Molecular characterization & recombination analysis of complete enterovirus-88 isolated from acute flaccid paralysis cases in India

Background & objectives: Focus on non-polio enteroviruses (NPEVs) causing acute flaccid paralysis (AFP) due to myelitis has increased with the containment of the poliovirus. Enterovirus-B88 (EV-B88) has been associated with the AFP cases in Bangladesh, Ghana, South Africa, Thailand and India. In India, EV-B88 infection was linked to AFP a decade ago; however, to date, no complete genome has been made available. In this study, the complete genome sequence of EV-B88 was identified and reported from two different States (Bihar and Uttar Pradesh) in India using the next-generation sequencing technique. Methods: Virus isolation was performed on the three AFP suspected cases as per the WHO-recommended protocol. Samples showing cytopathic effects in the human Rhabdocarcinoma were labelled as NPEVs. Next-generation sequencing was performed on these NPEVs to identify the aetiological agent. The contiguous sequences (contigs) generated were identified, and reference-based mapping was performed. Results: EV-B88 sequences retrieved in our study were found to be 83 per cent similar to the EV-B88 isolate from Bangladesh in 2001 (strain: BAN01-10398; Accession number: AY843306.1). Recombination analyses of these samples demonstrate recombination events with sequences from echovirus-18 and echovirus-30. Interpretation & conclusions: Recombination events in the EV-B serotypes are known, and this work reconfirms the same for EV-B88 isolates also. This study is a step in increasing the awareness about EV-B88 in India and emphasizes future studies to be conducted in the identification of other types of EV present in India.

Biopotency and toxicity of diverse group of insecticides under laboratory condition against sunflower defoliator Spilarctia obliqua (Walker)

The biopotency and toxicity of two groups, conventional and newer insecticides [eight commercial insecticides] were determined against Bihar or Common hairy caterpillar (BHC) Spilarctia obliqua (Walker). Experiment carried out in the laboratory by exposing BHC larvae to insecticides. Biopotency was measured at different time intervals from 12-72 h after insecticidal application showed that all of the insecticides outperformed the control. At 48 h after imposing, the highest mortality percentage (100) was observed on spinetoram 11.7 SC and chlorfenapyr 10 SC, which are comparable to cyantranaliprole 10.26 OD, followed by chlorantraniliprole 18.5 SC, ?-cyhalothrin 5 EC and chlorpyriphos 20 EC, with the lowest mortality percentage observed on tolfenpyrad 15 EC (66.67 %). In chlorantraniliprole, cyantranaliprole, spinetoram, tolfenpyrad, fipronil, chlorfenapyr, ?-cyhalothrin and chlorpyriphos, respectively, the toxicity level of insecticides was calculated based on median lethal concentration (LC50) values of 0.36, 0.48, 0.52, 0.50, 0.69, 0.98, 1.43 and 3.82 ppm. The overall conclusion of this trial was that spinetoram 11.7 SC and chlorfenapyr10 SC are the best chemicals for controlling the early stages of BHC larvae. In comparison to traditional insecticides, new insecticides have the highest level of toxicity

Correlation of waist-to-hip ratio with smoking and hypertension in coronary artery disease patients: Report from a tertiary care hospital in Bihar

Background: Obesity, especially central obesity has been proved to be a risk factor for overall deterioration of health with emphasis on cardiovascular disease. Aim and Objectives: In this study, we aimed to find if there is any correlation between waist-to-hip ratios with smoking and hypertension in patients from a tertiary care hospital in Bihar. Materials and Methods: After taking permission from the institutional ethics committee, this study was conducted in the department of physiology and medicine in a tertiary care hospital in Bihar. Coronary artery disease patients were recruited from the in-patient department of medicine department. The waist circumference and hip circumference were measured by fiberglass measuring tape to the nearest 1 cm. The smoking history and history of hypertension were obtained. Results: A total of 75 patients (57 male and 18 female) were included in the study. There was 26 (34.67%) smoker and 49 (65.33%) non-smoker. Among the patients 34 (45.33%) were suffering from hypertension and 41 (54.67%) patients did not suffer from hypertension (?2 = 0.15, z = 0.38, P = 0.70). There was no gender difference in waist-to-hip ratio (WHR) (t = 0.4553, P = 0.65). Among the patients, WHR, smoking, and hypertension did not show any significant correlation. Conclusion: Among the coronary patients, there was no correlation of WHR with smoking and hypertension. Even smoking and hypertension did not show any relationship. Hence, obesity, smoking, and hypertension should be considered as individual risk factors for coronary artery disease.

