Reporting adverse events of ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) among the vaccinated healthcare professionals: A cross-sectional survey

Background & objectives: The safety of the ChAdOx1 nCoV-19 vaccine is a cause of concern for many who have been vaccinated. The people have multiple concerns and fear regarding the adverse events of the vaccine. Thus, this study was undertaken to establish the safety profile of ChAdOx1 nCoV-19 Corona Virus Vaccine (Recombinant) among the healthcare professionals. Methods: This was a descriptive cross-sectional survey. After taking clearance from the institutional ethics committee 1500 healthcare professionals, who had their vaccination in the past two weeks were selected. They were provided with an online survey proforma regarding adverse events following immunization (AEFIs) of COVID-19 vaccine developed using google forms with an informed consent form affixed to it. Results: A total of 1036 individuals participated in the study. The mean and median (inter quartile range) age of the participants was 37.7 ±11.25 and 35 (29-46) yr, respectively. Of these, 52.1 per cent were female, 29.3 per cent were doctors, 33.4 per cent were nurses and 9.5 per cent were paramedical staff. Forty six per cent participants experienced one or more minor AEFIs such as pain, tenderness, redness, etc. at the injection site. Fatigue (31.75%), generalized feeling of unwell (28.57%), muscle pain (23.16%) and fever (21.71%) were the most commonly reported systemic AEFIs followed by headache (20.07%), dizziness (10.03%) and joint pains (15.25%). Most of them experienced these AEFIs within 24 h of the first dose of administration. About 42 per cent of the participants took oral antipyretics/analgesics for managing the AEFIs. Interpretation & conclusions: ChAdOx1 nCoV-19 Corona Virus Vaccine was found to be associated with mild local and systemic AEFIs that were more common after the first dose as compared to the second dose. There adverse events could be dealt with oral over-the-counter medications, with no requirement of hospitalization

Retrospective analysis of complications in 3600 patients of laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy results in specific complications which occur frequently as compared to open cholecystectomy. Several aspects of these complications and their treatment modalities were analyzed.Methods: 3600 cases of laparoscopic cholecystectomy performed by a single surgeon at various private hospitals in Jammu (Jammu and Kashmir), India during the period of 18 years from March 2002 to March 2020 were analyzed for the complications and their management.Results: Complications of laparoscopic cholecystectomy occurred in 14.5% of the patients. The most common complication was haemorrhage. Conversion to open cholecystectomy was necessary in 41 (1.13%) patients due to obscure anatomy as a result of adhesions and acute inflammation. In the study, 6 deaths (0.16%) were recorded.Conclusions: Laparoscopic surgeon should remain highly vigilant to detect major complications like injury to small gut at the time of entry into the peritoneal cavity or bile duct injury during laparoscopic cholecystectomy at an earliest and should timely manage such cases to save the life of the patient.

Modified three port laparoscopic cholecystectomy versus conventional four port technique

Background: The current  study was undertaken to compare the results of modified three-port laparoscopic cholecystectomy and conventional three or four-port surgery in terms of technical feasibility, safety of the technique, postoperative pain and need of post-operative analgesia, cosmetic satisfaction of the patient and cost effectiveness and were found to be better with the modified technique.Methods: In modified three port laparoscopic cholecystectomy technique, first 10 mm umbilical, second 5 mm epigastric and third 5 mm subcostal ports are made, i.e., "10-5-5" instead of "10-10-5" or "10-10-5-5" of conventional three or four port techniques and finally, gallbladder is extracted through the umbilical port.Results: The pain in the postoperative period and the requirement of postoperative analgesia were significantly less and there was better cosmetic satisfaction of the patients operated by the modified three port laparoscopic cholecystectomy technique as compared to conventional three or four port surgery.Conclusions: The modified three-port laparoscopic cholecystectomy technique is safe and has the same comfort and feasibility to the surgeon along with added advantage of less pain and better cosmetic appearance to the patient in comparison to the conventional three or four-port surgery, with no obvious increase in complications and is definitely a viable alternative procedure for the management of cholelithiasis.

