N ratio from 1:100 to < 1:25, appreciation of total nitrogen by 98 percent and 60 % degradation of lignin within a 30 days’ time period. The facts are corroborated by the respective very high (in the order of 1016 c.f.u. per gm or one Trillion Billion microflora per ton compost) population of bacteria, fungi and actinomycetes. Phytotoxicity Bioassay test values confirmed not only the absence of phytotoxic elements in compost, but also indicated that this compost can actually accelerate seed germination and root growth process. Estimation of methane mitigation potential under this technology utilizing the carbon assessment tool - Agriculture Carbon Footprint Assessor (ACFA, version: 1.0) indicated that untreated coir pith can potentially emit methane in the range of 5897 – 6025 kg CO2 equivalent (taking GWP24 years of methane: 75). GHG emission during biodegradation of coir pith utilizing Novcom Composting Technology, was found to be about 31 times lower (6.47 kg CO2 equivalent/ ton treated waste) than the reference values recorded in respect of any other standard biodegradation process. Especially in terms of methane the negligible emission under this composting technology is the highlight, as corroborated by the documented value of 0.61 kg CO2 equivalent/ ton treated waste. The evaluation confirmed that bioconversion of coir pith utilizing Novcom Composting Technology can enable methane mitigation of about 6000 ton CO2 equivalent per 1000 ton waste, directly from the source point. The study indicated that Novcom Composting Technology can transform not only a potential pollutant to a quality organic soil amendment, the process also etches out and effective pathway for methane abatement directly from the source point that has crucial impact not only in respect of Sustainable Development Goal (SDG) 13, but also SDG 15, SDG-3 and most importantly SDG-2. Hence, bioconversion of coir- pith utilizing this technology can also facilitate an effective model towards the Net Zero commitment with significant social and environmental impacts.

Knowledge on prevention and management of snake bite among adults in rural area of West Bengal

Background: Snake bite and its consequences may be largely prevented with adequate knowledge. Better knowledge can lead to positive attitude and subsequently good practices. Hence, it is of utmost need that people should have adequate knowledge regarding snake bite and its management. Aims and Objectives: The aims of this study were to assess the knowledge regarding prevention and management of snake bite among adults in a rural area of West Bengal and to find out any association between sociodemographic profile and knowledge on prevention as well as management of snake bite among the study participants. Materials and Methods: A community-based and observational descriptive study was conducted in the rural field practice area of Medial College, Kolkata, West Bengal for of 2 months. The study participants who were willing to participate in the study and gave written informed consent were included in the study. A pre-designed, pre-tested, and semi-structured data collection form was used. It was developed based on similar type of previous studies and was modified according to the local culture. The data collection form comprised sociodemographic profile of the study participants, their knowledge regarding snake bite, and its prevention and availability of first aid management. Results: A total of 134 participants were included in the study. The mean age was 45.81 ± 8.00 years. It was observed that majority of the study subjects believed in the knowledge that all types of snakes are poisonous (93.2%) and leads to death (90.3%). First aid measures such as application of tourniquet that was seen in only 4.4% of the cases. However, more than half of the study subjects (71.6%) believed in sucking the venom out of the wound. It was noted that higher education status, improved social class had better knowledge score of snake bite prevention and management as compared to their counterparts and this association was found to be statistically significant (P < 0.001). Conclusion: Knowledge of the study subjects on snake bite and its prevention is good, but still a large number of participants have inadequate knowledge on snake bite and its prevention. Community-based awareness program on prevention and management of snake bite, use of personal protective measures, and training of peripheral health workers ware specifically recommended.

A qualitative study on perceptions of COVID-19 vaccine among health care worker in a rural area of West Bengal, India

Background: COVID vaccines have been rolled out all over the world after emergency use authorization in the prevailing pandemic situation. However, hesitancy about its safety and efficacy exists among beneficiaries. Vaccine hesitancy can be a barrier to adequate immunization coverage. Aims and Objectives: This qualitative study was undertaken among health care workers in the rural field practice area of a tertiary care hospital, to find out their perceptions about COVID vaccines, and reasons behind hesitancy toward the same. Materials and Methods: Six focused group discussions (FGD) were held with the help of moderator. Each FGD had five members, so 30 members were included in the study. Health care workers included doctors, nurses, ANM/ASHAs, and other health care workers. Results: There were 17 males and 13 females. Doctors had a positive attitude toward vaccination, but other health care workers had mixed perception regarding vaccination. Most grass root level workers were sceptical about the efficacy of the vaccine. Conclusion: Mostly positive attitude toward COVID vaccines was observed in the present study. Hesitancy toward vaccines was observed in some health care workers, and it likely rooted from their inadequate knowledge about the vaccine.

