Health Status and Treatment Outcome of Tuberculosis with Diabetes Mellitus Cases, Rajkot City, Gujarat - A Longitudinal Study.

Background: India, with the highest number of tuberculosis (TB) cases in the world, is also facing epidemic growth in diabetes mellitus (DM). TB is curable while DM is a metabolic and incurable disease that if not controlled will affect the health status of a person. This study was conducted to assess the health status and treatment outcome of TB with DM cases. Materials and Methods: We selected a total of 64 newly registered pulmonary TB (PTB) with DM cases from five tuberculosis units (TUs) in Rajkot city from October 2019 to December 2020. At the end of treatment, 64 cases were analyzed for treatment outcome and 56 cases (5 deaths; 3 lost to follow-up) were followed up to observe progression in health status. The information was collected in pretested proforma by interview. Results: There was a significant improvement in TB symptoms (cough, weight loss, weakness, anorexia, evening rise of temperature, dyspnea, chest pain, hemoptysis), DM symptoms (frequent urination, excessive thirst and hunger, tingling and numbness), symptoms of mental health (fatigue, sleep disturbance, negative emotions, socially inactive), and adverse drug reactions (ADRs) on consecutive visits (McNemar's test, P < 0.001) and at the end of treatment (Cochran's Q test, P < 0.001). Improvement of nutritional status was also found statistically significant on consecutive visits (Wilcoxon test, P < 0.001) and at the end of treatment (Friedman's test, P < 0.001). The cure rate was 82.8% and 4.7% of cases had completed treatment. Conclusion: At the end of treatment, there was a significant improvement in health status and treatment outcome; also good cure rate was reported among cases.

Prevalence of extraintestinal manifestations in ulcerative colitis and associated risk factors.

BACKGROUND: The data on prevalence of extraintestinal manifestations (EIM) in ulcerative colitis (UC) are  scanty and highly variable. METHODS: Consecutive patients with UC were prospectively evaluated from November 2016 to August 2017. A detailed history was obtained and physical examination was done. Presence of EIM was confirmed by a consultant rheumatologist, ophthalmologist and dermatologist. Tests performed were hemogram, liver function test, abdominal ultrasound, slit lamp examination, X-ray and magnetic resonance imaging when deemed necessary. RESULTS: A total of 227 patients with UC were enrolled in this study. The prevalence of EIM was 7.92%. Mucocutaneous (4.84%) manifestations were the commonest, followed by musculoskeletal (1.32%) and ocular (0.88%). Hepatobiliary (0.44%) and vascular (0.44) manifestations were present in equal frequency. History of appendicectomy was associated with  EIM. CONCLUSION: The prevalence of EIM in UC was low in our study. History of appendicectomy was a risk factor for EIM.

Descriptive Epidemiology of Unintentional Childhood Injuries in India: An ICMR Taskforce Multisite Study.

BACKGROUND: Children 0-14 years constitute about 31.4% of Indian population, among whom the magnitude and risk factors of childhood injuries have not been adequately studied. OBJECTIVE: To study the prevalence of and assess the factors associated with unintentional injuries among children aged 6 month - 18 years in various regions. METHODOLOGY: This multi-centric, cross-sectional, community-based study was conducted at 11 sites across India. States included were Gujarat, Karnataka, Madhya Pradesh, Punjab, Sikkim, Tamil Nadu, Uttarakhand, and West Bengal between March, 2018 and September, 2020. A total of 2341 urban and rural households from each site were selected based on probability proportionate to size. The World Health Organization (WHO) child injury questionnaire adapted to the Indian settings was used after validation. Information on injuries was collected for previous 12 months. Definitions for types (road traffic accidents, falls, burns, poisoning, drowning, animal-related injuries) and severity of injuries was adapted from the WHO study. Information was elicited from parents/primary caregivers. Data were collected electronically, and handled with a management information system. RESULTS: In the 25751 households studied, there were 31020 children aged 6 months-18 years. A total of 1452 children (66.1% males) had 1535 unintentional injuries (excluding minor injuries) had occurred in the preceding one year. The overall prevalence of unintentional injuries excluding minor injuries was 4.7% (95% CI: 4.4-4.9). The commonest type of injury was fall-related (842, 54.8%) and the least common was drowning (3, 0.2%). Injuries in the home environment accounted for more than 50% of cases. CONCLUSIONS: The findings of the study provide inputs for developing a comprehensive child injury prevention policy in the country. Child safe school with age-appropriate measures, a safe home environment, and road safety measures for children should be a three-pronged approach in minimizing the number and the severity of child injuries both in urban and rural areas.

