Predictors for Concurrent Diabetes in Tuberculosis Patients. Perspectives from Two Mining Districts of Eastern Tribal State Jharkhand, in India.

Background: Tuberculosis and diabetes both diseases are present in large numbers in the country and we are major contributors to both globally. With the objective to understand the various traits of patients having both tuberculosis and diabetes and to ascertain various possible predictors for such occurrence based on the public health database we carried out this study. We seek answers to questions like they have any effects? Are they having any additive role to play? Methods: One-year data from the NIKSHAY portal of both districts were analyzed to look for possible associations and other variable traits. Data were analyzed using standard methods to express data in frequency and percentage. Chi-square test was used to establish association, while step-wise approach was used to calculate univariate and multivariate logistic regression analysis for knowing various predictors. P-value of <0.05 was considered statistically significant. Results: Concurrent diabetes in tuberculosis patients was close to 294 (6%) in the 4933 individuals. In total, 65.2% of the study population were male. Diagnosis of tuberculosis was made most of the time by chest X-ray (49.4%) followed by Microscopy ZN staining and cartridge-based nucleic acid amplification test (CBNAAT). Death was more among diabetics (4.4%) as compared to nondiabetics (3.5%). Conclusion: Diabetes is increasing in tuberculosis patients; improvement in data quality is needed. More research is required to reveal various other reasons that make tuberculosis patients more prone to develop diabetes.

Factors associated with unexplained sudden deaths among adults aged 18-45 years in India - A multicentric matched case-control study.

BACKGROUND OBJECTIVES: In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case-control study. METHODS: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1 st October 2021-31 st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). RESULTS: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. INTERPRETATION CONCLUSIONS: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.

Understanding the phases of vaccine hesitancy during the COVID-19 pandemic.

Vaccine hesitancy is an important feature of every vaccination and COVID-19 vaccination is not an exception. During the COVID-19 pandemic, vaccine hesitancy has exhibited different phases and has shown both temporal and spatial variation in these phases. This has likely arisen due to varied socio-behavioural characteristics of humans and their response towards COVID 19 pandemic and its vaccination strategies. This commentary highlights that there are multiple phases of vaccine hesitancy: Vaccine Eagerness, Vaccine Ignorance, Vaccine Resistance, Vaccine Confidence, Vaccine Complacency and Vaccine Apathy. Though the phases seem to be sequential, they may co-exist at the same time in different regions and at different times in the same region. This may be attributed to several factors influencing the phases of vaccine hesitancy. The complexities of the societal reactions need to be understood in full to be addressed better. There is a dire need of different strategies of communication to deal with the various nuances of all of the phases. To address of vaccine hesitancy, an understanding of the societal reactions leading to various phases of vaccine hesitancy is of utmost importance.

Dietary salt consumption pattern as an antecedent risk factor for hypertension: Status, vision, and future recommendations.

Multiple salt reduction strategies have been devised from time to time, addressing the issues of hypertension without considering the other essential factors, like the variability of salt sensitivity from the person to person. In this paper, we discuss how high salt consumption is one modifiable risk factor associated with hypertension among Indians, and there needs to be updated cut-off values. A thorough literature search on salt consumption articles on well-known search engines like Cochrane Library, PubMed, Google Scholar and Embase electronic database revealed a paucity of data in this field for India. Several studies revealed that the mean salt intake among the Indian populations ranges between 5.22 and 42.30 g/day. Moreover, among other risk factors analysed, salt intake (≥ 5 gm/day) was significantly associated with the development of hypertension. Although the need to address reduced salt intake for primordial prevention of hypertension and related cardiovascular diseases (CVDs) in India is well acknowledged by the key stakeholders, social and cultural beliefs, unorganized food retail sector and lack of existing food policing are some of the potential barriers that affect the progress and employment of such effective strategies. Some multinational food companies have already research is warranted to evaluate the contextual barriers and facilitators and to adopt effective strategies to improve awareness among consumers, to encourage the endorsement of salt reduction by the food industry, and to facilitate the adoption of countrywide consumer-friendly food labelling. We concluded that salt consumption is high in India, although this assessment has been done primarily by subjective methods in India. People all across are recommended the same cut-off value of dietary salt consumption regardless of the diversity in dietary patterns and environmental conditions across the country. There is an urgent need to address these issues through evidence-based population research.

A cross sectional study exploring determinants for vaccine awareness, belief and hesitancy among health care professionals regarding Covid-19 vaccine, findings from a teaching hospital based in coal capital of India.

Background: India intends to start its 1st dose of vaccination against Covid-19 on January 16th, 2021 prioritizing its frontline health care professionals with either of the two vaccines-Covaxin or Covishield. Whenever a new vaccine is launched, it is marred with controversy and myths. To understand the doubts and concerns better, this study was conducted on health care professionals working in a tertiary care hospital. Materials and Methods: Willing respondents, who are working in the institute, were administered the questionnaire asking their views on knowledge, beliefs, and reasons for hesitancy regarding Covid-19 immunization. A Likert scale was used to quantify the responses regarding participants' knowledge, beliefs, and hesitancies regarding immunization with the available vaccines. Data were analyzed using MS office Excel sheets and JASP software was used to analyze the data thus obtained. Results: Out of 122 complete responses, we had 73 (60%) doctors, while 30 (24%) were nursing staff, the rest comprised of other health care workers, such as housekeeping staff, janitorial, etc., 66 (54%) respondents were unaware, while 25 (20%) respondents had hesitancy and 23 (18%) were having extremely negative views regarding vaccination. Some of the variables, such as age, role, marital status, gender, etc., were found to be possibly associated with these scores. Conclusion: Issues like concerns over vaccine safety, efficacy, reliability, etc., are deterrents for individuals and whole programme and vaccination drive across the nation. Time and again it has been seen that despite the vaccines' contribution in breaking the transmission, concerns are making people either hesitant or unmotivated to get the vaccines. More dialogues from the authorities regarding the issues of concern may pave the way for more motivation to accept vaccination and increase the vaccination coverage.

