Development and Evaluation of an Interprofessional Collaborative Practice Module for the Tracheostomy Procedure for Improved Patient Care.

The Interprofesional collaborative practice (IPCP) is the need of the hour for improved patient care. The procedure of tracheotomy is a life saving procedure and the implementation of the Interprofessional collaborative practice module for the same comprising of the ENT surgeon, Physiotherapist, Nursing staff, OT and Trauma technician decreases the number of complications. This study was carried out to develop and evaluate the Interprofessional collaborative practice module for Tracheostomy. The project has been carried out as a prospective before and after study with the departments of ENT, nursing and Allied health sciences. The facilitators were from the above departments.They were sensitized and developed the Interprofessional education (IPE team),which then collaborated to develop the IPCP module.This IPE team after faculty meetings developed the module with learning objectives, teaching learning methods and methods of assessment. Standardized Readiness scale for Interprofessional Learning Scale (RIPLS), was adopted for the module. The questionnaires for assessment and the module were structured and validated.The template of reflection was compiled for the execution of the module. The students training comprised of the demonstration session, baseline Team OSCE, practice sessions and the final Team OSCE. The baseline and final Team OSCE scores,reflections and RIPLS scores were compared. Team OSCE scores baseline vs Final for IPCP competencies i.e. Competency 1-Values and Ethics for Interprofessional Practice, Competency 2-Roles and Responsibilities, Competency 3-Interprofessional Communication, Competency 4-Teams and Teamwork during Pretracheostomy (PreT),Tracheostomy(T) and PostTracheostomy (PostT) were calculated. Faculty observations: TOSCE scores (pre T/T/postT) significantly improved for all the four IPCP competencies (p < 0.001). Self evaluation did not get any significant improvements in PreT and T but significant improvement (P < 0.001) in competency 2 for Post T. Peer evaluation there was significant improvement for the competencies 1 & 2 and overall as well (p < 0.001) during preT, competency 2 during T and competency 2, 3, 4 during PostT. The reflections had a highly significant change from baseline to final (p < 0.001).On final evaluation for the Readiness scale for Interprofessional learning the faculties and students had significant changes in opinions in all the items of the readiness scale (p < 0.05). The project was able to achieve a motivated IPE team which could successfully structure and effectively conduct the IPCP module for the procedure of tracheostomy.

Implication of single nucleotide polymorphisms in Interleukin-10 gene (rs1800896 and rs1800872) with severity of COVID-19.

Background: Coronavirus disease 2019 (COVID-19) is an ongoing pandemic which has emerged as a new challenge for the medical sciences. Severity of COVID-19 is mostly determined with overexpressed proinflammatory cytokines eventually leading to endothelial dysfunction causing vital organ injury, especially in the lungs. It has been postulated that various genetic mutations might be associated with an increased risk of disease severity in COVID-19. This study was thus carried out to determine the association of rs1800896 and rs1800872 genetic polymorphism in IL-10 gene in determining COVID-19 severity. Methods: The study included 160 RT-PCR confirmed COVID-19 patients with mild (n = 85) and severe (n = 75) conditions. All subjects were genotyped for Interleukin-10 (rs1800896 and rs1800872) gene polymorphisms using PCR-RFLP technique followed by statistical analysis. Results: This study found a significant gender and age-based discrepancy in COVID-19 severity with 1.85-and 3.81-fold increased risk of COVID-19 in males of mild and severe groups as compared to females (p = 0.046 and p < 0.001) and 4.35-fold high risk in subjects ≥ 50 (p < 0.001). Genotyping analysis showed that IL-10 (rs1800872) gene polymorphism was strongly associated with COVID-19 severity (p = 0.01) whereas, IL-10 rs1800896 polymorphism was not found to confer the risk of COVID-19 severity in our population. Conclusion: In this regard, the present study provided an evidence that IL-10 (rs1800872) gene polymorphism is strongly associated with COVID-19 severity and CC genotype confer a protective role in preventing severe disease progression. More detailed studies with a larger sample size on the genetic variations are required to establish the role of studied IL-10 gene polymorphisms with COVID-19 severity.

Domestic Violence During Pregnancy: Evaluating the Impact on Maternal and Perinatal Health-A Pilot Study in Uttar Pradesh.

