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   Table of Contents - Current issue
January-June 2021
Volume 7 | Issue 1
Page Nos. 1-70

Online since Tuesday, June 29, 2021

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Psychedemic of mental health problems and COVID-19: Are we doing enough? p. 1
Sonu Hangma Subba
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Global child health: What are the threats our children are facing? p. 4
Venkatraman Radhakrishnan
Disparities across the world are widening day by day. Children are the most vulnerable population impacted by the disparities. As governments and civil societies are successfully tackling traditional threats to children such as malnutrition, infectious diseases, and inadequate neonatal care, newer threats such as climate change, child trafficking, and childhood obesity are emerging. Threats like the COVID-19 pandemic, although not directly impacting children's health, have caused a significant effect on the delivery of child health services. The present article examines the current and future threats faced by children worldwide and offers solutions to mitigate those threats.
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Executive health checkup package at All India Institute of Medical Sciences, Bhubaneswar: A novel approach p. 8
Bimal Kumar Sahoo, Manish Taywade, Vikas Bhatia, Binod Kumar Patro, Sachidananda Mohanty
Early detectionof a disease leads to relatively simple courses of treatment and prevents life-threatening complications. Many health conditions can be corrected or maybe improved through treatment modalities if they are discovered by health screening facilities. Health screening program such as executive health checkup is convenient, affordable, inexpensive, and vastly beneficial for the patients. Hence, health screening saves lives immensely by early detection of diseases and preventing serious complications. It is an effective component of healthcare. It achieves more positive effects than medical treatment and at a lower cost. Health promotion is aimed at influencing people's social circumstances and lifestyles so that their health is improved (or maintained) and disease is prevented.
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Utility of acute-phase reactants testing in clinical practice p. 12
Shailaja Prabhala, Sumitra Sivakoti, Bijayalaxmi Sahoo
Acute-phase proteins (APPs) or acute phase reactants (APRs) are diverse biochemical proteins which are seen as a response in inflammatory processes due to varied etiologies. Some of these proteins increase and some decrease due to various mechanisms during inflammation. The secretion, time to attain peak concentrations, half-life, and degradation are different for different APPs. Some of the markers can be easily tested with minimum equipment whereas, others require sophisticated instruments. They are not pathognomonic for any one particular disease but their elevation may point toward a bacterial, viral, or noninfectious inflammatory process. Testing for APPs and interpreting the result in correlation with results of other tests and clinical details can help in arriving at a diagnosis, in ordering further appropriate tests and in taking treatment decisions. We attempted to look at the present published literature and summarize the different APRs in inflammation. A MEDLINE search for articles published in the English language, with acute-phase proteins [MeSH Terms] OR acute phase reactants [Text Word] was done for the years between 1985 and 2019. In addition, other cross-referenced articles were also searched for relevant data.
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Plant-based diet: A solution to the sustainability of life and environment Highly accessed article p. 19
Vikas Bhatia, Gokul Gopi, Priyamadhaba Behera
The entirety of food and drink that an individual continually expends is called a diet. Proper nutrition – a sufficient, all-around offset diet with regular physical activity, frames the establishment for good health. The majority of the currently prevalent dietary recommendations are based on the health benefits of different individual food products. With the rising concern regarding climate change and evidence highlighting the influence of our nutritional practices on the environment, the time has come to redefine the dietary guidelines and recommendations considering the environmental impact of diet along with the health benefits. Studies have been reliably consistent with demonstrating that an equicaloric diet rich in plant-based products and lower in animal products is beneficial to health and put a lesser burden on the earth. There are five Sustainable Developmental Goals that can be linked with our dietary practices (no poverty, no hunger, good health and well-being, responsible consumption and production, and climate change). A plant-based diet is a suitable solution to the current crisis of noncommunicable diseases and climate change. Moving on to such a dietary practice would require immense changes in the currently prevalent food system with an emphasis on better production and waste management strategies along with improvement in food delivery and consumption practices worldwide. This article brings insight regarding the benefits of a plant-based diet and the need to address the ecological impact of animal-based foods.