Screen Time in Under-five Children

Context:Screen-viewing in childhood is primarily a mean of entertainment, during the unstructured time. We aimed to review the burdenof the problem, delineate the associated factors and correlates, evaluate the impact of screen-time on the overall health of under-fivechildren, and the interventions to reduce screen-time. Evidence acquisition:Published articles from January 2009 to June 2018 weresearched through PubMed, Clinical Key, Scopus, Embase, and Google Scholar using key Medical Subject Heading words. Results: Theburden of screen-time varied from 21% to 98% in the middle-income, and 10% to 93.7% in the high-income countries. The socialecological model was used to illustrate associated factors and correlates including child, caregiver, micro and macro digital-mediaenvironment related factors. The interventions included increase in the physical activity, reduction in the body mass index, improvingsleep and dietary behaviors etc. The effectiveness of these interventions ranged from 0.3 minutes (standard error 13.3) to -47.16minutes (standard error 2.01). Conclusion: Clinicians should obtain history of screen-time in children, and advise limiting the screenexposure according to the child’s age. There is a need to generate evidence on burden and effectiveness of interventions amongchildren in the Indian settings, owing to the limited data.

Audiovisual informed consent process in vaccine trials: Experience from North India

Audiovisual (AV) recording of the informed consent process in a clinical or vaccine trial to document the consent process of participants (especially from vulnerable populations), ensures preservation of their rights and well-being. This paper describes the AV consent process during a phase III rotavirus vaccine trial among healthy infants in Chandigarh and examines its effects. Out of 155 parents/guardians of participating infants who were contacted to be a part of the study, 50 were reluctant to participate in the study trial (not necessarily in the AV consenting process). Among 105 parents/guardians of participating infants who expressed initial willingness to participate in the trial, all agreed to undergo the AV consenting process; and 100 finally consented to participate and were enrolled in the study. So, the participation rate was 64.5% (100/155) among those who were contacted, and 95.2% (100/105) among those who underwent the AV consenting process. AV recordings of these 100 patient representatives were transcribed and later translated into English for a thematic analysis of the text. A total of 105 queries were raised by 55 participants. All queries were patiently listened to and addressed, allaying most fears, especially those related to adverse events following intervention. The AV process ensured transparency and accountability of the investigators, responsive referral mechanism in case of adverse events, building an initial rapport with the participant, complete vaccination of the trial subjects, and provision for free private care consultation depending upon the willingness of the parents. These benefits of the AV consent process might have led to a higher participation rate

Hospital-based Surveillance of Rotavirus Diarrhea among Under- five Children in Chandigarh.

In a prospective hospital-based surveillance of 958 under five children admitted with acute gastroenteritis in Chandigarh (May 2011 to July 2012), 239 stool samples were collected. Rotavirus antigen was detected in 18.8% of samples by reverse transcriptase polymerase chain reaction. Genotypes G1P[8] (53.3%), G12P[6] (15.6%) were prevalent, and G3 not detected.

Inequity in Awareness and Utilization of Adolescent Reproductive and Sexual Health Services in Union Territory, Chandigarh, North India.

