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   Table of Contents - Current issue
January-June 2022
Volume 8 | Issue 1
Page Nos. 1-80

Online since Thursday, June 30, 2022

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A pandemic 'to be or not to be'- we should still be ready for monkeypox Highly accessed article p. 1
Sonu Hangma Subba
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Community medicine - A specialty of choice? p. 3
Jyolsna Nair, Deb Kumar Pal, Kajal Das, Bimal Kumar Sahoo, Manish Taywade
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Psychological impact of disease outbreaks on healthcare workers: A narrative review p. 5
Shweta Sunil, Manoj Kumar Sharma
Disease outbreaks can have an impact on one's mental health. A comprehensive knowledge about the psychological state of healthcare workers (HCWs) during disease outbreak is limited. This review aims to present HCWs' psychological issues due to multiple outbreaks in the past and present, including SARS, MERS, Ebola, and COVID-19. The results indicated the presence of affective symptoms, paranoia, and decreased trust among HCWs. The review reveals the need of research to understand strategies and interventions that can enhance the well-being of HCWs.
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Horizontal unidirectional airflow for reducing cross-infection of COVID-19: A narrative review p. 9
Hunny Sharma, Manisha Ruikar
Recent decades have witnessed the emergence of many airborne diseases such as severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19, which have highlighted the importance of effective ventilation in residential, work, or hospital premises. Ventilation which plays an essential role in reducing or diluting the airborne contaminants. However, it is not always easy to achieve by natural ventilation as it depends on many other factors such as temperature and climatic conditions. (wind velocity, wind direction, and housing pattern/design). Horizontal unidirectional airflow (HUAF) is one such method that can be achieved at low cost and can reduce cross-infection of COVID-19 to much extent. Hence, this narrative review aims to bring some insight into what is HUAF, how it can be achieved, and what are its possible implications in preventing COVID-19 transmission.
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Gender of the baby and its impact on the health-related quality of life of postpartum women p. 14
Pallika Singh, SK Rasania
Introduction: Health-related quality of life (HRQoL) is a multidimensional concept and is relatively neglected in both research and practice. Gender equality is a crucial measure of human rights for millions of women and girls around the world. Most postpartum researches have focused on physical complications. This study was conducted to analyze the impact of gender of the baby on the HRQoL of postpartum women at 6 weeks. Material and Methods: The study was conducted in a resettlement colony, Kalyanpuri, located in Delhi, India, with a sample size of 330 postpartum women. The data were collected in the 6th week of postpartum period using the Medical Outcomes Study Short Form 36 Health Survey for HRQoL. Results: The findings showed that the birth of a male baby led to a significantly (P < 0.05) better mean HRQoL score than the birth of a female baby. The mean scores of general health, vitality, social functioning, and mental health domains were significantly less in the case of a female newborn child. Conclusion: The male dominance in the Indian society which leads to financial supremacy and coercion for continuation of family lineage was an important predictor of lower HRQoL of the women in the postpartum period. This demonstrates the need for risk factor for gender equity to and achieve universal health coverage.
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What brings people to government urban primary care facilities? A community-based study from Delhi, India p. 18
Nitish Virmani, Ishaan Mittal, Chandrakant Lahariya
Introduction: Mohalla or Community Clinics of Delhi, India, provides free primary care services to the general population, with special focus on the underserved and marginalized. This study was conducted to analyze the perception and experience of target beneficiaries and to understand and document the determinants of people visiting these clinics. Material and Methods: A community-based study was conducted from October 2019 to April 2020. A semi-structured questionnaire was used for data collection. Correlation and comparative analysis were used. Thirty-seven Mohalla Clinics and their catchment areas were visited. A total of 391 respondents (including 35 health staff and 356 community members) were included. Results: Proximity of clinics, waiting times, age, perceived quality of treatment, and cleanliness at facilities were the factors that influenced the usage of clinics. Lack of first-aid facilities and long waiting time (at a few facilities) were identified challenges. There is a need for wider publicity and awareness about the clinics and regular analysis of data to determine an appropriate mid-course action to further increase utilization. Conclusion: Community Clinics of Delhi, India, have brought people back to government primary healthcare (PHC) facilities. The popularity of these clinics has encouraged a number of Indian states to set up similar facilities. The factors behind their success need to be studied in detail to derive lessons for making urban PHC accessible in other low- and middle-income countries.
