Women’s Literacy a Major Predictor of Population Size: Findings from National Family Health Survey-5

Background: The global population continues to rise at different rates in different parts of the world. While some countries are seeing a fast population increase, others are experiencing population loss. Significant ramifications of such changes in the global population distribution would be felt, as they are critical for meeting the Sustainable Development Goals (SDGs), or we might say that rapid population expansion poses obstacles to sustainable development. Estimating the population size and composition by age, sex, and other demographic parameters is crucial for analyzing the country’s future influence on poverty, sustainability, and development. This study tries to look at these parameters covered by the National Family Health Survey- 5 (NFHS 5) to see how accurate and trustworthy the predictors of district population size are. Methodology: The study assessed the predictors of the population size of any district. It was conducted using the secondary data of phase 1 of NFHS-5. The outcome variable is the population of each district. Household profiles, literacy among women, their marriage and fertility, contraceptive usage, and unmet need for family planning were considered to assess their potential as a predictor of the district’s population size. Principal component analysis (PCA) was conducted to identify the predictors. Result: PCA was conducted on 18 variables, resulting in 7 principal components. Cumulatively, these components explained 77.6% of the total variation in data. On multiple linear regression, four principal components were found significant and these were related to women’s literacy, contraceptive usage, early pregnancy, the marriage of fewer than 18 years, and those using health insurance. Conclusion: Thus, women’s literacy plays a pivotal role in determining a region’s population size.

Covid-19: Catalyst for a comprehensive law to combat potential pandemics in India

Despite the relative decline in communicable diseases, India witnesses hundreds of outbreaks every year. Including the current Covid-19 pandemic, India has suffered through several major pandemics and large-scale epidemics since 1900s. However, the response to most of the epidemics has been inadequate. The Epidemic Diseases Act, enacted in 1897 (EDA 1897), has been in action since and is based on the science and the socio-political environment of the country in the nineteenth century. India has several legal mechanisms to help contain and control the spread of epidemics, but on different platforms. There has been a paradigm shift in the socio-political milieu as well as scientific advancements in the prevention and control of epidemics. The century-old EDA 1897 has not been effective in containing and controlling such epidemics/pandemics, as has been witnessed during the ongoing Covid-19 pandemic. Hence, it needs to be revised to define an appropriate structural scalar chain, provide clear-cut and unambiguous terms/definitions and guidelines, delineate ethics and human rights, determine the duties and responsibilities of the affected population/community, determine the role of the private health sector, and provide for appropriate punitive measures to deter repeated violations.

Viral Load-based Evaluation of the Sensitivity of Antigen-based Rapid Detection Assay for SARS-CoV-2

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a global public health problem. The real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard test for the detection of SARS-CoV-2. However, the assay requires hours to get the final results. Therefore, antigen-based rapid assays are being used extensively to reduce the time. We have evaluated the performance of the antigen-based rapid test for the detection of SARS-CoV-2 virus in comparison with RT-PCR. Materials and methods: Nasopharyngeal and throat swabs were collected from 366 suspected patients of COVID-19 visiting our institute and subjected to qualitative RT-PCR and antigen-based rapid assays to detect the presence of SARS-CoV-2 virus. The sensitivity and specificity of the antigen-based assay were calculated in comparison with RT-PCR. Results: Compared with RT-PCR, sensitivity and specificity of the antigen-based rapid assay were observed to be 70.5% and 98.6%, respectively, in comparison with RT-PCR. However, the sensitivity of antigen-based rapid assay varied significantly with decreasing viral load. The sensitivity of the rapid antigen assay was equivalent to RT-PCR (23/23, 100%) at a higher viral load (Ct value 15�). In contrast, the antigen assay could only detect 3/21 (14.28%) samples with Ct value >30. Conclusion: The antigen-based assay could assist in the rapid screening of a large population. However, the rapid antigen assay might not detect early stages of infection represented by low viral load. Therefore, the antigen-based assay could not replace RT-PCR testing. The study reiterates that all antigen-based negative tests should be confirmed by RT-PCR.

