Validation of the Indian (Hindi) version of the life-space assessment scale among community-dwelling older adults: a multicentric cross-sectional study.

BACKGROUND: The Life-Space Assessment (LSA) is an instrument that measures mobility in older adults as they reach different areas, defined as life-spaces extending from home to beyond towns or regions. The purpose of the study was to develop the Hindi version of the LSA (LSA- H) and to investigate the validity and reliability of the Hindi version as well as its cultural adaptation. METHODS: A cross-sectional study of two hundred forty-five older adults participated in the study from four different study practice areas. Following forward backwards translation, the LSA-H was developed, and the scores were correlated with those of the Activities-Specific Balance Confidence Scale Hindi (ABC- H), the Physical Health Subscale of the WHO-BREF Questionnaire and the Geriatric Depression Scale: Short Form Hindi (GDS-SFH) to test the criterion and concurrent validity. RESULTS: The mean score and standard deviation of the LSA-H questionnaire were 56.53 ± 35.99, those of the Physical Health Subscale of the WHO-BREF instrument were 18.54 ± 7.87, those of the GDS-SFH questionnaire were 6.95 ± 4.21 and those of the ABC- H questionnaire were 54.40 ± 28.96. The Pearson correlation coefficient (r) between the LSA-H score and ABC-H score was 0.707 (p value < 0.0001), that between the LSA-H score and the Physical Health Subscale of the WHO-BREF was 0.766 (p value < 0.0001), and that between the LSA-H score and GDS-SFG score was - 0.674 (p value < 0.0001). CONCLUSION: This study demonstrated that the Hindi version of the LSA is a valid and reliable instrument for assessing living space among older adults in the Hindi language in an Indian population. Furthermore, the LSA-H was significantly correlated with other health assessment tools in terms of functional mobility, general health status and mental well-being.

Knowledge, Awareness, and Determinants of Medication Adherence in Hypertensive Patients: A Hospital-Based Cross-sectional Study in North India.

Background: Knowledge and awareness studies reveal the basic information of the community and the misconceptions in relation to practices of a disease. The identification of such factors is important as they directly influence the health care-related interventions. Hypertension is one of the emerging noncommunicable diseases (NCDs) globally. So, we conducted this study to assess the status of our community regarding hypertension. Materials and Methods: The study was conducted on 300 hypertensive patients to assess the knowledge and awareness by a hypertension fact questionnaire. Medication adherence was assessed in the same group of patients by Hill-Bone scale-a uniform scale used worldwide. Results: Our study revealed a greater number of females with hypertension as compared to males and a maximum number of patients being in the age-group of 61-70 years and belonging to rural areas. Most of the patients had a secondary education as a highest educational qualification with only 10% of patients being postgraduates. A fair number of patients had a good knowledge and awareness about their disease, and most of the respondents accounted forgetfulness as a main reason for nonadherence to therapy over other reasons. Conclusion: Our population has good knowledge and awareness about their disease despite not having very good educational qualifications, and we need to strengthen our healthcare programs for even more greater dissemination of information.

"Harm reduction approach for tuberculosis and substance use disorders: A review of approaches and implications in the Indian context".

There are limitations to traditional treatment approaches in addressing the needs of individuals with dual comorbidity of TB and SUD. The concept of harm reduction as a distinct approach to addressing substance use, focusing on minimising the negative consequences associated with it rather than advocating for complete abstinence. Different harm reduction strategies, such as opioid substitution therapy, needle and syringe programmes, testing for viral infections etc. have been effectively employed for SUDs in past. Similarly, TB risk minimization approaches like improving housing and nutrition and focused testing strategies are considered as harm reduction strategies for TB management. The relationship between tuberculosis (TB) and substance use disorders (SUDs) involves a complex interplay of biopsychosocial factors. It is crucial to prioritise integrated and closely monitored care in order to address the treatment challenges and potential drug interactions that may arise. In light of the acknowledged challenges like limited awareness, infrastructure, drug resistance, and stigma, it is imperative to explore potential avenues for the implementation of harm reduction strategies targeting individuals with comorbid TB and SUD in India. Potential strategies for addressing the issue includes a range of measures, such as augmenting investments in healthcare, integrating policies, tackling social determinants, and establishing shared platforms for psychosocial rehabilitation.

