Prevalence of goitre and iodine deficiency among school children (6-12 years) in rural areas of North Karnataka, India: A cross-sectional survey, 2016-19.

Introduction: Iodine deficiency disorders (IDD) have remained an unresolved public health problem in India. In this survey, we have estimated the prevalence of IDD among 6-12 years of school children in rural areas of north Karnataka, India and estimated the prevalence of low iodine content (<15 ppm) in salt at the household level and urine iodine excretion in this population. Material and Methods: In this cross-sectional survey, we recruited 16,827 children between 6 and 12 years of age through multistage sampling from six districts. Goitre was examined clinically for all children. Household-level salt iodine estimation and urinary iodine estimation were carried out among a subset of the participants. Results: Overall prevalence of goitre was 17.1% (95% CI: 16.5, 17.7). Out of this, 76.7% (n = 2116) had Grade-1 goitre, and 23.7% (n = 656) had Grade-2 goitre. The prevalence of goitre was higher among females (17.9%, vs. male 16.4%, P < 0.05). The prevalence of low iodine content (<15 ppm) in salt was 48.5% (95%CI: 46.7, 50.3). The overall median iodine excretion in urine was 85 µg/L (IQR: 60-150 µg/L). In total, 37.2% (n = 601) had mild iodine deficiency, 5.2% (n = 84) had moderate deficiency, and 10.1% (n = 163) had severe deficiency. All parameters showed high inter- and intradistrict variations. Conclusion: North Karnataka has a high goitre prevalence. Low use of iodized salt can be a major reason for the high prevalence of the condition. Ensuring the availability of iodized salt in this region and periodic surveillance to measure the impact of the programme should be the priority in this region.

Effectiveness of using technology as health education tool among diabetes patients in South India: A comparative analysis and community based intervention.

Introduction: Type 2 diabetes mellitus is a serious, progressive condition presenting with chronic hyperglycemia. Its prevalence is gradually increasing at a global level. A diabetic has to make multiple choices daily about the management of their condition, such as appropriate dietary intake, physical activity and adherence to drugs. There is hardly any input from a healthcare professional for guidance on a daily basis. Objectives: The aims of this study were to assess the change in knowledge by using various methods of health education as intervention and to compare the effect of technology as a tool of health education as compared to conventional methods of health education. Materials and Methods: A community-based interventional study was done in the field practice area of our Institute in South India. Two groups of people were selected from 40 adopted houses. One from urban; for intervention with technology, that is, health education using videos and the second group from rural population; for intervention with conventional method of health education, that is, using charts. Results: The mean baseline knowledge score in urban and rural area was 3.76 and 9.97, respectively. There was statistically significant increase in knowledge among both the groups. By the use of technology in the urban population knowledge level increased from 3.76 to 10.15 and was found to be statistically significant. The difference in increase in knowledge was higher in the technology group as compared to conventional group. Conclusion: In the era of smartphone, technology-based health education can reduce the total health care manpower which is deficient. Technology is a boon to introduce lifestyle modification in chronic diseases like Diabetes Mellitus.

Tuberculosis among resident doctors and nurses in a tertiary care hospital: A case-control study.

Background: Tuberculosis (TB) is one of the widely rampant infectious diseases worldwide. Healthcare workers (HCWs) such as Medical students and nurses are continuously exposed to this air-borne infection in hospitals and are vulnerable to the infection. Overcrowding at workplace, inadequate ventilation, lack of personal protective measures, improper eating habits, etc., further make the HCWs more susceptible to TB. Objectives: Study of sociodemographic profile of resident doctors and nurses; study of factors for occurrence of TB among HCWs in a tertiary care hospital. Materials and Methods: Case-control study conducted. Questionnaire used to collect data. Comparison was made between the TB cases and controls among HCWs to identify the epidemiological determinants of TB and derive preventive measures for the same. Results: By Chi-Square test, regularity of breakfast P < 0.001; BMI P - 0.001; total duration of exposure to TB patients P - 0.013; screening for TB P - 0.014; adequacy of sleep P - 0.029; adequacy of protein intake P - 0.035 were found to have a significant association with the occurrence of TB. Conclusion: Having regular meals at appropriate times, nutritional status, duration of exposure to TB patients, history of screening being done or not were found to have a significant association with the occurrence of TB.

Brachytherapy for Oral Cavity Cancers in the Era of Intensity-Modulated Radiotherapy: Save it or Shelve it.

