A comparative study on COVID-19 disease severity and outcome among patients admitted before and after vaccination at tertiary care hospital.

Background: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by SARS CoV-2 that emerged in Wuhan, China, and has rapidly spread worldwide. The mortality rate of critically ill COVID-19 patients is high. The objective of the study was to assess the COVID-19 disease severity and outcome among COVID-19 positive patients admitted before and after vaccination. Methodology: A prospective observational study conducted among all patients aged more than 18 years were included in the study. The patients who were positive before vaccination and received at least one dose of vaccine and positive after receiving two doses of vaccination included in the study. Disease severity was assessed in terms of high-resolution computed tomography (HRCT) score, intensive care unit (ICU) admission, SpO2 maintained, oxygen, plasma exchange, steroids received and on mechanical ventilation, and outcome was assessed on prognosis and stabilized/discharged to home. Results: A total of 172 were participated in the study with 101 (58.7%) males and 71 (41.3) females, respectively. Amongst them, 92 were affected before vaccination and 80 were affected before vaccination. The patients admitted in the ICU were 56 (32.6%) and 116 (67.4%) were not admitted in the ICU; among the patient admitted in ICU 42 (45.7%) before vaccination, and 14 (17.5%) were after vaccination, and difference was statistically significant with P- value <0.001. SPO2, steroids given, plasma exchange, oxygen >10 litres given and mechanical ventilation were positively associated with the vaccine received and disease severity with P- value <0.05. Conclusion: The severe COVID-19 had the worst outcome in the unvaccinated patients in terms of severity. Most partially vaccinated patients got infected before developing immunity; receiving at least one vaccination dose significantly reduced illness severity.

Morbidity profile of children from birth to 18 years of age referred for intervention to the district early intervention centre in a District Hospital, Andhra Pradesh.

BACKGROUND: The "Child Health Screening and Early Intervention Services" program aims at early detection and management of the four dimensions prevalent in children-defects at birth, diseases in children, deficiency conditions, and developmental delays, including disabilities. OBJECTIVE: The objective of the study was to assess the morbidity profile of children from birth to 18 years of age screened in the district early intervention center (DEIC). METHODS: A record-based descriptive study was done in the DEIC in Chittoor, Andhra Pradesh. The data were retrieved for 1-year from April 2017 to March 2018 into the excel sheet, and the combined master sheet was prepared for analysis. The analysis was done with SPSS 21.0 Version. RESULTS: A total of 10571 children were screened and referred to the DEIC during the period. Out of them, 5679 (53.7%) were male and 4892 (46.3%) were female. Among all the four types of morbidities screened, majority 4847 (45.9%) were having the childhood diseases, 4177 (39.5%) had developmental delays including disabilities, 1067 (10.1%) had different deficiencies, and 361 (3.4%) had birth defects. Among the adolescent health issues, 119 (1.1%) were screened and sent for the early intervention to the district hospital. CONCLUSIONS: A huge number of children were screened and referred to the DEIC every year for intervention. The health sector has to focus more on the resources like workforce, training of peripheral health workers at regular intervals about the different morbidities screened, that would help in identifying the morbidities at the earliest possible time and receive the intervention at the best center.

Utilization of Janani Shishu Suraksha Karyakram and estimation of out of pocket expenditure: A prospective follow-up study among mothers and newborns in Chittoor.

INTRODUCTION: Janani Sishu Suraksha Karyakram (JSSK) is a flagship program of India to reduce out of pocket expenditure (OOPE) of the families during childbirth and neonatal sicknesses. OBJECTIVES: To assess the utilization of JSSK while availing services for childbirth and newborn care in a secondary care hospital in Southern India; estimate the OOPE in services covered by JSSK and identify the associated factors with OOPE. METHODS: 228 mothers who delivered in the previous 2 days, were recruited from a secondary-level government hospital in Chittoor. Expenditure incurred under various components of JSSK was asked during the recruitment and subsequently through telephonic interviews. RESULTS: All components of JJSK, except transport, were fully utilized by the families. 138 mothers (60.5%, 95% CI: 54.0, 67.0), and all sick children (n = 138, 100%) who visited government hospital, incurred OOPE in the form of transport cost. The median expenditure of transport (from home to hospital and hospital to home) of the mothers was 250 INR (IQR: 100-513 INR). Transport expenditure was greater for the rural families (300 INR) than the urban families (100 INR) (p < 0.05). In multiple logistic regression, nuclear families were associated with high OOPE (AOR- 2.0, 95% CI: 1.1- 3.7). Though education of the mother showed high association (AOR- 2.7, 95% CI: 1.0- 7.8), it was not statistically significant (p = 0.05). CONCLUSION: The families utilize most of the components of JSSK, except transport. Family-centric counselling of the beneficiaries during antenatal check-ups and home visits by the healthcare workers can reduce transport-related OOPE.