INTRODUCTION: Domestic Violence [DV] is a global health problem of pandemic proportions. WHO identifies it as psychological, physical or sexual violence or threats of the same, in the premises of one's home. The perpetrator can be husband, intimate partner, friend or a family member. DV during pregnancy has widespread implications on adverse obstetric maternal and foetal outcomes. AIM OF THE STUDY: To find out the prevalence of domestic violence in antenatal women and observe the association between DV and maternal and perinatal outcome. METHODOLOGY: It is a cohort study carried out at ELMCH, over a period of 10 months. Data were collected from pregnant women reporting to the outpatient department of obstetrics and gynaecology in their third trimester of pregnancy. The pregnancies were followed up till delivery and one week postpartum to study the obstetric and perinatal outcome. Appropriate statistical methods were applied to determine significance of the observations, and odds ratio was calculated for the risk factors. RESULTS: The prevalence of DV during pregnancy was 22.2%, with psychological violence being the most common form observed. Increased relative risk was found for hypertensive disorders of pregnancy, antepartum haemorrhage, recurrent urinary tract infection and preterm labour. Apgar scores of babies in affected mothers was lower, and there were significantly greater NICU admissions. This was independent of period of gestation at delivery. CONCLUSION: DV affects at least 1/4th of antenatal women. Majority of them do not realise the extent and forms of DV and accept the violence as a routine norm of marital life. DV during pregnancy has a significant association with adverse obstetric and perinatal outcomes.

Association of endothelial nitric oxide synthase (eNOS) and norepinephrine transporter (NET) genes polymorphism with type 2 diabetes mellitus.

Genetic factors in combination with environmental factors play a critical role in the development type 2 diabetes mellitus (T2DM) which is growing as an epidemic globally. In present study we aim to assess the association of eNOS (G894T, rs1799983) and NET (G1287A, rs5569) genes polymorphism with T2DM. A case-control study including a total of 400 North Indian subjects (200 T2DM cases and 200 controls) was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach to analyze genetic polymorphism. Alleles/genotype frequencies between cases and controls were compared using χ2 and Student's t-tests. Odds ratios and 95% confidence intervals were calculated by logistic regression to assess the relative association between disease and genotypes. In case of NET gene, GG (P = 0.002 in T2DM males, 0.053 in overall T2DM cases) genotype and G allele (P = 0.003 in T2DM males, 0.027 in overall T2DM cases) were found to be a positive risk factors and AG genotype (P = 0.012 in T2DM males) and A allele (P = 0.003 in T2DM males, P = 0.027 in overall T2DM cases) as negative risk factor for T2DM. No association of eNOS gene polymorphism was found with T2DM (P values of all genotypes and alleles were greater than 0.05). NET gene polymorphism might be associated with the risk of T2DM whereas; eNOS gene polymorphism do not confer any risk of T2DM in North Indian Ethnic group. It is hoped that understanding genetic causes of T2DM will lead to earlier diagnosis, preventive measures and more effective and specific treatment.

Mutation in the beta3 subunit of Guanine nucleotide-binding protein (GNB3) gene is not associated with Type II diabetes mellitus risk: a case-control study of a North Indian population.

CONTEXT: Genetics play a major role in development and pathophysiology of Type 2 diabetes mellitus (T2DM). OBJECTIVE: To asses the association of Guanine nucleotide-binding protein (GNB3) (C825T) gene's polymorphism with T2DM. MATERIALS AND METHODS: A case-control study including 400 North Indians was performed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) approach to analyze genetic polymorphism. RESULTS: No significant difference was observed in genotype and allele frequencies of GNB3 gene on comparing cases with controls. DISCUSSION: Our study is in agreement with studies on Polish, Japanese, Hispanic-American and Danish populations who observed no significant association between GNB3 (C825T) polymorphism and T2DM. CONCLUSION: GNB3 (C825T) polymorphism is not associated with T2DM.

Association of angiotensin-converting enzyme (ACE) and fatty acid binding protein 2 (FABP2) genes polymorphism with type 2 diabetes mellitus in Northern India.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is growing in an epidemic manner across the world with an expected doubling of the incidence to millions of affected individuals in the last decades. At present, adequate data are not available regarding the ACE and FABP2 polymorphisms and their susceptibility with T2DM cases in the North Indian population. Thus we conceived the need for further study of ACE (I/D) and FABP2 (Ala54Thr) genes polymorphism and its susceptibility to T2DM in the North Indian population. MATERIALS AND METHODS: In this study, a total of 300 subjects (including 190 T2DM cases and 110 controls) participated. ACE and FABP2 gene polymorphisms in the cases and controls were evaluated by polymerase chain reaction and restriction fragment length polymorphism. RESULTS: The frequencies of ACE I/I, I/D and D/D genotypes in T2DM cases and controls were 28.73%, 55.17%, 16.09% and 13.63%, 57.95%, 28.40%, respectively. The frequencies of FABP2 Ala54Ala, Ala54Thr and Thr54Thr in T2DM cases were 18.39%, 66.66%, 14.94% and 22.72%, 61.36%, 15.90% in controls, respectively. ACE I/I genotype was significantly more frequent in cases as compared to controls (p = 0.003, χ(2) = 9.13). CONCLUSION: It appears that the ACE I/I genotype frequency was significantly higher in the T2DM cases as compared to the controls.

Knowledge About HIV/AIDS Among Secondary School Students.