Prevalence of Anxiety, Depression and Self-Care Behaviour during the Covid-19 Pandemic in the General Population

Introduction: SARS-CoV-2 has affected not only physical health but also devastated mental wellbeing. The government of India ordered a nationwide lockdown limiting movement of the entire 1.3 billion populations. The impact of the pandemic on depression, anxiety and self-care behaviour among the general population was investigated. Methods: An online cross-sectional survey was carried out with an anonymous questionnaire using validated instruments. Multivariable linear regression analysis was carried out to find the role of each variable in determining the relevant scores. Result: The mean age of the 1052 participants was 30.52 (SD � 13.42) years. The mean score of depression and anxiety was 5.96 and 5.27 respectively. Moderate to severe depression was noted among 18.68% and moderate to severe anxiety was noted among 16.1% of the respondents. Gender was a significant predictor of all three (depression, anxiety, and coping) scores, while the civil status predicted both depression and anxiety scores and age predicted only the depression score. Conclusion: A considerable proportion of the surveyed population in our setting has manifested symptoms of anxiety and depression. Gender, civil status and age predicted various scores.

Assessment of Cold Chain System for Routine Immunization of Primary Health centres of the Bhojpur district of Bihar

Background: Immunization is an important among activity in the Public Health Services. The vaccines are highly temperature sensitive and vaccine potency once lost cannot be restored. A well-managed cold chain will increase the efficiency of immunization and reduce vaccine wastage. An assessment of cold chain system for vaccine storage was done in the all PHCs of the study area. Aims & Objectives: To evaluate the cold chain practices, with particular reference to assessing the availability of cold chain equipment, vaccine storage practices, monitoring of cold chain in primary health centres (PHCs) of Bhojpur district. Material & Methods: A cross-sectional study was conducted at all the cold chain points of 14 PHCs of Bhojpur district during January to May 2015. A predesigned, pretested checklist was used by the trained investigators during their visits. The information was evaluated on the basis of important components related to the cold chain points. Results: All the PHCs had a dedicated cold chain room with sufficient number of cold chain equipment. Consolidated effective vaccine management score for cold chain points of 8 (57.1%) PHCs were average (60-79%). None of the PHCs have satisfactory score (≥ 80%). Vaccine storage practice and availability of complete RI micro-plan were found satisfactory at 12 (85.7%) PHCs. Maintenance of cold chain equipment were satisfactory at 10 (71%) PHCs. But, temperature monitoring. (5) (35.7%) and waste disposal related to routine immunization 3 (21.4%) PHCs were disappointing. Conclusion: The primary health centres had average performance related to the cold chain system, which is a matter of concern warranting for the cold chain monitoring. We recommend supportive supervision as the key measures in improvement of cold chain system.

Primary meningeal melanocytoma.

Meningeal melanocytoma is an uncommon benign pigmented primary lesion that has to be distinguished as a pathological entity separate from other benign melanin containing tumours as well as its overtly malignant counterpart, melanoma. In the present study, a 58 year old lady presented with bilateral sensory and motor symptoms in the lower limbs. The MRI scan showed a dumb-bell shaped lesion in the spinal canal at 6th cervical vertebra to 1st thoracic vertebra (C6-T1) level mimicking a schwannoma and histologically proved to be melanocytoma.

A ten-year retrospective study on poisoning cases in two major cities of Malaysia and India.

This is a retrospective study conducted at Kuala Lumpur, Malaysia, and Delhi, India to make preliminary assessment about poisoning cases and their etiologies. The study was aimed at finding out the common age group involved, methods of poisoning, and types of substances used for committing suicide. Besides this, it also attempts to relate with ethnic groups and their choice. The commonest age group affected in both Malaysia and India appears to be the 16–30 group. Indians are more likely to commit suicide by poisoning (58.9%), compared to Chinese (28.5%), and Malays (5.3%). The majority of the cases of poisoning were suicidal in nature (58.8%), followed by accidental (16.6%), and homicidal (0.1%), while a significant number of cases were unclear in nature (24.4%). This study serves as a pilot project for more detailed prospective and retrospective studies involving multiple centres in the future.

