Association between passive smoking and dental caries status in children: A cross-sectional analytical study.

BACKGROUND: Several risk factors contribute to the development of dental caries in children, including sociodemographic, dietary, oral hygiene-related and other miscellaneous factors. Maternal smoking was highly associated with dental caries when compared to smoking by fathers or other household members. OBJECTIVES: The aim of the study was to determine the prevalence of dental caries and their association with exposure to environmental tobacco smoke (ETS) among 5- to 10-year-old students attending private and government schools. MATERIAL AND METHODS: A cross-sectional analytical study was conducted among schoolchildren. Data was collected from the primary caregivers using a pre-tested form to assess the ETS exposure under 5 domains based on history: antenatal exposure; exposure during the index period; exposure in the school neighborhood; exposure in restaurants/roadside stalls; and exposure in bus stops/railway stations. Dental caries was assessed based on the World Health Organization (WHO) guidelines from 1997. The association was reported using prevalence ratios (PRs) (95% confidence interval (CI)). RESULTS: Data was obtained from 211 schoolchildren attending government (39.8%) and private schools (60.2%). The overall prevalence (95% CI) of dental caries was 49.3% (42.5-56.1%). Among all the risk factors evaluated in the study, exposure to ETS was associated with a significantly increased risk of dental caries. The adjusted prevalence ratio (APR) of ETS exposure varied with the mother's educational status and high sugar exposure, although this was statistically insignificant. CONCLUSIONS: The prevalence of dental caries among schoolchildren aged 5 to 10 years in the city was moderate and similar to the national average. Among the risk factors assessed in the study, antenatal exposure to ETS was found to significantly increase the prevalence of dental caries by 41% after adjusting for other factors. Therefore, it is important to educate parents on the causal role of ETS exposure in dental caries.

Incidence of COVID-19 infection and its variation with demographic and clinical profile: lessons learned at a COVID-19 RT-PCR laboratory in Nagpur, India.

Introduction. The coronavirus disease 2019 (COVID-19) pandemic emerged as a global health crisis in 2020. The first case in India was reported on 30 January 2020 and the disease spread throughout the country within months. Old persons, immunocompromised patients and persons with co-morbidities, especially of the respiratory system, have a more severe and often fatal outcome to the disease. In this study we have analysed the socio-demographic trend of the COVID-19 outbreak in Nagpur and adjoining districts. Methods. The study was conducted from April to December 2020. Nasopharyngeal and oropharyngeal swabs collected from suspected cases of COVID-19 were tested using reverse-transcription polymerase chain reaction (RT-PCR) at a diagnostic molecular laboratory at a tertiary care hospital in central India. Patient-related data on demographic profile and indication for testing were obtained from laboratory requisition forms. The results of the inconclusive repeat samples were also noted. The data were analysed using SPSS v24.0. Results. A total of 46 898 samples were received from April to December 2020, of which 41 410 were included in the study; 90.6 % of samples belonged to adults and 9.4 % belonged to children. The overall positivity rate in the samples was 19.3 %, although it varied over the period. The yield was significantly high in the elderly age group (25.5 %) and symptomatic patients (22.6 %). On repeat testing of patients whose first test was inconclusive, 17.1% were positive. There was a steady increase of both the number of tests and the rate of positivity in the initial period of the study, followed by a sharp decline. Conclusion. We can conclude that rigorous contact tracing and COVID-appropriate behaviour (wearing a mask, social distancing and hand hygiene) are required to break the chain of transmission. Elderly people are more susceptible to infection and should follow stringent precautions. It is also important to perform repeat testing of those individuals whose tests are inconclusive with fresh samples so that no positive cases are missed. Understanding of demographics is crucial for better management of this crisis and proper allocation of resources.

Does negative pressure wound therapy with saline instillation improve wound healing compared to conventional negative pressure wound therapy? - A randomized controlled trial in patients with extremity ulcers.