Understanding Sanitation Dynamics in Bihar, India: Evidence from the Field Survey

Background: Although a good number of individual household latrines have been constructed in Bihar during the past few years, still, a huge task remains to be completed. The paper is based on the study of “concurrent monitoring of LSBA/SBM [G] in select districts of Bihar”. Objectives: The aim is to understand different dimensions of the sanitation situation in Bihar. The objective is to suggest policy based on the findings. Materials and Methods: This study is based on primary data collected at the household level and public institutions in six districts of Bihar. Results: The analysis reveals that except a few categories, socioeconomic indicators such as religion, economic condition, or educational attainments have no significant impact on having a latrine at the household level. The variations in the construction of latrines among different districts emphasize that the public program needs to be implemented more effectively. It is also found that women are more vulnerable in a situation of open defecation. Conclusion: The challenge is to encourage people for the sustained use of the constructed latrines. This puts emphasis on changing the behavioral pattern of the people. This requires organizing a continuous awareness generation program with the aim to change the behavior.

PERCEPTION AND SATISFACTION OF TOURIST TOWARDS THE BIHAR AS A TOURISM DESTINATION

Tourist satisfaction has been touted as a way to boost a destination's competitiveness. In order to gain a better understanding of tourists towards the Bihar as a tourism destination, present is a case study of Bihar, with the goal of identifying the underlying dimensions of tourists' satisfaction, determining whether tourists can be divided into distinct segments, and examining the significant differences between segments and socio-demographic and travel arrangement characteristics. Three clusters emerged from a segmentation procedure based on destination dimensions: the 'Higher-Satisfied,' the 'In- Betweeners,' and the 'Lower-Satisfied.' The study's implications and conclusions are discussed in relation to future marketing of Bihar tourism

Pattern of anorectal malformation in a tertiary care hospital of Bihar

Background: Anorectal malformation (ARM) is common cause of neonatal intestinal obstruction and is one of the most common neonatal surgical emergency encountered by paediatric surgeons. There is no published study about the prevalence of ARM cases within the referral zone of the hospital. This study was done to demonstrate the burden of Anorectal malformation and their surgical intervention as seen in Indira Gandhi Institute of medical science, Patna, Bihar.Methods: Data were retrospectively collected over a period of four years between January 2015 and December 2018. The data collected were demographic status of the patient, diagnosis, associated anomaly, duration of hospital stay and their surgical intervention.Results: There were 395 cases of anorectal malformation out of 93203 OPD patients (0.42%). Male to female ratio of 3.01:1.  ARM also represented 25.3%   of neonatal emergency surgical procedures. The majority of the patient had presented in the neonatal period (51.6%) with mean weight of 2.6 kg. The most common type of ARM found in male patient was rectourethral fistula n=215 (54.4%) in which 164 (76.2%) patients were with rectobulbar fistula and 51 (23.8%) patients had rectoprostatic fistula. Sixty nine (17.4%) female patients presented with perineal fistula.Conclusions: We found a clear male preponderance of anorectal malformation in our study. Patients affected were mostly from poor socioeconomic strata of the society. Present study confirms huge work load of anorectal malformation in this region. This will be helpful in future planning and effective management including financial constraints of the treatment for our poor patients.

