Healthcare Scenario: Health for All to Sustainable Development Goals

Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. There is a huge cross section of the population that continues to struggle to gain access to affordable good quality healthcare. Although the rich can access healthcare by paying large sums of money, the poor are under major threat of financial duress. In Primary health care level public share is more with affordable cost but with compromised quality while in tertiary level private share is more with quality but at high cost and is focused in urban areas. Government has started spending at tertiary care level (newer AIIMS) to broaden the care spectrum but without much improvement at primary health care level.Accountable health care remains challenge for middle and low income countries. Accountability refers to “the principle that individuals, organizations and the community are responsible for their actions and may be required to explain them to others” (1). Low levels of public health financing, supply side gaps, an acute shortage of human resources and the rising cost of healthcare continue to severely affect access, affordability and quality of health services across the country. These issues make difficult for the public sector to remain accountable. The government has been attempting to address two main challenges: to ensure that all citizens can access healthcare equitably and to ensure that healthcare is made available at an affordable cost and without compromising on quality. So three important pillars for effective HCDS are cost, Access & Quality.

Quantification of RAPD by an automated pupillometer in asymmetric glaucoma and its correlation with manual pupillary assessment

Purpose:

The relative afferent pupillary defect (RAPD) is an important sign of asymmetrical retinal ganglion cell damage. The purpose of this study was to quantify RAPD by a pupillometer (RAPiDo, Neuroptics) and assess its correlation with asymmetric glaucoma and manual pupillary assessment.

Methods:

A total of 173 subjects were enrolled in the study and categorized into glaucoma, n = 130, and control, n = 43. Subjects were all recruited in the Glaucoma Clinic of the Aravind Eye Hospital in Madurai during their follow-up. They were 18 years and older, with best corrected visual acuity of 6/36 or better. Exclusion criteria included all retinal pathologies, optic atrophies, ocular injuries, severe uveitis, cloudy corneas, dense cataracts, or use of mydriatics or miotic drugs. RAPD was assessed in all subjects using an automated pupillometer and the results were compared with the swinging flash light test conducted on the same subjects by an experienced ophthalmologist. We looked at the correlation between RAPD and the intereye difference in cup-to-disc ratio (CDR), mean deviation (MD) of visual field testing, and retinal nerve fiber layer (RNFL) thickness. Sensitivity and specificity were assessed by area under the receiver operator characteristic (AUROC) analysis.

Results:

Glaucoma patients had significant RAPD (0.55 ± 0.05 log units) when compared with the controls (0.25 ± 0.05 log units), P < 0.001. Significant intereye differences in CDR, MD, and RNFL between glaucoma and control (P < 0.001) were seen. There was a good correlation between the magnitude and sign of RAPD and these intereye differences in CDR (r = 0.52, P < 0.001), MD (r = 0.44, P < 0.001) and RNFL thickness (r = 0.59, P < 0.001). When compared with the experienced ophthalmologist, AUROC was 0.94, with 89% sensitivity and 91.7% specificity.

Conclusion:

The good correlation between the magnitude of RAPD, as measured by the automated pupillometer, and intereye differences in MD, CDR, and RNFL thickness in glaucomatous, and the good sensitivity and specificity when compared with the experienced ophthalmologist, suggest that pupillometry may be useful as a screening tool to assess asymmetric glaucoma.

Modified BG Prasad Socio-economic Classification, Update - 2019

Modified BG Prasad socioeconomic scale has been in use for determining the socio-economic status of study subjects in community-based health studies in India since 1961.It is an income-based scale and, therefore, constant update is required to take inflation and depreciation of rupee into account. For industrial workers (IW), the consumer price index (CPI) is used to calculate updated income categories at any given point of time, viz Jan 2019. These details of the calculations involved will help many researchers to calculate specific income categories for their ongoing and prospective research work in current calendar year. On the Department of Labour website (www.labourbureaunew.gov.in), state-specific CPI values are also available and should be used to determine more accurate income categories.

The 'forgotten rubber band' syndrome - A systematic review of a uniquely 'desi' complication with a case illustration

BACKGROUND

Once an exceedingly rare entity, multiple cases of forgotten rubber band syndrome or the so-called 'dhaaga' syndrome have now been reported in the literature.