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Evaluation of palliative care training program for medical interns in a tertiary care teaching hospital, South India p. 23
Suguna Elayaperumal, Vinayagamoorthy Venugopal, S Adinarayanan, Amol R Dongre
Introduction: The Department of Community Medicine has been training medical interns for providing hospital-based palliative care (HBPC) and community-based palliative care (CBPC) services with an interprofessional team. This study was done to evaluate the training program on palliative care developed for medical interns. Material and Methods: It was a retro-pre type of program evaluation done among 172 interns between January 2016 and December 2017. One day program was conducted for the interns by faculty trained in palliative care, followed by placement in HBPC and CBPC program. At the end of training, self-perceived improvement in knowledge was collected on a five-point Likert scale. Certificates were issued on completion. Data were entered and analyzed using Epi Info (version software. Wilcoxon signed-rank test was applied between pre- and post-scores. Manual content analysis was done for open-ended questions. Results: The mean age of the participants was 22.5 ± 0.8 years, with 76 (44.2%) males and 96 (55.8%) females. There was statistically significant improvement in perceived knowledge scores after attending the training. Areas of learning, values learned, and uses of learning in future career and suggestions for improving the training program were the categories obtained. Conclusion: The training program improved the self-perceived knowledge on palliative care among medical interns. The exposure to HBPC and CBPC program had a positive effect on their attitude and perceived skills for caring of chronically ill patients. Such programs can be initiated by other palliative care providing institutions for training medical interns.
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Study on occupational ventilatory defects among workers employed in cement factories of Darjeeling district, West Bengal, India p. 28
Payel Sarkar, Daliya Biswas, Eashin Gazi, Kaushik Ishore
Introduction: Cement factory workers are at a high risk of exposure to crystalline silica-laden cement dusts and at a higher risk of developing chronic obstructive pulmonary disease (COPD), like chronic bronchitis, emphysema and restrictive lung disease like silicosis. This study was done to measure the extent of occupational ventilatory defect among workers employed inside cement factories. Material and Methods: A cross sectional study was conducted among cement factory workers using questionnaire on respiratory symptoms 1986 and spirometry was done after seeking permission from the concerned authority and Institutional Ethics Committee. Logistic regression analysis was done to test for statistical significance. Results: Ventilatory defect was present among one fourth of the factory workers. Obstructive type of lung disease was much higher (94.6%) than restrictive lung disease (5.4%). Almost half of the study subjects had presented with different types of respiratory symptoms. Breathlessness on exertion was commonest symptom, followed by cough day and night. Ventilatory defects were noted to be much higher (86.5%) among the workers working in the cement factories for more than 10 years and increasing trend was observed with increment in their age and years of working at the factory. Ventilatory defect were significantly high among smokers (29.5%), subjects who started smoking in early age (35.9%) and there is increasing trend of defects with a greater number of cigarettes intake. Conclusion: Periodically awareness generation and mandatory use of personal protective equipment should be practiced among workers in cement factories.
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Knowledge, attitudes and utilization of food labels among undergraduate medical students in a medical college in Chennai – A cross sectional survey p. 33
Sinthiya Annamalai, Vijayaprasad Gopichandran
Introduction: Food labeling is an important method of providing food-related information on the package of food products, to facilitate people's choice of safe and appropriate foods. Medical students are potential agents of change in food label utilization behavior in the community. The objectives of this study were to evaluate the knowledge, attitudes, and utilization of food labels among undergraduate medical students in a medical college in Chennai. Material & Methods: We conducted a cross-sectional survey of 200 students studying in the 1st to 3rd year in a medical college through an online Google Forms survey, self-administered by the students after online informed consent was obtained. We gathered information on their knowledge, attitudes, and utilization of food labels. Results: Of 400 students approached, 200 responded to the online survey. They had good knowledge about food labels. Female students had 3.4 (1.59 to 7.25) times better knowledge compared to men. The students had a positive attitude toward food labels, and a majority thought that the food labels are useful. Utilization of food labels to understand the nutritive content (55%), additives (57%), and manufacturer details (47%) was poor. Utilization of food labels was 2.7 times more (1.142–6.587) among those who did regular exercise, and it was 0.2 (0.09 to 0.9) times less among those who were on a strict diet. Conclusion: Medical students had a sound knowledge and good attitude toward food labels, but their food label utilization patterns were still poor. There is a need to incorporate food labeling in the undergraduate medical curriculum and inculcate better food label utilization behavior.