Clinical Profile of Cutaneous Tuberculosis in a Tertiary Care Teaching Hospital in Eastern Bihar

Introduction: Sleep-deprivation is a state of combinedabsence of sleep and extended wakefulness. Notoriouslyknown to be associated with slowing of cognitive processeslike attention, working memory, and executive functions, it isalso a consequence of insomnia which in turn is an infamoussymptom of depression. Depression has adverse effects onsocial functioning, which further shape its course and outcome.Material and Methods: This systematic review is basedon a systematic search of electronic database PubMedand provides an overview of literature defining cognitiveimpairment and depression, followed by their associationswith sleep deprivation, entailing possible mechanisms ofthese inter-relationships along with the networks in the humanbrain which are susceptible or resilient towards the effectsof insufficient sleep. A total of 47 such articles and studiesconsidering all these aspects were reviewed.Results: Reductions in functional MRI signals in thedorsolateral prefrontal cortex in sleep deprivation are thoughtto account for attention deficits. Impaired working memoryseconded by an overall increase in reaction times wereobserved, while scanning efficiency was claimed to remainunaffected,by some authors. Long term potentiation wasseen to decrease due to sleep deprivation. Alterations in theHPA axis, stress and high cortisol levels, low brain-derivedneurotrophic factor levels were also interlinked with bothsleep deprivation and depression.Conclusion: Sleep deprivation interrupts physiologicalfunctions, neurocognitive processes, and worsens depression.Hence sleep for upto six to eight hours each night isrecommended on the lines of this review.

Epidemiological Profile of Hip Fractures: A Case-Control Study in a Tertiary Care Teaching Hospital of Bihar

Hip fractures have become an important cause of morbidity and mortality among adults all over the world. The objective of this study was to study epidemiological profile of hip fractures and assess the risk factors responsible for hip fractures in patients attending orthopaedics department of a tertiary care hospital in Bihar and to compare these factors with healthy control population. Methods: The present study was a retrospective case-control study conducted in a tertiary care hospital in Gaya, Bihar. Forty cases and forty controls were selected. Results: BMI was found to be statistically lower in the fracture group (p=0.035) as compared to controls. 67.5% of fractures were extra-capsular and 32.5% were intra-capsular. Overall, age 60-69 years showed the maximum burden of hip fractures. Fractures taking place indoors (62.5%) were higher than those occurring outdoors (37.5%). Physically active in the past (p=0.036) and alcohol usage (OR, 4.75; p= 0.045) were the factors which were significantly associated with the hip fracture. Conclusion: Hip fractures in Indian population are on a rising trend. Efforts should be made to reduce morbidities associated with hip fractures.

Admissions to a sick new born care unit in a secondary care hospital: Profile and outcomes

Background: To reduce neonatal mortality in North Bihar, evidence is required about the impact of sick newborn care units (SNCUs) in secondary level hospitals on mortality at the end of the neonatal period. Objectives: The objective of the study is to assess the profile of neonates admitted to an SNCU and the outcome at the completion of neonatal period. Methods: A cohort of neonates admitted from March to June 2014 to an SNCU was assessed through family interviews and hospital records. Demographic details (age, sex, and socioeconomic status) and clinical details (antenatal care, birthplace, weight, diagnosis, and family history) were documented. Follow-up was done at discharge or death or referral and the completion of neonatal period. The primary outcome was survival at the completion of neonatal period. Secondary outcomes were case fatality rate at discharge and weight gain. Results: Of 210 neonates assessed, 87.6% (95% confidence interval [CI] 82.4–91.4) survived till the end of the neonatal period. The case fatality rate at the time of discharge was 0.9% (95% CI 0.3–3.4). Majority of the diagnoses were infections, hyperbilirubinemia, and infant of diabetic mother. Mean weight gain at the end of neonatal period (n = 157) was 706 g (P = 0.00). Sex ratio at admission was 567 girls to 1000 boys (95% CI 428/1000–751/1000). No neonate from lower socioeconomic families was admitted. Conclusions: SNCUs in remote areas can bring down neonatal mortality in North Bihar. Unequal access of SNCUs services to girls and lower socioeconomic groups highlighted the existing barriers which require attention.