An observational study on utilization of blood and blood components in a tertiary care hospital of Kolkata, West Bengal

Background: Blood is essential for human survival though it is a scarce and precious resource. Blood Transfusions also have some risks, like immunomodulation in the recipients, transmission of infectious agents, and may lead to serious adverse reaction. Hence, it is necessary to make an efficient use of blood and blood products. Aims and Objectives: With this background, the present study was carried out at the blood bank of Medical College and Hospital, a tertiary care hospital of West Bengal, India to evaluate the utilization pattern of blood and blood components. Materials and Methods: Facility based, observational, descriptive, and cross-sectional epidemiological study was conducted on the basis of secondary data collected from records of blood bank, medical college, Kolkata, regarding blood and blood component transfusion pattern of patients who were admitted in medical college and hospital and received blood and blood components from blood bank medical college, Kolkata during period from September 1, 2021, to September 15, 2021. Results: Total number of transfusion recipients during the study period was 1339. Total 2621 no of blood and blood components were issued. About 66.84% (895) of all recipients were transfused with single unit of blood or blood component. Packed red blood cells were the maximum utilized blood component. The most common diagnosis for patients requiring blood and blood components was anemia. Conclusion: A large proportion of patients were transfused with single unit of blood or blood component, which might not be beneficial. Training, regular meeting with clinicians and periodic assessment of blood usage are recommended to prevent inappropriate transfusion.

An epidemiological study on assessing patients' satisfaction with services obtained from Medical College and Hospital, Kolkata

Background: Patient satisfaction has been defined as the degree of congruency between a patient’s expectations of ideal care and his/her perception of the real care he receives. It is a multidimensional aspect, represents a vital key marker for the quality of health care delivery and this is an internationally accepted factor which needs to be studied repeatedly for smooth functioning of the health care systems. It has been an important issue for health care managers. Patient satisfaction level is an important and useful indicator for measuring quality in healthcare. Aims and Objectives: This study was planned to assess patient satisfaction with services provided in the study area and to find out whether there is any association between the socio-demographic characters with the satisfaction level from the services provided. Materials and Methods: The study is an observational, descriptive study with cross-sectional study design. An exit interview of 162 adult patients, selected by convenience sampling attending various out-patient department of medical college, Kolkata was conducted over a period of 2 months; using a pre-designed pre-tested semi-structured data collection form. Statistical analyses were done using Chi-square tests, at P ? 0.05 level of significance. Results: The study highlighted that majority (60.5%) of the study participants belonged to 31–60 years age group. It was also noted that majority of the patients were satisfied with overall services available except for ventilation and toilet facilities. Lower educated participants were satisfied with overall behavior of the healthcare providers. Rural participants and those from lower socio-economic status were satisfied with overall availability of general basic facilities. Lower educated participants were less satisfied with overall satisfaction level at various service windows. Gainfully employed participants were satisfied compared to unemployed participants. There was a statistically significant association between the education status and occupation of the study subjects with overall satisfaction level at various service windows. It was found that lower educated participants were less satisfied with overall satisfaction level at various service windows, compared to higher educated participants (P < 0.05). Conclusion: The present study revealed that majority of the patients were satisfied with the overall services provided at medical college, Kolkata.

A study on gender preference among pregnant mothers attending antenatal clinic of a tertiary care hospital, Kolkata

Background: A balanced sex ratio is needed to stabilize India, a patriarchal subcontinent. Aim and Objective: The study aims to find out whether there is any association between the socio-demographic characters and perceived gender preference among the study subjects. Materials and Methods: The study is an observational, descriptive study with cross-sectional study design. An exit interview of 80 pregnant mothers, both primi and multigravida, selected by systematic random sampling attending antenatal clinic of Medical College, Kolkata for 1st time was conducted for 1 month, using a pre-designed pre-tested semi-structured data collection form after ethics committee approval. Statistical analyses were done using Chi-square tests, at P ? 0.05 level of significance in Statistical Package for Social Sciences. Results: Mean age of study participants was 24.15 ± 4.38 years. The majority (77.5%) of them belonged to age group 20–29 years. 58.8% mothers were nulliparous, 53.8% from rural areas, 63.7% followed Islam, 52.5% from joint family, 31.3% belonged to middle class. 95% of the mothers had no history of abortion. Regarding education, the majority (32.5%) of the study participants were educated till secondary level. Among their husbands, 28.7% were educated till middle level. 40% study participants had no any gender preference, 40% had male preference and 20% had female preference. Main reason behind male preference was an earlier female child. Some preferred daughters due to their earlier male child. Nulliparous mothers had no gender preference while lesser-educated mothers had gender preference. Conclusion: The majority of the study participants had gender preference. Male preference was more than female preference.