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Diagnostic accuracy of Diabetes in Pregnancy Study Group of India criteria for the screening of gestational diabetes mellitus in primary care setting p. 25
Nitya Balagopalan, Rambha Pathak, Farzana Islam, Aruna Nigam, Prem Kapur, Sarita Agarwal
Introduction: Although the Diabetes in Pregnancy Study Group of India (DIPSI) criterion is recommended by the Government of India guidelines, there is lack of consensus on a universal criterion for diagnosis of gestational diabetes. This has led to a wide variation of pregnant women being diagnosed with gestational diabetes mellitus (GDM). The WHO 1999 and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria are widely used globally and in India as well. The objective of this study was to evaluate the diagnostic accuracy of DIPSI criteria in comparison to WHO 1999 and IADPSG criteria for diagnosis of GDM. Materials and Methods: A community-based study was conducted for a period of 1 year. Oral glucose tolerance test was done on 506 pregnant women identified through house-to-house survey. The proportion of GDM cases by WHO, IADPSG, and DIPSI criteria was calculated. The diagnostic accuracy of DIPSI criteria was assessed by calculating sensitivity, specificity, and predictive values taking WHO and IADSPG criteria as gold standard. Results: The prevalence of GDM was 14.2% by WHO criteria, 13% by DIPSI criteria, and 27.3% by IADPSG criteria; 10.3% were diagnosed by all the three criteria. The sensitivity and specificity of DIPSI criteria when the WHO criteria was taken as the gold standard was found to be 86.1% and 99.08%. The sensitivity and specificity of DIPSI criteria when the IADPSG criteria was taken as gold standard was found to be 44.93% and 98.91%, respectively. Conclusion: The prevalence of GDM is found to be much higher by IADPSG criteria as compared to the WHO and DIPSI criteria. The single-step approach DIPSI criteria have good diagnostic accuracy and can be used in epidemiological studies and are feasible for diagnosis of GDM in primary care settings.
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Mental health problems among health-care workers during the COVID-19 pandemic p. 31
Anil Bindu Sukumaran, L Manju, Regi Jose, Meghana Narendran, C Padmini, P NazeemaBeevi, Divija Vijith, R Beena Kumari, Shilpa Prakash, Jithu S. J. Nath, PV Benny
Introduction: As the pandemic of COVID-19 stretches, its wings across the different parts of the world over the past few months, it is very likely that mental health problems increase, particularly among the health-care workers who have higher risk of exposure to the disease and also to sufferings of the people affected with the disease. Objective: To assess the prevalence and factors associated with depression, anxiety, and stress among health-care workers from Kerala during the COVID-19 pandemic. Materials and Methods: A cross-sectional study among 544 health-care workers from Kerala was conducted by a self-administered online questionnaire in Google Forms by chain referral sampling with Depression, Anxiety, and Stress Scale-21 scale during initial phase of the COVID-19 pandemic. The tests of significance used were Mann–Whitney U-tests and Kruskal–Wallis tests. Odds ratios and 95% confidence interval are estimated. Results: During the early pandemic period, 9.7% of health-care workers had mild depression and 13.3% had moderate-to-severe depression. While 4% had mild anxiety and 3.5% had moderate-to-severe anxiety, about 6.8% had mild stress and 6.4% had moderate-to-severe stress. The anxiety symptoms were significantly higher among nurses compared to doctors. Emotional and social support from higher health authorities is a significant protective factor against stress and depression. Frontline workers have 84% higher risk to have depression. Conclusions: Frontline health-care workers who are directly involved in the screening, diagnosis, treatment, and care for patients with COVID-19 are at higher risk of experiencing poor mental health outcomes. Emotional and social support from higher health authorities is a significant protective factor against depression and stress among health-care workers.