Determinants of Myocardial Infarction in Saurashtra Region, Gujarat: A Case-control Study.

BACKGROUND: Myocardial infarction (MI) is a multifactorial noncommunicable disease. The study was conducted with an objective to assess the role of various sociodemographic and clinicoepidemiological determinants of MI. MATERIALS AND METHODS: The cases and controls were selected in the ratio of 1:1 and were group matched for age, sex, and type of residence. Cases of MI were selected from the intensive coronary care unit of the medicine department at a tertiary care hospital, Rajkot, for 1 year. Controls were selected from the general population of Rajkot district. Information was collected in pretested pro forma using the interview technique. RESULTS: A total of 406 cases and equal number of controls were enrolled in the study. Several risk factors identified for MI included illiteracy, upper socioeconomic class, family history of MI, Type A personality, hypertension, diabetes mellitus, obese or overweight, high waist-hip ratio, low intake of leafy vegetables, low intake of fruits, and history of acute life event for the past 1 year. On applying logistic regression model, these factors were also identified as independent determinants for MI. CONCLUSION: The findings confirm the role of conventional risk factors for MI and also highlight the role of sociodemographic factors such as illiteracy, higher social class, low intake of leafy vegetables and fruits, and history of acute life event.

Magnitude of Gestational Diabetes Mellitus, its Influencing Factors and Diagnostic Accuracy of Capillary Blood Testing for its Detection at a Tertiary Care Centre, Rajkot, Gujarat.

BACKGROUND: Gestational diabetes mellitus (GDM) occurs during pregnancy which affects mother, fetus, and outcome of pregnancy, hence early detection is necessary. The objective of this study was to ascertain the validity of glucometer over standard biochemical testing for detection of GDM and to estimate prevalence of GDM and its associated risk factors. MATERIALS AND METHODS: A hospital-based study was conducted at Antenatal clinics of Obstetrics Department, tertiary care hospital, based on the "National Guidelines for Diagnosis and Management of GDM." Totally 357 pregnant women between 21 and 28 weeks of gestational age agreed were included in the study from January to March 2016. After obtaining written consent, one step procedure was offered to pregnant women by giving 75 g of anhydrous glucose dissolving in 200-250 ml of water. After 2 h, glucose level was estimated by capillary testing with glucometer and venous glucose by glucose oxidase test. RESULTS: GDM was found in 20.4% pregnant women with capillary testing done by glucometer compare to 11.5% with venous blood testing. GDM was found higher among literates, homemakers, Hindus, people living in nuclear family, belongs to middle class, residing in urban area, primigravidae, obese and with gestational age between 21 and 24 weeks. Intermediate agreement (Kappa = 0.42) was found between two methods with sensitivity of 70.7%, specificity of 86.1%, positive predictive value 39.7%, and negative predictive value 95.8%. CONCLUSION: Intermediate agreement between two methods indicates glucometer testing can be used to screen pregnant women at an early gestational age (21 weeks), at the community level by health-care workers.

Profile of Dengue Fever in Hospitalized Children in Saurashtra, Gujarat, 2013-2017.

OBJECTIVE: To study the five year trend of epidemiological and demographic characteristics of dengue infections from year 2013 to 2017 among children upto 15 years. METHODS: This study presents data from review of microbiology department records of samples for dengue testing with information supplied by clinicians on the investigation request form. Patients were tested for NS1 Ag, IgM Ab or both. RESULTS: Out of 4216 samples, 1072 (25.4%) were positive for dengue. Positivity ranged from 44.2% in year 2013, 25.8% in 2015 to 16.2% in year 2017. Most cases reported were among male (57.9%), from urban areas (77.9%) and Rajkot district (75.7%). Reporting of dengue cases increased from July to November with peak during October every year. CONCLUSIONS: Serum samples for dengue serology were more commonly positive in July-September months during the study period, and in male children, and those from urban areas.

Prevalence of obesity and overweight and their comparison by three growth standards among affluent school students aged 8-18 years in Rajkot.