High-level aminoglycoside resistance in Acinetobacter baumannii recovered from Intensive Care Unit patients in Northeastern India

Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen, its ability to acquire resistance to carbapenems and aminoglycosides, has complicated their treatment regimen. The present study investigates the prevalence and diversity of aminoglycoside-modifying enzymes and 16S methyltransferases in A. baumannii isolates recovered from patients admitted in Intensive Care Unit (ICU) of a tertiary referral hospital in Northeastern India. Materials and Methods: We investigated the high-level aminoglycoside-resistance (HLAR) (gentamicin and amikacin minimum inhibitory concentration ? 512 ?g/ml) among 164 multidrug-resistant A. baumannii obtained from ICU. Genes encoding aminoglycoside-modifying enzymes, 16S methyltransferase and coexisting beta-lactamases were amplified. Horizontal transferability, plasmid stability and elimination assays were performed. Clonality and sequence types were evaluated by repetitive extragenic palindromic-polymerase chain reaction and multilocus sequence typing (MLST) respectively. Results: A total of 130 (79.2%) isolates were found to exhibit HLAR, with acquired aminoglycoside-resistance genes in 109 (83.8%) isolates along with coexisting extended-spectrum beta-lactamases and metallo-beta-lactamases. Genes aph (3') I, aph (3') VIa and armA were predominant and horizontally transferable. Plasmids were eliminated with single sodium dodecyl sulphate treatment. Seventeen haplotypes were found responsible for the infection. MLST revealed circulation of ST583 and ST188 in ICU. Conclusions: This study reveals the presence of aminoglycoside-resistance genes in combination with blaCTXM and blaNDM, which are highly stable and not frequently reported from this geographical region. Further, the study could predict limited treatment option and need for formulating infection control strategy.

Multidrug-resistant Enterobacteriaceae including metallo-β-lactamase producers are predominant pathogens of healthcare-associated infections in an Indian teaching hospital.

Purpose: A study was carried out in an Indian teaching hospital in 2009 to detect the rate of surgical site infections (SSI) and peripheral vascular access site infections. Materials and Methods: The study was a point-prevalence study involving over 300 patients. The presence of infection was determined according to the CDC criteria. Swabs were taken from the infected sites and identification and sensitivity were carried out using VITEK® 2 automated system. Characterisation of β-lactamase was carried out at ARRML, Colindale, London. Results: The rate of SSI was 15% for the clean and clean-contaminated categories while that for the dirty contaminated category was 85% (NNIS risk index 0). Cultures yielded definite or probable pathogens from 64% (9/14) of the patients with SSI. In 1/3 rd of the cultures, Staphylococcus aureus was grown and the rest had Enterobacteriaceae, either extended-spectrum β-lactamase (ESBL) producers or Amp-C hyperproducers and, alarmingly, three isolates were positive for newly recognised New Delhi metallo-β-lactamase-1 (NDM-1). In medicine, 87% (n = 99) of the patients had a peripheral IV access device, 55% developed associated phlebitis/infection and, in seven, probable pathogens were isolated (Candida species and Escherichia coli producing ESBL and NDM-1, respectively, Staphylococcus aureus and Enterococcus faecium). All ESBL and metallo-β-lactamase producers were resistant to multiple classes of antimicrobials, the latter being sensitive only to colistin and tigecycline. The study also found that all post-operative patients were on antibiotics, 92% on IV [213 defined daily doses (DDD)/100 post-op patients] limited mainly to the third-generation cephalosporins (26%) and aminoglycosides (24%) and imidazole derivatives (30%). In medicine, 83% (n = 82) were on IV antibiotics (123 DDD/100 bed-days), limited mainly to the third-generation cephalosporins (74%). Conclusion: Indiscriminate use of antibiotics is a major problem predisposing patients to harm by multi-resistant pathogens. Carbapenems were in little use in this hospital, but the selection pressure exerted by cephalosporins and other unrelated classes was sufficient to select NDM-1-producing strains due to co-selection, suggesting a role of single plasmid carrying resistance genes to multiple classes.