BACKGROUND: Wounds are important health problems that cause significant financial burden and loss of time to work, more so in low and lower middle income countries. Negative pressure wound therapy (NPWT) is widely established in managing acute and chronic extremity wounds. We studied the effects of addition of normal saline instillation to NPWT in terms of changes in granulation tissue, bacterial-burden and overall wound healing using readily available means and materials including wall suction for negative pressure, sponge and adhesive transparent sheet for dressing and normal saline for irrigation. METHODS: All patients with extremity ulcers initially underwent surgical debridement. They were then allotted into two groups, group 1 (NPWT with normal saline instillation- NPWTi) including 25 patients and group 2 (NPWT) including 23 patients. Tissue-bit samples taken on day1 and day 10 were used for bacteriology and for assessing histology. The wound surface-area was measured using the software ImageJ on day 1 and day 10. RESULTS: Median log difference in colony-count between day1 and day10 was 0.6 (0.2-1.4) in group1 and 0.13 (0.04-0.6) in group 2 (p < 0.05). Mean percentage reduction in wound size was 28.82 and 19.80 in group 1 and group 2 respectively (p < 0.05). Histological parameters of wound healing assessed as surface epithelium, granulation, inflammatory cells, proliferative blood-vessels and fibroblasts were significantly better in group1. A drawback observed with NPWTi was skin maceration around the ulcer which was successfully managed. CONCLUSION: Our findings suggest that wound healing is significantly better when saline instillation is combined with NPWT. It can aid in complex extremity ulcers management by reducing the size of the wound with healthier looking granulation tissue.

Assessing the Status of Mandatory Tuberculosis Case Notification among Private Practitioners in Urban Puducherry.

BACKGROUND: In India, tuberculosis (TB) was made a notifiable disease in 2012 and nonnotification was made a punishable offense in March 2018. In 2018, 25% of TB cases notified were from private sector. OBJECTIVES: The objective of the study is to assess the proportion of private practitioners (PPs) who notified TB cases to the Revised National Tuberculosis Control Programme (RNTCP) and to identify the facilitating factors and barriers to TB case notification, including channels most preferred for notification. METHODOLOGY: This descriptive cross-sectional study was conducted among PPs in urban Puducherry. PPs were included consecutively, and data were collected using a pretested structured questionnaire. RESULTS: Almost 60% (75 of 125) of PPs had dealt with presumptive TB cases in the last 1 year. Only one of 16 PPs who diagnosed and two of four PPs who treated had notified. PPs preferred electronic modes of notification such as e-mail and short messaging service (SMS). Concerns regarding patient confidentiality and delay in collection of notification forms from PPs by RNTCP were the barriers to notification. CONCLUSIONS: Notification for TB diagnosis was poor as PPs preferred to refer cases to RNTCP rather than notifying. Only four PPs had initiated TB treatment, of whom two PPs (50%) had notified.

Coverage of mass drug administration for elimination of lymphatic filariasis in urban Nagpur, Central India: A mixed method study.

BACKGROUND AND AIMS: Mass Drug Administration (MDA) coverage remains an important indicator in elimination of Lymphatic Filariasis (LF), especially in context of recent changes in programme strategies in India, such as incorporation of Ivermectin and involvement of urban Accredited Social Health Activists (ASHAs). This study aimed at assessing the coverage and compliance with MDA of Filariasis as well as exploring perspective of beneficiaries for non-consumption in selected slum area of Nagpur city. METHODS: Mixed-method study design comprising of quantitative assessment of MDA coverage, followed by qualitative method to explore the reasons of non-compliance was used in selected slum areas of Nagpur city. Using cluster sampling, 240 households were selected and house-to-house visits were made to interview the eligible participants. In-depth interviews were conducted among selected non-compliant participants. STATISTICAL ANALYSIS: Multivariable logistic regression analysis to identify the factors associated with non-consumption. Thematic analysis was done to obtain the reasons of non-consumption as perceived by the beneficiaries. RESULTS: Among the 1096 individuals studied, distribution and consumption coverage were 55.2% and 48.5%, respectively. Effective supervised consumption was further low (28.9%). Coverage compliance gap (CCG) was 12.1%. Male sex and younger age (2-5 years) were significant socio-demographic determinants of non-consumption. No repeat visit to houses left in first round, fear of side effects, pill burden, poor understanding about the need were important reasons as revealed by qualitative inquiry. CONCLUSION: Effective pre-campaign awareness, incorporation of context specific drug delivery strategies and strengthening monitoring system are essential for successful MDA implementation.

Household out-of-pocket expenditure on health care - A cross-sectional study among urban and rural households, Puducherry.

