Cost of implementing the QualityRights programme in public hospitals in Gujarat providing mental healthcare

Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems’ perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (?) 0.59 million to ? 2.59 million [1United States Dollars (US $) = ? 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.

Detection of Antibiotic Resistance and Biofilm-Producing Ability of Staphylococcus Species in Clinical Isolates

Background: Staphylococci are responsible for life-threatening infections in hospitals and community. Their ability to produce multiple virulence factors and antibiotic resistance is an important reason of high mortality in staphylococcal infections. Biofilm production by these organisms makes it difficult to treat. Most of the treating antibiotics are failing and making it a matter of concern. Aims?This study aims to detect the increased antibiotic resistance in biofilm-producing Staphylococcus and to compare the performance of three potential methods of detection. Methods?A total of 81 isolates of staphylococci including coagulase negative staphylococci (CoNs), methicillin resistant S. aureus (MRSA), and methicillin sensitive S. aureus (MSSA) are included in this study. After the identification, an antibiotic sensitivity test was performed. Biofilm detection was done by three different methods: Congo red agar method, tube adherence method, and microtiter plate method. Result?Out of the 81 samples, 37 CoNs, 17 MRSA, and 27 MSSA were identified. Out of them we got 43 (53%) biofilm producers by Congo red agar method, 40 (49%) by tube adherence method, and 52 (64%) producers by tissue culture plate/microtiter plate method. Most of the biofilm producers showed multiple drug resistance. Conclusion?We found out that the microtiter plate method is sensitive and reliable as compared with the other two methods. Antibiotic resistance was found to be very common in biofilm producers. This was due to the resistance developed as a result of the matrix that does not let the antibiotic bind with the organisms. This can make the treatment of Staphylococcus very difficult in the future as the rate of drug resistance is faster as compared with newly emerging antibiotics.

Perception of college-going girls towards corneal donation in North India: A latent class analysis study

Purpose: To assess the perception of college?going girls toward corneal donation in Northern India. Methods: An online survey with a pre?structured, pre?validated questionnaire was conducted on 1721 college?going girls in Northern India. The knowledge and attitude scores were regressed, and latent class analysis was carried out. Results: The average of scores for all participants was computed individually for the knowledge questions and the attitude questions, and based on this score, total participants were divided into two groups: Better corneal donation behaviors (BCDB) and poor corneal donation behaviors. The binomial logistic regression model of knowledge domain for predicting BCDB, age of the participant, their awareness about corneal donation, and willingness to discuss eye donation among family members were found significant. Similarly, for the attitude domain, awareness about corneal donation, knowledge about hours within which ideal eye donation needs to be undertaken, and knowledge about eye donation during coronavirus disease 2019 (COVID?19) pandemic were found to be significant. Latent class analysis identified one subset of participants having poorer knowledge and attitude scores and that they were more from a rural background, were having more than first order as birth order, were belonging to SC/ST classes, had illiterate or secondary education of father and mother, and were living in rented houses. Conclusion: The findings of the study significantly contribute to devising a mechanism to improve knowledge and influencing the attitude about eye donation among the youth, especially young women, who can act as counselors and motivators for the masses as well as their own families, in the generations to come.

Thymoma: A rare presentation as recurrent pericardial effusion

Recurrent pericardial effusion is always complicated for the primary care physician to diagnose, and it often goes undiagnosed. Thymoma is rare cancer, but it is the most common tumor in the anterior mediastinum. It can present in a variety of ways; it can be asymptomatic for an extended period of time and only rarely as pericardial effusion. A 68‑year‑old male presented to us with two episodes of pericardial effusion in the previous 2 years and was later diagnosed with thymoma.