Women with septic abortion: who, how and why? A prospective study from tertiary care hospital in India.

A prospective descriptive interview based hospital study was carried on 47 women admitted with septic abortion to evaluate their psychosocial, demographic and clinical profile These women were predominantly parous (75%), hindus (60%), between 20-30 years of age (60%) and mostly married (91.4%) house wives (63.8%). More than 90% already had one or more male child. The contraceptive use was dismally low (23.4%). Their knowledge about legalisation, place and persons authorized to conduct abortions was very less, however large majority (87%) underwent abortions within 3 months of pregnancy. Large family, poverty and spacing were the main reasons cited for abortions. Abdominal pain, fever, genital bleeding, diarhoea and abdominal distension were presenting clinical features in order of frequency. Advanced sepsis and associated medical and surgical complications were present in more than half the patients and 6% succumbed to these problems. The current experience was an eye opener for most of them and changed their future attitude. Hence education, economic prosperity, easy access to reproductive health facilities and institutional management of sepsis is the key to make abortions safe.

Achalasia cardia: A study of 113 patients managed with indigenous dilator.

BACKGROUND: Endoscopic dilatation of achalasia cardia is an effective nonsurgical management option. It requires costly pneumatic dilators which are used under fluoroscopic guidance. This study assesses the efficacy and safety of an indigenous pneumatic dilator used without fluoroscopic guidance. METHODS: Over a period of eleven years, 113 patients (69M, 44F) ofachalasia cardia underwent dilatation with indigenous pneumatic dilators without fluoroscopic guidance. The dilatation was performed under endoscopic vision. RESULTS: The procedure was successful in all patients. After six weeks following dilatation, there was significant improvement in the mean dysphagia score 3.63 + 0.61 to 0.53 + 0.93 (P<0.01). The response was still significant (0.78 + 1.03, P <0.05) at the end of one year. Excellent response with single dilatation was seen in 70.7% patients. After two dilatation sessions 92% of patients showed an excellent response. One patient had perforation. There was no mortality. CONCLUSION: Pneumatic dilatation under endoscopic vision without fluoroscopic assistance with the indigenous dilator is very effective and safe for short term treatment of achalasia carida.

Endoscopic band ligation for non variceal bleed.

Endoscopic band ligation (EBL) is an infrequently used modality for treatment of non-variceal hemorrhage. We report the successful use of this technique for the management of bleed from blue rubber bleb nevus syndrome lesions and post polypectomy bleeding stalk.

Lipid peroxidation and antioxidant enzymes in gestational diabetics.

The exact pro-oxidant and antioxidant status in gestational diabetes is still unclear. To add new insight to the question, changes in the lipid peroxidation products (MDA) and activities of antioxidant enzymes: superoxide dismutase (SOD) and catalase in red blood cell hemolysates were evaluated in 20 women with gestational diabetes. 20 healthy pregnant women served as the control group. Statistical analysis was done using unpaired Student' t - test. Pregnant women with gestational diabetes showed an increase in lipoperoxidation products (P < 0.001) and a decrease in SOD activity (P < 0.01) as compared to normal pregnant women while no significant change was observed in catalase activity. These findings suggest increased oxidative stress and decreased detoxification or free radical scavenging capacity in pregnancy complicated by diabetes.

Quadriparesis in a young female suffering from rheumatoid arthritis.

Cervical spine is involved in a significant proportion of patients suffering from rheumatoid arthritis. Although cervical spine disease may often be 'benign', neurological complications are not uncommon. Patients of rheumatoid arthritis should be screened for cervical spine involvement and appropriately treated with combination of anti-rheumatic drugs. We report a case of quadriparesis secondary to subluxation and disc herniation at C4-C5 level in a young woman with rheumatoid arthritis of short duration.

