Profile of distress callers and service utilisation of tele-counselling among the population of Assam, India: an exploratory study during COVID-19

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected people globally by causing psychological, social, and economic chaos. The Assam Police, India started telephone helplines to address the psychological issues. Aims: To evaluate the sociodemographic profile of the distress callers, their psychosocial concerns, the interventions provided by the service provider, and whether the service users were satisfied with the intervention(s) or not. Method: It was a cross-sectional study done during the period of lockdown (7-24 April 2020). All the callers who called the helpline were screened for anxiety, depression, suicidal thoughts (when required), and the psychosocial issues which they were facing were explored. They were provided the psychological intervention(s) at the appropriate time, and they were asked to rate their experience at the end. Results: A total of 239 callers used the tele-counselling services. The majority of callers were male (79.1%). Most of the callers were between 19-35 years of age group (66.5%), married (52.5%), and graduates (31%). Two-thirds of the callers called to seek guidance for their own issues and one-third for their relatives or friends. Callers had anxiety (46%), depressive disorder (8.3%), and depressive symptoms not qualifying for depressive disorder (14%), and suicidal thoughts (5.44%). The commonest intervention provided to the callers was supportive (77.8%), followed by psychoeducation (30.5%), cognitive behaviour therapy (24.7%), relaxation (23.6%) and behaviour therapy (13.4%). Most of the callers utilised more than one type of therapy. Overall, most of the callers were satisfied and appreciated the tele-counselling services. Conclusion: The findings could help in formulating psychological interventions to improve the mental health of vulnerable groups in the post-COVID-19 period to reduce psychiatric morbidity and mortality.

Murine models of Aspergillosis: Role of collectins in host defense.

Aspergillus fumigatus, a ubiquitous fungus, causes a wide spectrum of clinical conditions ranging from allergic to invasive aspergillosis depending upon the hosts’ immune status. Several animal models have been generated to mimic the human clinical conditions in allergic and invasive aspergillosis. The onset, duration and severity of the disease developed in models varied depending on the animal strain/fungal isolate, quantity and mode of administration of fungal antigens/spores, duration of the treatment, and type of immunosuppressive agent used. These models provide insight into host and pathogen factors and prove to be useful for evaluation of diagnostic markers and effective therapies. A series of studies established the protective role of collectins in murine models of Allergic Bronchopulmonary Aspergillosis and Invasive Pulmonary Aspergillosis. Collectins, namely surfactant protein A (SP-A), surfactant protein D (SP-D) and mannan binding lectin (MBL), are pattern recognition molecules regulating both innate and adaptive immune response against pathogens. In the present review, we discussed various murine models of allergic and invasive aspergillosis and the role of collectins in host defense against aspergillosis.

Solar elastosis in conjunctival squamous cell neoplasm.

Aim: To study the role of solar elastosis in the patient's with Conjunctival Squamous Cell Neoplasia (CSCN). Materials and Methods: Paraffin embedded 30 Conjunctival Squamous Cell Neoplasia tissues were studied for the presence of solar elastosis by Verhoeff's stain. Nineteen Squamous Cell Carcinoma (SCC), 6 Carcinoma In Situ (CIS) and 5 Conjunctival Intraepithelial Neoplasia (CIN) specimens were included in the study. Disease free conjunctiva and pterygium tissues were used as negative and positive control respectively. Results: Solar elastosis was found to be present in 19 of 30 (63.3%) Conjunctival Squamous Cell neoplasia specimens. Conclusion: Our study showed the presence of solar elastosis in conjunctival squamous cell neoplasia. Poor socioeconomic condition is an important factor as most of the elastosis positive patients were farmers.

Catastrophic health expenditure & coping strategies associated with acute coronary syndrome in Kerala, India.

