A technological approach to “Reaching the Unreached” – Leveraging teleophthalmology services in Rural Gujarat

Purpose: Early detection of sight?threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost?saving estimates for the end user. Methods: A prospective, observational, cross?sectional hospital?based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Results: Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost?saving for the patients. An average of Rs. 621/? were saved per patient for the community in our study. Conclusion: Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community.

Capacity building of community health workers: One size does not fit both rural and urban settings

The Accredited Social Health Activist (ASHA) programme in India is the world's largest all-female Community Health Workers (CHWs) programme. ASHAs are supposed to bridge the gap between community and health services by functioning as healthcare catalysts, service providers, and community-level health activists. This paper discusses the ethical challenges posed by using the same template for capacity building of ASHAs in rural and urban contexts, without accounting for the differences. Urban heterogeneity and rapidly growing urbanisation demand special attention for crucial programme activities like the capacity-building of ASHAs. When the relevant literature like policy and programme documents, training modules, and implementation guidelines were analysed, it was evident that the simple transplantation of rural models to urban contexts would not be a useful strategy. The recommended areas for improvement are the urban-specific customisation of ASHAs’ roles, the consideration of urban heterogeneity in the training content and pedagogy, utilising the advantages of the urban set-up, ensuring supportive supervision mechanisms for ASHAs, strengthening overall inter-sectoral convergence and community processes in urban areas.

LEATHERY THERIDIIDS OF THE GENUS PHORONCIDIA (ARANEADAE: THERIDIIDAE) RECORDED FIRST TIME IN NAVSARI, GUJARAT, INDIA

A ?rst report of the genus Phoroncidia Westwood, 1835 described from Navsari district, Gujarat, India. It is distinguished from other species in this genus in having a pair of dorsal and large median posterior humps. The group of Phoroncidia is also new to Gujarat, India.

Knowledge, attitude, and prevention of self-medication practices among the general population of Gujarat

Objectives: The practice of self-medication (SM) without consulting a health-care professional among the populace of both developed and developing countries like India may lead to a delay in therapeutic effectiveness. The present study was conducted to assess the knowledge, attitude, and practice of SM among the general population of Gujarat. Material and Methods: An observational, cross-sectional questionnaire-based study was conducted among 488 participants between April 2021 and May 2021 to evaluate the several aspects of SM. In April 2021, this study was conducted on both the genders of 18–80 years of urban and rural areas of Gujarat. Data were analyzed for descriptive statistics. The data presented in the form of percentages using tables and figures. The responses were collected and analyzed using GraphPad v.8 and Microsoft Excel for percentage and statistical significance. Results: Prevalence of SM was 78.3%. It was found to be practiced more among the younger age group (55.32%) than the older. Graduates practiced SM more than the others (P < 0.004). Significant association was found between its practice and residency (P < 0.03), marital status (P < 0.003), education (P < 0.004), and occupation (P < 0.0007). Fever, cough, and cold were the most common conditions noted for SM practice followed by headache. It was noticed that 63.5% participants were procured medications from pharmacy. Multivitamins, nonsteroidal anti-inflammatory drugs, and antibiotics were the most frequent medications used by participants. Conclusion: The prevalence of SM is alarming which causes serious health issues and needs an intervention. Planning of health awareness programs, educating people, and pharmacists are necessary for promoting rational use of medication.

A STUDY ON AGRICULTURE FINANCE: NEW PARADIGM FOR GUJARAT AGRICULTURE SECTOR

India as developing country is hugely depending upon agriculture due to labour intensive technique adopted in agriculture sector. Gujarat is greater contributor because of its demographical advantage and crop pattern. Despite of industrial growth in Gujarat state, it can be said that Gujarat still did not lost its potential and growth in playing its part in agricultural development. Agriculture finance on other side has its crucial role to play in growth of agriculture Finance. The present paper indicates the potential and performance of agriculture in Gujarat state and also attempt has been made to address agriculture finance performance in Gujarat. Gujarat has not preserved and developed its natural resources when it comes to farming. Farmers also suffer due to lack of irrigation facilities. The methods of cultivation in most areas of India are still ancient. Farmers are not able to adopt modernization due to lack of fund and exposure towards it. It is the government which concentrate more on agriculture finance by providing micro credit, crop loan and crop insurance, which aim to uplift stand of living of the farmers.

