Mucormycosis in COVID-19 patients: A cross-sectional study at IGIMS, Patna.

Introduction: During the second wave of COVID-19, the incidence of mucormycosis has increased more rapidly. The most common causes attributed to the rise of mucormycosis in COVID-19 are uncontrolled diabetes, the excessive use of corticosteroids, and long-term stays in the intensive care unit, organ or bone marrow transplantation, etc. Objective: To determine the sociodemographic and associated risk factors, pattern of disease, treatment of mucormycosis and outcome of individual at time of discharge and after three months and six months of follow-up. Methodology: This cross-sectional study included all treated mucormycosis cases with prior COVID-19 infection. Data collected from medical records using purposive sampling. Survivors followed up at 3 and 6 months after discharge. Results: In our study, we analyzed 161 mucormycosis cases identified through positive RTPCR/Rapid Antigen reports. Among them, 72% were males and 28% were females. Diabetes mellitus was present in 71.4% and hypertension in 29.8% of patients. The case-fatality rate was 6.8% at discharge, increasing to 18.6% after 3 months and 28% after 6 months of follow-up. Statistical analysis was conducted using SPSS version 15. This analysis helped us draw meaningful conclusions from the data, highlighting the impact of comorbidities and time on mucormycosis outcomes. Conclusion: Post-COVID mucormycosis in India was primarily observed in patients with uncontrolled diabetes, immunodeficiency due to other comorbidities, and dysfunctional immune systems.

CHSI costing study-Challenges and solutions for cost data collection in private hospitals in India.

INTRODUCTION: Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (AB PM-JAY) has enabled the Government of India to become a strategic purchaser of health care services from private providers. To generate base cost evidence for evidence-based policymaking the Costing of Health Services in India (CHSI) study was commissioned in 2018 for the price setting of health benefit packages. This paper reports the findings of a process evaluation of the cost data collection in the private hospitals. METHODS: The process evaluation of health system costing in private hospitals was an exploratory survey with mixed methods (quantitative and qualitative). We used three approaches-an online survey using a semi-structured questionnaire, in-depth interviews, and a review of monitoring data. The process of data collection was assessed in terms of time taken for different aspects, resources used, level and nature of difficulty encountered, challenges and solutions. RESULTS: The mean time taken for data collection in a private hospital was 9.31 (± 1.0) person months including time for obtaining permissions, actual data collection and entry, and addressing queries for data completeness and quality. The longest time was taken to collect data on human resources (30%), while it took the least time for collecting information on building and space (5%). On a scale of 1 (lowest) to 10 (highest) difficulty levels, the data on human resources was the most difficult to collect. This included data on salaries (8), time allocation (5.5) and leaves (5). DISCUSSION: Cost data from private hospitals is crucial for mixed health systems. Developing formal mechanisms of cost accounting data and data sharing as pre-requisites for empanelment under a national insurance scheme can significantly ease the process of cost data collection.

Sexual attitude and behavior among medical students: A single institution survey.

Background: Human behavior including sexual activity is mostly culturally bound; particularly individuals at a younger age do build their sexual knowledge through various sources like by forming intimacy with similar age group individuals and use of media or literature available for the information. Values and beliefs about sexuality are manifested in a person's individual sexual behaviors based on family, religion and socio-cultural influence on knowledge about sexuality and sexual experiences. However, modernization may have inadvertently changed people's attitudes and permissiveness among sexually active youths in our society. Methodology: This study adapted a cross-sectional descriptive-cum-exploratory research design conducted in an in-group of a single educational institute. A structured, pre-tested, self-administered questionnaire was used to collect the relevant information from the subjects. This study aims to receive information about the knowledge, practices and attitudes regarding sexual behavior among 340 undergraduate medical students in a medical college at Patna, Bihar. Results: This study showed significant findings regarding changing attitudes of the new generation toward sex and sexual practices as 78.5% of respondents were found between the age group of 20-25 years among which 58.5% were males and 41.5% were females. The average age of sexual debut was found to be 21 years among which 97.3% of the participants were heterosexual. Gender and religion were significantly associated with few components of sexual attitudes. Conclusion: Sex is one of the most sensitive aspects of a human life which is not usually talked about in open space and requires a lot of privacy in thoughts and practices. There is a strong need to introduce age-appropriate sexual knowledge at school and college level to establish healthy sexual attitudes among the young generation. As medical health practitioners, it is necessary to disseminate appropriate guidance and non-biased services to the welfare of the beneficiaries shaping their sexual attitudes for responsible and safe sexual practices.

Prevalence and correlates of nicotine dependence among the construction site workers at IGIMS, Patna.

Introduction: Nicotine dependence has increased over the years and so has the prevalence of smokeless tobacco use. If the dependence is increasing, we must look for newer tobacco cessation strategies and implemented them. Tobacco causes premature deaths and nicotine dependence has both psychological and physical dependence. Method: The study was planned and an interview was conducted to collect the sociodemographic details, tobacco, and fagerstrom nicotine dependence scale - smokeless tobacco (FTND-ST) for nicotine dependence. The questionnaire was adopted from the WHO questionnaire and a pre-tested, predesigned, semi-structured questionnaire was used. Result: About almost half of the population is dependent on nicotine (51.6%). Daily smokeless tobacco users who are married and have a tobacco user in the family are mostly dependent on smokeless tobacco. Severity of smokeless tobacco dependence for nicotine dependence among smokeless tobacco users were associated with low academic achievement, increased awareness of side effects, and increase in duration and frequency of use. Conclusion: Nicotine dependence has increased despite efforts in the field in the recent years. Therefore, we need to have a mechanism for combining behavioral therapy and pharmacotherapy that may increase smoking cessation rates.

Cost of Surgical Care at Public Sector District Hospitals in India: Implications for Universal Health Coverage and Publicly Financed Health Insurance Schemes.

BACKGROUND: In low- and middle-income countries (LMICs), provisioning for surgical care is a public health priority. Ayushman Bharat Pradhan Mantri-Jan Aarogya Yojana (AB PM-JAY) is India's largest national insurance scheme providing free surgical and medical care. In this paper, we present the costs of surgical health benefit packages (HBPs) for secondary care in public district hospitals. METHODS: The costs were estimated using mixed (top-down and bottom-up) micro-costing methods. In phase II of the Costing of Health Services in India (CHSI) study, data were collected from a sample of 27 district hospitals from nine states of India. The district hospitals were selected using stratified random sampling based on the district's composite development score. We estimated unit costs for individual services-outpatient (OP) visit, per bed-day in inpatient (IP) and intensive care unit (ICU) stays, and surgical procedures. Together, this was used to estimate the cost of 250 AB PM-JAY HBPs. RESULTS: At the current level of utilization, the mean cost per OP consultation varied from US$4.10 to US$2.60 among different surgical specialities. The mean unit cost per IP bed-day ranged from US$13.40 to US$35.60. For the ICU, the mean unit cost per bed-day was US$74. Further, the unit cost of HBPs varied from US$564 for bone tumour excision to US$49 for lid tear repair. CONCLUSIONS: Data on the cost of delivering surgical care at the level of district hospitals is of critical value for evidence-based policymaking, price-setting for surgical care and planning to strengthen the availability of high quality and cost-effective surgical care in district hospitals.