Background: Adolescents are a heterogeneous, vulnerable, and sexually active group. Geographical and educational health disparities exist among urban, rural, and slum adolescents and among out-of-school and school-going adolescents, respectively. Adolescent reproductive and sexual health (ARSH) services should be implemented in a manner to minimize health inequities among them. Objectives: To ascertain the extent of awareness and utilization of ARSH services provided under reproductive and child health(RCH) program among adolescents in Chandigarh. Materials and Methods: A crosssectional study was conducted among 854 adolescents (402 household, 200 out-of-school, and 252 school-going adolescents) in Chandigarh using pretested validated interview schedule on awareness and utilization of adolescent reproductive and sexual health services from February to April 2011 in North Indian Union Territory of Chandigarh. Ordinal regression analysis was done to study the association of socio-demographic variables with awareness and utilization of ARSH. Results: Awareness about contraception and health services was significantly less among rural (12.7% and 1.1%, respectively) adolescents as compared to slum (17.9% and 4.6%, respectively) and urban adolescents (33.5% and 7.8%, respectively) (P < 0.05). Out-ofschool adolescents were utilizing the preventive [odds ratio (OR) 0.39, P < 0.001] and curative services significantly lesser (OR = 0.54, P < 0.001) and had higher substance abuse (OR = 4.26, P= 0.006). Awareness was significantly associated with older age of adolescents (OR = 4.4,P < 0.001), poor education of father (OR = 0.5, P = 0.002), rural area (OR = 0.56, P = 0.001), and out-of-school status (OR = 0.35, P < 0.001). Conclusion: Awareness and utilization of ARSH services was inequitable and was more among urban and school-going adolescents. Educational status was the most important factor affecting it.

Introducing Combined Measles, Mumps and Rubella Vaccine in Chandigarh, India: Issues and Concerns.

Cyclical outbreaks of mumps have been noticed across Chandigarh city during winter months. Chandigarh does not provide measles, mumps and rubella (MMR) vaccination in the State immunization schedule. Epidemiological shift in age at diagnosis of mumps was noticed with higher incidence in older children and adults. Increased occurrence of complications can be predicted with this age shift. Silent burden of rubella with serious outcomes in newborns further strengthen the case for MMR vaccine inclusion in routine immunization program of Chandigarh.

Impact of National Rural Health Mission on Perinatal Mortality in Rural India.

Innovations under National Rural Health Mission have paved the way for increased utilization of hospitals for childbirth. The association of increase in hospital deliveries with decline in the perinatal mortality rate in rural India after the launch of NRHM in 2005 was assessed using the Sample Registration System reports. Relative increase in hospital deliveries was 57% from year 2005 to 2008 but relative decline in the PNMR was only 2.5% in the rural areas of Indian states (r=0.2; 95% confidence interval -0.2-0.6; P=0.3). Hence, quality of care at the time of childbirth needs to be assessed.

Knowledge and skills of primary health care workers trained on integrated management of neonatal and childhood illness: Follow-up assessment 3 years after the training.

Background: The primary health care workers of a district in northern India were trained in the year 2006 for Integrated Management of Neonatal and Childhood Illness (IMNCI) using two different training methods: conventional 8-day training and new interrupted 5-day training. Knowledge and skills may decline over a period of time. Rate of decline may be associated with the type of training. A study was thus conducted to see the retention of knowledge and skills in the two training groups, 3 years after the initial training. Materials and Methods: This study was done in the Panchkula district of Haryana state in northern India. In the year 2006, 50 primary health care workers were given new interrupted 5-day training and another 35 workers were given conventional 8-day training on IMNCI. Knowledge and skills of the same workers were evaluated in the year 2009, using the same methodology and tools as were used in the year 2006. Data analysis was done to see the extent of decline in knowledge and skills in these 3 years and whether decline was more in any particular training group. Results: Compared to post-training score in the year 2006, composite knowledge and skill scores for Auxilliary Nurse Midwives (ANMs) and Anganwari workers (AWWs) together declined significantly in the year 2009 from 74.6 to 58.0 in 8-day training group and from 73.2 to 57.0 in 5-day training group (P < 0.001). Follow-up composite scores in the two training groups were similar. Whereas the decline was more for knowledge scores in 8-day training group and for skill score in 5-day training group, the pattern of decline was inconsistent for different health conditions and among ANMs and AWWs. Conclusion: Long-term retention of knowledge and skills in 5-day group was equivalent to that in 8-day training group. Refresher trainings may boost up the decline in the knowledge and skills.

Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India.