A Study of Pediatric Leprosy in a Tertiary Care Center in a Western State of India: A Descriptive Study

Elimination of leprosy as public health problem (defined as a registered prevalence of less than 1 case per 10,000 population) was achieved globally in 2000 and in 2005 from India. However, new cases including those in children continue to be reported. As pediatric leprosy shows active transmission of infection in the community, these have special epidemiological significance. The objective of this study was to study the profile of leprosy and deformity in pediatric age group (<15 years). A descriptive cohort study was carried out. The present study comprises of pediatric leprosy patients among 200 patients of leprosy who presented to outpatient Department of a tertiary dermatology center in Western Gujarat during the period 2009-10 and followed up until 2016. All newly diagnosed, on-treatment and relapse cases of leprosy in pediatric age group during that period were included. Detailed history, relevant past and family history were noted. A detailed physical examination was carried out, Slit Skin Smear (SSS) and punch biopsy to confirm the diagnosis was also done. The patients were then classified as per WHO into Paucibacillary(PB) / Multibacillary(MB) cases for treatment purpose and treatment provided accordingly. The patients were regularly followed up during the study period. Findings shows that out of 200 patients, 7.5% (n=15) patients belonged to pediatric age group. Tuberculoid leprosy was the commonest type seen in 53.2% (n=8) of pediatric patients. Male: Female ratio (4:1) was much higher in cahildren than adults. 33% (n=5/15) patients had a positive household contact. There were no deformities seen in this age group. This study signifies the importance of transmission in close contacts. However, the matter of concern remains that 67% of children had no household contacts. Such cases require in-depth epidemiological investigations for other possible sources of transmission.

Assessment of Incidence of Enterocytozoon hepatopenaei (EHP) in Penaeus vannamei in Maharashtra and Gujarat

The occurrence of Enterocytozoon hepatopenaei in Penaeus vannamei samples were collected from Maharashtra and Gujarat farms. In the present study, shrimp samples from various shrimp ponds from two districts of Maharashtra and two districts of Gujarat were collected over a period of one year (February 2016 to April 2017). A total of 4513 shrimp samples were assessed for the presence of EHP by molecular characterization. Out of shrimp samples analysed, 31.2% samples were positive for EHP. The screening of EHP was done by single step and nested PCR targeting spore wall protein gene (SWP) of EHP resulting in product size of 514 bp and 148 bp for EHP respectively

Evaluation of integrated Child Development Services program in Gujarat, India for the years 2012 to 2015.

Background: The Integrated Child Development Services (ICDS) scheme has been operational for more than three decades in India. Objective: To evaluate the various aspects of the ICDS program in terms of inputs, process and outcome (coverage), utilization, and issues related to the ICDS program. Methods: A total of 130 Anganwadi centers (AWCs) were selected including 95 AWCs from rural areas and 35 AWCs from urban areas from April 2012 to March 2015, from 12 districts of Gujarat and the union territory of Diu. Information was collected for infrastructure, baseline characteristics of AWWs, provision, coverage and utilization of various ICDS services, and various issues related to program operation. Results: A majority of pregnant (94.7%) and lactating (74.4%) mothers, and adolescent girls (86.6%) were availing ICDS services. In 96.9% of the AWCs, a growth chart was available and 92.3% AWWs were using it accurately. A total of 14.9% children were underweight including 13.5% moderately and 1.4% severely malnourished children. Two-third (66.2%) children were covered by supplementary nutrition (SN). Only 14.6% of the AWCs reported 100% preschool education (PSE) coverage among children. More than half (55.4%) of the AWCs reported an interruption in supply during the last 6 months. Various issues were reported by AWWs related to the ICDS. Conclusion: The study has reported gaps in terms of infrastructure facility, different trainings, coverage, supply, and provision of SN, status of PSE activities in AWCs, and provision of different services to the beneficiaries.

