Establishing Linguistic Equivalency of the Marathi Translation of the Ages and Stages Questionnaires, Third Edition (ASQ-3).

OBJECTIVE: This study aims to establish linguistic equivalence of the Marathi translation of the Ages and Stages Questionnaires-Third Edition (ASQ-3) in an urban setting of India. METHODS: All items of the ASQ-3 were translated and back translated by translators from a non-medical background, piloted on 40 families and reviewed by an expert panel. The final version, adjusted for linguistic equivalence, was tested on 111 bilingual parents recruited to complete questionnaires about their children in both English and Marathi. Intraclass correlation coefficient (ICC), a measure of reliability, were calculated between responses in both languages for each domain of the ASQ-3. RESULTS: ICC for each of the five domains were communication: 0.77; gross motor: 0.88; fine motor: 0.80; problem solving: 0.84; personal-social: 0.84. There were no statistically significant differences between Marathi and English questionnaires. CONCLUSION: This Marathi translation of the ASQ-3 was linguistically equivalent to the English version, and can be utilized for developmental screening with Marathi-speaking families.

Symptomatic survey of COVID-19 in the rural health and demographic surveillance site of Maharashtra, India.

Introduction: The COVID-19 epidemic is fast-evolving and restrictions to contain it changes quickly. The secondary attack rate (SAR) indicates the infectiousness at the household level, and it provides a clue of load of infections in the community. Rapid implementation of a large scale, but brief survey provides a nationally representative view of the pandemic's progression and impact as well as the effect of the measures taken to control the spread. Materials and Methods: This cross-sectional study was done for a period of 2 months July-August 2020, in one of the rural health and demographic surveillance system (HDSS) site in India among 11,507 households having 46,571 individuals with the objective to determine the prevalence of the COVID-19 infection and to estimate the family SAR. The data were collected using the mobile phone by calling the head of the households registered under the HDSS. The research tool was created using questions based on the guidelines provided by the Ministry of Health and Family Welfare, India. The interviewers were first trained in data collection. Results: The households of 33,780 individuals were contacted and 33 patients were diagnosed as COVID positive, prevalence rate of 0.1% was thus documented through telephonic survey. The mean age of COVID patients was found to be 37 ± 16 years, and 63% of the diagnosed patients were males, majority of them belonged to above poverty line households. During the survey, 46 individuals reported to have the symptoms suggestive of COVID, fever and cough were the most commonly reported symptoms. The family SAR of 17.2% was documented. Conclusion: Thus to conclude a low COVID-19 prevalence rate of 0.1%, a higher family SAR of 17.2% was reported in the current study. Timely diagnosis and quarantine of close contacts should be continued to be implemented rigorously to prevent the spread of the COVID-19 virus. These efforts will be useful to contain the epidemic before it reaches an alarming level in the rural areas.

Résumé Introduction: L'épidémie de COVID-19 évolue rapidement et les restrictions pour la contenir changent rapidement. Le taux d'attaque secondaire (SAR) indique l'infectiosité au niveau du ménage et fournit un indice de la charge d'infections dans la communauté. La mise en œuvre rapide d'une enquête à grande échelle mais brève fournit une vue représentative à l'échelle nationale de la progression et de l'impact de la pandémie ainsi que de l'effet des mesures prises pour contrôler la propagation. Matériels et Méthodes: cette étude transversale a été réalisée sur une période de 2 mois de juillet à août 2020, dans l'un des sites du système de surveillance sanitaire et démographique en milieu rural (HDSS) en Inde auprès de 11 507 ménages comptant 46 571 individus dans le but de déterminer prévalence de l'infection au COVID-19 et d'estimer le DAS familial. Les données ont été collectées à l'aide du téléphone mobile en appelant le chef de ménage inscrit au HDSS. L'outil de recherche a été créé à l'aide de questions basées sur les directives fournies par le ministère indien de la Santé et du Bien-être familial. Les enquêteurs ont d'abord été formés à la collecte de données. Résultats: les ménages de 33 780 individus ont été contactés et 33 patients ont été diagnostiqués positifs au COVID, un taux de prévalence de 0,1 % a ainsi été documenté par une enquête téléphonique. L'âge moyen des patients COVID était de 37 ± 16 ans, et 63 % des patients diagnostiqués étaient des hommes, la majorité d'entre eux appartenant à des ménages au-dessus du seuil de pauvreté. Au cours de l'enquête, 46 personnes ont déclaré avoir des symptômes évocateurs de COVID, la fièvre et la toux étaient les symptômes les plus fréquemment signalés. Le SAR familial de 17,2 % a été documenté. Conclusion: Ainsi, pour conclure à un faible taux de prévalence de la COVID-19 de 0,1 %, un DAS familial supérieur de 17,2 % a été rapporté dans la présente étude. Le diagnostic rapide et la mise en quarantaine des contacts étroits doivent être poursuivis et mis en œuvre de manière rigoureuse pour empêcher la propagation du virus COVID-19. Ces efforts seront utiles pour contenir l'épidémie avant qu'elle n'atteigne un niveau alarmant dans les zones rurales. Mots-clés: COVID 19, système de surveillance sanitaire et démographique, téléphone portable, prévalence, milieu rural, taux d'attaque secondaire.