Background & objectives: India contributes a significant number of deaths attributed to coronary artery disease (CAD) compared to the rest of the world. Data on catastrophic health expenditure (CHE) related to acute coronary syndrome (ACS), the major cause of deaths in CAD, are limited in the literature. We estimated the magnitude of CHE and studied the strategies used to cope with CHE. Methods: Two hundred and ten ACS patients (mean age 56 yr, 83% men) were randomly selected proportionately from six hospitals in Thiruvananthapuram district, Kerala, India. Information on demographics, ACS-related out-of-pocket expenditure and coping strategies was collected using a pre-tested structured interview schedule. CHE, defined as ACS-related expenditures exceeding 40 per cent of a household's capacity to pay, was estimated using the World Health Organization methods. Health security was defined as protection against out-of-pocket expenditure through an employer or government provided social security scheme. Socio-demographic variables, effect on participants’ employment, loans or asset sales for treatment purposes, health security coverage and type of treatment were considered as potential correlates of CHE. Multiple logistic regression analyses were conducted to identify the correlates of CHE. Results: CHE was experienced by 84 per cent (95% CI: 79.04, 88.96) of participants as a consequence of treating ACS. Participants belonging to low socio-economic status (SES) were 15 times (odds ratio (OR): 14.51, 95% CI: 1.69-124.41), whose jobs were adversely affected were seven times (OR: 7.21, CI: 1.54-33.80), who had no health security were six times (OR: 6.00, CI: 2.02-17.81) and who underwent any intervention were three times (OR: 3.24, CI: 1.03-10.16) more likely to have CHE compared to their counterparts. The coping strategies adopted by the participants were loans (41%), savings (14%), health insurance (8%) and a combination of the above (37%). Interpretation & conclusions: Our findings show that viable financing mechanism for treating ACS is warranted to prevent CHE particularly among low SES participants, those having no health security, requiring intervention procedures and those with adversely affected employment.

Compensation for trial-related injury: does simplicity compromise fairness.

India’s regulatory framework for research ethics is two pronged. Schedule Y of the Drugs and Cosmetics Act, 1940, of the Government of India, lays down the requirements for undertaking clinical trials for drugs and medical devices in India; it also requires compliance with the ICMR’s Ethical guidelines for biomedical research on human participants for such trials. Other health research may use the ICMR’s guidelines but this is not mandatory. The regulatory framework is operationalised through the offices of the Central Drugs Standard Control Organisation. However, the mechanisms of monitoring drug trials using this framework have proved to be rather weak.

Awareness, attitude and perceived barriers regarding implementation of the cigarettes and other tobacco products act in Assam, India.

Background : Tobacco use is a major public health problem in India. The Cigarettes and Other Tobacco Products Act (COTPA) was developed to curb this epidemic. Because no study has been conducted on the awareness, attitude and perceived barriers regarding the implementation of COTPA, this study was undertaken. Materials and Methods : A community-based cross-sectional survey was conducted among 300 adults (mean age 41 years, 52% men) selected by cluster sampling method from Guwahati Municipal Corporation. Information on awareness, attitude and their predictors and barriers for implementation was collected using a pretested, structured interview schedule. Multivariate analysis was done using SPSS. Results : Adults older than 50 years were 3 times (odds ratio [OR] 3.02, 95% CI 1.44-6.31) and those with more than 10 years of schooling were 4 times (OR 3.60, 95% CI 1.70-7.70) more likely to have good awareness of COTPA compared with their counter parts. Those belonging to the middle socioeconomic status (SES) were 3 times (OR 3.36, 95% CI 1.13-10.01), those who reported secondhand smoking harmful were 3 times (OR 3.32, 95% CI 1.45-7.62), and those with more than 10 years of schooling were 3 times (OR 2.92, 95% CI 1.01-8.45) more likely to have positive attitude toward COTPA compared with their counterparts. Lack of complete information and awareness of the Act, public opposition, cultural acceptance of tobacco use, lack of political support, and less priority for tobacco control were reported as barriers for COTPA implementation. Conclusion : Efforts should be made to increase the awareness of COTPA focusing on younger population, less educated, and those belonging to the low SES.

Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India.

Background & objectives: Kerala State is a harbinger of what will happen in future to the rest of India in chronic non-communicable diseases (NCD). We assessed: (i) the burden of NCD risk factors; (ii) estimated the relations of behavioural risk factors to socio-demographic correlates, anthropometric risk factors with behavioural risk factors; (iii) evaluated if socio-demographic, behavioural and anthropometric risk factors predicted biochemical risk factors; and (iv) estimated awareness, treatment and adequacy of control of hypertension and diabetes, in Kerala state. Methods: A total of 7449 individuals (51% women) stratified by age group, sex and place of residence were selected and information on behavioural risk factors; tobacco use, diet, physical activity, alcohol use, measured anthropometry, blood pressure was collected. Fasting blood samples were analysed for blood glucose, total cholesterol, high density lipoprotein cholesterol and triglycerides in a sample subset. Using multiple logistic regression models the associations between socio-demographic and anthropometric variables with biochemical risk factors were estimated. Results: The burden of NCD risk factors was high in our sample. Prevalence of behavioural and each of the biochemical risk factors increased with age, adjusting for other factors including sex and the place of residence. The odds ratios relating anthropometric variables to biochemical variables were modest, suggesting that anthropometric variables may not be useful surrogates for biochemical risk factors for population screening purposes. Interpretation & conclusions: In this large study of community-based sample in Kerala, high burden of NCD risk factors was observed, comparable to that in the United States. These data may serve to propel multisectoral efforts to lower the community burden of NCD risk factors in India in general, and in Kerala, in particular.