Background & objectives: Severe clinical pneumonia and meningitis caused by Haemophilus influenzae type b in children less than 5 yr old is preventable by use of Hib vaccine. However, data on Hib burden in India are limited. To support an evidence-based decision for Hib vaccine introduction in India, a vaccine probe study was planned. This paper presents the results of the preparatory phase for such a study, which aimed to determine the feasibility of conducting a randomized vaccine probe study and to estimate the incidence of all causes of pneumonia and meningitis. The preparatory study included population-based, hospital-based and carriage surveillance. Methods: Children aged 18-24 months and were enrolled at PGIMER, Chandigarh, CMC, Vellore and NICED, Kolkata, from July 2005 to December 2006. At the time of enrollment, parents were informed about the signs and symptoms of pneumonia and meningitis, and were encouraged to take the child to study hospitals for treatment. Hospitalized children less than two years of age suspected of having pneumonia and/or meningitis were enrolled in study hospitals, whether or not they were from the cohort population. Patients were examined clinically and received chest radiograph for suspected cases of pneumonia or lumbar puncture for suspected cases of meningitis. Blood culture was done for both pneumonia and meningitis patients. Cerebrospinal fluid (CSF) was tested for biochemistry, culture, latex agglutination test and polymerase chain reaction. Nasopharyngeal swabs were collected from healthy children less than 2 yr of age at immunization clinics to estimate Hib carriage. Results: A cohort of 17,951 children were recruited for the population-based arm. The incidence of severe clinical pneumonia ranged from 2717 to 7890 per 100,000 child-years of observation; suspected meningitis ranged from 1971 to 2433 per 100,000 child-years of observation. In the hospital-based study 7/90 (7.8%), 29/98 (29.6%) and 38/181 (21.0%) of CSF samples with cell count ≥100 WBCs/mm3 were purulent at Chandigarh, Kolkata and Vellore respectively. Of these purulent CSF samples, Hib was detected in 2, 6 and 11 cases, respectively. The Hib nasopharyngeal carriage prevalence ranged from 6.0 - 7.6 per cent. Interpretation & conclusions: Incidence of severe clinical pneumonia is comparable with other studies from India but that of suspected meningitis is higher. Although rates of Hib meningitis cannot be calculated from a hospital-based study, there is evidence of Hib meningitis in these study settings. Hib carriage prevalence indicates that Hib is present and circulating in these study areas. There is a significant burden of pneumonia and meningitis among children in India. Continued strengthening of laboratory capacity and bacterial surveillance systems are necessary.

Ocular morbidity prevalence among school children in Shimla, Himachal, North India.

BACKGROUND: Data on eye diseases among school children is not readily available. Considering the fact that one-third of India's blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important. AIM: To estimate the prevalence of ocular morbidity among school children of age 6-16 years. SETTINGS: Government and private coeducational schools in urban area of Shimla. DESIGN: Cross-sectional. MATERIALS AND METHODS: Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination. STATISTICAL ANALYSIS: The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level. RESULTS: Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%), refractive errors 22% (CI=21.1-22.8%), squint 2.5% (CI=2.4-2.6%), color blindness 2.3% (CI=2.2-2.4%), vitamin A deficiency 1.8 % (CI=1.7-1.9%), conjunctivitis 0.8% (CI=0.79-0.81%). Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P< 0.5) more in government schools. CONCLUSION: A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders.

Prenatal Diagnosis of Meckel-Gruber Syndrome with Dandy Walker Malformation

We report a 38 week old female fetus affected by Meckel-Gruber syndrome. Polycystic dysplastic kidneys, oligohydroamnios, symmetrical IUGR, hydrocephalus with Dandy-Walker cyst was observed on ultrasonographic (USG) examination. Small occipital encephalocele with polydactly was noted after delivery of child.

Ureterocele

Ureterocele, a rare condition, is a congenital saccular dilation of terminal portion of the ureter. Presented here is a case report of a patient who had complaints of recurrent urinary tract infection and right loin pain. The ultrasonography followed by intravenous pyelography proved it to be the case of ureterocele.

Spinal Intradural Metastasis

We describe a rare case of intradural Spinal metastasis.We discuss herein the clinical presentation and role of surgery and radiotherapy in such cases.