Auditory evoked responses in gestational diabetics.

Electrophysiological correlates of sensory function in diabetic pregnancy have not been documented. Present study reports changes in Auditory evoked responses (AER) in gestational diabetics when compared with normal pregnant controls. Human AER are generally classified into early Auditory brainstem responses (AER), Mid latency responses (MLR) and late Slow vertex responses (SVR). These potentials were recorded in 20 women with diabetic pregnancy using Ag/AgCl electrodes from Cz-A1 and Cz-A2 position on MEB 5200 Neuropack II ... plus (Nihon Kohden, Japan) Evoked Potential Recorder. The evoked potentials in gestational diabetics were compared with 20 age matched normal pregnant women using Student's t-test. Absolute latencies of waves I to V, Inter peak latencies I-III and I-V of ABR were significantly increased whereas amplitude of wave V decreased in diabetic pregnant women. No significant change in latency of any component of MLR was observed between the two groups whereas significant prolongation of latencies of all components of SVR was observed in diabetic pregnant women as compared to normal control group. These findings indicate prolongation of both peripheral transmission time (PTT) and central transmission time (CTT) in diabetic pregnant females. Prolongation of latencies of SVR components in this study implicates cortex in the central diabetic neuropathy in women with gestational diabetes.

Concomitant acral necrosis and haemolytic uraemic syndrome following ingestion of quinine.

Thrombotic microangiopathy, which broadly includes thrombotic thrombocytopaenic purpura (TTP) and haemolytic uraemic syndrome (HUS), is a multisystemic disorder that is characterised by thrombocytopaenia, microangiopathic haemolytic anemia and ischaemic manifestations, resulting from platelet agglutination in the arterial microvasculature. Acral necrosis (distal necrosis of fingers and toes) occurs usually as a sequel to severe Raynaud's phenomenon, a vasculospastic disorder frequently related to endothelial cell dysfunction. We report a case of quinine induced TTP-HUS and acral necrosis, two distinct clinical abnormalities which have not yet been reported together in association with quinine. Both of these conditions in this case resolved promptly to treatment with corticosteroids.

Impact of daily versus weekly hematinic supplementation on anemia in pregnant women.

OBJECTIVE: To compare the effectivity of weekly versus daily iron therapy in reducing maternal anemia and to evaluate the association of maternal hemoglobin and fetal growth. DESIGN: Prospective. SETTING: Tertiary care teaching hospital in an urban metropolis. METHOD: 40 pregnant women received daily and 40 pregnant women received weekly oral therapy (335 mg of ferrous sulphate and 500 g folic acid) for a period of 14 weeks. The age of each pregnant woman and their baseline anthropometric data (weight, height and body mass index) were estimated. Hemoglobin and hematocrit estimations were carried out during follow period at 4 wks, 8 wks and 14 weeks. Serum ferritin values as a marker of iron status were also calculated in both the groups initially, at 14 weeks and at the time of delivery. Fetal anthropometric indices of 137 full term neonates delivered to mothers included in either of the supplementation groups or admitted to the hospital were also studied in relation to maternal hemoglobin concentration. RESULTS: Forty subjects each were initially randomized into groups I and II. The age of pregnant women along with their baseline anthropometric data were similar in both groups. A total of 29 pregnant women in group I and 27 pregnant women in group II could be regularly followed up. The increase in hemoglobin and hematocrit values were similar in daily and weekly supplemented mothers. An intention to treat analysis also showed similar results. The ferritin values were similar at the start of supplementation and after 14 wks of weekly or daily iron therapy. Birth weight, crown heel length, head circumference of the neonate and placental weight increased significantly with rise in maternal hemoglobin levels. CONCLUSION: Weekly iron supplementation is an effective mode of treating anemia among pregnant women and maternal anemia during pregnancy is adversely associated with fetal growth.