Proteomic Analysis of the Mycobacterium tuberculosis Outer Membrane for Potential Implications in Uptake of Small Molecules.

Increased resistance to current antimycobacterial agents and a potential bias toward relatively hydrophobic chemical entities highlight an urgent need to understand how current anti-TB drugs enter the tubercle bacilli. While inner membrane proteins are well-studied, how small molecules cross the impenetrable outer membrane remains unknown. Here, we employed mass spectrometry-based proteomics to show that octyl-ß-d-glucopyranoside selectively extracts the outer membrane proteins of Mycobacterium tuberculosis. Differentially expressed proteins between nutrient-replete and nutrient-depleted conditions were enriched to identify proteins involved in nutrient uptake. We demonstrate cell surface localization of seven new proteins using immunofluorescence and show that overexpression of the proteins LpqY and ProX leads to hypersensitivity toward streptomycin, while overexpression of SubI, SpmT, and Rv2041 exhibited higher membrane permeability, assessed through an EtBr accumulation assay. Further, proton NMR metabolomics suggests the role of six outer membrane proteins in glycerol uptake. This study identifies several outer membrane proteins that are involved in the permeation of small hydrophilic molecules and are potential targets for enhancing the uptake and efficacy of anti-TB drugs.

Indian Model of Integrated Healthcare (IMIH): a conceptual framework for a coordinated referral system in resource-constrained settings.

INTRODUCTION: With the escalating burden of chronic disease and multimorbidity in India, owing to its ageing population and overwhelming health needs, the Indian Health care delivery System (HDS) is under constant pressure due to rising public expectations and ambitious new health goals. The three tired HDS should work in coherence to ensure continuity of care, which needs a coordinated referral system. This calls for optimising health care through Integrated care (IC). The existing IC models have been primarily developed and adopted in High-Income Countries. The present study attempts to review the applicability of existing IC models and frame a customised model for resource-constrained settings. METHODS: A two-stage methodology was used. Firstly, a narrative literature review was done to identify gaps in existing IC models, as per the World Health Organization framework approach. The literature search was done from electronic journal article databases, and relevant literature that reported conceptual and theoretical concepts of IC. Secondly, we conceptualised an IC concept according to India's existing HDS, validated by multiple rounds of brainstorming among co-authors. Further senior co-authors independently reviewed the conceptualised IC model as per national relevance. RESULTS: Existing IC models were categorised as individual, group and disease-specific, and population-based models. The limitations of having prolonged delivery time, focusing only on chronic diseases and being economically expensive to implement, along with requirement of completely restructuring and reorganising the existing HDS makes the adoption of existing IC models not feasible for India. The Indian Model of Integrated Healthcare (IMIH) model proposes three levels of integration: Macro, Meso, and Micro levels, using the existing HDS. The core components include a Central Gateway Control Room, using existing digital platforms at macro levels, a bucket overflow model at the meso level, a Triple-layered Concentric Circle outpatient department (OPD) design, and a three-door OPD concept at the micro level. CONCLUSION: IMIH offers features that consider resource constraints and local context of LMICs while being economically viable. It envisages a step toward UHC by optimising existing resources and ensuring a continuum of care. However, health being a state subject, various socio-political and legal/administrative issues warrant further discussion before implementation.

How much do we follow birth preparedness? A community-based snapshot study from rural Delhi, India.