Tobacco use among school going children in Bihar, India

Tobacco use has become prevalent in India and nearly 15% of youth use tobacco in one or other form. However, very few studies have explored the use, knowledge about its hazard, and attitudes of tobacco use among youths. So, this study was done to determine the pattern of use as well as knowledge and perception of tobacco among students attending schools of 8th to 9th grad in Sasaram, Bihar. Methods: A cross sectional survey was performed among 515 students in the 8th and 9th grades in 8 schools in Sasaram, Bihar. The study period was from 1st January to 31st December, 2018. Results: Ever use of smokeless tobacco was reported by 31 (6.1%) students in the survey. 18 (3.5%) students reported ever using smoked tobacco. Students were more likely to identify cigarettes and bidis as tobacco products compared to smokeless tobacco products like gutkha and khaini. Betel nut products were used by 91 (17.7%) students. Conclusion: The high rate of smokeless tobacco and betel nut use along with less levels of knowledge about their contents and harms suggests that tobacco control programs of Government of India targeting youth should ensure that these products are adequately explained and understood by students all over India.

Perspectives on adolescent girls’ health-seeking behaviour in relation to reproductive health in Rohats, Bihar, India

Adolescents girls face major problems related to menstrual abnormalities which lead to morbidity that may have an adverse effect on their school attendance. The objective of this study was to collect and analyse data on prevalence of menstrual patterns and menstrual disorders among adolescent girls attending Adolescent Reproductive Sexual Health clinic in a tertiary care teaching hospital in Rohtas, Bihar and assessing their treatment seeking behaviour. Methods: We conducted a cross sectional study o 140 girls in the age group of 10-19 years in a study period of one year. Demographic information and characteristics of menstrual bleeding were noted. Results: The study sample consisted of 140 girls with mean age 14.9± 2.5 years. Most of the girls were in the age group 12-14 years (37.8%). 79.3% girls had attained menarche at a mean age of 12.5 ± 1.3 years. The most common menstrual disorder was painful menstruation seen in 66.7% girls. The mean number of bleeding days was observed to be 5±1.7 days. The most common associated symptom reported by girls was backache. As per treatment seeking behaviour of adolescent girls, only 25.5% girls with history of heavy menstrual bleeding, 27% with painful menses and 34.8% with irregular cycles took medical advice by a doctor. Oligomenorrhoea was observed in 11.7% girls. Conclusion: In spite of high prevalence of menstrual disorder, only a few adolescent girls seek expert medical advice. There is a need to create awareness among girls about seeking medical advice for menstrual problems.

Russel’s score and diabetes mellitus type 2 “finding the association”: a cross sectional study from one of the districts in Bihar, India

Background: Diabetes has been on the rise since last decade or so with prevalence rate changing as more research is being done. India is one of the most burdened country from diabetes specially type 2. With changing life style other diseases are also on the rise and evidence is being generated to find tangible association. One such disease is periodontitis. As evidence from the State of Bihar for association between periodontitis and diabetes mellitus is negligible this study was conducted to find the same.Methods: A cross sectional observational study in community settings was done for three months on 200 diabetic willing participants. Data was generated using a semi structured pretested questionnaire. Data analysis was done using SPSS version 22.0 and statistical measures of central tendency like mean, mode, median and standard deviation were used.  For establishing association chi square tests were used. P values<0.05 were considered to be statistically significant.Results: 61.5% of the participants were male while 65.5% were from rural area. The study population was on an average on the older side with a mean age of 52±12.15 and on the bulky size with a BMI of 28.85±4.08. Authors got the average Russel’s score to be 1.1±1.79. The mean blood sugar level for fasting was 146.40±59.99 and post prandial levels was 211.59±82.49. A Russel score category of established periodontal disease and terminal disease was present in 77.5% of participants having an altered fasting blood sugar level. Majority of the males had established periodontal disease and terminal disease. Patients with elevated postprandial blood sugar levels had more established periodontal disease and terminal disease.Conclusions: Oral health is definitely associated with diabetes mellitus type 2 and its other factors like duration, glycaemic control, blood sugar levels etc. Public awareness regarding this is minimal. More research and awareness regarding this will help in keeping the diabetic population healthy.