Head and neck cancer treatment includes a multidisciplinary approach involving all specialties. Surgery and radiotherapy are equally effective in controlling small tumors. Intensity-modulated radiotherapy (IMRT) and interstitial brachytherapy (ISBT) play an important role in the treatment of head and neck cancers. Both are proved to be highly conformal techniques of radiotherapy. Our aim is to compare dosimetric aspects of ISBT alone, IMRT alone, and IMRT combined with ISBT in early stage node negative oral cavity cancer. Ten cases of histopathologically proven early stage node negative oral cavity cancer were treated with external beam therapy followed by interstitial brachytherapy boost or ISBT alone. All these patients had undergone computerized tomography (CT) planning for brachytherapy. Retrospectively, these images were utilized, and three sets of plans were done for each patient's CT image set. Group A was IMRT alone plans, groups B had combined IMRT with ISBT boost, and group C was ISBT alone plans. Dosimetric details such as target coverage, dose to critical organs, and conformity index were compared between the three sets of plans. The mean values of the doses to the critical organs with IMRT alone and IMRT with ISBT boost were brainstem 10.40 Gy and 9.20 Gy, spinal cord 19.20 Gy and 16.10 Gy, mandible 62.99 Gy and 66.50 Gy, and I/L and C/L parotids were 6.03 Gy and 5.50 Gy and 5.70 Gy and 5.10 Gy where as in ISBT alone plans mean values were brainstem 1.30 Gy, spinal cord 1.40 Gy, mandible 36.50 Gy, I/L, and C/L parotids were 1.60 Gy and 1.00 Gy. Conformity index (CI) between IMRT and ISBT plans were 0.8580 and 0.7140 respectively. With comparable CI values, doses to critical organs appear to be in favor of ISBT plans as opposed to IMRT, and this was found to be statistically significant. Brachytherapy shows a dosimetric advantage over IMRT in this setting and could be translated to a benefit in terms of toxicities, organ preservation, and cosmesis in the actual clinical scenario. However, whether this would translate to significant benefit in terms of clinical outcome needs to be still verified.

Prevalence of Consumption of Smokeless Tobacco Products and Exposure to Second-Hand Smoke among Women in the Reproductive Age Group in a Rural Area of Koppal, Karnataka.

BACKGROUND: Tobacco use is one of the most important causes of death and disease globally. Nearly one-third of the population in India uses tobacco, and smokeless form is culturally acceptable even among women. OBJECTIVES: (1) To estimate the prevalence of consumption of smokeless tobacco (SLT) products among women in the reproductive age group in the study setting. (2) To determine the various factors associated with the consumption of SLT. (3) To estimate the prevalence of exposure to second-hand smoke among the study participants. MATERIALS AND METHODS: A cross-sectional study was conducted in the field area of primary health center Irkalgad, Koppal in March 2018. A cluster sampling technique was used and a total of 829 women were included. Data were collected using pretested and semi-structured questionnaire and analyzed using the Epi info software version 3.5.4 (Centers for Disease Control and Prevention" (CDC), Atlanta, Georgia, United States of America). RESULTS: The prevalence of consumption of SLT products was 17.85%, and the most common product consumed was tobacco with betel quid. Tobacco consumption was found to be significantly associated with age, literacy, marital, and employment status of the study participants. CONCLUSION: The present study concludes that SLT consumption is high among women in the reproductive age group in the study setting and identifies multiple determinants for effective planning of interventions.

General outpatient department in tertiary care institute: A model to be adopted by medical colleges.

CONTEXT: Teaching medical institutes and tertiary care hospitals in various cities are overcrowded and overburdened. The general outpatient department (GOPD) plays a vital role as screening OPD to triage patients who require secondary or tertiary care and refer them to appropriate OPD. Primary health care is initiated at the GOPD itself and the mechanism of referral is established. AIM: To study GOPD model and its services in the institute. To assess perception of patients towards it. SETTINGS AND DESIGN: It was an observational study conducted in a medical college of Mumbai, Maharashtra for 1 month on persons attending the GOPD. MATERIALS AND METHODS: Data and monthly reports were used for baseline comparisons and exit interviews of patients were taken using questionnaire. STATISTICAL ANALYSIS USED: Quantitative analysis was done using the proportions and means for the number of patients served daily by the GOPD and medicine OPD. RESULTS: Around 44% of services were therapeutic in nature and it had contributed to a significant reduction in patient load into another specialist department. Nearly 30% cases needed referrals during the study period. Statistically, the significant value was obtained for patient satisfaction for consultation services from GOPD. CONCLUSIONS: A statistically significant value for patient satisfaction for consultation services from GOPD indicates that patients were in favor of such type of services.

Association of Serum Vitamin D Levels with Bacterial Load in Pulmonary Tuberculosis Patients.