Introduction: Maternal healthcare remains a challenging public health problem in low and middle-income countries like India. The comprehension and services regarding practices related to birth preparedness and its complications in rural areas of India remain poor and underused. In view of this, we conducted this study to explore the preparedness of the pregnant women in the community residing in rural settlements of Delhi. Methods: This cross-sectional community-based study was carried out in 165 currently pregnant women selected through proportionate sampling from rural Delhi. A semi-structured questionnaire adapted from Birth Preparedness and Complication Readiness (BPCR) tool kit was used. Binary and multivariate regression analysis was applied to identify the predictors of BPCR. Results: In our study, BPCR index was found to be 25.78%. Only 17.6% pregnant women were well prepared. Multigravida, literacy, and higher socioeconomic status were found significant predictors for well preparedness for child birth and complication readiness in bivariate analysis. In multivariate logistic regression, multigravida and literacy were found to be predictors for well preparedness. Conclusion: The skill and knowledge level of the mother-in-laws and other women along with husband in the family needs to be improved in context of pregnancy and child birth. Frontline health workers can assist the to-be mothers and their family members in informed decision-making for better feto-maternal outcomes.

Mapping the stability of febrile illness hotspots in Punjab from 2012 to 2019- a spatial clustering and regression analysis.

INTRODUCTION: Febrile illnesses (FI) represent a typical spectrum of diseases in low-resource settings, either in isolation or with other common symptoms. They contribute substantially to morbidity and mortality in India. The primary objective was to study the burden of FI based on Integrated Disease Surveillance Programme (IDSP) data in Punjab, analyze geospatial and temporal trends and patterns, and identify the potential hotspots for effective intervention. METHODS: A retrospective ecological study used the district-level IDSP reports between 2012 and 2019. Diseases responsible for FI on a large scale, like Dengue, Chikungunya, Malaria (Plasmodium Falciparum, P. Vivax), Enteric fever, and Pyrexia of Unknown Origin (PUO), were included in the analysis. The digital map of Punjab was obtained from GitHub. Spatial autocorrelation and cluster analysis were done using Moran's I and Getis-Ord G* to determine hotspots of FI using the incidence and crude disease numbers reported under IDSP. Further, negative binomial regression was used to determine the association between Spatio-temporal and population variables per the census 2011. Stable hotspots were depicted using heat maps generated from district-wise yearly data. RESULTS: PUO was the highest reported FI. We observed a rising trend in the incidence of Dengue, Chikungunya, and Enteric fever, which depicted occasional spikes during the study period. FI expressed significant inter-district variations and clustering during the start of the study period, with more dispersion in the latter part of the study period. P.Vivax malaria depicted stable hotspots in southern districts of Punjab. In contrast, P. Falciparum malaria, Chikungunya, and PUO expressed no spatial patterns. Enteric Fever incidence was high in central and northeastern districts but depicted no stable spatial patterns. Certain districts were common incidence hotspots for multiple diseases. The number of cases in each district has shown over-dispersion for each disease and has little dependence on population, gender, or residence as per regression analysis. CONCLUSIONS: The study demonstrates that information obtained through IDSP can describe the spatial epidemiology of FI at crude spatial scales and drive concerted efforts against FI by identifying actionable points.

Parameters Affecting the Kidney Size in Individuals without Known Renal Pathology: an Ultrasonographic Study.

Background:Renal size can be affected by various causal elements such as age, sex, and demographic characteristics. It is crucial for medical professionals to consider these factors when making clinical decisions. The purpose of this investigation was to establish normograms for renal measurements and explore their association with the anthropometric variables in the natives of Northern India. Methods:A total of 105 individuals with presumed healthy kidneys were enrolled in the present study. Kidney length, width and parenchymal thickness were measured, and data were analysed to identify potential differences related to age, gender and side. Correlation analysis was conducted to examine the relationship between kidney measurements and body biometrics, including body height, body weight, body mass index (BMI) and body surface area (BSA). Results:Mean values for kidney length, width and parenchymal thickness in the 209 kidneys analysed were as follows: right kidney - length 10.65 ± 1.34 cm, width 4.5 ± 0.42 cm and parenchymal thickness 0.91 ± 0.16 cm; left kidney - length 10.7 ± 1.69 cm, width 4.78 ± 1.26 cm and parenchymal thickness 0.76 ± 0.40 cm. Thickness showed significant differences between the right and left kidneys. No significant differences in renal parameters were found between males and females. Analysis based on age groups revealed an increase in renal length and thickness with advancing age, while width decreased in the middle age group (31-40 years) and then increased. Weak positive correlations were observed between kidney parameters and body height, body weight, BSA, and BMI. Conclusion:Renal parameters can vary among different populations depending on age, demographic characteristics, and ethnicity. Therefore, relying on commonly cited values for renal sonographic interpretation or clinical decision-making may not be appropriate. Interpreting renal measurements should be based on reference data specific to the studied population.

