A study to assess the nutritional status and dietary gap among pulmonary tuberculosis patients in Raipur city.

Background: Undernutrition raises the likelihood of progressing from tuberculosis (TB) infection to active TB illness and causes weight loss. Proper food and nutrition are important in the treatment of tuberculosis patients. Active tuberculosis necessitates a substantial energy expenditure. The Tuberculosis treatment guidelines neglect the nutritional supplementation part of Tuberculosis management. The study aims to determine the factors affecting the nutritional status of pulmonary Tuberculosis patients. Material and Methods: A hospital-based cross-sectional study was conducted from December 2021 to January 2022 among the patients newly diagnosed and above 18 years of age coming to DOTS Centre (DMC) of Pt J.N.M. Medical College, Raipur. Total 120 subjects were selected by consecutive sampling method. Data was analyzed using SPSS version 24, and P value <0.05 was considered statistically significant. Result: Among 120 study subjects, malnourished was 54.16% (BMI <18.50 kg/m2), normal was 35% (BMI 18.50-24.99 kg/m2), overweight was 6.67% (BMI 25-29.99 kg/m2), and obese were 4.17% (BMI 30-34.99 kg/m2). Among 120 study subjects, the maximum number of them (96.3%) had a dietary gap in their diets which was equal in two groups of 1-50% calorie deficit and 51-100% calorie deficit. Conclusion: A high proportion of tuberculosis patients were undernourished, and even a very distal factor for undernutrition became proximal for tuberculosis patients. To control tuberculosis and to end the tuberculosis disease, an improvement in the nutritional status of the patient should be our priority. By knowing the importance of nutrition in TB patients, the primary care physicians can decrease the morbidity and mortality in TB patients.

Morbidity pattern and impact of hydroxyurea therapy among sickle cell patients in Raipur district of Chhattisgarh.

Background: Sickle cell disease (SCD) is a disorder marked by a single-point mutation in the beta-globin gene. Hydroxyurea is a globally accepted disease-modifying agent that sounds to be effective in managing clinically and probably preventing complications of SCD. The current study aims to document the morbidity pattern and impact of Hydroxyurea therapy in the Outpatient Department of Sickle Cell Institute, Raipur. Materials and Methods: This cross-sectional study was conducted among randomly selected sixty-five patients (adults and children above six years). After obtaining informed consent, relevant data were collected in a predesigned pretested questionnaire. The appropriate statistical exercise was applied for the interpretation of results and inferences. Results: Acute febrile illness 54 (83%) and 53 (81.5%) reported pain crisis observed to have the most common morbidity among the study subjects, followed by 55.4% (36), 33 (50.8%) jaundice and difficulty breathing, respectively. Joint pain was the most commonly observed complaint, particularly at the knee joint (76.9%). Other complaints such as hand-foot syndrome (24.6%), epistaxis (27.7%), and acute chest syndrome (21.5%). Vaso-occlusive crisis (72.4%), difficulty in walking (60.0%) and eyesight (35.4%), leg ulcers (9.2%), and dactylitis (3.1%) were also documented as clinical manifestations among study participants. Less than half (44.46%) had an awareness about SCD. Hydroxyurea therapy was highly significant in improving the patient's clinical picture (P < 0.01), especially following the frequency of hospitalization and the requirement for blood transfusion. Conclusion: Pain crisis is the most common morbidity among study participants with a low level of knowledge about SCD with febrile illness. Hydroxyurea therapy was found to be quite effective as a disease-modifying therapy, especially for reducing the frequency of blood transfusion and lowering hospitalization rates among SCD patients.

Organizing Health Camp: Opportunities for Building Public Health Skills.

Health camps are one of the commonly performed activities by different organizations with different intentions. The purpose ranges from reaching out to unreached populations to increasing client base and thus increasing revenue generation. A multi-speciality health camp was organised at Rural Health & Training Centre (RHTC), Mendhasala, Khurdha. We describe the camp profile and utilization of different specialties in this study. The camp was attended by mostly adults and elderly (90.3%) and inhabitants of the same village (80.5%). General medicine (30.6%) and orthopedics (31.9%) were the two specialties most consulted at the said camp. The success of a health camp is described by the number of attendees, which looks only at resource utilization. We have documented the lessons learned from organizing a health camp from a public health learning point of view. A 10-point checklist is recommended for the successful organization of a health camp.

An in-depth appraisal of clinico-biochemical and radiological findings of COVID-19 patients during the COVID-19 pandemic in a dedicated COVID Care Hospital in Eastern India and its outcome in relation to the COVAXIN vaccination status: A 2-year study.