A selective method for the qualitative determination of paroxetine in forensic biological samples by liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Paroxetine is a schedule H antidepressant drug. It has occasionally been implicated in lethal overdoses. To identify and estimate the level of this drug in toxicological samples is a forensic challenge. Attempts have been made in the past to extract and detect paroxetine in blood samples by using a variety of techniques such as gas chromatography, gas chromatography-mass spectrometry, high pressure liquid chromatography, liquid chromatography-mass spectrometry, etc. However, no studies have been reported in other biological samples. In this study, an attempt has been made to identify paroxetine in biological samples by liquid chromatography-tandem mass spectrometry in multiple reaction monitoring mode at 330.15192.11. The product ion spectra proved to be very helpful in identification of the drug. Furthermore, multiple reaction monitoring (MRM) enhances the reliability and specificity of the method. The use of modified mobile phase produces good quality of qualifier ions. This method appears to be simple, sensitive, specific, and reliable.

In vitro cardiogenesis can be initiated in human CD34+ cells.

BACKGROUND: The extensive damage that occurs in the cardiac tissue after myocardial infarct is the major concern in post infarct management. It is very well known that adult stem cells mobilized by administration of G-CSF result in homing of stem cells into the damaged myocardium. This is because of the fact that stem cells have the ability to proliferate and capacity to generate into multiple cell lineages. METHOD: A healthy donor was selected as per the guidelines given by the institutional ethical committee and Helsinki declaration. The donor was given G-CSF 5 microg/kg/day and stem cells were harvested from the peripheral blood using Fresenius ASTec204 cell separator. The PBSC were then evaluated by immunohistochemical staining using anti-human CD34 monoclonal antibodies. The cells were then cultured in DMEM with 10% FCS for 17 weeks and in vitro cardiogenesis was initiated by adding 4 microM/l 5'Azacytidine. RESULTS: In vitro cardiogenesis was initiated in pure CD34+ cells with 5' Azacytidine. The cells showed spontaneous beating after 24 hours of treatment and after 5 weeks, the cells connected with the adjoining cells by a myotube. In these cells, expression of myosin light chain (MLC2v) gene and GATA-4 transcription factor validated the development of cardiomyocytes. CONCLUSION: It is observed that the transplantation of autologous stem cells/fetal cardiomyocytes in the heart scar tissue developed due to infarct, limited the scar expansion, and prevented post infarct heart failures. Homing process due to the transplantation of autologous stem cells is time consuming; therefore, transplantation of cardiomyocytes developed from autologous stem cells could be the future method of correcting the infracted myocardium.

Adsorption studies on wastewaters from cypermethrin manufacturing process using activated coconut shell carbon.

Cypermethrin is a pyrethroid pesticide and is used in the control of a wide range of insects on crops like vegetables, cereals, maize etc. In the present study, the adsorption efficiency of coconut shell based activated carbon for the removal of color and organic matter from cypermethrin pesticide manufacturing industrial wastewater was investigated. Effect of carbon dosage, pH and contact time on the removal of COD was also studied. Equilibrium and kinetic studies were carried out and the data was fitted in Freundlich and Langmuir models. The study proved that activated coconut shell carbon (acc) is an efficient adsorbent for treatment of cypermethrin industrial wastewaters under study.

Development of spray reagent for TLC detection of pyrethroid insecticides using picric acid.

There have been a variety of approaches developed since the 1970s to detect pyrethroid pesticides based on gas chromatography (GC), thin layer chromatography (TLC), and high performance liquid chromatography (HPLC) with ultraviolet detection. A new thin layer chromatographic method was developed for the detection of common pyrethroids in forensic toxicology case exhibits. Various solvent systems were tried as mobile phase with different spray reagents; picric acid was used as specific spray reagent for deltamethrin, fenvalerate, and cypermethrin. The method developed is rapid and sensitive and can be used for routine case analysis with better separation. A new modified spray reagent was developed for the detection of synthetic pyrethroids containing a hydrolysable nitrile group such as deltamethrin, fenvalerate and cypermethrin using picric acid, that produces reddish-orange spots on a yellow background.