Comprehensive coordinated community based palliative care (C3PaC) model for cancer patients in North India: a mixed-method implementation research study protocol.

BACKGROUND: Cancer remains an escalating and challenging public health issue. The management, especially palliative care (PC), is disintegrated and out of reach of in need patients. The overall aim of the project is to develop a feasible and scalable Comprehensive Coordinated Community based PC model for Cancer Patients (C3PaC); congruent with socio-cultural, context and unmet needs in north India. METHODS: A mixed method approach will be used for three-phased pre- and post-intervention study in one of the districts of North India, having a high incidence of cancer. During phase I, validated tools will be used for quantitative assessment of palliative needs among cancer patients and their caregivers. Barriers and challenges for provision of palliative care will be explored using in-depth interviews and focus group discussions among participants and health care workers. The findings of phase I along with inputs from national experts and literature review will provide inputs for the development of the C3PAC model in phase II. During phase III C3PAC model will be deployed over a period of 12 months and its impact assessed. Categorical and continuous variables will be depicted as frequency (percentages) and mean ± SD/median (IQR) respectively. Chi-square test/Fischer test, independent samples Student t-tests and Mann-Whitney U tests will be used for categorical, normally and non-normally distributed continuous variables, respectively. Qualitative data will be analyzed using thematic analysis using Atlas.ti 8 software. DISCUSSION: The proposed model is designed to address the unmet palliative care needs, to empower community-based healthcare providers in comprehensive home-based PC and to improve the quality of life of cancer patients and caregivers. This model will provide pragmatic scalable solutions in comparable health systems particularly in low- and lower-middle Income countries. TRIAL REGISTRATION: The study has been registered with the Clinical Trial Registry-India (CTRI/2023/04/051357).

Prediction of Sinter Properties Using a Hyper-Parameter-Tuned Artificial Neural Network.

The present work aims at performing prediction validation for the physical properties of coke layered and nonlayered hybrid pelletized sinter (HPS) using artificial neural networks (ANNs). Physical property analyses were experimentally performed on the two HPS products. The ANN model was then trained to obtain the best prediction results with the grid-search hyper-parameter tuning method. The learning rate, momentum constant, and the number of neurons varied over specified ranges. The binary variable conversion was utilized to assess the two sintering processes. The nonlayered HPS product of 4 mm micropellets at basicity 1.75 and using 8% coke shows a good combination of physical properties, whereas HPS of 4 mm micropellets at 1.5 basicity using 4% coke as fuel and 2% coke as layering gives a radical improvement in physical properties. The yield of the HPS product is 96.07%, with the shatter index (SI), tumbler index (TI), and abrasion index (AI) values being 86.12, 79.60, and 5.74%, respectively. Hence, HPS can be preferred by implementing the layering of coke powder. The prediction analyses showed that the multilayer perceptron model (MLP) network with a 4-29-5 structure showed prediction accuracies of over 99.99% and a mean squared error (MSE) of 2.87 × 10-4. It verifies the accuracy and prediction effectiveness of the hyper-parameter-tuned ANN model.

India's Multi-Sectoral Response to Oxygen Surge Demand during COVID-19 Pandemic: A Scoping Review.