Frailty as a predictor of outcome in heart failure in the elderly: An observational study at a tertiary care center

Introduction: Heart failure is the leading contributor to global morbidity and mortality. Frailty is an emerging prognostic factor in heart failure. There is little data on the prognostic role of frailty in patients admitted for acute heart failure as most studies have been done on stable heart failure patients. Methodology: The study included elderly (age ≥60 years) patients admitted with acute heart failure at a tertiary care center in India. Patients with dementia, cognitive impairment, and documented terminal illness were excluded. The sample size was 85 patients. Frailty assessment was done using short performance physical battery (SPPB) and Fried phenotype scales and follow‑up data was collected at 3 months postdischarge telephonically. The primary objective of the study was to determine the proportion of frailty in elderly in‑hospital heart failure patients. The secondary objectives were to see the agreement between the frailty assessment tools used (SPPB and Fried phenotype). Results: Eighty seven patients were included in the study. The majority were male (n = 45) and had heart failure with reduced ejection fraction (n = 56). Coronary artery disease (CAD) (n = 60) was the most common cause of heart failure. Eighty-two patients had at least one comorbidity. The proportion of frailty as per the SPPB was 43.67%, and as per the Fried phenotype was 68.9%. A total of 4 deaths and 15 re-admissions occurred during the follow-up period of 3 months. The majority belonged to the frail category as per both the frailty scales (P < 0.001 for SPPB, P = 0.087 for Fried phenotype). Fleiss’s kappa coefficient for agreement between the scales was 0.373 (SE = 0.106, P < 0.001), which signifies that there was a fair agreement between the two scales. The Spearman Rank correlation coefficient was −0.691 (P < 0.01) between the two scales. Hence, the SPPB score inversely correlated with the Fried phenotype. Conclusion: Frailty is largely prevalent in elderly heart failure patients. It can be used to predict poor outcomes in these patients. Clinicians should identify these high-risk patients at the time of discharge from their facility and consider interventions (tailored rehabilitation programs) to minimize the adverse outcomes.

Enhancement of mangiferin by fungal endophytes isolated from Salacia chinensis L. and Salacia oblonga Wall.

Microbes residing in the internal tissues of a plant are called endophytes, and are known for producing phytochemicals such as taxol, podophyllotoxin, azadirachtin and vinca alkaloids. In this study, out of five isolates from Salacia species, two fungi Penicillium capsulatum and Aspergillus fumigatus have been evaluated and confirmed by polymerase chain reaction (PCR) amplification for their endophytic action to produce mangiferin. Mangiferin has been reported to possess protective properties, including antioxidant, antidiabetic and immunomodulatory. It has been reported that the content of mangiferin is 7-9% in Mangifera indica, and is also present in other plants like Swertia chirata, Salacia chinensis, and Hypericum aucheri. Therefore, an attempt was made to explore the biotechnological approach and regulation studies to increase the production of mangiferin in S. chinensis and S. oblonga. Endophytes were isolated, screened, and analyzed, to evaluate the mangiferin in fungal extracts in comparison with crude plant extracts. An HPLC analysis was used to determine the mangiferin content present in the fungal extract of S. chinensis stem (74.74 g/mL), followed by fungi extracts of S. oblonga root (33.75 g/mL) and S. chinensis root (30.50 g/mL), compared with the plant extracts. These results were confirmed by FTIR analyses

Ocular morbidities among the geriatric persons, attending the ophthalmology outpatient department of a tertiary care hospital in eastern Odisha: A cross-sectional study