Obesity and overweight emerged as an important public health problem in India. The present study was conducted to estimate the prevalence of obesity and overweight and compare it using three different standards among affluent school students aged 8-18 years from Rajkot, Gujarat. Anthropometric measurements of students of four schools from 3rd to 12th standards were taken. The prevalence of overweight and obesity was assessed using three standards - revised Indian Association of Pediatrics (IAP) 2015, WHO 2007, and International Obesity Task Force (IOTF) standards. A total of 1496 children including 79.1% boys and 20.9% girls participated in the study. The prevalence of obesity was reported 14% by IAP standards, 11.1% by WHO standards, and 5.1% by IOTF standards. Overweight children prevalence was reported more (19.1%) with IAP standards, followed by 15.8% with IOTF standards and 15.3% by WHO standards. High prevalence of obesity and overweight was reported with IAP 2015 standards and WHO 2007 standards.

Epidemiological characteristics of dengue disease in Saurashtra region, India, during year 2015.

BACKGROUND: Dengue is an important vector-borne disease with a spectrum of classical fever to hemorrhagic fever to dengue shock syndrome. The present study was conducted with objective to study epidemiological and demographic characteristics of dengue infections during the year 2015 in Saurashtra region, Gujarat state, India. MATERIALS AND METHODS: The study was conducted at Tertiary Care Hospital, Rajkot, during the year 2015. A total of 3312 blood samples were collected and tested for dengue NS1 antigen and IgM antibody by capture ELISA testing from various districts of Saurashtra region. A pretested structured data sheet was used as a tool for data collection, and data analysis was done. RESULTS: Out of 3312 tested samples, 33.4% samples were found positive for dengue. Suspected cases were reported from all age groups, including majority from 15 to 24 years (31.1%) and 25 to 44 years (30.0%) and also 8.4% from 0 to 4 years. More than two-third (68.7%) of males were dengue positive than female cases. Significant numbers of cases (P < 0.01) were residing in urban areas (65.7%). Two-third cases (66.8%) diagnosed after 7 days of fever by IgM antibody test. Increasing number of dengue cases reported from July and reached to peak during October 2015. CONCLUSION: The present study reported that dengue mainly affected males and urban population. Perennial occurrence with seasonal increase during monsoon and postmonsoon months was reported. Effective implementation of vector control measures through efforts toward vector breeding source reduction and with the use of personal prophylactic measures against mosquito bites will help in reducing the dengue prevalence in the community.

Prevalence of Obesity and Overweight Among School Children Aged 8-18 Years in Rajkot, Gujarat.

A total of 1496 school children aged 8-18 years (79.1% boys) participated in this study. Prevalence of obesity and overweight was estimated by using three different growth standards. Revised IAP 2015 growth standards detected more obese and overweight children than WHO 2007 and IOTF standards.

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.

Challenges in Collating Spirometry Reference Data for South-Asian Children: An Observational Study.

METHODS: Spirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110). RESULTS: Following exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5-17 years). When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1) and forced vital capacity (FVC) in South-Asian children were on average 15% lower, ranging from 4-19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The 'GLI-Other' equation fitted data from North India reasonably well while 'GLI-Black' equations provided a better approximation for South-Asian data than the 'GLI-White' equation. However, marked discrepancies in the mean lung function z-scores between centres especially when examined according to socio-economic conditions precluded derivation of a single South-Asian GLI-adjustment. CONCLUSION: Until improved and more robust prediction equations can be derived, we recommend the use of 'GLI-Black' equations for interpreting most South-Asian data, although 'GLI-Other' may be more appropriate for North Indian data. Prospective data collection using standardised protocols to explore potential sources of variation due to socio-economic circumstances, secular changes in growth/predictors of lung function and ethnicities within the South-Asian classification are urgently required.

Evaluation of National Leprosy Eradication Program after Integration into General Health System in Rajkot District, Gujarat from 2003 to 2014.