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Medical officer's perspectives and professional challenges in handling poisoning cases in rural India p. 39
Kakasaheb Mahadik, Asawari Raut, Monidipa Chowdhury, Ali Haider Asad, Shubham More
Introduction: Poisoning is a significant public health problem in developing countries, more so in rural areas. Very little is known about the treatment available for poisoning cases in the context of rural health care provision in India. This study explores the perceptions of the primary health care medical officers regarding the management of poisoning cases. Material and Methods: A semistructured, self-designed survey form was used to interview the medical officers in Pune district. The interview focused on understanding rural hospital settings in terms of infrastructure, available facilities, and medical officers' perception of professional challenges in the management of poisoning cases. Results: Underreporting of poisoning cases in these primary health centers (PHCs) and transferring to higher hospitals without basic first aid provided was noted through interviews. Conclusion: Medical officers in rural PHCs lack the necessary training and knowledge required for the management of poisonings which is further worsened by lack of resources. There is a need to focus on poison management in continuous medical education. Training programs and education for medical officers are needs of the hour.
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COVID-19 pandemic: Probing the dynamics in the North Himalayan state p. 44
Priya Sharma, Saurabh Rattan, Vikram Katoch, Gurdarshan Gupta, Jai P Narain
Introduction: Coronavirus disease or COVID-19 emerged in December 2019 in China and thereafter spread to all regions of the world including India. In the Himalayan state of Himachal Pradesh, India, the first case was identified in the month of March 2020. As the most populous district of the state of Himachal Pradesh, Kangra not only identified the first case in the state but also thereafter suffered disproportionately due to the virus causing severe health and economic disruption. The study was carried out to better understand the pattern and trends of COVID-19 pandemic in the district since its emergence, covering the first and the second wave to use the data to prepare the future course of action. Materials and Methods: A robust database comprising real-time data in a line list format was created. The observations covered all confirmed COVID-19 cases in the district from March 20, 2020, to June 30, 2021, in terms of disease progression and distribution in time, place, and person, and the possible risk factors for severe disease. Results: During the study period, 45,871 cases and 1030 deaths were reported in Kangra district, with a case fatality rate of 2.2%. Of the 12 districts of the state, Kangra reported the highest number of cases (22.6%) and deaths (29.7%). Ninety percent of all cases occurred during the second wave. While the first wave peaked in December 2020 with 2596 cases, the highest number of cases occurred in May 2021 when as many as 25,625 cases were reported. The test positivity rate of 15.2% during the second wave which was many times higher than that seen during the previous year. The case fatality rates during the first and second waves were 2.2% and 2.1%, respectively. Conclusions: The study highlights an explosive surge in COVID-19 cases during the second wave, indicating the highly infectious nature of the virus. While absolute number of deaths was several times greater during the second wave, the case fatality rates did not differ greatly between the two waves.
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Multiplicity of noncommunicable diseases among the elderly in a suburban area of Delhi p. 50
Tushar Prabhakar, Manish Kumar Goel, Anita Shankar Acharya
Introduction: Continuing advancements in quality of health care has led to increased life expectancy over time. This in turn has resulted in increased prevalence of noncommunicable diseases (NCDs), especially among the elderly. An appropriate portrayal of its epidemiology is essential to adequately understand the health-care needs of the population. The evidence generated from the study will give us an incentive to address the rising burden of polymorbidities. We did the study to assess the prevalence and pattern of NCDs in the elderly above 60 years of age and to determine age- and sex-wise distribution of single and multiple NCDs. Materials and Methods: A community-based cross-sectional study was conducted among 350 elderly participants over 60 years of age in Mehrauli area of Delhi. Data were collected using a semi-structured questionnaire. Detailed general and systemic examination was also done. Results: A total of 87.4% of the study population were suffering from at least one NCD. The number of NCDs per person is 2.41. Overall, 80 out of the total 350 study participants (22.9%) had a single NCD, whereas 226 (64.6%) had two or more NCDs. Hypertension was the most prevalent NCD, followed by cataract, osteoarthritis, diabetes mellitus, and obesity. Conclusion: The prevalence of NCDs was quite high among the elderly. Multimorbidity was more common among the oldest-old age group and elderly women. This calls for increased focus on timely and comprehensive screening for NCDs in adults and asserts the need to approach the screening and management of NCDs in a more holistic way and not as isolated health events.