Background: According to the census of 2011, 13% of the Indian population was 60 years of age or older. As the geriatric population is the most vulnerable part of society, they are prone to all type of diseases including eye problems which are preventable or correctable but requires constant medical, financial, and social support. This study will find the magnitude of various ocular morbidities and their relationship with sociodemographic factors among geriatrics. Objective: 1. To find the magnitude of ocular morbidities among the elderly. 2. To study the relationship of different sociodemographic factors with ocular morbidities. 3. To estimate the average time spent for getting ophthalmic care at the outpatient department (OPD). Subjects and Methods: It was a hospital-based cross-sectional study conducted in the Ophthalmology OPD of Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, from January to December 2016. A total of 1320 geriatric persons were enrolled during this period. Ethical clearance was obtained. Results: Out of the 1320 geriatric patients, 58.86% were in the age group of 60–69 years, 35.22% in 70–79 years, and 5.9% ?80 years with a mean age of 67.7 ± 6.7 years. Males accounted for 70.98% and females for 29.02%. Different ocular morbidities detected are cataract (59.2%), refractive error (18%), ocular injury (5.9%), diabetic retinopathy (3.9%), glaucoma and chronic dacryocystitis (3%), and foreign body in the eye (2%). The total waiting time in the ophthalmology OPD to get ophthalmic care was 7.8 ± 3.2 min. The total consultation time in the OPD was 75.59 ± 27.15 min. Conclusion: The most common cause of visual impairment/blindness in the geriatric age group are cataract and refractive errors which are treated/corrected free of cost at any government health facility under the National Programme for Control of Blindness. People should be aware of the causes, prevention modalities, and treatment of the causes of blindness.

Early Initiation of Low-Dose Hydrocortisone Therapy for Septic Shock in Geriatric Patients: A Randomized Control Trial

Background: The management of septic shock has undergone significant modifications in the past decade. Various studies have concluded that while corticosteroids reduce the duration of shock, they do not have any proven mortality benefit. Moreover, the time of initiation of corticosteroids has been debatable. Since, little literature is available on geriatric patients, we have designed a randomized trial to assess the importance of early initiation of low dose hydrocortisone comparing with the standard therapy. Objectives: To determine the efficacy of early initiation of low dose hydrocortisone in reducing mortality in septic shock in geriatric patients. Methods: We conducted a single blinded, randomized controlled trial at a tertiary care hospital in India. Geriatric patients (age>60 years) fulfilling the criteria for septic shock were included in the study. All the participants were randomly assigned to two arms- intervention and standard therapy group. The outcomes were studied in terms of 28-day mortality, duration of ICU stay, duration of vasopressor requirement and need for mechanical ventilation Results: Total 120 patients were randomized to either Intervention arm (N=61) or the Standard therapy arm (N=59). The number of patients with reversal of shock was higher in the intervention arm (53.4%) but no statistically significant association (p= 0.575) was found. There was no significant difference between the two groups in terms of 28- day mortality, length of ICU stay, need for mechanical ventilation and duration of vasopressor support. Conclusion: This single centre trial demonstrated that there was no survival benefit associated with the early initiation of low dose hydrocortisone treatment in patients with vasopressor-dependent septic shock. It raised the concern that whether steroids are safe in elderly patients with septic shock.

Association of screen time, quality of sleep and dry eye in college-going women of Northern India

Purpose: To evaluate the association of daily screen time and quality of sleep with the prevalence of dry eye among college?going women. Methods: This study was a cross?sectional, comparative questionnaire?based study of 547 college?going women in northern India. A 10?item Mini Sleep Questionnaire was used to check the quality of sleep, and the Standard Patient Evaluation of Eye Dryness (SPEED) scale was used to examine the prevalence of dry eye among college?going women. Results: Multinomial logistic regression showed a significant association between dry eye with daily screen time spent (P < 0.05) and the quality of sleep (P < 0.05) among college?going girls. Using Latent Class Analysis, two latent classes were selected based on the Bayesian Information Criteria. It was found that the majority population falls in class two and was having Severe Sleep?Wake difficulty. It was seen that the participants in class two belonged to the age bracket of 18–21 years, were from stream Humanities, education of father and mother equal to graduation, father working only, belonging to the nuclear family, having one sibling, hailing from the urban locality, spending more than 6 h daily on?screen, a majority of them using mobile phones, not using eye lubricants, and reported an increase in screen time during COVID?19. Conclusion: Dry eye and sleep quality are essential global health issues, and coupled with increased screen time, may pose a challenge in the present era. Preventive strategies need to be incorporated in school and college curriculums to promote physical, social, and psychological well?being and quality of life