Oxygen support became one of the rate-limiting steps for medical care during COVID-19 pandemic in India. The primary aim of this study was to appraise the manufacturing, supply, and distribution of medical oxygen during the pandemic. The secondary objectives were to highlight the coordination of various stakeholders to mitigate the oxygen surge and to present a critical analysis of India's response to the emergent situation. Using an analytic approach, we have delineated India's response to mitigate the medical oxygen surge during the distressing second peak between March-May 2021. In the pre-COVID-19 era, of the total 6900 MT of oxygen produced in India, only 1000 MT was available for medical usage, which was increased up to 19940 MT through the strengthening of in-house oxygen manufacturing, low-cost innovations, and enhanced storage facilities. High-burden states were identified, and transport was facilitated through departments of railways, defence and civil aviation. Real-time scrutiny of the oxygen supply was provided. Essential customs duties on importing oxygen and vital equipment were exempted, along with other swift decisions. National Oxygen Stewardship Program' was initiated to build the capacity of health care workers in oxygen therapy and rational use of surplus oxygen. The pandemic overwhelmed the health system. But a coordinated multi-stakeholder approach facilitated the fight against oxygen surge. However, a comprehensive pandemic response will need more than just oxygen. This resourceful utilization offers a silver lining and facilitates the improvement of health systems and health outcomes in the long term.

Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India.

Background: Acceptance of vaccines has been on a decline in recent times, with vaccine hesitancy being listed as one of the top 10 global health threats. This study analysed vaccine hesitancy and belief towards vaccination among caregivers of children aged below 5 years. Methods: In this cross-sectional study, 196 caregivers of children aged 6 months to below 5 years who had attended an immunization clinic at a tertiary care institute of Eastern India from March to May 2019 were surveyed. Consecutive sampling was used to recruit eligible study participants. The survey assessed the attitudes of parents towards childhood vaccination by using the Vaccine Hesitancy Scale and their beliefs towards vaccination. Univariate analysis was performed to assess the association of various sociodemographic factors with vaccine hesitancy. Results: Among the caregivers, most (48%) mothers were aged 26-35 years, literate and homemakers. Vaccine hesitancy was observed in 9.18% of the participants. Only the age of the child was significantly associated with vaccine hesitancy. Nearly half (48.5%) of the participants were concerned about the serious adverse effects of vaccines, and a third (30.6%) agreed that newer vaccines are associated with higher risks than the older ones. Caregivers felt that vaccines are no longer required for uncommon diseases. Conclusion: Concerns regarding vaccine hesitancy are prevalent even among caregivers attending a tertiary care institute. Thus, additional studies are required to assess hesitancy in urban, rural, remote and inaccessible areas. Policymakers ought to conduct periodic assessments and implement necessary remedial measures for the long-term sustenance of the benefits of the national immunization programme.

Bounded Consensus Tracking of Heterogeneous Multiagent Systems Under Digraphs With Diverse Communication and Input Delays.

We study the bounded consensus tracking problem for the heterogeneous multiagent system composed of single- and double-integrator agents in the presence of diverse communication and input delays. The objective is to ensure bounded tracking when only a portion of agents has access to the desired trajectory while agents interact with each other through a directed communication network. To achieve this goal, we propose a protocol consisting of a consensus-based trajectory estimator followed by a controller tracking the estimated trajectory for each agent. Though the agents involved in the mission are heterogeneous, the estimators of all the agents are designed as coupled single integrators to provide estimates of the acceleration, velocity, and position along the desired trajectory. The coupled single-integrator estimator followed by the tracking controller strategy leads to a decoupling whereby the allowable estimator gains for an agent depend only on its communication delays and its controller gains depend only on its input delay. The tracking errors remain bounded even if the desired acceleration is unknown to all the agents. Simulation results are carried out to validate the proposed consensus tracking algorithm.

Prevalence and determinants of hypertension and associated comorbidities in non-pregnant women of reproductive age group (15-49 years): Evidence from National Family Health Survey (NFHS-4), India.