Monitoring of fluoride concentration in ground water of Prakasham District in India: correlation with physico-chemical parameters.

Fluoride concentrations in surface and ground water samples were determined in eight villages of Prakasham district in India. Thirty-eight samples were collected and analysed for fluoride content along with pH, electrical conductivity, total dissolved solids (TDS), total hardness, total alkalinity, chlorides (C1), sulfates (SO2-) and nitrates (NO ). Fluoride concentrations in surface and ground water samples of these villages varied between 0.5 and 9.0 mg/L. Groundwater samples contained high concentrations of fluorides compared to open well and pond water samples, which could be a major source of fluoride in water since the geological formation of this area consists of fluorite and fluoropatite. From the data, it is evident that the population in the study area is severely affected by fluorosis. Dental and skeletal fluorosis and deformation of bones in children as well as adults were observed in the study area indicating the consequences of excess fluoride concentration. Fluoride concentrations showed good correlation with TDS concentrations (R2 of 0.61) compared to other physico-chemical parameters [EC (R2 - 0.36), nitrate (R - 0.24), total hardness (R - 0.12), chloride (R2 - 0.06) and sulfate (R2 - 4 x 10(-6))].

Predictors of treatment delays for tuberculosis in Sikkim.

BACKGROUND: This study examined the factors associated with delays (i) between the onset of symptoms and the patient's first visit to a medical facility (patient delay), and (ii) between a patient's visit to a medical facility and the diagnosis of tuberculosis (health system delay). METHODS: A cross-sectional survey was conducted of 323 patients (median age 30 years, men: 190) reporting to 2 tuberculosis units and 4 microscopy centres in East Sikkim using a pre-tested structured interview schedule. Patient records were verified for dates of investigations, diagnosis and treatment. Bivariate and multivariate analyses were done to find out the associations between dependent and independent variables. RESULTS: The median patient and health system delays were 21 and 7 days, respectively. Patient delay >30 days was reported by 17% and health system delay > 7 days by 49% of the participants. Patient delay was associated with self-medication (OR 2.28, 95% CI: 1.0-5.18), choice of government doctors as first contact (OR 2.76, 95% CI: 1.15-6.62), use of traditional healers (OR 2.18, 95% CI: 1.03-4.61) and cost of treatment 3Rs 400 compared with <Rs 100 (OR 2.52, 95% CI: 1.17-5.38). Important predictors of health system delays were first contact with private doctors (OR 33.1, 95% CI: 13.44-81.49) and cost of treatment (OR 2.5; 95% CI: 1.22-5.128). CONCLUSION: Efforts need to be made to eliminate the factors causing a delay in the initiation of treatment of patients with tuberculosis. These should include increasing awareness to avoid self-medication, the availability of free treatment, and training traditional healers and private doctors in the treatment of tuberculosis.

Prevalence-correlates-awareness-treatment and control of hypertension in kumarakom, kerala: baseline results of a community-based intervention program.

BACKGROUND, Hypertension is one of the major causes of cardiovascular morbidity and mortality. However, awareness, treatment, and control of hypertension remain major challenges worldwide. In this article, we present the baseline prevalence of hypertension from an ongoing intervention program for its control in a community-based sample in Kerala, Southern India. METHODS, We measured blood pressure, body weight, and height of 4955 individuals above the age of 30 yers (men;2159:mean-age: 50 years) and collected information on alcohol use, tobacco use, and other demographic variables using a pre-tested structured questionnaire. RESULTS, The overall prevalence of hypertension (JNC-VII) was 36.7% ( 95% CI:35.5-38.0; men: 36.0% and women 37.2% ) in multipile logistic regression analysis, a body mass index of >/=25 kg/m(2) was associated with a 1.65-fold (95% CI:1.37-1.98) prevalence of hypertension compared to a body mass index <25kg/m(2). Individuals with diabetes mellitus had 2.10 higher odds of hypertension prevalence (95% CI: 1.62-2.73) compared to people wihtout diabetes mellitus. Participants with increased waist circumference (90 cm in men, 85 cm in women) were 1.84 times more likely to be hypertensive compared to those with normal waist circumference (95% CI: 1.55-2.19). Among hypertensives, 24% were aware of the condition, 20% were on treatment, and 6.4% achieved effective blood pressure control. CONCLUSION, A higher body mass index, increased waist circumference, and self-reported diabetes mellitus were the important correlates of hypertension in our community-based sample. Our data emphasize the importance of educational interventions and appropriate lifestyle modifications that target increased body mass index and waist circumference to reduce the community burden of hypertension.