Introduction: COVID-19 pandemic hit Odisha province from April 2020 to December 2020, then from April 2021 to August 2021 and from February 2022 to April 2022 as the first, second, and third waves, respectively, with the most severe form witnessed during the second wave. Kalinga Institute of Medical Sciences hospital in Odisha was declared a Dedicated COVID Hospital (DCH) during those three waves and witnessed 9485 cases of admissions among which there were 1214 deaths. COVAXIN vaccination of the vulnerable population was launched in February 2021 onwards. This study has been done to know the clinic-biochemical profiles, radiologic findings of COVID-19 admitted patients, the predictors of mortality in the second wave, and clinical outcomes in the three waves in relation to COVAXIN vaccination status. Material and Methods: This was a serial three-round retrospective study from the electronic medical records using multistage random sampling where we collected and critically analyzed the demographic, and all the relevant possible health data of the cases that consist of 514 cases admitted in three waves. The data from death certificates among the 555 cases in the second wave have been analyzed to conclude predictors of mortality. Results: Mortality increased with age, male gender, comorbidities, and raised C-reactive protein level. High NL ratio, extent of pulmonary involvement. There was a wide variation in incidence and spectrum of illness starting from 79% incidence of mild symptomatic in the initial and third wave, but remained in the range of 35-65% in the second wave, respectively, and the most noticeable symptomatic illness was that of the upper respiratory tract. In fulminant cases, the mode of presentations was severe pneumonia and acute respiratory distress syndrome. Males were more sufferers than females. Children had better outcomes compared to adults. COVID-associated coagulopathy had a normal platelet count. Subsequently, in 2021 year onwards vaccination of the vulnerable population was launched in a phased manner that changed the dynamics of the disease outcome by better survival chances despite intercurrent COVID infection by induction of herd immunity. On the contrary, there was a higher prevalence of serious illness among non-vaccinated individuals. While the cases continued during the second wave of the pandemic, long COVID became a clinical entity of symptomatic that persisted or recurred among the COVID illness recovered cases after reverse transcriptase polymerase chain reaction results for COVID-19 became negative. The symptoms consisted of fatigue, cough, dyspnea as pulmonary manifestations and extra-pulmonary involvement of the cardiac, renal, and central nervous systems and the pulmonary imaging features consisted of interstitial pneumonia, consolidation, cavity pattern, and prone to microbial infection. These events lead to morbidity and admission. Coinciding with the vaccination of all population of Odisha province with the first dose of the vaccine by around the period of the first quarter of 2022, there was a new variant named Omicron responsible in the third wave, in which the majority of the admitted cases had.mild upper respiratory illness. This was not as lethal as its predecessors due to its lower propensity to invade the lungs and blood vessels. Conclusion: Immune dysregulation plays a central role in the pathogenesis of the manifestations. Vaccine-induced protection and the induction of herd immunity played a proactive role in the waning of the severity of clinical presentations.

Geospatial Hotspot Analysis and Endemicity Trends of Missing and Unrecovered Children in India.

BACKGROUND: Children constitute a nation's true asset. A country's future relies upon the proper development of its children, which necessitates a supportive environment and sufficient opportunities. Children, under the age of 18 years form a considerable percentage of India's population which imparts a huge responsibility for the nation. Everyday we come across news about a child going missing. The National Crime Record Bureau (NCRB) states that 73,138 children were reported missing overall in 2018. The prevalence increased by 8.9% in 2019, a worrisome situation. The cause behind children going missing is multi-dimensional like poverty, unemployment, loss of livelihood, natural calamities, social conflicts, and migration to urban areas. At present, missing children remain a neglected and non-urgent intervention area for everyone. Only the parents whose children are missing can feel the vacuum and sorrow of the situation. The sociologies of India's missing children merit dimensional and circumstantial examination. The sociological space into which a child goes missing is highly under-researched in India. This study helped in understanding the magnitude of missing cases across India based on existing literature and secondary sources. It also identified the potentially safe and worst areas with regard to missing children. The endemicity helped in identifying the changing trends in each of these areas of interest, which could serve as baseline data for policymakers and law enforcement alike. MATERIALS AND METHODS: This is a cross-sectional analytical type of study. The data of missing and unrecovered children for the past five years (2021-2017) were obtained from open government data portal (https://data.gov.in) and geospatial hotspot analysis was done using the Getis-Order-G statistics on the same using GeoPandas and PySAL libraries of python. The endemicity of missing cases was studied using hierarchical cluster analysis and self-organizing maps using Python. RESULTS: For boys, Uttar Pradesh, Rajasthan, and Madhya Pradesh remained consistent hotspots (high risk of missing cases) across all five years of study whereas Karnataka became a hotspot for 2020 and 2021. Among the cold spots (low risk of missing cases), Andaman and Nicobar Islands remained consistent cold spot across all five years of study and has emerged as a safe haven for boys. The missing girls' data reveals that Uttar Pradesh has consistently been the worst state for girls (along with their neighbors) as it possess the risk of girls going missing all through the study period with Chhattisgarh being included from 2019 onwards. Jharkhand, Gujarat, Sikkim, and Andaman and Nicobar Islands have consistently been cold spots across the board and have emerged as areas with low risk for missing girls. CONCLUSION: This study helps us in understanding the magnitude of missing cases across India and it also identifies which are potentially safe areas as well as worst areas with regard to missing children. The endemicity also helps us in identifying the changing trends in each of these areas of interest. This will serve as a great resource for policy makers and law enforcement alike.