Natural Versus Synthetic Surfactant Therapy in Respiratory Distress Syndrome of Prematurity.

OBJECTIVES: To compare the clinical efficacy and the cost of treatment between the newborns who received either a natural or a protein-free synthetic surfactant for respiratory distress syndrome (RDS) of prematurity. METHODS: This is a retrospective analytical study incorporating comparisons of clinical parameters and cost in newborns having RDS of prematurity who received either Survanta (bovine lung extract), a natural surfactant or Surfact (protein-free colfosceril palmitate), a synthetic surfactant. RESULTS: There were 100 newborns who received either of the natural (n = 52) or synthetic (n = 48) surfactant with mean (SD) gestational age and mean (SD) birth weight of 31.5 (2.6) wk, 1425 (461) g and 32.2 (2.2) wk, 1519 (413) g, respectively. Majority of the newborns (> 90%) received endotracheal surfactant within the first 24 h of life and had similar baseline characteristics in either group. No differences were noted in ventilator settings on admission and 24 h after surfactant/admission. Oxygen requirement, extubation age, complications, hospital stay, and mortality were similar across groups, except that the necrotizing enterocolitis was noted only in natural surfactant group. There was a significant pharmacy cost savings in synthetic surfactant group. CONCLUSION: Synthetic surfactant was comparable to natural surfactant with regard to outcomes, like ventilator settings, hospital stay, and mortality. Pharmacy cost was less in synthetic surfactant group.

Does abnormal Doppler on cranial ultrasound predict disability in infants with hypoxic-ischaemic encephalopathy? A systematic review.

AIM: To evaluate whether abnormal resistive index or cerebral blood flow velocity (CBFV) on cranial ultrasound predicts disability (≥1 year) in infants with hypoxic-ischaemic encephalopathy (HIE). METHOD: This was a systematic review and meta-analysis of studies comparing developmental outcomes of infants with HIE with normal versus abnormal resistive index or CBFV. RESULTS: Twenty-six studies were included (pre-therapeutic hypothermia era, 20; therapeutic hypothermia era, six). Data from 15 studies (pre-therapeutic hypothermia, 10; therapeutic hypothermia, five) were available for meta-analysis. Pooled sensitivity and specificity, summary area under the receiver operating characteristic curve, and diagnostic odds ratio of resistive index or CBFV for predicting 'death or severe disability' were as follows. Pre-therapeutic hypothermia era: 0.83 (95% confidence interval [CI] 0.45-0.97) and 0.92 (95% CI 0.74-0.98), 0.94 (95% CI 0.92-0.96), 54 (95% CI 7-391). Therapeutic hypothermia era (measurements before therapeutic hypothermia): 0.62 (95% CI 0.41-0.80) and 0.96 (95% CI 0.88-0.99), 0.93 (95% CI 0.89-0.94), 23 (95% CI 6-91). Therapeutic hypothermia era (measurements during/after therapeutic hypothermia): 0.51 (95% CI 0.24-0.78) and 0.83 (95% CI 0.73-0.90), 0.81 (95% CI 0.78-0.85), 5 (95% CI 2-13). Overall Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating of evidence was 'low' or 'very low'. INTERPRETATION: Low-level evidence suggests that abnormal resistive index or CBFV can predict death or disability with high sensitivity and specificity in infants with HIE who are not cooled. The specificity of these tests was high when performed before starting cooling in infants who received therapeutic hypothermia. WHAT THIS PAPER ADDS: Cerebral doppler ultrasound may be useful in predicting death or disability in infants with hypoxic-ischaemic encephalopathy who are not cooled. Cerebral doppler ultrasound may also be useful in infants who are cooled, if done before starting cooling. Cerebral doppler ultrasound may not be useful when performed during or after completing cooling.