Tobacco use among medical students in Orissa.

BACKGROUND: Tobacco use is the most important cause of preventable morbidity, disability and premature mortality. There is a lack of adequate and reliable data on tobacco use among medical students and their perceived role as future doctors in tobacco control. We aimed to find out factors associated with tobacco use among medical students and their perceived role in tobacco control as future doctors. METHODS: A cross-sectional study was conducted among 1189 undergraduate medical students (68.5% men, median age: 21 years, age range: 17-27 years) in all 3 medical colleges of Orissa. Information on tobacco use, associated factors and their perceived role in tobacco control as future doctors was collected using a pre-tested anonymous questionnaire. Bivariate and multivariate analyses were done among the men respondents to find out associations between current tobacco use and predictor variables. RESULTS: The prevalence of current tobacco use was 8.7% (95% CI: 7.1-10.3); men: 12.4%, women: 0.8%. Among 286 ever users, 34% started using tobacco after joining medical college. Students with a higher personal monthly expenditure and with a family history of tobacco use were more likely to be current users. Third-year students were 3.2-times more likely to be currenttobacco users (OR: 3.21; CI: 1.43-7.19) compared to first-year students. Students who reported own tobacco use as not very harmful were 4.7-times more likely to be current users compared with those who reported otherwise (OR: 4.7; CI: 2.64-8.37). Compared to non-users, current tobacco users were less likely (p = 0.026) to assess tobacco use in their patients and were less likely (p = 0.012) to advise patients against tobacco use. CONCLUSION: Steps should be initiated early in medical colleges to prevent tobacco use, particularly among men students and those with a family history of tobacco use.

Prevalence and correlates of tobacco use among 10-12 year old school students in Patna District, Bihar, India.

In order to assess the prevalence and correlates of tobacco use among school students (10-12 years), information on tobacco use and socio-demographic variables was collected from 1626 students (male 1027) using a questionnaire. Bivariate and multiple regression analysis were done. Ever users in the sample were 16.6% (95 % CI 14.8, 18.4) and current users were 5.1 % (95 % CI 4.1, 61). Current use was significantly associated with male sex (OR 2.3, CI 1.09 5.14), students not participating in sports (OR 2, CI 1.04 4.04), tobacco use among friends (OR 4, CI 2.02 8.25), unaware of harmful effects of tobacco (OR 2.6, CI 1.1 6.14) and students who were used by parents and teachers to buy tobacco for them (OR 2.1, CI 1.4 4.19). Tobacco control programs focusing on male students, those who do not participate in sports, those whose friends use tobacco and those who are used by parents and teachers to buy tobacco are warranted.

Tobacco use in Kerala: findings from three recent studies.

BACKGROUND: We reviewed the literature on tobacco use in Kerala and present data from three recently conducted unpublished studies. METHODS: Three cross-sectional studies were conducted; a community-based study of 1,298 individuals aged 15 years and above (mean age 37.4 years, men 630), a school-based study of 1,323 boys (mean age 14.7 years), and a college-based study of 1,254 male students (mean age 18.2 years). Information on tobacco use and sociodemographic variables was collected using pre-tested, structured interview schedules and questionnaires. RESULTS: In the community study, 72% of men and 6% of women had ever used tobacco. Compared to men with > 12 years of schooling, those with < 5 years of schooling were 7 times more likely to smoke (OR 7, CI 3.2-15.6). The age at initiation of smoking was 19 years among those < 25 years of age compared to 25.5 years among ever smokers > 44 years. In the school study, the age at initiation among boys aged < or = 1 3 years was 10.7 years compared with 13.2 years among > or = 16-year-old boys. Boys whose fathers and friends used tobacco were 2 times and 2.9 times more likely to use tobacco (OR 2.0, CI 1.3-3.1 and OR 2.9, CI 1.6-5.1), respectively, compared with their counterparts. In the college study, 29% of the commerce students used tobacco compared with 5.3% of polytechnic students (p < 0.001). CONCLUSION: Survey data suggest that the age at initiation of tobacco use appears to be falling. A series of cross-sectional studies with larger sample sizes of the youth is required to confirm this impression. Tobacco use habits of fathers and peers are significant influences on youth smoking. There is a need to focus on particular types of colleges as these appear to have high-risk tobacco use environments.