Acceptance of covid-19 vaccine among the healthcare providers in India.

Background: By increasing immunity, the corona virus disease-19 (COVID-19) vaccine is expected to reduce the rate of infection and severity of infection, as well as the rate of hospitalisation. Healthcare providers (HCPs) can provide a good example when it comes to their health habits. HCPs are believed to have the best vaccine acceptance rates because they are open-minded and informed. By concentrating on COVID-19 vaccine attitudes among HCPs in India, the current study gives a clear picture of vaccine acceptability. Material and Methods: A cross-sectional observational study approach was used. Participants in the study gave their informed permission. Snowball sampling was employed to spread the survey around social media platforms (mostly WhatsApp groups and email IDs). The survey was open from April 1 through April 30, 2021, and a total of 316 responses were received. SPSS software, version 25, was used for statistical analysis (SPSS, Inc., Chicago, IL, USA). Results: The participants' average age was 32.8 ± 9.7, with 57% of them being male. 16.5% of the 316 individuals had a history of chronic illness. 40.5% had ever experienced COVID-19 symptoms, and 24.1% had been diagnosed with COVID-19 while on duty. Only 16.5% strongly agreed that they could get COVID-19 in the near future, and 48.1% disputed that obtaining COVID-19 infection would make them very unwell. Only 40.5% of participants were concerned about the possible side effects of the vaccine, while 63.2% were not concerned about the possible side effects of the vaccine. Only 39.2% were concerned about the affordability (high price) of vaccines. The majority (95%) of participants agreed to be vaccinated when sufficient information was provided, and only 31.7% agreed to be vaccinated if they were vaccinated free of charge. Conclusion: Due to the high level of current willingness among healthcare professionals to accept COVID-19 vaccines, these data may not be available to the general public. Understanding the complex and interrelated factors that influence vaccination decisions and the determinants of vaccine hesitancy in a particular population is essential to inform interventions to improve immunization coverage.

Pathogens Isolated and Their Association With the Long-Term Outcome in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

BACKGROUND: Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation. MATERIALS AND METHODS: It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical Research Center, Bhubaneswar, from October 2018 to February 2022. Patients who were admitted with acute exacerbation of COPD and treated as per GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2021 guidelines were included in the study. Those patients in the severe category, who had clinically recovered, had undergone pulmonary physiotherapy, were on prescribed medications and home oxygen therapy after discharge, were followed up every three months by telephone calls. Any exacerbation, clinical stability, or mortality information was recorded. RESULTS: Out of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms such as Acinetobacter baumannii, Klebsiella pneumoniae, and  Pseudomonas aeruginosa were isolated. Readmission was more among patients with coinfection. CONCLUSION:  Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates, Acinetobacter baumannii and Klebsiella pneumoniae were predominantly detected. Poor clinical outcomes were noticed more among the coinfection group.

Status of socio-demographic and behavioral profile of younger and older HIV high risk groups in Chhattisgarh.