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Evaluating the effectiveness of a verbal autopsy workshop: A comparative analysis of pre- and posttest p. 37
Neeraj Agarwal, Neha Chaudhary, Shamshad Ahmad, Pankaj Kumar Pathak
Introduction: AIIMS Delhi developed an online platform Mortality in India established through Verbal Autopsies, which ultimately provides data on the cause of death in the country. AIIMS Patna being one of the partner institutions in this initiative of AIIMS Delhi, thus, conducted a 2-day workshop of Registrar General of India supervisors with the objective to strengthen the knowledge of participants and improve their practices on writing a good narrative during verbal autopsy (VA) using a key symptom list. Materials and Methods: A total of 32 participants attended the 2-day workshop at the Department of Community and Family Medicine, AIIMS Patna, in January 2019. A pretest questionnaire was administered before the start of the workshop and to test the improvement in knowledge of participants after attending the workshop, the same questionnaire was again administered as a posttest at the end of the workshop. Feedback of participants was also collected on a predesigned semi-structured questionnaire. The collected responses were entered in MS Excel 2010. Descriptive and inferential statistics were calculated using SPSS version 16.0 software. Results: There was a statistically significant improvement (P < 0.001) in the mean posttest score (8.6 ± 1.2) as compared to the mean pretest score (6.1 ± 2.8). Maximum participants, i.e., 15 (46.8%), reported that filling VA forms in a narrative way was the most useful part of the workshop. All the participants, i.e., 32 (100%), strongly agreed that the workshop was appropriately organized, content of the training was relevant, they were encouraged to actively participate, and adequate material was provided. Conclusion: Further intensive workshop with more field training and refresher training at regular intervals is expected in future.
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First few cases of COVID-19 admitted in a teaching hospital of North Kerala – Insights gained on the clinico-epidemiological presentations, management and patient perceptions on transmission dynamics p. 41
Asma Ayesha Rahim, Sujina V Muthukutty, Shinas P Babu, Praseeda Chandran, M P Shahul Hameed, SP Anitha
Introduction: The first case of COVID-19 in India was confirmed in Kerala on January 2020, with the state effectively crushing the epidemic curve. Objectives: This study aims to describe the clinico-epidemiological profile and transmission dynamics of confirmed COVID-19 cases admitted in our health care facility. Materials and Methods: A case series study of 19 laboratory-confirmed cases in the early pandemic phase was done (13th March–April 9th 2020). Information on sociodemographic variables, exposure histories, clinical symptoms, and treatment were collected from case records and in-depth telephonic interviews. Descriptive analysis of selected variables was done. Incubation periods and receipt of infection were estimated from patient histories. Results: About 78.9% were male, in the age group of 22–86 years (Median-42 years). 18/19 (94.7%) of laboratory-confirmed cases were imported, half of them from UAE. Fever and cough were the predominant symptoms, followed by sore throat, breathlessness, headache, muscle pain, and loose stools with majority (85%) reporting mild symptoms. Five patients were asymptomatic. Mean duration from symptom onset to reporting is 4 ± 4.47 days. Two patients developed complications, one requiring hemodialysis and ventilator support. About 42% of patients had at least one comorbidity. Mean duration of symptom clearance and hospital stay was 6.76 days and 19.41 ± 6.801 days, respectively. Virological clearance was noted in 13.06 ± 7.32 days. Conclusions: Epidemiological findings from these cases aided in prompt public health responses across the districts in Kerala.
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Coverage assessment of maternal and child health services provided at Urban Health and Nutrition Day in urban slums of Jamnagar Municipal Corporation area p. 49
Mubashshera Firdous Khan, Ilesh S Kotecha
Introduction: Urban Health and Nutrition Day (UHND) is an initiative to provide preventive, promotive, and curative maternal and child health services monthly on fixed day. It is mainly designed to reach out to those who are living in urban slums and for serving vulnerable. The study was conducted to assess the utilization of services provided to mother and child at Mamta session. Materials and Methods: A cross-sectional study was conducted in urban slums of Jamnagar. In the first stage, 30 Anganwadi centers were chosen by systematic random sampling, and in the second stage, 8 postnatal women with 8 children were included. Results: Out of 240 participants, 80% of women registered their pregnancy at Mamta session and 86% were having Mother and Child Protection Card at the time of visit. Basic health checkups containing blood pressure and weight were measured for around 90%, three-fourth of women were checked for hemoglobin % and urine for albumin, and only 29% were done with abdominal examination. Health education component was found to be much-sidelined portion of UHND session in both mother and child care in this study. From surveyed children, 81.6% were registered at session site; from those registered, 62% attend the session regularly; 80% of children were weighed; only 12% of children's weight was recorded in Mamta card; and 50% of mothers were explained about weight and its interpretation. Fifty-four percent of women had given colostrum to their babies, and the same proportion of mother gave prelacteal feed to their children. Conclusion: There is a need to sensitize health workers about the importance of giving health education to mothers which is found to be the most poorly executed component of the study.