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Cost analysis of outpatient department prescriptions in the community pharmacies during the coronavirus disease-2019 pandemic in Maharashtra p. 56
Sharon Reji, Preeti Santosh Mishra, Salman Retiwale, Prasanna R Deshpande
Introduction: Community pharmacy is a place under the direct supervision of the pharmacist where the prescription orders are compounded and dispensed. In India, there are limited studies published on the economic evaluation of community pharmacy. This study aimed to conduct a cost analysis of outpatient department prescriptions in the community pharmacies during the coronavirus disease-2019 pandemic on various parameters such as the total cost, average cost/prescriptions, age-wise cost, prescribers, drug class, pharmacy wise, route of administration, and diagnosis cost. Material and Methods: The analysis of total and average cost per prescription was conducted. The study was carried out for 6 months during. The number and type of drugs prescribed and the frequency and total cost of the prescriptions were noted. Statistical analysis was conducted for different demographics and various parameters. Results: A total of 1166 prescriptions were analyzed in the study. Out of 3704 drugs prescribed 99.9% were branded ones. The average number of drugs/prescriptions was 3.17. The predominance of male patients (60%) was seen. On the overall cost of prescriptions the statistical significance of the overall cost was established at (P < 0.00001). The sum of all the prescriptions accounted for ₹.10, 86,504.65. The average cost/prescription was ₹.931.82. Conclusion: The average total cost/prescription was found to be higher in our study. There is a need for further studies to be done in the field of community pharmacy.
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Parents' and teachers' perceptions of emotional and behavioral problems in school-going adolescents p. 63
U Harikrishnan, Grace Lalhlupuii Sailo
Introduction: Parents and teachers are the primary consultants to understand the emotional and behavioral problems of school-going adolescents. The current study focuses on parents' and class teachers' perspectives of school-going adolescents' emotional and behavioral problems. Material and Methods: A Cross-sectional questionnaire-based study was conducted among 19 schools from government-private and rural-urban schools across Kollam District, Kerala. Malayalam/English version of the strength and difficulties questionnaire was administered among a sample of 600 parents and 60 class teachers of school-going adolescents. Results: Multiple linear regression analysis showed that parents' reports is significantly predicted by gender (P < 0.01), urban-rural settings (P < 0.001) and socioeconomic status (P < 0.01). Teachers' reports have significantly been predicted by urban-rural settings (P < 0.01) and socioeconomic status (P < 0.001). Conclusion: More attention is needed for the protection of adolescent's mental health and fills mental health gaps in services.
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A clinico-epidemiological profile of scrub typhus cases admitted in a tertiary hospital in South India p. 67
Purabi Phukan
Scrub typhus (ST) is a consistently underreported disease. The disease is spreading to newer areas, and an understanding of disease epidemiology is needed in the local Indian and current context. This study describes the demographic characteristics, monthly distribution, clinical and laboratory presentations, and treatment outcome of the ST cases recently identified. Case sheets of 15 ST patients diagnosed from January 2019 to December 2020 were analyzed. The majority of the patients were male. Eighty percent of the patients were from rural or suburban areas. Higher admission was observed from September to December. Fever (100%), skin rash (73.3%), body ache (53.3%), and vomiting (53.3%) were the most common clinical features. The onset of fever till the appearance of skin rash was 3 ± 1.2 days. The mean day from onset of symptoms till diagnosis was 6.8 ± 3.9 days. Eschar was found in only two patients. Nine (60%) patients already had complications at the time of admission. Most patients presented a laboratory picture of thrombocytopenia, neutrophilic leukocytosis, and anemia. Complications such as septic shock, acute kidney injury, and hepatic involvement were observed. All responded to doxycycline within 48 h. No fatalities were observed. Early clinical suspicion of ST among those with high fever, skin rash and thrombocytopenia, and transaminitis showed positive clinical outcome.
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Paraquat-induced lung fibrosis and multiorgan failure: A case report from North India p. 73
Jyoti Aggarwal, Amtoj Singh Lamba, Saurabh Gaba, Monica Gupta
Paraquat is a herbicide which is widely used by agricultural communities worldwide. It is extremely toxic for humans and ingestion of as less as 30 mL of 20%–24% concentration is usually lethal. The lack of an effective antidote is a concern due to the fatal outcomes associated with ingestion of paraquat. Herein, we are presenting a case of fatal paraquat poisoning in a young male from a center in India. The clinical course was complicated by liver, renal, and lung injury. We also describe its mechanism of toxicity, clinical features, and newer strategies being tried for treatment.
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COVID-19 – reminds failure of compliant precaution practices in the society p. 77
Prasan Kumar Panda, Ravi Shankar
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An easy, efficient, and safe method to extend utilization of N95 masks: A physician's perspective p. 79
Debabrata Biswas, Rubik Ray, Debarati Biswas
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