Background: Hypertension in women is generally underestimated and undiagnosed as women are considered to be at a lower risk of cardiovascular disease than men in addition to gender-related differences in healthcare seeking behaviour and access to healthcare. As hypertension extends a substantial impact on the cardiovascular health of women and can pose an enormous burden on the healthcare systems in India, identification of its risk factors along with co-morbidities becomes necessary for planning of cardiovascular risk prevention, reduction and mitigation interventions. Aim: This study aimed at estimating the prevalence and associated demographic and lifestyle risk factors of hypertension (HT) along with examining comorbidity patterns in women of reproductive age (15-49 years) in India. Material and Methods: We analyzed data of 667,258 non-pregnant women of the reproductive age group (15-49 years) from the National Family Health Survey (NFHS)-4 dataset. We used maps to present the spatial patterns of HT in women across states and union territories and logistic regression modelling to identify associated factors. Results: The overall prevalence of HT was 10.9% among women (15-49 years), with 60.7% of these having at least one comorbidity. While the prevalence of 'HT only' was higher in women 15-29 years of age (48.0%), the prevalence of HT with co-morbidities was higher in women aged ≥30 years (63.3%). Logistic regression analysis showed higher odds of 'HT and ³ two comorbidities' with age ³30 years (AOR 3.46, 95% CI 3.23-3.72), higher odds of 'HT only' with alcohol consumption (AOR 1.32, 95%CI 1.23-1.42), and higher odds of 'HT and one comorbidity' with BMI ³23 Kg/m2 (AOR 1.17, 95%CI 1.14-1.21). Also, region-wise, the prevalence of HT was highest in the states of Uttar Pradesh (11.6%), Madhya Pradesh (8.0%), and Assam (6.9%). Conclusion: The high prevalence of HT among women aged 15-49 years has serious medical, socio-economic, implications that warrant urgent and immediate gender-specific healthcare interventions. Along with lifestyle modifications, early and timely screening of HT, increasing awareness among young school-going girls, including rural areas, could flatten the HT population curve in India.

Health research in the state of Odisha, India: A decadal bibliometric analysis (2011-2020).

Background: Bibliometric analyses are an important tool for evaluating health research outputs in terms of their distribution, trends, contributors, focus, and funding sources. The transition from millennium to sustainable development goals has led to a gradual shift in the health policy, and possibly, research priorities of low-income settings in the Empowered Action Group (EAG) states lagging in socioeconomic and health parameters, and also ranking low on innovations and research. In this study, we depict the recent trends, quantity, type, focus, and sources of health-related research in the EAG state of Odisha, India. Methods: Peer-reviewed published original research articles related to human health published between 1 January, 2011 and 31 December, 2020 and where the study population was the residents of Odisha, or the study site was in Odisha, exclusively or partially, were analyzed. The publication characteristics were tabulated, including the title, journal name, open access, date of publication, number of authors, designation of the authors, number of institutes involved, and name of the institute of the first author. The details of the study setting, study site, ethical clearance, and funding source were also analyzed. Results: The study identified 2,285 articles from database searches and included 666 articles after screening for bibliometric analysis. Most of the manuscripts had between three and six authors (43.5%). Two institutes from the state, the Regional Medical Research Center (ICMR-RMRC) and Kalinga Institute of Industrial Technology (KIIT), together contributed to 22.4% of the published manuscripts. Nearly 45.9% of the studies were community-based while 45.3% were hospital-based. While most of the published work was on infectious diseases, the proportion came down with time. An overwhelming majority of the studies were observational and less than 10% were experimental in design. Conclusions: The analysis shows a substantial increase in the number of publications in this decade. Priority setting of healthcare problems, increased funding, and capacity-building can give a much-necessitated impetus to more quality- and evidence-based research for aiding policy implementation and improvement of the overall health.

Depression and quality of life among elderly: Comparative cross-sectional study between elderly in community and old age homes in Eastern India.

