Awareness and knowledge of diabetic retinopathy and associated factors in Goa: A hospital-based cross-sectional study

Purpose: To assess the awareness and knowledge about diabetic retinopathy (DR) and associated factors among patients visiting the tertiary health center in Goa. Methods: A cross-sectional descriptive study was conducted using a standard predesigned and pretested closed-ended structured questionnaire to assess the awareness, knowledge, attitude and practice about DR among patients visiting a tertiary health center. Results: Three hundred and fifty-eight subjects participated in the study. Only 125 (34.9% [95% CI: 30.0–40.1]) subjects were aware of DR and 122 (34.1% [95% CI: 29.2–39.2]) had adequate knowledge about DR. Awareness and knowledge of DR were significantly high among the subjects who completed college level of education (66.7%, OR = 2.78; 95% CI: 1.73–4.48, P < 0.001 and 55.9%, OR = 3.92; 95% CI: 2.41–6.38, P < 0.001) and who spoke English (52.5%, OR = 3.37; 95% CI: 2.14–5.30, P < 0.001 and 50.4%, OR = 3.26; 95% CI: 2.07–5.14, P < 0.001). Christians reported better knowledge about DR compared to other religions (48.8%, OR = 2.27; 95% CI: 1.38–3.75, P = 0.005). Negative association was noted between the knowledge of DR and presence of diabetes (29.4%, OR = 0.64; 95% CI: 0.41–0.99, P = 0.048). The practice pattern was strongly associated (OR = 7.47; 95% CI: 4.51–12.38, P < 0.001) with the knowledge of DR. Attitude was not influenced by any of the factors. Conclusion: We found that awareness and knowledge about DR were unsatisfactory; literacy contributed significantly toward it. These findings also suggest that there is an immediate need to enhance the awareness and knowledge of diabetic eye diseases in order to reduce the burden of visual impairment.

Barriers and enablers to low vision care services in a tertiary eye care hospital: A mixed method study

Purpose: Visual impairment is a major health concern all over the world. Globally, it has been studied that utilization of low vision care (LVC) services varies from 3% to 15%. This study describes barriers to access the LVC services and suggest enablers to improve the uptake of services in a tertiary eye care hospital. Methods: A snapshot qualitative research design with purposive sampling was adopted. Qualitative part of the study involved 13 eye care practitioners (ECPs) and 7 patients with low vision participated in one to one in-depth interviews. The interviews were audio recorded, transcribed, inductively coded, and analyzed. The barriers to access LVC services were identified and enablers to improve the uptake of services were implemented. The referral rate and utilization of LVC services were analyzed in the quantitative part. Results: Themes emerged out of qualitative part of the study were barriers, perceived benefits, and enablers to improve the uptake of LVC services. Barriers among ECPs included lack of awareness on referral criteria and available LVC. Barriers among patients were lack of knowledge and understanding about the need for services. The enablers included development of referral criteria and referral pathway to LVC services, creating awareness of LVC services to patients and ECPs, stratification levels of LVC services, and implementation of LVC counseling chamber. Referral rate improved from 25.6% to 51.2% and the utilization of services increased from 67.9% to 81.7% after implementation of the recommended enablers. Conclusion: Execution of stratified enablers increased the uptake of LVC services benefiting more number of people with low vision in this study.

Drug resistance profile of human Mycobacterium avium complex strains from India.

PURPOSE: To determine minimum inhibitory concentration (MIC) of various anti-tuberculosis drugs for Mycobacterium avium complex (MAC) strains isolated from clinical samples. METHODS: Forty-nine human isolates of MAC were tested for susceptibility to nine chemotherapeutic agents. All isolates were from Indian patients suffering from chronic pulmonary mycobacteriosis. Drug susceptibility was performed both by agar dilution and MIC method. MIC values were analysed, both visually and by enzyme-linked immunosorbent assay reader. RESULTS: More than 40% of the MAC isolates were sensitive to ciprofloxacine (48.98%), amikacin (46.94%) and roxithromycin (42.86%) by the MIC method. In contrast, the isolates showed high degree of resistance to the first line antituberculosis drugs: only 28.6% were sensitive to rifampicine, 22.85% to isoniazid and ethambutol each and 36.7% were sensitive to streptomycin. In addition, 22.85% of the strains were sensitive to clofazimine and 34.7% to kanamycin. CONCLUSIONS: Results of the study confirm the suitability of the rapid broth micro dilution (MIC) method as a simple yet reliable method to assay for the drug susceptibility of nontuberculosis mycobacterium.

Depression in medical disorders.

This review highlights the occurrence of depressive disorders in medically ill patients. It discusses the difficulties in diagnosing depression in the medically ill due to the vegetative symptoms of depression which are also a feature of many medical diseases. Depression in the medically ill may be due to the disease itself, its psychological reaction, due to complications because of metabolic or other disturbances, or due to the medications for the treatment of the disease. The role of active consultation liaison between medical specialists and mental health professionals will help provide total care to the medically ill.

Depression: psychosocial basis.

Normal emotions like sadness need to be differentiated from depressive illnesses. A number of psychological and social theories have been proposed to explain depression in the psychosocial context in which it occurs. A multifactorial bio-psychosocial approach to causation of depression provides a holistic understanding of the patient and also helps to plan appropriate pharmacological and psychosocial therapies to treat the patient.