BACKGROUND: National Leprosy Eradication Program (NLEP) was launched in 1983 with the goal of elimination of leprosy as a public health problem. AIM: To evaluate the NLEP performance after integration into general health system from April 2003 to March 2014. MATERIAL AND METHODS: A retrospective record based study was conducted by obtaining data from Rajkot district leprosy center. Prevalence rate (PR), new case detection rate (NCDR), proportion of female cases, child cases, multibacillary (MB) cases, Grade II disability among new cases and release from treatment (RFT) cases were evaluated from April 2003 to March 2014 and analyzed by using Chi-square for trend analysis test. RESULTS: The PR of leprosy per 10,000 populations was significantly declined (P < 0.001) from 0.44 in 2003-2004 to 0.15 during March 2014. Reduction in NCDR trend was statistically significant (P < 0.001). The proportion of female cases among newly detected cases showed fluctuation from 36.23% in 2003-2004 to 37.10% in 2013-2014 (P > 0.05). The proportion of child cases also showed significantly declining trend from 12.08% in 2003-2004 to 6.70% in 2013-2014 (P < 0.05). Significant number of MB cases decreased from 122 (2003-2004) to 69 (2013-2014) (P < 0.001). Grade II disability proportion was 1.45% in the year 2003-2004, increased to 5.2% in 2009-2010 and then again decreased to 3.4% in 2013-2014 (P > 0.05). Proportion of patients RFT showed fluctuation from 66.66% (2003-2004) to 45.68% (2009-2010) and then 64.66% (2013-2014) (P < 0.001). CONCLUSION: The NLEP is having a favorable impact on the problem of leprosy by maintaining the elimination level of leprosy in Rajkot district over a decade.

Epidemiological and demographic characteristics of dengue disease at a tertiary care centre in Saurashtra region during the year 2013.

BACKGROUND & OBJECTIVES: Dengue is one of the most important vector-borne viral infection which may lead to haemorrhage or even shock. The present study was conducted with an objective to study the epidemiological and demographic characteristics of dengue disease during the year 2013 in Saurashtra region of Gujarat state, India. METHODS: A longitudinal study was conducted at sentinel surveillance centre for dengue disease at microbiology department of tertiary care hospital in Rajkot, Gujarat from 1 January 2013 to 31 December 2013. A total of 4366 blood samples were collected during study period and serologically tested for dengue NS1 antigen and IgM antibody by capture ELISA testing from various districts of Saurashtra region. Patients with acute onset of illness, high grade fever, severe headache, backache, musculoskeletal pain or retro-bulbar pain with or without rashes were considered as clinically suspected case of dengue virus infection. Patient who presented with fever and found positive for Dengue NS1 Ag and/or IgM Ab was considered as a case. A pre-tested structured proforma was used as a tool for data collection. The data was entered into EpiInfo software and analyzed by using appropriate statistical test (chi-square test). RESULTS: Out of 4366 tested samples, 41.3% samples were found positive for dengue. Majority of samples were tested in age group 16-25 yr (33.9%) and 26-45 yr (31.1%). The ratio of male cases (60.8%) was higher than female cases. Two-third (68.7%) suspected cases were residing in urban areas of Saurashtra region. More than half of the cases (57%) were diagnosed within five days of fever by NS1 antigen test. The reporting of number of cases increased from July 2013, which reached to peak during September 2013 followed by decrease till December 2013. INTERPRETATION & CONCLUSION: Dengue predominately affected males and urban population. A seasonal occurrence was reported mainly during monsoon season. A long term serosurveillance study may help to provide more information about the intensity, seasonal incidence and seasonal effect.

Evaluation of Integrated Child Development Services program in Gujarat, India.

OBJECTIVE: To evaluate Integrated Child Development Services (ICDS) program in terms of infrastructure of Anganwadi centers, inputs, process, coverage and utilization of services, and issues related to program operation in twelve districts of Gujarat, India. DESIGN: Facility (Anganwadi) based study. SETTING: Twelve districts of Gujarat, India (April 1, 2012 to March 31, 2013). PARTICIPANTS: ICDS service providers (60 Anganwadi workers from 46 rural and 14 urban Anganwadi centers) and their beneficiaries. MAIN OUTCOME MEASURES: Coverage of supplementary nutrition, pre-school education, immunization and referral services. RESULTS: Supplementary nutrition coverage was reported in 48.3% in children. Interruption in supply of supplementary nutrition during last six months was reported in 61.7% Anganwadi centers. Only 20% centers reported 100% pre-school education coverage among children. Immunization of all children was recorded in only 10% Anganwadi centers, while in 76.7% centers, no such records were available. Regular health checkup of beneficiaries was done in 30% centers. Referral slips were available in 18.3% Anganwadi centers and referral of sick children was done from only 8.3% centers. CONCLUSIONS: There are program gaps in coverage of supplementary nutrition in children, its regular supply to the beneficiaries, in pre-school activities coverage, recording of immunization, and regular health check-up of beneficiaries and referral of sick children.