CONTEXT: A major proportion of health expenditure is by households as out-of-pocket expenditure (OOPE) in India. Recent estimates at district level are required for planning implementation of Universal Health Coverage. AIMS: To estimate the proportion of households incurring OOPE and the average amount spent by the household for healthcare. SETTINGS AND DESIGN: A cross-sectional study was conducted during August 2016 in the field practice areas of a medical college in Puducherry. A random sample of 240 households (120 rural and 120 urban) with 1,029 participants (531 rural and 498 urban) were surveyed. SUBJECTS AND METHODS: A pretested questionnaire was used to collect information on sociodemographic details, morbidity, healthcare services utilized, and expenses incurred. Recall period of 1 month was fixed for OP/Pharmacy Services and 6 months for IP services. RESULTS: In total, 120 rural and 120 urban households were surveyed; out of which, majority of the households were below poverty line [rural (83.3%, n = 100), urban (69.2%, n = 83)] and belonged to other backward classes [rural (60.8%, n = 73), urban (83.3%, n = 100)]. The proportion (95% CI) of households which incurred OOPE was 68.3% (59.5%-76%) in rural and 65.8% (57%-73.7%) in urban areas. The median (inter quartile range) proportion of OOPE out of the household budget was 3.31% (0.4%-10.96%) in rural and 5.15% (0.83%-16.3%) in urban areas. CONCLUSIONS: Even in a resource rich setting as the selected areas of Puducherry, majority of the households (67%) reported OOPE. The study estimates are lesser than the national estimates, but the availability and accessibility of resources are higher in Puducherry compared with the other parts of country.

Effectiveness of Pedometer-Based Walking Program to Improve Physical Activity of Workers in a Software Industry: An Experimental Study.

BACKGROUND: Workplace acts as an efficient target for health promotion activities. Pedometer can act as a motivator and monitor of physical activity. AIMS: The aim of the study was to assess the effect of pedometer usage in increasing physical activity and the level of adherence among employees of a software company in Puducherry. METHODS: An interventional study was conducted with a prepost design. A single group of software company employees (n = 46), age ≥30 years selected by simple random sampling, was included in the study. Intervention consisted of health education program on physical activity, goal setting, and instructions regarding the use of pedometers for 1 week. Physical activity levels were measured at baseline and endline using global physical activity questionnaire. RESULTS: Out of the 46 participants, 93% of the participants used the pedometer for at least 6 days. The difference between maximum observed step count during the week (median 9834 steps) and at baseline (6963 steps) was significant. Overall, 93.5% found pedometers to be useful for improving physical activity. Proportion of individuals with adequate physical activity based on Metabolic equivalents (MET) minutes increased from 41.3% (n = 19) at baseline to 69.6% at endline (n = 32) (P = 0.004). CONCLUSIONS: This study shows that a pedometer-driven walking intervention in the workplace setting is feasible and effective in increasing physical activity over a short term. Further research is required to test the effect of supportive strategies and long-term effectiveness of pedometer use.

Does operative fixation of isolated fractures of ulna shaft results in different outcomes than non-operative management by long arm cast?

OBJECTIVE: The optimal treatment for isolated fractures of ulnar shaft is debatable. The purpose of this study was to compare functional outcomes and radiological union in patients treated for isolated fractures of the ulnar shaft by open reduction and internal fixation and a long arm cast. METHODS: This prospective study was conducted at level I trauma center from November 2014 to March 2016. 30 patients with isolated fractures of ulnar shaft were randomized to two groups to receive treatment by open reduction and internal fixation by plates and screws and a long arm cast. Outcome assessment was done by Disabilities of Arm Shoulder and Hand (DASH) score, range of motion at wrist and elbow, grip strength and radiological union. Quantitative variables were summarized Mean or Median. Normality was assessed using Kolmogorov-Smirnov test. Independent samples t-test and Mann-Whitney test were used for normally distributed variables and non-normally distributed variables respectively. Categorical variables were summarized as proportions. Effect of the intervention for categorical variables was assessed using Chi-square test. RESULTS: There was no difference between the groups for pain on Visual Analogue Scale (VAS), grip strength, DASH score, and union at the end of 12 months. There was no difference between the groups for range of motion at the elbow and wrist. 12 (85.7%) patients in the ORIF group and 15 (93.7%) in the cast group united at the end of 12 months. The mean time to union was 13 weeks in the ORIF group and 18 weeks in the cast group. CONCLUSION: Open reduction and internal fixation results in anatomical restoration of ulna, but this does not translates to better functional outcomes in short term (12 months).

Association of non-allopathic drugs and dietary factors with chronic kidney disease: A matched case-control study in South India.