OBJETIVO: Avaliar se o índice de resistência anormal ou a velocidade do fluxo sanguíneo cerebral (VFSC) na ultrassonografia craniana prediz incapacidade (≥1 ano) em bebês com encefalopatia hipóxico-isquêmica (EHI). MÉTODO: Esta foi uma revisão sistemática e meta-análise de estudos comparando os resultados do desenvolvimento de bebês com EHI com índice de resistência normal versus anormal ou VFSC. RESULTADOS: Vinte e seis estudos foram incluídos (hipotermia pré-terapêutica, 20; hipotermia terapêutica, 6). Dados de 15 estudos (hipotermia pré-terapêutica, 10; hipotermia terapêutica, 5) estavam disponíveis para meta-análise. Sensibilidade e especificidade agrupadas, área de resumo sob a curva característica de operação do receptor e razão de chances de diagnóstico do índice resistivo ou VFSC para prever "morte ou incapacidade grave" foram os seguintes. (1) Hipotermia pré-terapêutica: 0,83 (intervalo de confiança de 95% [IC] 0,45-0,97) e 0,92 (IC 95% 0,74-0,98), 0,94 (IC 95% 0,92-0,96),54 (IC 95% 7-391). (2) Hipotermia terapêutica (medições antes da hipotermia terapêutica): 0,62 (IC 95% 0,41-0,80) e 0,96 (IC 95% 0,88-0,99), 0,93 (IC 95% 0,89-0,94), 23 (IC 95% 6-91). (3) Hipotermia terapêutica (medidas durante/após a hipotermia terapêutica): 0,51 (IC 95% 0,24-0,78) e 0,83 (IC 95% 0,73-0,90), 0,81 (IC 95% 0,78-0,85),5 (IC 95% 2 -13). A classificação geral das evidências de Avaliação, Desenvolvimento e Avaliação de Recomendações (GRADE) foi 'baixa' ou 'muito baixa'. INTERPRETAÇÃO: Evidências de baixo nível sugerem que anormalidades índice resistivo ou VFSC pode prever morte ou incapacidade com alta sensibilidade e especificidade em bebês com EHI que não são resfriados. A especificidade desses testes foi alta quando realizados antes do início do resfriamento em bebês que receberam hipotermia terapêutica.

Objective Evaluation of Cerebral Venous Sinus Attenuation on Plain CT Brain and Detecting Anemia. Noticing the "Unnoticed".

CONTEXT: Plain computed tomography (CT) of the brain is an important first-line investigation of choice in an acute neurologic setup. Unless clinically suspected concealed areas like the confluence of venous sinuses often go unnoticed. Diagnosing anemia, thrombosis, or polycythemia correlating the CT attenuation values might prove to be fruitful in early patient management where the mode of varied clinical presentations causes a clinical dilemma. AIMS: 1) To determine the objective correlation between CT attenuation of the cerebral venous sinus and hemoglobin (Hb) as well as hematocrit (HCT) value and 2) to detect anemia from measuring venous sinus attenuation. METHODS AND MATERIALS: An exploratory study design of 200 patients, who had plain CT of the head and Hb and HCT levels obtained within 24 h of the scan. STATISTICAL ANALYSIS USED: Two-tailed unpaired t-test was used to test the difference between two independent samples. Correlation and regression analyses were used to assess the correlation between two quantitative variables. RESULTS: A significant correlation was observed between the Hb-Hounsfield unit (HU) and HCT-HU. The simple linear regression model revealed that HU (P value < 0.001) was significantly correlated with Hb and the regression model was, Hb = 2.1 + 0.2 × HU. Similarly, HU (P value < 0.001) was significantly correlated with HCT and regression model was HCT = 6.2 + 0.7 × HU. CONCLUSIONS: Objective attenuation values of dural sinuses on plain CT can be positively correlated with Hb and HCT values. Considering the cutoff of 35.5 HU, we were able to show the specificity of 100% for the detection of anemia.

Radiographic findings in COVID-19: Comparison between AI and radiologist.

CONTEXT: As the burden of COVID-19 enhances, the need of a fast and reliable screening method is imperative. Chest radiographs plays a pivotal role in rapidly triaging the patients. Unfortunately, in low-resource settings, there is a scarcity of trained radiologists. AIM: This study evaluates and compares the performance of an artificial intelligence (AI) system with a radiologist in detecting chest radiograph findings due to COVID-19. SUBJECTS AND METHODS: The test set consisted of 457 CXR images of patients with suspected COVID-19 pneumonia over a period of three months. The radiographs were evaluated by a radiologist with experience of more than 13 years and by the AI system (NeuraCovid, a web application that pairs with the AI model COVID-NET). Performance of AI system and the radiologist were compared by calculating the sensitivity, specificity and generating a receiver operating characteristic curve. RT-PCR test results were used as the gold standard. RESULTS: The radiologist obtained a sensitivity and specificity of 44.1% and 92.5%, respectively, whereas the AI had a sensitivity and specificity of 41.6% and 60%, respectively. The area under curve for correctly classifying CXR images as COVID-19 pneumonia was 0.48 for the AI system and 0.68 for the radiologist. The radiologist's prediction was found to be superior to that of the AI with a P VALUE of 0.005. CONCLUSION: The specificity and sensitivity of detecting lung involvement in COVID-19, by the radiologist, was found to be superior to that by the AI system.