Angiosarcoma of pericardium: a report of two cases.

Angiosarcomas are uncommon malignant neoplasms characterized by rapidly proliferating extensively infiltrating anaplastic cells derived from blood vessels and lining irregular, blood-filled spaces. The cells manifest many of the functional and morphological properties of normal endothelium. They are collectively one of the rarest forms of soft tissue neoplasms. Here we present two cases of pericardial angiosarcoma, one of them showing widespread dissemination, which caused considerable diagnostic dilemma and the diagnosis could only be established very late in their course of disease.

Pregnancy unmasking lymphangioleiomyomatosis.

A 30 year-old housewife presented with cough and shortness of breath which progressed during her ensuing pregnancy, culminating in a still-birth at 9 months of gestation and requiring her hospitalisation in the immediate postpartum period. HRCT scan of the thorax showed thin-walled cysts and open lung biopsy confirmed the clinical impression of lymphangioleiomyomatosis. She was put on oral medroxyprogesterone acetate. After disease flare-up in the postpartum period her symptoms have stabilised.

Antibiotic sensitivity pattern of the bacteria isolated from nosocomial infections in ICU.

The incidence of nosocomial infections in ICU is 4-5 times greater than in general ward. Critically ill patients are always at higher risk of developing nosocomial infections with resistant strains. This study is an attempt to know the antibiotic sensitivity pattern of the common isolates in ICU. Samples comprising urine, blood, endotracheal secretions and throat swabs were collected from 102 ICU patients of them, 56 patients showed evidence of nosocomial infection (54.9%), from whom 120 different organisms were isolated. Antibiotic sensitivity test was done according to Kirby Bauer method. Klebsiella pneumoniae were the most prevalent isolates from respiratory tract infections followed by Proteus spp, Escherichia coli, Staphylococci spp. and Acinetobacter spp. The gram negative enteric bacilli were uniformly resistant to betalactam antibiotics as well as betalactam-betalactamase inhibitors. Resistance to Ciprofloxacin and Ceftriaxone ranged from 50-100% and 25-83.3% respectively. Staphylococci were 100% resistant to penicillin and tetracycline, 80% to cotrimoxazole, 60% to erythromycin and gentamicin and 40% to amikacin. Acinetobacter spp. were highly resistant to most of the antibacterial agents except gentamicin while Pseudomonas spp. showed 75% resistance to it. The increased prevalence of resistant organisms in ICU probably reflects lack of proper antibiotic policy resulting in prolonged and indiscriminate use of antimicrobial agent.

Prominence of symptoms and level of stigma among depressed patients in Calcutta.

A pilot study of 29 patients for research on clinical depression employed the framework of cultural epidemiology to examine illness-related experience, meaning, behaviour with a Bengali version of the explanatory Model Interview Catalogue (EMIC). This report examined patterns of distress and stigma with reference to the most troubling patient-specified symptom. All subjects were psychiatric outpatients in the Institute of Psychiatry, Calcutta, and met Diagnostic and Statistical Manual (DSM)-IV criteria for a major depressive episode. Only 5 patients (17.2%) identified sadness as the most troubling problem, and 48.3% specified pains and other somatic symptoms instead. An internally consistent stigma scale with Cronbach's alpha of .67, comprised 13 items, was used to assess stigma. In addition to the scale score for each subject, the contribution of each item was reported and compared. A suggestive, though not significantly lower value of the stigma score for patients reporting somatic symptoms as most troubling, compared with sadness, was consistent with findings from prior studies showing a positive relationship between the magnitude of depression and stigma. These findings are discussed with reference to their impact on recognition and help seeking among patients, and recognition and management of depression by general practitioner. Culturally distinctive presentations and social contexts of depression and other mental illnesses should be addressed in professional training and public health communications.

Neovascularisation offers a new perspective to glutamine related therapy.