BACKGROUND: The multifactorial etiology of chronic kidney disease (CKD) is known to vary with geographical region. Although diabetes and hypertension are the major known contributors for CKD, the role of other risk factors relevant to India needs to be explored. This study was done to find out the role of dietary factors and nonallopathic drugs in CKD. MATERIALS AND METHODS: A hospital-based individual pair-matched case-control study was conducted in a tertiary care center in South India. The sample included 80 incident cases of CKD matched with 80 controls. Factors assessed in the study include sociodemographic factors, medical history, dietary factors, nonallopathic drugs, substance use, and other possible confounders. Univariate analysis was performed using McNemar's test and multivariate analysis was done using conditional logistic regression. RESULTS: On multivariate analysis, lifetime exposure to nonallopathic drugs increased risk of CKD by approximately five times [odds ratio (OR): 5.15, confidence interval (CI): 1.27-20.87] and chicken intake (two to three times a month to once a week) had an increased risk by approximately four times (OR = 4.23, CI: 1.13-15.80). Fish intake at a frequency of two to three times or more reduced the risk of CKD by 94% (OR = 0.06, CI: 0.01-0.43). CONCLUSION: Chicken intake and lifetime exposure to nonallopathic drugs could increase risk for CKD in South India. Increased fish intake was found to be protective for CKD.

Radiologic assessment of femoral and tibial tunnel placement based on anatomic landmarks in arthroscopic single bundle anterior cruciate ligament reconstruction.

BACKGROUND: Accurate tibial and femoral tunnel placement has a significant effect on outcomes after anterior cruciate ligament reconstruction (ACLR). Postoperative radiographs provide a reliable and valid way for the assessment of anatomical tunnel placement after ACLR. The aim of this study was to examine the radiographic location of tibial and femoral tunnels in patients who underwent arthroscopic ACLR using anatomic landmarks. Patients who underwent arthroscopic ACLR from January 2014 to March 2016 were included in this retrospective cohort study. MATERIALS AND METHODS: 45 patients who underwent arthroscopic ACLR, postoperative radiographs were studied. Femoral and tibial tunnel positions on sagittal and coronal radiographic views, graft impingement, and femoral roof angle were measured. Radiological parameters were summarized as mean ± standard deviation and proportions as applicable. Interobserver agreement was measured using intraclass correlation coefficient. RESULTS: The position of the tibial tunnel was found to be at an average of 35.1% ± 7.4% posterior from the anterior edge of the tibia. The femoral tunnel was found at an average of 30% ± 1% anterior to the posterior femoral cortex along the Blumensaat's line. Radiographic impingement was found in 34% of the patients. The roof angle averaged 34.3° ± 4.3°. The position of the tibial tunnel was found at an average of 44.16% ± 3.98% from the medial edge of the tibial plateau. The coronal tibial tunnel angle averaged 67.5° ± 8.9°. The coronal angle of the femoral tunnel averaged 41.9° ± 8.5°. CONCLUSIONS: The femoral and tibial tunnel placements correlated well with anatomic landmarks except for radiographic impingement which was present in 34% of the patients.

Effect of chronic alcohol and tobacco use on retinal nerve fibre layer thickness: a case-control study.

OBJECTIVE: To identify the effects of chronic alcohol and/or tobacco use on retinal nerve fibre layer (RNFL) thickness and to find the association between severity of addiction with RNFL thinning. METHODOLOGY: A case-control study was performed in 200 eyes of cases and 200 healthy control eyes. Cases were recruited from deaddiction clinic having history of alcohol and/or tobacco use for at least 5 years. Severity of alcohol and tobacco was graded by Alcohol Use Disorders Identification Test (AUDIT) and Fagerstorm Nicotine Dependence (FTND) scale, respectively. Age-matched and gender-matched individuals attending ophthalmology outpatient department without addiction were recruited as controls. RNFL thickness was measured using Stratus optical coherence tomography (OCT). RESULTS: Statistically significant RNFL thinning was noted in all quadrants except nasal quadrant in the cases. Statistically significant thinning was seen in all quadrants except nasal with increased FTND scale. Thinning was noted in all quadrants with higher AUDIT scale, but this was statistically not significant. CONCLUSION: Chronic alcohol and tobacco use are likely to cause RNFL thinning. OCT can be used as a screening tool to suspect visual morbidities in chronic tobacco and alcohol users.