South Asian Working Action Group on SARCOpenia (SWAG-SARCO) e A consensus document

The South Asian population is rapidly ageing and sarcopenia is likely to become a huge burden in this region if proper action is not taken in time. Several sarcopenia guidelines are available, from the western world and from East Asia. However, these guidelines are not fully relevant for the South Asian healthcare ecosystem. South Asia is ethnically, culturally, and phenotypically unique. Additionally, the region is seeing an increase in non-communicable lifestyle disease and obesity. Both these conditions can lead to sarcopenia. However, secondary sarcopenia and sarcopenic obesity are either not dealt with in detail or are missing in other guidelines. Hence, we present a consensus on the screening, diagnosis and management of sarcopenia, which addresses the gaps in the current guidelines. This South Asian consensus gives equal importance to muscle function, muscle strength, and muscle mass; provides cost-effective clinical and easy to implement solutions; highlights secondary sarcopenia and sarcopenic obesity; lists commonly used biomarkers; reminds us that osteo-arthro-muscular triad should be seen as a single entity to address sarcopenia; stresses on prevention over treatment; and prioritizes nonpharmacological over pharmacological management. As literature is scarce from this region, the authors call for more South Asian research guided interventions.

A study of Mental Health Status in Healthcare Workers posted in a dedicated COVID-19 Hospital

Background: The massive toll due to COVID-19 has resulted in stretching of resources of healthcare systems and has led to unique demands on healthcare workers (HCWs) that are not seen in usual practice, which predispose them to mental health problems. The aim of the study was to assess mental health status in healthcare workers posted in COVID hospital as Mental health issues may impact decision making among HCWs, leading to medical errors and may also impact wellbeing in the long term. Methodology: This was a cross-sectional study. 799 HCWs posted in the COVID-19 wing of a tertiary care hospital were studied. Socio-demographic details were recorded and a Gujarati version of GHQ-28 was applied. A total score of ? 4 on GHQ-28 was considered indicative of ‘caseness’ or ‘psychiatric morbidity’. Association of outcomes like total GHQ-28 score, and responses on individual items of GHQ indicative of fatigue, sleep disturbances, stress, irritability, anxiety and others with variables like age, gender, profession, years of experience, marital status and family type was assessed. Results: 40 individuals (5%) reported at least one of the symptoms. The most commonly reported symptom was sleep disturbance, reported by 38 participants (4.75%), followed by stress in 34 participants (4.25%), fatigue in 29 participants (3.62%) and anxiety in 24 (3.00%). Decision-making problems, hopelessness, death wishes/suicidal ideation were rare. Conclusion: Age > 45 years was a significant predictor for GHQ-28 total score being ?4 and stress, experience > 5 years was statistically significantly associated with sleep disturbance, and being female was a significant predictor for fatigue.

Epithelioid inflammatory myofibroblastic sarcoma: the youngest case reported

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of the inflammatory myofibroblastic tumor. It has an aggressive clinical course and a high rate of recurrence. EIMS primarily affects children and young adults. Hereby, we report this entity in a 4-month-old infant who presented with an abdominal mass. Imaging studies revealed a large hypodense mesentery-based lesion involving the right half and mid-region of the abdomen. The mass with an attached segment of the small bowel was excised in toto. Grossly, a large encapsulated tumor was identified arising from the mesentery of the small bowel. The histological examination showed a tumor consisting of epithelioid to spindle cells loosely arranged in a myxoid background with numerous blood vessels and lymphoplasmacytic inflammatory infiltrate. On immunohistochemistry, the tumor cells showed positivity for ALK1 (nuclear), desmin, SMA, CD68, and focal positivity for CD30. A final diagnosis of EIMS of the small intestine was rendered. To the best of our knowledge, this case is the youngest reported case in literature.