Angiogenesis or the generation of new blood vessel, is an important factor in the growth of a solid tumor. Hence, it becomes a necessary parameter of any kind of therapeutic study. Glutamine is an essential nutrient of tumor tissue and glutamine related therapy involves clearance of circulatory glutamine by glutaminase. Therefore, using different murine solid tumor models, the present study was undertaken to find out whether the S-180 cell glutaminase has any effect on angiogenesis of solid tumor, or not. Result indicates that the purified S-180 cell glutaminase reduces tumor volume and restrict the generation of neo blood vessels. Therefore, it can be concluded that this enzyme may be an effective device against the cancer metastasis.

Evidence for integration of IS1 and IS10 in recombinant plasmid containing rearrangement hot-spot(rhs) common-shared block(CSB) in Escherichia coli K-12.

The integration of IS1 and IS10 was reported in the recombinant plasmid containing the 3070 bp rearrangement hotspot(rhs) common-shared block(CSB) in Escherichia coli K-12. The integration of IS1 was found to be in rhs(CSB) portion, whereas the integration of IS10 was found to be in both rhs(CSB) and vector portions. The bacterial cells containing the recombinant plasmid grew very slowly. But the integration of IS1 or IS10 in rhs(CSB) portion made the host grow rapidly and overgrew the slow-growing population inheriting the recombinant plasmids without IS-sequences. The sites of integration of IS1 and IS10 were different as was judged from restriction endonuclease mapping. These are rare examples of interchromosomal mobilisation of IS1 and IS10 from host chromosome into plasmid.

TSH assay using dried blood samples: a screening method for congenital hypothyroidism.

Capillary blood samples from three hundred healthy, full-term newborn within 48 and 120 hours of delivery, were collected on filter paper for analysis of thyroid-stimulating hormone (TSH). Blood was collected by pricking the heel of the newborn and spotted and dried on filter paper cards. The samples were analysed by immunoradiometric assay (IRMA) to determine the TSH level. Some fifteen percent of a total 1928 deliveries at two hospitals during a period of one year were included in the study. Male:female ratio was 1.1:1. There was no maternal history of thyroid disease. None of the babies had any clinical feature of hypothyroidism. On analysis, TSH level ranged from 0.6-19.3 microU/ml with a mean (SD) of 7.19 (4.21) microU/ml. TSH assay from dried filter paper blood spot is technically possible and is a cost-effective and reliable method for a screening programme. This is the first time in Bangladesh that this method has been successfully carried out.

Activation and germination of spores of Bacillus thuringiensis var israelensis by alkaline pH and larval (Aedes aegypti) gut fluid.

Alkaline activation of the spores of crystalliferous (Cry+) and acrystalliferous (Cry-) strains of Bacillus thuringiensis var israelensis; wild type B. cereus and its transcipient crystalliferous derivatives and wild type B. subtilis was studied. Also the effect of larval (Aedes aegypti) gut fluid on the activation of spores of these strains was studied. Only the spores of the crystal forming strains were found to be activated by 0.1 M K2CO3 (pH 10) and by the larval gut fluid. The process of alkaline activation was independent of whether crystals were present with the spores in the activation solution. This indicates that protoxin in the spore coat is responsible for the alkaline activation process and may have ecological implications for the organism.

Comparative study of beta-adrenoceptor blocking efficacy of two formulations of esmolol in vivo and in vitro.

The objective of the present study was to compare the cardiovascular beta-blocking activity of two different formulations of esmolol. Spontaneously beating guinea-pig isolated atria and the heart rate and blood pressure of anaesthetized cat were employed in the study to compare the beta-blocking efficacy of the two formulations of esmolol using isoprenaline as an agonist. In guinea-pig isolated atria the standard esmolol formulation (Brevibloc) reduced basal atrial rate more significantly than the indigenously formulated esmolol (test formulation). Both the formulations produced similar parallel rightward shift of cumulative concentration response curves of isoprenaline with closely comparable pA2 values. In anaesthetized cats, only indigenous esmolol formulation significantly decreased basal heart rate. Both the formulations did not modify the basal blood pressure and isoprenaline-induced fall in blood pressure, despite significantly blocking isoprenaline-induced tachycardia. It is suggested that both the formulations produced similar degree of beta-1 adrenoceptor blocking activity.

beta-specific mRNA in suppressor T-cell line and hybridoma that do not synthesize beta-polypeptide.

The beta-specific mRNA were identified in the suppressor cell-line of murine and suppressor hybridoma of mouse origin by mRNA-DNA hybridization and isolation of cDNA with DNA and antibody probes.