A Study On Efficacy And Tolerability Of Miltefosine For Childhood Visceral Leishmaniasis In A Tertiary Care Centre In Eastern Bihar

Introduction: Leishmania donovani is an intracellular protozoan parasite of genus Leishmania. It causes Visceral leishmaniasis (VL), which is a disseminated and serious form of leishmaniasis. VL causes an estimated 500,000 new cases of disease and 60,000 deaths every year. VL is deadly and debilitating disease affecting children of Bihar and U.P. Antimony resistance is a serious problem, Amphotericin B and Pentamidine are effective by parenteral administration, associated with toxicities. Thus there is a need for an effective, orally administered, non–toxic and less expensive alternative drug like Miltefosine, to be used in children. Aims and Objectives: The present study was designed to observe the efficacy of Miltefosine in VL, in Bihar by evaluating the usage of adult dosage of Miltefosine (2.5 mg/kg/d for 28 days) in 160 children (age, 2–11 years). Materials and Methods: Our study is an open–label, clinical trial involving 160 patients admitted at JLNMCH, Bhagalpur, Bihar who were parasitologically proven cases of VL who received Miltefosine and were followed up for the following one year. Results: Out of 160 children, 2 died of pneumonia, other 158 patients demonstrated no parasites after treatment and improved clinically. 6 patients relapsed, 2 patients lost follow–up. Cure rate was 94% .Side effects included vomiting or diarrhea (each 25%) and transient elevations in the AST level (55%). Conclusions: The present study concludes that Miltefosine is effective, well tolerated, and easily administrable oral drug in the treatment of VL in Children in resource poor country like India

Study on Obesity and Overweight among School Going Adolescents of Nalanda District

Obesity is associated with many health problems. Obesity rates are gradually increasing. The present descriptive study was conducted to find the prevalence and factors of overweight and obesity among school children of Nalanda. It was seen that 5.3% children were overweight and 1.7% were obese. Living in urban area, being female, less outdoor activities, lesser indoor activities and habit of fast food eating are associated with higher chances of obesity. Health education is needed to control the situation.

Community based Study on distribution of Blood Pressure and its correlates among School Going Children of Nalanda District

Hypertension is major risk factor for many illnesses. Studies have shown that burden of hypertension in children is increasing. Hence, this study was conducted to find distribution of blood pressure and correlates among School Going Children of Nalanda District. Mean SBP was 107.1±7.8 mm of Hg and mean DBP was 71.0±4.4 mm of Hg. It was seen that mean SBP and DBP were higher for males as compared to females (p=0.00) and higher age (p<0.05) and not related to religion (p>0.05) and socioeconomic status (p>0.05). Routine BP measurement in children is vital.

Cross-sectional Study on Pulmonary Function Tests among Adolescent Medical Students of VIMS, Pawapuri

PFTs are important tool for assessment of respiratory system. This study was conducted among 189 adolescent medicos of VIMS, Pawapuri to assess the pulmonary function tests. It was observed that the difference in FVC for males and females was not significant (p=0.16). FEV1 for males and females were different significantly (p=0.02). However, FEV1/ FVC % was similar in males and females (p=0.76). PEFR was different in males and females but this difference was not significant (p=0.053). This provides baseline data of PFTs for adolescent age group in this area.

Study of factors associated with open defecation in a rural area of Nalanda District

Open defecation has many health hazards. Still, it is rampant in different parts of the country. The present study was conducted to find the prevalence of open defecation and factors associated with this behaviour among residents of rural area of Nalanda District. Open defecation was practiced by 35% of rural population. It was significantly associated with age (p=0.02), sex (p=0.01), education (p=0.00) and occupation (p=0.00). Association with caste (p=0.23), type of family (p=0.63) and type of housing (p=0.053) was not significant. Open defecation has strong roots in our culture and access/ availability of toilets poses many challenges.

Rollout of Quality Assurance Interventions in Labor Room in Two Districts of Bihar, India.