Characteristics of Hospitalized Patients with Severe and Non-Severe Pandemic Influenza A (H1N1) in Saurashtra Region, India (Two Waves Analysis).

BACKGROUND: In India, the first case of 2009 pandemic influenza A (H1N1) virus infection was reported in May 2009 and the same in Saurashtra region in August 2009. We describe the epidemiology and factors associated with severe and non-severe cases of 2009 influenza A (H1N1) infection reported in the Saurashtra region. MATERIALS AND METHODS: From September 2009 to January 2011, we reported 511 patients who were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals of Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing was used to confirm infection. Factors associated with severe cases were determined by comparing with non-severe cases. RESULTS: Out of 511 patients, 140 had severe disease (requiring intensive care or died) and 371 non-severe diseases (admitted in wards and survived). Median age of 30 years; median time of 5 days from onset of illness to diagnosis, and 4 days median time was reported for hospital stay among severe disease patients. More than half (60.7%) were females. Out of the patients with severe disease, 52.1% patients residing in urban area (OR = 1.68, CI = 1.13-2.49). Significant association was reported among severe disease patients for delayed referral from general practitioner/physician after initial treatment. All patients received antiviral drug, however, only 27.1% received within 2 days of illness. Presence of coexisting condition (pregnancy (OR = 0.19, CI = 0.08-0.48) was strongly associated with severe disease. CONCLUSION: Delayed referral from general practitioner/physician, duration of antiviral treatment, presence of coexisting condition (i.e., pregnancy) were responsible for intensive care or mortality among severe influenza A (H1N1) illness.

Effect of antiretroviral therapy on clinical and immunologic disease progression in HIV positive children: One-year follow-up study.

OBJECTIVE: To study the effect of antiretroviral therapy (ART) on clinical, immunologic, and nutritional progression of disease in human immunodeficiency virus (HIV)-infected children for 1 year. MATERIALS AND METHODS: The study included 54 children aged 1.5-15 years who registered at the ART center, Surat, from August 2007 to August 2009. During the study period, the children were followed-up at 6 monthly intervals up to 1 year after starting ART. World Health Organization (WHO) clinical staging and CD4 cell count as per national guidelines, and nutritional status were used to measure clinical and immunologic progression of disease up to 1 year. RESULTS: Out of 54 children, mother-to-child transmission was reported in 96.2% children; for 74% of the children, both parents were HIV positive. All the children were classified according to WHO clinical staging into 4 stages and as per CD4 cell count (%), followed up at 6 and 12 months and the benefits with ART reported. At 12 months follow-up, 15% of the study group children had died. Both mean CD4 count and a relative percentage showed significant increase (P < 0.01) in the study group 1 year after ART. CONCLUSION: The present study reports benefits of ART in terms of clinical and immunologic progression of disease, nutritional status of HIV-infected children after 1 year of ART.

Clinical and epidemiological characteristics of 2009 pandemic influenza A in hospitalized pediatric patients of the Saurashtra region, India.

BACKGROUND: The first case of 2009 pandemic influenza A or H1N1 virus infection in India was reported in May 2009 and in the Saurashtra region in August 2009. We describe the two waves clinicoepidemiological characteristics of children who were hospitalized with 2009 influenza A infection in the Saurashtra region. METHODS: From September 2009 to February 2011, we treated 117 children infected with 2009 influenza A virus who were admitted in different hospitals in Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test was used to confirm infection, and the clinico-epidemiological features of the disease were closely monitored. RESULTS: In the 117 patients, with a median age of 2 years, 59.8% were male. The median time from onset of the disease to influenza A diagnosis was 5 days, and that from onset of the disease to hospitalization was 7 days. The admitted patients took oseltamivir, but only 11.1% of them took it within 2 days after onset of the disease. More than one fourth (29.1%) of the admitted patients died. The most common symptoms of the patients were cough (98.3%), fever (94.0%), sore throat and shortness of breathing. Pneumonia was detected by chest radiography in 80.2% of the patients. CONCLUSIONS: In children with infection-related illness, the survival rate was about 71% after oseltamivir treatment. The median time for virus detection with real-time RT-PCR is 5 days. Early diagnosis and treatment may reduce the severity of the disease.