Study of pattern of acute myocardial infarction in tertiary care hospital of Ahmedabad, Gujarat.

Background: Myocardial infarction is one of the most common causes of death in adult and elderly people. Aim and objectives: To study age and sex wise incidence, various risk factors, involvement of anatomical site and mortality in cases of acute myocardial infarction. Material and Methods: The present study included 100 cases of acute myocardial infarction admitted in the intensive coronary care unit of tertiary care hospital, Ahmedabad. Patients with classical ECG changes of hyper-acute or acute MI with transient rise in cardiac enzyme levels and presence of pathological q waves accompanied by elevation of ST segment and symmetrical inversion of T waves with rise in cardiac enzyme levels were included. Results: Maximum MI cases occurred in sixth decade and more common in male. smoking was the most common risk factor and enterior wall MI was most common. Maximum mortality was found in MI involving anterior wall, inferior wall and right ventricle all together. Conclusion: Study of pattern of myocardial infarction, age and sex wise incidence, risk factor, anatomical site and mortality in cases of myocardial infarction is very useful for the treatment and prevention purposes.

Knowledge, attitude and practice of community pharmacists of Gujarat towards adverse drug reactions.

Background: Adverse drug reactions (ADR) are one of the leading causes of mortality and morbidity in India. Community pharmacists are first to report and also in contact with patients, so assessing their knowledge, attitude and practice towards adverse drug reactions is very helpful. Aim: To assess knowledge, attitude and practices of community pharmacists of Gujarat towards adverse drug reactions (ADR). Material and methods: Cross-sectional study was conducted at Gujarat during the period of January 2014 to June 2014 among 150 community pharmacists. We had interviewed them with questionnaire which included 8 questions related to knowledge, 6 questions related to attitude and 6 questions related to practice towards adverse drug reaction (ADR). Results: Community pharmacists had poor knowledge and practice but good attitude towards adverse drug reactions (ADR). Conclusion: Our findings suggested the need for positive, evidence based educational and managerial interventions regularly to improve ADR reporting.

A Bilateral Multiple Renal Artery with Lobulated Left Kidney – A Case Report.

Introduction: A precise knowledge of variation of the renal artery is essential for a variety of surgical and radiological procedures. Method: One such variation observed during routine educational dissection of a 65-year-old male cadaver at SMIMER, Surat. The cadaver was preserved using standard embalming technique and dissection carried out based on the method given in “CUNNINGHAM’S MANUAL OF PRACTICAL ANATOMY” Volume-II. Observation: (i) On right side an additional renal artery originated from the right side of abdominal aorta above the normal renal artery which soon divides into two branches which run parallel towards the renal hilum. The normal renal artery arches forward and downward in front of right renal vein and divides into two segmental arteries. The upper branch of additional artery give supra renal branch and continue as upper segmental artery while the lower branch divide into two segmental arteries. (ii) On left side one small additional renal artery originated from the left side of abdominal aorta above the normal renal artery and pass horizontally above left renal vein towards renal hilum. The normal artery arches behind left renal vein and divide into two segmental arteries. Another additional artery originated from left side of abdominal aorta just below the origin of inferior mesenteric artery run upward and laterally and divide into two segmental arteries one of which supply the accessory lobule of left kidney and another branch supply lower pole of left kidney. Conclusion: The comprehensive knowledge of variations of renal artery is the key issue in determining the technical feasibility of different surgical interventions of kidney.

Estimation of stature from hand length in living subjects of Gujarat Region.