Background: Quality of care at the facilities during childbirth remains a major concern. Improved quality could have the greatest dividend in saving maternal and newborn lives. Objective: The objective of this study was to implement quality assurance measures in the labor rooms of select public health facilities in two districts of Bihar. Methods: The labor room quality assurance intervention was implemented in two districts, Gaya and Purnea in Bihar. Health facilities having >200 deliveries/month were assessed using labor room quality assurance checklist developed by the Ministry of Health and Family Welfare. The critical gaps affecting service delivery were identified, and a list of priority actions for quality improvement was developed. An intervention model was rolled out in consultation with the district authorities focusing on the building blocks of the health system. The interventions were implemented from August 2014 to March 2016 in selected facilities after which an assessment was conducted. Results: Initial assessment of labor room was conducted in 24 facilities. After 2 years of intervention, there was a definite improvement in quality assurance scores in most facilities. The infection control scores increased by 20 points in Gaya (from 40 to 59.9) and 10 points in Purnea (from 57.6 to 67.1). The highest gain in scores was observed in quality management component in Gaya (from 6.2 to 58.2). The model attempted to incorporate all the elements of the health system to ensure scalability and sustainability. Conclusion: It is possible to have an implementable quality assurance mechanism within public health system with sustained efforts and commitment.

Macrobenthic Diversity During Pre and Post Drought Period of a Floodplain Wetland in Vaishali District of Bihar.

Qualitative and quantitative estimation of macrobenthic fauna was done during pre and post drought period. A total of 18 species of macrobenthos were recorded during pre drought and 17 in post drought period. Maximum number of species was reported in Mollusca followed by Diptera and Oligochaeta. The average contribution of Mollusca was 94.72%, Dipetra 2.98% and Oligochaeta 2.30% to total benthic species of the Chaur. Bellamya bengalensis, Gabbia orcula, Gyraulus convexiusculus, Lymnaea acuminata and Lymnaea auricularia were the molluccs which were found in all the monthly samples. Number wise Gyraulus convexiusculus was most abundant followed by Gabbia orcula while Lamellidens marginalis and Pila glabosa were the least abundant. In pre drought period average number of macrobenthos was 3176/m2 while in post drought period, it was 2676/m2. Analysis of the various index showed that diversity of benthic fauna was higher in WIN season followed by RMON, PRM and MON season. Winter seems to be a favourable season for benthic organisms. Availability of different species of mollusks indicated the good cultural and unpolluted condition of Chaur.

Low serum zinc levels in an endemic area of visceral leishmaniasis in Bihar, India.

Background & objectives: India carries approximately 50 per cent of the global burden of visceral leishmaniasis and majority of patients from the poor, rural communities of Bihar State. Zinc is an essential trace element and its relevance for proper functioning of the entire immune system is already well documented. Though low serum zinc levels have been reported in many parasitic diseases, limited information is available regarding zinc status in human leishmaniasis. We investigated to define the relationship between zinc level in visceral leishmaniasis (VL) patients in endemic and non-endemic regions. Methods: Venous blood was collected from 88 patients, 16 parasitologically confirmed VL, 35 healthy controls from endemic area (Bihar) and 37 healthy urban controls from non-endemic area, Delhi. In all the three groups, levels of serum albumin, total protein (markers of nutritional status) and zinc were estimated by colorimetric methods. Results: Serum zinc levels were found to be significantly lower (P<0.001) in VL patients than non-endemic controls. The serum zinc levels in VL endemic controls were also significantly lower (P<0.001) than non-endemic controls, but these values were not statistically significantly different from VL patients. However, all samples from Bihar (VL patients and controls) had lower serum zinc levels than non-endemic controls from Delhi. Interpretation & conclusion: Low serum Zn levels, in healthy subjects from Bihar and more significantly in VL patients of this region, are possibly associated with vulnerability and endemicity of visceral leishmaniasis in the region. Further studies need to be done to assess the role of oral zinc supplementation in better management and prevention of VL, particularly in endemic areas.