Giant virilising adrenal cortical carcinoma

Androgen secreting adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Approximately 80% of tumors are functional, most commonly secreting glucocorticoids. We herewith report a case of a huge functional ACC of the right adrenal gland in a 33-year-old female who presented with complaints of hirsutism, amenorrhea and an abdominal lump. On abdominal examination a large lump was palpable in the right hypochondrium reaching up to the umbilicus. Contrast-enhance computed tomography (CECT) revealed a mass in the right suprarenal region. The tumor measured 29 cm × 20 cm × 12 cm and weighed 7.8 kg, the largest reported case of ACC in the world to the best of our knowledge.

Clinical and laboratory profile of dengue fever in children in a tertiary care hospital of Navi Mumbai, India

Background: Dengue fever is a mosquito born arboviral illness endemic in tropical countries and causes significant mortality and morbidity due to lack of definitive treatment. The objective of this study was to assess the clinical and laboratory profile of confirmed cases of dengue in children up to 12 years of age and also to charactrise the risk factors for severe dengue.Methods: This is a descriptive, observational, retrospective study done in the Department of Pediatrics, Terna Medical College, Nerul, Navi Mumbai, India.   Medical records of all children up to 12 years of age diagnosed to have dengue   were reviewed.  Their clinical and laboratory profile were recorded in a pro forma and analyzed. All cases were classified as per WHO guidelines into non severe and severe dengue cases.Results: Among the 117 confirmed dengue cases, (84.6%) had non severe dengue and (15.4%) had severe dengue. The most common age group affected was 9-12 years (45.3%) with a male to female ratio of 2.4:1. Fever was the most common clinical feature seen in all cases followed by headache (83%), myalgia (81%), ascites (24.7%), vomiting (17.9%). Clinical signs of ascitis, hepatomegally, gastrointestinal bleeding, pleural effusion and shock were predominantly associated with severe dengue cases. Laboratory parameters showed leukopenia in 58.1% and thrombocytopenia (platelet counts <20,000/cumm3) in16.2% cases. Elevated liver enzymes, raised hematocrit (36.3%) and coagulation abnormalities were seen in over 50% dengue cases and were significantly associated with severe dengue dengue.Conclusions: Knowledge of clinical   and laboratory profile of dengue cases of a particular area will help in early prediction of risk factors for severe dengue resulting in favourable outcome of such cases.

Migration of Abdominal Pain - An Effective Tool to Identify Appendicitis and the Only Parameter to Screen.

Acute appendicitis is a common disease. It may be tough to identify even with radiological and laboratory investigations. Migratory pain in the abdomen is a helpful key symptom, provided the patient presents within 24 hours of onset of appendicitis. METHODSPatients clinically presenting as acute appendicitis and operated for appendicectomy were recruited in the study. The presence and absence of migratory pain in the abdomen were evaluated and compared with the histopathology of the appendix. Parameters of diagnostic accuracy were measured. RESULTSThe sensitivity and specificity of migration of abdominal pain was found to be 97 percent and 100 percent respectively. The positive predictive value and the negative predictive value was 100 percent and 94 percent respectively. Overall diagnostic accuracy was 98%. CONCLUSIONSMigratory pain in the abdomen is a significant symptom to identify as well to rule out acute appendicitis.

Reliability of Leukocytosis in Diagnosing Acute Appendicitis.

Acute appendicitis is a frequently encountered surgical disease. Detection is difficult even with imaging and blood investigations. Total leukocyte count is a promising investigation. Its role in the confirmation of acute appendicitis is investigated and analysed in the present study. MethodsPatients having acute appendicitis treated by surgical intervention (appendicectomy) were included in the study. The leukocyte count measured before surgery was compared with histopathology findings of the appendix. Parameters of diagnostic accuracy of leukocytosis were measured by standard formulae. ResultsThe sensitivity and specificity of leucocytosis were found to be 76 percent and 12.5 percent respectively. The positive predictive value and negative predictive value of leucocytosis was 65 percent and 20 percent respectively. Overall diagnostic accuracy was 56 percent. The results were compared with histopathology of acute appendicitis. ConclusionsLeukocytosis is a helpful investigation to support the diagnosis of acute appendicitis.