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An online study to assess the disposal of personal protective equipment at home amid COVID-19 pandemic in India p. 55
Archana Thakur, Swapnil Tanaji Sangle, Shrilekha Rao, Rodney Preetham Vaz, Pallika Singh, SK Rasania
Introduction: In the current COVID-19 pandemic, when most of cases are asymptomatic or mild, and being kept on home isolation, personal protective equipment (PPE) used by them is potentially infectious and needs to be treated like biomedical wastes. The objective of the study is to assess the disposal of PPE used by general public in the current COVID-19 pandemic in India. Materials and Methods: This was a 1-week online cross-sectional descriptive study conducted among residents of India, in the age group of >18 years. The sample was convenient. The study tool was online self-designed, semi-structured, pretested, and self-administered questionnaire. Results: A total of 559 study subjects were analyzed. Maximum (77.8%) subjects were of age 18–40 years with almost equal proportion of male and female. Overall satisfactory disposal of PPE was done by 9.7% of subjects. Conclusion: The PPE disposal in the community is not satisfactory despite majority of the study participants claimed to be aware of PPE disposal guidelines.
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Prevalence of tobacco use and associated factors among Injecting Drug Users and Men who have Sex with Men p. 59
Deepak Sharma, Naveen Krishan Goel, Munish Kumar Sharma, Dinesh Kumar Walia, Meenal Madhukar Thakare, Vanita Gupta, Sandeep Mittal, Manish Sharma
Introduction: Tobacco use is a leading cause of ill-health, disability, and death worldwide. The current study aimed at estimating the prevalence of tobacco use and identify factors associated with it among injecting drug users (IDUs) and men who have sex with men (MSM). Materials and Methods: A cross-sectional study was conducted among 100 IDUs and 100 MSM each, recruited with the help of outreach workers and peer educators of Nongovernment Organizations working for them. Tobacco usage behavior was assessed using an interviewer-administered questionnaire. Epi Info software for windows (CDC Atlanta) was used to calculate proportions and evaluate the association between tobacco use and independent variables. Results: The current tobacco use prevalence among IDUs was 91% (smokers 75%, smokeless tobacco users 45%). Similarly, the current tobacco use prevalence among MSM study participants was 48% (smokers 28%, smokeless tobacco users 32%). Around half of the current tobacco users had tried to quit tobacco in the past 12 months. Conclusions: There is a high proportion of tobacco use among both IDUs and MSM. It is therefore of utmost importance to strengthen tobacco cessation efforts in these groups.
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Neti Kriya as a therapeutic intervention for chronic allergic rhinitis p. 63
Pratibha Hemant Rajbhoj, Ranjeet Singh Bhogal, Sharadchandra D Bhalekar
Allergic Rhinitis is a recurrently occurring respiratory disorder, therefore the technique of Neti Kriya might be helpful to cure it. This case report describes the effect of Neti Kriya on a single patient of Acute Rhinitis, with the help of RQLQ, CQQ, and AEC. The patient reported to be asymptomatic post-intervention, with improved domains of RQLQ and CQQ. The raised AEC at the baseline showed normal range post-intervention. This case report showed that the regular practice of Neti Kriya could be effective in treating chronic AR.
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Till we win- India's fight against the COVID-19 pandemic p. 66
Kapil Yadav, KJ Subhashini
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Beti Bachao Beti Padhao Scheme, Haryana: Improvement in sex ratio at birth and other achievements p. 68
Yogender Malik
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