Establishing a Demographic, Development and Environmental Geospatial Surveillance Platform in India: Planning and Implementation.

BACKGROUND: Inadequate administrative health data, suboptimal public health infrastructure, rapid and unplanned urbanization, environmental degradation, and poor penetration of information technology make the tracking of health and well-being of populations and their social determinants in the developing countries challenging. Technology-integrated comprehensive surveillance platforms have the potential to overcome these gaps. OBJECTIVE: This paper provides methodological insights into establishing a geographic information system (GIS)-integrated, comprehensive surveillance platform in rural North India, a resource-constrained setting. METHODS: The International Clinical Epidemiology Network Trust International established a comprehensive SOMAARTH Demographic, Development, and Environmental Surveillance Site (DDESS) in rural Palwal, a district in Haryana, North India. The surveillance platform evolved by adopting four major steps: (1) site preparation, (2) data construction, (3) data quality assurance, and (4) data update and maintenance system. Arc GIS 10.3 and QGIS 2.14 software were employed for geospatial data construction. Surveillance data architecture was built upon the geospatial land parcel datasets. Dedicated software (SOMAARTH-1) was developed for handling high volume of longitudinal datasets. The built infrastructure data pertaining to land use, water bodies, roads, railways, community trails, landmarks, water, sanitation and food environment, weather and air quality, and demographic characteristics were constructed in a relational manner. RESULTS: The comprehensive surveillance platform encompassed a population of 0.2 million individuals residing in 51 villages over a land mass of 251.7 sq km having 32,662 households and 19,260 nonresidential features (cattle shed, shops, health, education, banking, religious institutions, etc). All land parcels were assigned georeferenced location identification numbers to enable space and time monitoring. Subdivision of villages into sectors helped identify socially homogenous community clusters (418/676, 61.8%, sectors). Water and hygiene parameters of the whole area were mapped on the GIS platform and quantified. Risk of physical exposure to harmful environment (poor water and sanitation indicators) was significantly associated with the caste of individual household (P=.001), and the path was mediated through the socioeconomic status and density of waste spots (liquid and solid) of the sector in which these households were located. Ground-truthing for ascertaining the land parcel level accuracies, community involvement in mapping exercise, and identification of small habitations not recorded in the administrative data were key learnings. CONCLUSIONS: The SOMAARTH DDESS experience allowed us to document and explore dynamic relationships, associations, and pathways across multiple levels of the system (ie, individual, household, neighborhood, and village) through a geospatial interface. This could be used for characterization and monitoring of a wide range of proximal and distal determinants of health.

Estimation of postmortem interval from human pericardial fluid electrolytes concentrations in Chandigarh zone of India: log transformed linear regression model.

Estimation of postmortem interval from changes in postmortem pericardial fluid electrolytes concentration is the topic of discussion in the study. Querido [Querido D. Double logarithmic, linear relationship between plasma sodium/potassium concentration ratio and postmortem interval during the 6-96h postmortem period in rats. Forensic Sci Int 1990;44:125-34; Querido D. Linearization of the relationship between postmortem plasma chloride concentration and postmortem interval in rats. Forensic Sci Int 1990;45:117-27] and Singh et al. [Singh D, Prashad R, Parkash C, Bansal YS, Sharma SK, Pandey AN. Linearization of relationship between serum sodium, potassium concentration, their ratio and time since deaths in Chandigarh zone of north west India. Forensic Sci Int 2002;130:107; Singh D, Prashad R, Parkash C, Sharma SK, Pandey AN. Double logarithmic linear relationship between plasma chloride concentration and time since death in humans in Chandigarh zone of north west India. Legal Med 2003;5:49-54] had demonstrated a highly significant double logarithmic linear relationship between the time since death and the plasma sodium/potassium ratio as well as with plasma chloride concentration in Wistar rats and human, respectively. In view of these facts, the present study was carried out to substantiate this propensity in this transcellular extension of blood plasma. Electrolytes analysis in postmortem pericardial fluid obtained from 311 subjects revealed that correlation of time since deaths with potassium, sodium/potassium ratio and phosphorus was highly significant (p<0.001) during 2.5-58h of deaths. Not withstanding, time since death although modulated by ambient temperature could be predicted by log transformed multiple regression equation derived from the combination of potassium, chloride and phosphorus electrolytes concentration with standard error (SE) of prediction (in log hours) of 0.1840h and by double logarithmic model with SE (in log hours) of 0.1959, 0.2068 and 0.2088h from potassium, sodium/potassium ratio and phosphorus electrolytes, respectively.

Radiopaque shadow in the lumbar region on plain X-ray abdomen: diagnostic dilemma.

A 28-year-old man presented with right flank pain. Radiological investigations suggested the diagnosis of a calcified mass in the retroperitoneum below the right kidney. Laparoscopic exploration using the retroperitoneoscopic approach was performed. However, it was not possible to locate the lesion and an open exploration was done. During exploration a large fecolith was found trapped in a diverticulum of the cecum.