Spontaneous uterine rupture of an unscarred uterus in primigravida: case report

A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality. Study report a case of spontaneous rupture of an unscarred uterus at 36 weeks of gestation in a 22-years primigravid woman. Ultrasonography showed posterior low-lying placenta praevia with lower margin touching internal OS. Operative findings during emergent caesarean section revealed e/o 2 L of hemoperitoneum, uterus was bicornuate and pregnancy was in the right horn. There was fundal rupture of right horn measuring approximately 6-7 cm anteroposterior. Incision was taken on the lower part of right horn and placenta was seen on anterior wall. Baby delivered as breech after incising placenta. Postoperative recovery was uneventful. In, conclusion, bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation.

Pregnancy outcomes in non-gynecological and non-hematological cancers: a retrospective cohort

Background: Of all the cancers in women, about 10% manifest in the reproductive age group. These can be broadly classified as gynaecological cancers and non-gynaecological cancers; Among the non-gynaecological cancers besides haematological cancer, breast, thyroid, colon, bone and CNS are seen rarely. Clinical acumen in diagnosis and management of these rare cancers that appear during pregnancy or before pregnancy are difficult due to insufficient guidelines and rarity of the conditions.Methods: A retrospective analysis of rare cancers during a period of 10 years in this hospital was performed. Data concerning the gestational age at delivery, birth weight, mode of delivery and complications and the management of the cancers during the pregnancy were collected.Results: Among the 41 women with these rare non-gynecological, non-hematological cancers, 13 pregnancies were in women with prior history of cancers and 28 pregnancies were with current history of cancer. Majority of these cases with prior history were thyroid cancers who had uneventful pregnancies and delivered normally. Among pregnancies with current history of cancer, breast, CNS, GIT, and head and neck were the cancers with 5-6 cancers in each category. About 50% of these cancers were delivered early between 31-35 weeks to facilitate optimal treatment. Cancers with guarded prognosis diagnosed before 20 weeks had a termination of pregnancy.Conclusions: Cancers during pregnancies are rare and their care must be individualized.

Relationships Between Causes of Psychiatric Readmission and To Validate Psychoeducational Module

Background: Readmission rate can provide an importantindicator of the global functioning of the health system such as,the articulation between inpatient treatment and communityinterventions. It provides an important tool in planning mentalhealth services. The present study highlights the causes ofreadmissions for psychiatric patients with a view to preparepsychoeducational module. It has scope in various fields likemedical and paramedical. It will help to prevent relapse andreadmissions in psychiatric patients and to the nurses inproviding psychoeducation to the patient and family.Materials and Methods: The study was conducted 100psychiatric patients who were re-admitted in 2 selectedinpatient mental health setups in Pune, Maharashtra. Semistructured questionnaire based on causes of psychiatricreadmissions was used which consisted of 30 questions withmultiple options. Descriptive and inferential statistics wereplanned to analyze the data obtained through interviews.Findings of previous functional pattern of readmitted patients–It was analyzed by mean, median, mode, standard deviationand mean %. The relationship between causes of psychiatricreadmissions and selected demographic variables were foundout by using Chi Square test.Results: The data presented in the table 2, figure 1 showsthat highest affected functional pattern in previous 3 months isself activity (35.07%) followed by dietary pattern (36.5%),health promotional activities (42.3%), relation with family(49.1%), social adjustment (52.7%) and self care (61.6%). Themost non affected functional pattern is economical adjustment(69.11%).Conclusion: Schizophrenia is the common condition of whichmaximum readmissions are found. With the help ofpsychoeducational module, the staff nurses, student nursescan provide psychoeducation to the patients and caregiversabout the comprehensive care of psychiatric patients at thehome including the psychosocial rehabilitation. Thus, therelapse and readmission of psychiatric patients can beprevented in mental health setups