BACKGROUND: Depression among elderly is an emerging public health concern. Along with other comorbidities, depression affects the quality of life and functional ability of the geriatric population. This study aimed to assess the depression and quality of life among elderly and compare these parameters among the inhabitants of old age home and in the community. MATERIALS AND METHODS: A cross-sectional study was conducted among the elderly of the community and old-age homes in the urban areas of Raipur, Chhattisgarh between March and July 2016. Hundred elderly (50 in each group) participated in the study. Geriatric Depression Scale 15 (GDS-15) and Older People Quality of Life (OPQoL)-35 scale were used to assess the geriatric depression and quality of life, respectively. Association between depression and demographic variables were analyzed by Chi-square/Fisher's exact test. Pearson's correlation coefficient was calculated between GDS-15 and OPQoL-35 scale. RESULTS: The prevalence of geriatric depression was 59%. Quality of life was better among the old-age home elderly participants than that of community elderly when compared for score of life over all (11.78 vs. 13.56), health (12.8 vs. 14.0), social relationship (10.48 vs. 13.9), control over life (11.92 vs. 14.08), home and neighborhoods (9.38 vs. 12.36), psychological and emotional wellbeing (10.96 vs. 13.7), financial circumstances (14.5 vs. 16.7), and leisure and activities (13.86 vs. 15.28). Moderate positive correlation was observed between depression and quality of life. CONCLUSION: The higher prevalence in our study emphasizes the need to delineate the actual burden in the elderly population and provide necessary supportive measures. It needs to be addressed adequately through a coordinated primary care approach and community and social support. Timely and adequate management of depression can improve the quality-of-life outcomes.

Lymphadenopathy subsequent to Covishield (ChAdOx1 nCoV-19) Corona virus vaccine: ultrasound findings and clinical implications.

Introduction: Post anti-COVID-19 vaccine lymphadenopathies have been recently described in literature, from different parts of the world. Although there have been studies on lymphadenopathy following mRNA vaccines, there is a paucity of studies on lymphadenopathy following inactivated viral vaccines, such as Covishield. Aim: In this study, we explored lymphadenopathy subsequent to Covishield vaccine in terms of its various ultrasound parameters in the Indian population. Methods: This hospital-based longitudinal study was conducted among 50 adult beneficiaries of Covishield vaccine. Sociodemographic details and relevant clinical history were recorded using a semi-structured performa. Detailed ultrasound (USG) examination of the bilateral axillae was done on the day of vaccination and after 6-12 days post vaccination. Vaccine beneficiaries were evaluated for the presence of any vaccine-associated lymphadenopathy and described the presence, number, size, morphology, cortical thickness, and presence or absence of echogenic hilum. Results: Out of total (63) lymph nodes evaluated sonologically, majority (80.9%) of lymph nodes showed the features of benign lymphadenopathy. However, 12.6% (8/63) lymph nodes showed diffusely thickened cortex with preserved central echogenic hilum, 4.76% (3/63) lymph nodes showed eccentric cortical thickness with preserved hilar pattern, while only one lymph node showed diffuse cortical thickening with loss of central echogenic hilum. Conclusion: With an increase in vaccination coverage, clinicians are likely to confront increasing cases of vaccine-associated axillary lymphadenopathy. Therefore, they should exercise care, that contemporary anti-COVID-19 vaccination can present an aetiology of axillary lymph nodes with suspicious USG features.

Regional Water Availability and WASH Indicators as Predictors of Malnutrition in Under-5 Children: Analysis of the National Family Health Survey, India (2015-16).