Is exposure to indoor secondhand smoke associated with poor mental health? Results from non-conflict and post-conflict setting.

The purpose of this study was to examine the association between exposure to indoor SHS and self-reported HRQoL among healthy non-smoking students at the University of Belgrade, Serbia and Kosovska Mitrovica located in the post-conflict Kosovo province. Students who presented at Student Public Health Center in Belgrade in 2009 and Kosovska Mitrovica in 2015 for mandatory health checks were invited to participate. Data were collected using socio-demographic and behavioral questionnaire, health-related quality of life questionnaire Short Form-36 (SF-36) and Beck Depression Inventory (BDI). A total of 82.3% students in Belgrade sample and 76.0% in Kosovska Mitrovica sample reported daily exposure to indoor SHS. After adjustment for socio-demographic characteristics and behavior, daily exposure to indoor SHS for more than 6 hours was associated with poorer Vitality (ß = -5.55, 95% confidence interval [CI] -9.49, -1.61) and Mental Health (ß = 5.00, 95% CI-8.94, -1.07) only among students at the University of Belgrade. This study showed that the association between longer daily indoor SHS exposure and poor mental health HRQoL was not consistent in non-conflict and post-conflict setting. This association was not found in a post-conflict setting. Strict no smoking policies are needed in student housing, university campuses and all public spaces.

Tobacco smoking and health-related quality of life among university students: Mediating effect of depression.

The aim of this study was to assess the association between cigarette smoking and health-related quality of life (HRQoL) among students in two different universities, and the potential mediating effect of depression. Participants were students who came for mandatory check-ups at Student Health Care Centers in two Universities in Serbia, differing by socio-politically and economically environments. Students completed socio-demographic questionnaire, Beck Depression Inventory (BDI) and the SF-36 questionnaire for assessment of HRQoL. In both populations, after adjustment for socio-demographic, behavioral and health factors, smoking was associated with poorer Mental Composite Score (MCS) and Physical Composite Score (PCS) (Belgrade 1,624 students: MCS ß = 3.38, 95% confidence interval [CI] 1.31, 5.44, PCS ß = 1.01, 95% CI -0.50, 2.52; Kosovska Mitrovica 514 students: MCS ß = 5.06, 95% CI 1.74, 8.37, PCS ß = 3.29, 95% CI 0.75, 5.83). After additional adjustment for BDI score, the observed associations were lost (Belgrade: MCS ß = 1.12, 95% CI -0.57, 2.80, PCS ß = -0.40, 95% CI -1.71, 0.92; Kosovska Mitrovica: MCS ß = 0.77, 95% CI -2.06, 3.60, PCS ß = 0.56, 95% CI -1.75, 2.87). Higher BDI score was associated with poorer PCS and MCS across all quintiles. The association of smoking with impairment of HRQoL among university students in two different settings was mediated by higher levels of depressive symptoms. These findings highlight the need for further research on the interaction between smoking, mental health and quality of life, with implications for prevention, diagnosis and treatment.

Prayers and beliefs among relatives of children admitted in pediatrics wards.

CONTEXT: Spirituality/Religion is important to many parents and they may call upon God to make the child healthier and normal. AIMS: We surveyed parents/relatives of children admitted to in-patient services for their praying practices and beliefs thereof. SETTINGS AND DESIGN: Cross-sectional survey in 150 parents/relatives of patients admitted to pediatric ward, pediatric intensive care (PICU) unit, and neonatal intensive care unit (NICU) (50 each). MATERIALS AND METHODS: We collected demographic, praying practices' information and asked them to fill a Prayer Questionnaire Score Chart which classified the individual's religiosity. STATISTICAL ANALYSIS USED: Descriptive statistics, Chi-square test, independent t-test, and one-way ANOVA were used for analysis. RESULTS: Hindus constituted 126 (84%) participants. In 118 (78.67%) cases, mothers responded to survey. Average time of prayer in PICU (159 min) was more than NICU (109 min) and pediatric ward (114 min). Average frequency of prayer before admission (10.49) was less significant than frequency of prayer after admission (13.64) (P value < 0.001). Most of the people, 91 (60.67%), prayed by standing near statues of God or praying silently while recalling God's images. Almost all people, 149 (99.33%), believed that both medical care and prayer were required for recovery of patient. According to patient's relatives, average 52% recovery of patient was due to medicine. CONCLUSIONS: Prayer was an integral component of parents/relatives' daily spiritual/religious ritual that was directed toward the admitted child's recovery. Statistically significant increase in frequency of praying after admission indicates the importance of prayers and spirituality in their minds as a part of treatment.