Prevalence and Its Associated Determinants of Diabetic Peripheral Neuropathy (DPN) in Individuals Having Type-2 Diabetes Mellitus in Rural South India.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is a well-known microvascular complication of type 2 diabetes mellitus attributed to chronic hyperglycemia and is defined as the presence of peripheral nerve dysfunction after exclusion of other causes. METHODOLOGY: This was a multicentric facility-based cross-sectional study with the objectives to assess the sociodemographic and economic status of the participants, to estimate the prevalence of the DPN using the screening methods, and to see the association with other factors. A predesigned semi-structured questionnaire, Semmes-Weinstein 10-g monofilament test, ankle reflexes, and vibration perception threshold test was used for the data collection and blood sugars levels were taken from the recent laboratory report. RESULTS: Among 336, 202 (60.1%) were male and 134 (39.9%) were female. The prevalence of the DPN was 39.3% among them 28.9% in males and 10.4% in females, respectively. The other determinants of the participants, 264 (78.6%) had the Glycated hemoglobin (HbA1c) >7, 205 (61%) had a burning foot sensation, 124 (36.9%) of them were had numbness of the foot, almost 50% of them had pricking sensation in the foot and more than one-third (130) of them had callosity over foot. CONCLUSIONS: The study showed the severity of DPN was significantly associated with age, sex, duration of diabetes, HbA1c value, hypertension, and body mass index.

Prevalence of mental illness and their association with sociodemographic factors in the rural geriatric population in Chittoor, Andhra Pradesh, India: A community-based study.

BACKGROUND: Mental health problems such as cognitive impairment, depression, anxiety, and sleep disorders arising out of senility, neurosis, and living conditions are common in the geriatric population. OBJECTIVE: The objective of this study was to estimate the prevalence of mental illness and to describe their sociodemographic factors in the rural geriatric population and see their association with other factors. METHODOLOGY: A community-based cross-sectional study was done on individuals aged more than 60 years. The study instruments were predesigned semi-structured questionnaire, Folstein's Mini-Mental Status Examination Scale for assessing dementia in cognitive functioning and Yesavages Geriatric Depression Scale to estimate the prevalence of depression and to assess the activities of the daily living by Barthel index and the anxiety were assessed based on the perception of the participants while conducting the interview. RESULTS: A total of 415 individuals participated, out of them 199 (47.9%) were males and 216 (52.1%) were females. Prevalence of mental illness was 217 (52.2%) with one or the other type of mental illness. The prevalence of cognitive impairment was 47.7% and depression according to Geriatric Depression Scale >5 was 27.7%. The remaining 62 (14.9%) had dementia and 30 (7.2%) had anxiety disorder as the mental illness. The socio-demographic factors such as age more than 70 years, female gender, illiterates, living in joint family, middle and lower socio-economic class, financially totally dependent and had poor and unfair relationship with the family members were strongly associated with the mental illness and it was statistically significant with P < 0.05. CONCLUSION: Measures should be taken to support the elders, establish community elderly societies, advisory offices, and services to help the elderly. The sequence of social interventions required for the management of the elderly psychological problems.

Work-related Neck Pain Among Desk Job Workers of Tertiary Care Hospital in New Delhi, India: Burden and Determinants.

BACKGROUND: Work-related Neck Pain (WRNP) is a leading cause of disability and absenteeism. There is dearth of information about burden and determinants of WRNP in health facility setting in India. MATERIALS AND METHODS: A cross-sectional study was carried out at tertiary care hospital in New Delhi. All Group C desk job workers involved in the administrative work were included in the study. Participants were screened for WRNP by using pretested semi-structured questionnaire. Detailed information on probable risk factors was collected among patients with WRNP. Neck examination by trained investigator was done. Work place assessment was done by using observation check-list using the recommendations of the ISO Standard (Ergonomic requirements for office work with visual display terminals). Crude and adjusted odds ratio was calculated with 95% confidence interval to understand the determinants of WRNP. RESULTS: In total, 441 participants were included in the study. Of them, 58% were males. Majority of participants aged between31-50 years. One-year prevalence of neck pain and WRNP was reported as 43.3%, (95% CI 38.7%-47.9%) and 28.3%, (95% CI 24.3%-32.7%) respectively. On multivariate analysis, female gender (OR-2.0 95% CI) and poor perception of breaks during working hours (OR-2.4 95% CI), along with work place related factors such as posture (OR-5.4 95% CI) and height of the screen (<10 cms) (OR-2.6) were identified as independent determinants of WRNP. CONCLUSION: High one-year prevalence of WRNP was reported among desk job workers. Burden of WRNP was reported more among females as compared to males. Most common factor identified was Computer use for more than 4-6 hours was most important predictor of WRNP followed by work related factors such as height of screen and posture are associated with WRNP.