BACKGROUND: Vitamin D is known to have diverse effects on various systems in the body. There is evidence to suggest that a link exists between the serum vitamin D status and tuberculosis. The present study was designed to assess the alterations in serum 25-hydroxyvitamin D levels in newly diagnosed sputum acid fast bacilli (AFB) positive pulmonary tuberculosis patients and to study the association, if any, between serum vitamin D levels and different levels of sputum smear positivity. METHODS: Serum 25-hydroxyvitamin D levels were estimated in 65 sputum AFB positive pulmonary tuberculosis patients and 65 age and gender-matched healthy controls. RESULTS: The levels of serum 25 hydroxy-vitamin D in tuberculosis patients were not statistically different from the levels of serum 25 hydroxy-vitamin D in healthy controls. However, among patients with pulmonary tuberculosis, there was a significant negative correlation between the levels of serum 25 hydroxy-vitamin D and levels of sputum positivity. CONCLUSION: Serum vitamin D levels negatively correlates with bacterial load in patients with active pulmonary tuberculosis.

Using optimal combination of teaching-learning methods (open book assignment and group tutorials) as revision exercises to improve learning outcome in low achievers in biochemistry.

Graduate medical students of India are taught Biochemistry by didactic lectures and they hardly get any opportunity to clarify their doubts and reinforce the concepts which they learn in these lectures. We used a combination of teaching-learning (T-L) methods (open book assignment followed by group tutorials) to study their efficacy in improving the learning outcome. About 143 graduate medical students were classified into low (<50%: group 1, n = 23), medium (50-75%: group 2, n = 74), and high (>75%: group 3, n = 46) achievers, based on their internal assessment marks. After the regular teaching module on the topics "Vitamins and Enzymology", all the students attempted an open book assignment without peer consultation. Then all the students participated in group tutorials. The effects on the groups were evaluated by pre and posttests at the end of each phase, with the same set of MCQs. Gain from group tutorials and overall gain was significantly higher in the low achievers, compared to other groups. High and medium achievers obtained more gain from open book assignment, than group tutorials. The overall gain was significantly higher than the gain obtained from open book assignment or group tutorials, in all three groups. All the three groups retained the gain even after 1 week of the exercise. Hence, optimal use of novel T-L methods (open book assignment followed by group tutorials) as revision exercises help in strengthening concepts in Biochemistry in this oft neglected group of low achievers in graduate medical education. © 2016 by The International Union of Biochemistry and Molecular Biology, 44(4):321-325, 2016.

Male health clinic strategy in control of STI/HIV: a program review.

A community-based, longitudinal interventional study was conducted in a slum in north-east (NE) Mumbai, using a pretested, semi-structured proforma and a pre- and follow-up interview schedule to assess the male health clinic (MHC) strategy as an approach for the control of sexually transmitted infections (STIs) in males. The focus groups that emerged for behavior change communication (BCC) activities were clients in second and third decades of life, unmarried and married but not staying with wife, clients with no permanent place of occupation, clients with habit of alcohol, and illiterate clients. Postintervention, there was an overall increase in STI knowledge score, alcohol habit score, and high-risk sexual activity score. Less than 50% of the clients received advice on substance abuse and information on consequences of STI/human immunodeficiency virus (HIV). The study concluded that MHC strategy is an effective approach for control of STIs in males and recommended strengthening of the weaker components of the strategy with focus on the important client groups.

Impact of HIV/AIDS on quality of life of people living with HIV/AIDS in Chitradurga district, Karnataka.

BACKGROUND: HIV/AIDS is fatal illness which leaves the victim vulnerable. Quality of life in individuals living with HIV/AIDS is becoming crucial for measuring commonly used endpoints. The study of psychosocial factors also influences the health outcome of People Living with HIV/AIDS. AIM: To assess the Quality of life of PLHA in relation to various socio-demographic and clinical correlates. SETTING AND DESIGN: A community care center in Chitradurga district and it is a Cross sectional study. METHODS AND MATERIALS: About 395 PLHAs registered in the centre constituted the sample. WHOQOL - 120 instrument was used for assessing quality of life. The socio demographic factors were also obtained in pre designed proforma. STATISTICAL ANALYSIS USED: Proportions, Mean, Std deviation, One way Analysis of Variance (ANOVA). RESULTS AND CONCLUSION: The Quality of Life scores for all domains were intermediate for the PLHAs between (10 - 14). The mean scores were highest for psychological domain. There was a significant difference in QOL of PLHA who were on ART and Not on ART in some domains. PLHAs who were literates, married, Single, employed, income more than 1500 not on ART, CD4 count more than 200, earlier stages of HIV, living with spouse and students had high mean scores. Mean difference of QOL scores with duration of ART intake were statistically significant in psychological and Spirituality domains. QOL was found to be determined by education, income, occupation, ART status, duration of taking ART and clinical categories of the disease.