BACKGROUND: Water, sanitation and hygiene (WASH) practices determine child nutrition in resource-constrained countries and are influenced by regional water availability. We assessed any relationship between malnutrition and WASH practices among under-5 children in India's areas as per water availability. METHODS: We did a secondary data analysis of the National Family Health Survey-IV. Stunting, wasting and being underweight were the significant outcomes. Regional water availability, households' source of water, sanitation and disposal of the child stool were the major independent variables. We report the prevalence estimates, bivariate associations and adjusted odds ratio to predict the child's malnutrition per regional water availability after using appropriate sampling weight. RESULTS: Of the 186 875 children, 41%, 20% and 36% were stunted, wasted and underweight. Only 26% of children had access to improved drinking water sources, whereas 50.0% were defecating in open. Around 65% of children's stools were disposed of in unhygienic ways. Undernutrition depicted a significant association with independent variables. There were higher chances of stunting with a decrease in regional water availability, unimproved sanitation and unhygienic ways of stool disposal. Wasting was intensified by all these factors, except the safe disposal of stools. CONCLUSIONS: WASH indicators exert a protective effect on undernutrition.

Cost of Ambulatory Care in Diabetes: Findings From a Non-Communicable Disease Clinic of a Tertiary Care Institute in Eastern India.

BACKGROUND: This study was conducted to evaluate the cost of ambulatory care of diabetes in a non-communicable disease (NCD) clinic in eastern India. METHODS: This hospital-based cross-sectional cost description study was conducted from July to August 2018. A total of 192 diagnosed cases aged 18-70 years with a minimum history of one year since diagnosis attending the NCD clinic for the first time were included. Information was collected using a pre-tested schedule based on the cost of illness approach that consisted of socio-demographic details, disease status, and cost of ambulatory care. Cost of the drugs was calculated using a standardized repository of drug costs. The estimated expenditure of previous three months was calculated and extrapolated to one year to calculate yearly expenditure. RESULTS: The mean age of the study participants was 43.93±10.41 years and the mean duration of diabetes was 6.64±6.08 years. The median direct cost due to diabetes was Rs 9560 (136.57 USD) annually. It was higher in females (Rs 10,056, 143.45 USD) than in males (Rs 9020, 128.85 USD). In direct medical costs, a major part was constituted by the drugs, oral hypoglycemic agents, and/or insulin (approximately 70%). CONCLUSIONS: In an ambulatory framework too, diabetes causes a substantial financial burden on the individual in India. In the wake of resource constraints in Indian health settings, the public health system needs to be adequately strengthened by policymakers to address the growing number of diabetics and long-standing complications.

Higher coronavirus disease-19 mortality linked to comorbidities: A comparison between low-middle income and high-income countries.

BACKGROUND: Global burden of disease (GBD) provides the estimates of mortality and morbidity, while case fatality rate (CFR) helps in understanding the severity of the disease. People infected with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) with underlying medical conditions have shown higher levels of unfavorable outcomes including mortality. We assessed the association of SARS-CoV-2 CFR with disability-adjusted life years (DALY) of various comorbidities in the low-middle income countries (LMIC) and high-income countries (HIC) to study the relationship of coronavirus disease-19 (COVID-19) mortality with GBDs and to understand the linkage between COVID-19 mortality and comorbidities. MATERIALS AND METHODS: This was an ecological study with secondary data analysis comparing the DALY of various morbidities from GBD with CFR of COVID-19. Gross domestic product was the basis of stratifying 177 countries into low-middle income (LMIC) and high-income groups (HIC). The mortality was analyzed using Pearson correlation and linear regression. RESULTS: The median global CFR of SARS-CoV-2 was 2.15. The median CFR among LMIC (n = 60) and HIC (n = 117) was 2.01 (0.00-28.20) and 2.29 (0.00-17.26), respectively. The regression analysis found that, in both LMIC and HIC, maternal disorders were associated with higher SARS-CoV-2 CFR, while tuberculosis, mental health disorders, and were associated with lower CFR. Further, in LMIC, musculoskeletal disorders and nutritional deficiencies were associated with higher CFR, while respiratory disorders were associated with lower CFR. CONCLUSIONS: SARS-CoV-2 infection appears to be a systemic disease. Individuals with comorbidities, such as maternal disorders, neurological diseases, musculoskeletal disorders, and nutritional deficiencies, have poorer outcomes with COVID-19, leading to higher mortality.