BACKGROUND: HIV/AIDS has emerged as the single most formidable challenge to public health. School children of today are exposed to the risk of HIV/AIDS. AIMS: The study was conducted to determine the knowledge among secondary school students regarding HIV/AIDS and provide suggestions for HIV/AIDS education in schools. MATERIALS AND METHODS: A cross-sectional study was conducted among students of tenth to twelfth standard in the intermediate schools of Lucknow, India, from July to October 2011. A total of 215 students, both boys and girls, were enrolled in the study. RESULTS: In this study, for majority of the students (85%), the source of information about HIV/AIDS was the television. Regarding knowledge about modes of transmission of HIV/AIDS among girl students, 95.1% of them told that it is through unprotected sex. A total of 75.8% students said that it was transmitted from mother to child. CONCLUSION: It was observed that the knowledge of the school students was quite satisfactory for most of the variables like modes of transmission, including mother-to-child transmission of the disease. However, schools should come forward to design awareness campaigns for the benefit of the students.

Association of MTHFR and PPARγ2 gene polymorphisms in relation to type 2 diabetes mellitus cases among north Indian population.

BACKGROUND: Type 2 diabetes mellitus is a multifactorial and polygenic disease, which is considered as a major life threatening problem all over the world. There has been a worldwide effort in the identification of susceptibility genes for type 2 diabetes mellitus and its complications. At present, adequate data is not available dealing with MTHFR (rs1801133) and PPARγ2 (rs1801282) gene polymorphisms and its association with type 2 diabetes mellitus cases among north Indian populations. Thus, we conceived the need for further studies to investigate MTHFR and PPARγ2 gene polymorphisms and their susceptibility to type 2 diabetes mellitus in north Indian population. MATERIALS AND METHODS: In this study, a total 175 subjects including 87 type 2 diabetes mellitus cases and 88 controls were enrolled. MTHFR and PPARγ2 gene polymorphisms in the cases and controls were evaluated by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). RESULTS: The MTHFR gene CC, CT, TT genotype frequencies obtained were 40%, 43%, and 17% in type 2 diabetes mellitus cases and 56%, 29%, and 15% in healthy controls respectively. The OR for CC was 0.54 (95%CI 0.29-0.98, P=0.041, χ(2)=4.18, power=0.98), for CT 1.76 (95%CI 0.94-3.30, P=0.07, χ(2)=3.2, power=0.96), and for TT 1.2 (95%CI 0.53-2.70, P=0.66, χ(2)=0.198, power=0.76). The PPARγ2 gene GG CG, CC genotype frequencies obtained were 28%, 41%, and 31% in cases and 40%, 39%, and 21% in healthy controls respectively. OR for GG was 0.58 (95%CI 0.30-1.09, P=0.08, χ(2)=2.9, power=0.96), for CG 1.12 (95%CI 0.61-2.05, P=0.71, χ(2)=0.137, power=0.778), and for CC 1.63 (95%CI 0.82-3.23, P=0.156, χ(2)=2.01, power=0.92). CONCLUSION: It might be recommended that MTHFR CC genotype seems to be a good marker for the early identification of population at risk of type 2 diabetes mellitus. While we have detected significant difference in allelic frequencies of PPARγ2 C (Proline) and G (Alanine), but at genotypic level significant difference was not detected in this case-control study. Further study with larger groups may be required to validate the study.

Methylenetetrahydrofolate reductase C677T genetic polymorphisms and risk of leukaemia among the North Indian population.

BACKGROUND: Leukaemia is a heterogeneous disease in which haematopoietic progenitor cells acquire genetic lesions that lead to a block in differentiation, increased self-renewal, and unregulated proliferation. The enzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), involved in folate metabolism, plays a crucial role in cells because folate availability is important for DNA integrity. The aim of this case-control study was to evaluate the association of the C677T MTHFR gene polymorphism with acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL), chronic myeloid leukaemia (CML) and chronic lymphocytic leukaemia (CLL). MATERIALS AND METHODS: A total of 275 leukaemia cases - including AML (n = 112), ALL (n = 81), CML (n = 43), CLL (n = 39) - and 251 age/sex-matched healthy control individuals participated in this study. MTHFR C677T polymorphisms in the cases and controls were evaluated by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). RESULTS: The average MTHFR 677CC, 677CT, 677TT genotype frequencies of total leukaemia cases were 68.73%, 19.64%, and 11.64% in cases, and 71.71%, 24.30%, and 3.98% in healthy controls, respectively. The average frequency of the MTHFR 677T allele was 21.45% among the cases compared to 16.13% among the controls. CONCLUSIONS: In the present case-control study we have observed a higher frequency of the MTHFR 677TT genotype in cases of leukaemia (AML, ALL, CML and CLL) as compared with controls; this might be due to ethnic and geographic variation. As per our findings, although the frequency of the MTHFR 677T allele is moderately high in AML, ALL and CLL, no statistically significant association was found; on the other hand statistically significant association was found in the context of CML cases.