Effect of milk supplementation on the status of micronutrients among rural school children aged 5-19 years in a tribal predominating district of India.

BACKGROUND: In the tribal state of Jharkhand, there have been very few studies on micronutrient deficiency and how it is addressed among school children. This study was conceived and undertaken to assess the effect of milk supplementation on the micronutrient status of school children. DESIGN: A comparative observational study was conducted among school children of a tribal district in India during 2017-2018. Two groups of schools/clusters were randomly selected, one with milk supplementation and the other without supplementation. A total of 318 children from the two groups of schools were recruited for biochemical analysis of certain micronutrients, such as calcium, vitamin D, vitamin B12 and iron (haemoglobin level), using cluster random sampling. Data were analysed using SPSS V.20.0 software, and multiple logistic regression analysis was done to determine the predictors of serum calcium and vitamin B12 level among school children. RESULTS: Almost all children from both groups had vitamin D deficiency. A higher risk of lower serum vitamin B12 level (OR 2.59, 95% CI 1.61 to 4.16) and calcium level (OR 3.36, 95% CI 1.74 to 6.49) was observed in children of the control group. The difference in the proportion of anaemia in the two study groups was found to be statistically insignificant. Milk consumption was found to be the only significant predictor of normal vitamin B12 and calcium level in the present study. CONCLUSIONS: In this study, it was concluded that milk consumption may help in improving the calcium and vitamin B12 status of school children of a tribal state, whereas it does not have any significant effect on vitamin D level.

Socio-demographic differentials of cognitive development and nutrition among school children: evidence from the tribal areas of Jharkhand, India.

BACKGROUND: This study attempts to assess the differentials of cognitive development and nutrition of school children in tribal areas of Jharkhand, India. METHODOLOGY: A cross-sectional study was carried out in 16 schools of Jharkhand amongst 962 children during the period of November to December 2017. Anthropometry, hemoglobin and IQ tests were assessed along-with their socio-demographic characteristics using standard procedures after obtaining their guardian's consent. Various tests of significance were used such as an independent sample t-test and Fisher's exact test along with multinomial logistic regression for determination of predictors for low-normal to borderline IQ among school children. RESULTS: Stunting and thinness were noted in 38% and 35% children, respectively, whereas anemia and low IQ were observed in more than 4/5th of the total children assessed. Anemia was more common in children >12 years of age and IQ was lower in tribal ethnic children (p < 0.05) amongst socio-demographic characteristics. Among the predictors, only tribal ethnicity appeared to be associated with low IQ [odds ratio (OR)-1.85; 95% confidence interval (CI) - 1.25, 2.75]. CONCLUSION: Despite various nutrition-related programs being run in government schools, the malnutrition and hemoglobin status of the children presents a poor picture. Cognitive development of children particularly tribal children is unsatisfactory and needs to be worked upon by government agencies.

Mapping fear among doctors manning screening clinics for COVID19. Results from cloud based survey in Eastern parts of India.

BACKGROUND: As the number of cases of COVID19 from novel corona virus 2019 rises so are the number of deaths ensuing from it. Doctors have been in front in these calamitous times across the world. India has less number of doctors so doctors are overwhelmed with more number of patients to cater. Thereby they are also fearing that they will be exposed much as they often work in limited resource settings. METHODS: An on line survey was to include doctors from eastern states in India for measuring the reasons of their fear and suggest possible solutions based on the results achieved thus. After IEC clearance a semi-structured anonymous questionnaire was sent on google forms as links on known to doctors, working in screening OPDs or flu clinics especially for COVID-19. RESULTS: Out of 59 Doctors majority were provided with sanitizers for practicing hand hygiene. Gloves were provided everywhere but masks particularly N95 and Triple Layer surgical masks were not there for all. Training was not given universally. Fear was dependent on age in our sample. CONCLUSION: Training and strict adherence to infection control measures along with resources can help in removing the fear.

A Hospital Based Study to Establish the Correlation between Recurrent Wheeze and Vitamin D Deficiency Among Children of Age Group Less than 3 Years in Indian Scenario.

INTRODUCTION: Early childhood wheezing is a heterogeneous condition, which has several phenotypic expressions and a complex relationship with the development of asthma later in life. New studies indicate the prevalence of recurrent wheeze to be associated with Vitamin D deficiency. This has not been explored in Indian settings widely, mandating this exploration. AIM: To determine the severity of Vitamin D deficiency and its association with recurrent wheeze in children less than 3 years of age. MATERIALS AND METHODS: Consecutive type of non-probability sampling was followed for selection of study subjects with a total sample size to be 122 children in the Hospital setting. A pre- formed, pre- tested, structured interview schedule was used to obtain information. Estimation of 25 (OH) Vitamin D was done using ELISA method. Kit used for estimation was DLD Diagnostika GMBH 25(OH) Vitamin D ELISA from Germany. Standard statistical tools were used including Logistic regression analysis, and ROC curve, p value <0.05 was considered to be statistically significant. SPSS software version 17.0 was used. RESULTS: Each 10ng/ml decrease in Vitamin D level is associated with 7.25% greater odds of wheezing. Our study also suggests, exclusive breast feeding and delaying of complementary feeding beyond 6 months of age are significant predictors of Vitamin D deficiency and have indirect association with increased incidence of wheezing in children. CONCLUSION: The study concluded that Vitamin D deficiency is associated with increased risk of recurrent wheezing.