Background: The hand length can be used as a basis for estimating stature in cases where only fragmentary or mutilated remains of an unknown person are recovered and also in age related loss in stature. Objectives: To investigate the relationship between Personal Stature and Hand Length in living subjects of Gujarat region and derive a population specific formula (regression equation) to estimate Stature from Hand Length. Methods: Height and Hand Lengths were measured of total 510 living subjects (258 males & 252 females) between the age group of 18-25 years belonging to Gujarat Region. Results: A positive correlation was found between Height and Hand Length and it was statistically significant. Regression equation for stature Estimation was formulated using Hand Length in both sexes. Conclusion: Dimensions of Hand can provide good reliability in estimation of stature. Simple linear regression equation so far derived can be used for estimation of height. If either of the measurement (Hand length or Total Height) is known, the other can be calculated. This fact will be of practical use in Medico Legal investigations and in Anthropometry.

Hemoglobinopathies in South Gujarat population and incidence of anemia in them.

Objective: To Screen of South Gujarat population for determination of prevalence of different hemoglobinopathies particularly beta thalassemia trait (BTT) and sickle cell trait (SCT) and find out the incidence of anemia in them. Material and Methods: The present study screened 32,857 samples of students from different school and colleges in South Gujarat. Blood samples were initially tested for solubility test and complete hemogram on hematology analyzer. Samples having MCV (≤78), MCH (≤28) and/or positive solubility test were investigated for Hb electrophoresis on cellulose acetate membrane (pH 8.6). Hb A 2 level ≥3.5% was considered as diagnostic for BTT. High performance liquid chromatography on Biorad Hb variant system was done on samples having doubtful results. Result: Overall prevalence of BTT and SCT in South Gujarat was 4.4% and 1.3% respectively. Gamit, Vasava, Chaudhary, and Mahyavanshi castes had high prevalence of BTT (15.9%, 13.6%, 12.6%, and 6.9%) as well as SCT (22.2%, 15.2, 22.3, and 4.2%) respectively. Other communities like Lohana (10.8%), Sindhi (10.2%), Prajapati (6.3%), and Ghanchi (6.2%) also showed higher prevalence of BTT. Incidence of mild to moderate anemia was higher in BTT and SCT compared to non-BTT or non-SCT subjects. Conclusion : Study suggests that BTT is the most prevalent hemoglobinopathy in South Gujarat. β-thalassemia and Sickle cell anemia are highly prevalent in Mahyavanshi, Chaudhary, Gamit, Vasava and Rohit. Prajapati, Lohana, Leva Patel, and Ghanchi have β- thalassemia risk. SCT is more frequently detected in Dhodia Patel and Kukanas.

Profile of deaths due to electrocution: A retrospective study.

We carried out a retrospective analysis of deaths due to electrocution from the medico-legal deaths reported to our institution. Majority of the victims were males belonging to the age group of 11-50 years. Almost all deaths were accidental and most of them were concentrated in the period of monsoon implicating the important role of wetness in causing these deaths. In contrast to the studies done in the West, bathtubs, heaters or hair dryers were not involved in any of the deaths. The mortality rate due to electrocution was significantly higher at 4.4 per one lakhs (100000) population in the present study as against the figures of 0.94 and 0.14 from Bulgaria and Canada respectively. Most of the deaths were either instantaneous or immediate and most of the deaths were preventable by electrocution. It signifies that people living at home did not have elementary knowledge of risks of electrocution; therefore awareness about use of good quality electric appliances and cables is the need of the hour.

Ethnoveterinary practices associated with animal healthcare in Dang District of South Gujarat, India.

The paper deals with the indigenous knowledge of local communities on medicinal plants used for curing various diseases in Dang district, Gujarat state. Information collected is based on interview and observation was cross-checked with traditional herbal practitioners in the region. Adivasi, Kukunas, Kamits, Bhika, Warlis, and Kunbis are the chief communities in this area. This study revealed that 34 plant species were used for curing various diseases and disorders in animals, in this region.