Background: The prevention of new infections in high-risk groups is a major thrust in National AIDS Control Program. There is enough evidence that many epidemiological and behavioral determinants which make High Risk Group vulnerable to HIV transmission. The most effective means of controlling the spread of HIV is through the implementation of Targeted Interventions (TIs) efforts by which services are catered to them. Furthermore, stigma and marginalization are often linked to this population, which may lead to difficulties while accessing social and health services (SHS) due to behavioral, cultural and language barriers or lack of knowledge of the system. So, finding the sociodemographic & behavioral profile can give a breakthrough in improving the quality of life of HIV high risk groups. Material and Methods: A cross sectional study was conducted during September to December 2019 in two districts (i.e., Raipur & Durg) among HRGs of Chhattisgarh. Training cum sensitization of survey team e.g., peer educators, outreach workers, counselors, project managers prior to the survey was done for data collection. Results: A Total of 3963 HRGs were registered with TI NGOs, 3418 (86.2%) were screened. The mean age of study participants was 27.69 ± 6.1. Compliance of participation was 86.2%. HRGs were observed to have malnutrition (BMI <18.5 &> 25.0). 7 cases of Pulmonary TB were found among IDUs. Prevalence of diabetes and Hypertension was 1.2% and 1.1% respectively. Substance abuse (i.e., for Alcohol and Tobacco) was significantly higher among IDUs and FSWs. Conclusion: This study reinforces the fact that for accessing High Risk Groups and retrieval of relevant information can best be obtained by their care givers i.e., TI NGOs personnel. Also understanding the sociodemographic and behavioral profiles are central to designing targeted HIV prevention interventions for them.

Neonatal dermatitis neglecta---Neglect by health system: A case report.

A 29 days old female child presented to the general outpatient department of Community Health Center with greenish black crusting over left ear for 7-8days duration without any other signs and symptoms. We report the diagnosis and management of the condition through ad-hoc store and forward tele-dermatology. This is the first reported case of dermatitis neglecta in neo-natal period.

Adherence of Doctors to Standard Diarrhoeal Management Guideline During Treatment of Under-Five Diarrhoeal Episodes: A Study From Eastern India.

Introduction Diarrhoea is one of the major preventable causes of childhood death in tribal areas of India. Most acute diarrhoea in childhood can be managed with oral rehydration salt (ORS) and zinc. This study aimed to assess the adherence of doctors to standard diarrheal management guidelines while treating under-five diarrhoeal episodes. Methods The cross-sectional study was conducted in 10 blocks of Kandhamal district in southern Odisha, India. The under-five childhood diarrhoea prescriptions from July to August 2018 were audited during September 2018. One health facility from each block and 15 prescriptions from each health facility were selected randomly. Data were collected and entered in Epicollect5 and analyzed using Statistical Packages for Social Sciences Version 22.0 (IBM Corp., Armonk, NY). Categorical variables were presented as proportions. Results A total of 150 under-five acute diarrhoea prescriptions were audited from 10 health facilities. One hundred ten prescriptions were from the out-patient department and 40 prescriptions were from the admitted diarrhoeal patients. The majority of them included ORS (77.3%) and zinc (75.3%) in the prescription, however, only half of the prescriptions (52.7%) had recommended dose and duration of zinc. All admitted patients received intravenous fluids. Most prescriptions (89.3%) did not document the hydration status of the patient. All prescriptions were silent about the severe acute malnutrition status of the children before administering fluid therapy. Antibiotics were prescribed in 80% of the prescriptions. Prebiotics, probiotics and anti-spasmodic were prescribed in 37.3% of the prescriptions. Conclusion Adherence of doctors to acute diarrheal management guidelines for the management of under-five diarrhoea was poor in our study. Further researches and training are required to improve childhood diarrhoea management in health facilities of tribal areas of India.

Community perception regarding diarrhoea management practices in a tribal predominant aspirational district of Odisha: A mixed-method study.

CONTEXT: Childhood diarrhea is still a major problem in developing countries, and the condition is worse in tribal areas. AIMS: The study aims to assess the community perception related to diarrhea management in an aspirational district of Odisha, India. SUBJECTS AND METHODS: A mixed-method study was conducted in Kandhamal, an aspirational district of Odisha, Eastern India, from June to October 2018. An in-depth interview was conducted among community health workers, and a cross-sectional survey was done for the household interview. The data were collected in a mobile-based application, Epicollect5, and in-depth interviews were recorded digitally. STATISTICAL ANALYSIS USED: The data were analyzed in the Statistical Package for Social Sciences (SPSS) version 22.0. Categorical variables are presented in proportions. Force-field analysis was conducted to assess the driving and restraining forces of diarrhea. Content analysis was done for the digitally recorded data. RESULTS: Nine out of ten people were aware of the benefit of breastfeeding during diarrheal episodes in children aged under 5 years, and <50% were aware of zinc benefit. Poor sanitation, lack of safe water, poor hygiene practices, socioeconomic status, and illiteracy are the major challenges in diarrheal control in the tribal area. CONCLUSIONS: Improving the demand by creating community awareness regarding management of diarrhea, availability of essential drugs (ORS and zinc) at the community level, and capacity building of community health workers for management of diarrhea can reduce diarrhea-related morbidity and mortality in tribal areas of India. Handwashing, hygiene practices, and availability of safe water need to be promoted in the tribal region. In the long term, the socioeconomic determinants have to be addressed.