OBJECTIVES

To conduct a thorough and systematic review of the literature for all articles reporting a chronic type of rubber band syndrome and to present an additional similar case as an illustration.

STUDY DESIGN

Systematic review and case report.

METHODOLOGY

PubMed, EMBASE and Google Scholar databases were searched for relevant articles using different combinations of the keywords till 20^th June 2017. All articles reporting cases of chronic rubber band syndrome with a discharging sinus were included. Pearling of the bibliographies of selected articles was conducted to locate articles missed by the primary database search. Data from these reports were collected on pre-defined forms and the results were analysed.

RESULTS

A total of 15 cases have been reported in the literature so far and all cases are from India. Thirteen of these have been reported in the wrist region. Median duration of presentation is 7.6 months after the application of elastic band. Characteristic clinical signs are a circumferential linear scar with discharging sinus (multiple sinuses noted in around one-fourth of the cases). 'Soft tissue constriction sign' on plain radiograph is pathognomonic for this condition. Rate of missed/misdiagnosis is very high (46.7%) and it has been confused with tubercular osteomyelitis which is endemic in India. All cases responded to surgical debridement of circumferential fibrous tissue and foreign body removal with good functional outcomes.

CONCLUSIONS

A high index of suspicion must be maintained for this 'syndrome' in chronic osteomyelitis cases presenting with a linear, circumferential scar and discharging sinus in India. Soft tissue constriction sign on plain radiographs are pathognomonic.

Specific Absorption Rate (SAR) value of mobile phones: An awareness study among mobile users

Mobile phone is an inevitable part of ones life. Once been luxury has now become necessity. It’s been used by all age group people for different application apart from calling and texting. The advance in mobile technology has brought many new applications using mobile. But while using cell phone for talking or being connected to someone the user gets exposed to harmful Electro Magnetic Radiations. The exposure rate to these radiations vary from handset to handset. When cell phones are used in close proximity to human body, the radiations emitted from cell phones penetrate deep inside the human skin. Penetrated radiations produce induced electric field inside the body, resulting in absorption of power, which can be analyzed using a parameter called specific absorption rate (SAR). But still one question arises in mind that are people really aware of Safety standard especially SAR value. What does SAR value mean? It’s the specific absorption ratio measure of amount of radio frequency intensity or energy absorbed by body while connected on cellular network. It is defined as the power absorbed per mass of tissue and has units of watts per kilogram (W/kg) and in a way defines safety range of mobile handset .This study aims to measure the knowledge and awareness of SAR value of handset and the factors that influence awareness of SAR value. This is the largest sample study about mobile usage and awareness of SAR amongst mobile users .

Why Need for National Expert Group Technical Consultation on Prevention and Treatment of Iron Deficiency Anemia

Iron deficiency anemia is the most common nutrient deficiency in India. It impacts the lives of millions of mothers and children in our country through impaired health, development, quality of life and productivity. The Government of India initiated National Iron-plus Initiative Programme (NIPI) for Control of Iron Deficiency Anaemia in 2013 with an aim to prevent and treat anaemia amongst different age groups, namely i) 6-59 months; ii) 6-10 years; iii) 11-19 years, iv) Pregnant and lactating Mothers, and v) Women in Reproductive age group.

Modified BG Prasads Socio-economic Classification-2018: The need of an update in the present scenario

Modified BG Prasad socioeconomic scale has been in use for determining the socio-economic status of study subjects in community-based health studies in India since 1961.It is an income-based scale and, therefore, constant update is required to take inflation and depreciation of rupee into account. For industrial workers (IW), the consumer price index (CPI) is used to calculate updated income categories at any given point of time, viz Jan 2018.These details of the calculations involved will help many researchers to calculate specific income categories for their ongoing and prospective research work in current calendar year. On the Department of Labour website (www.labourbureaunew.gov.in), state-specific CPI values are also available and should be used to determine more accurate income categories.The current exercise is a step towards increasing the validity of use of classification with relevance to the current price levels and enabling a real time update for a considerable time in the near future.The health behavior of an individual or a community is interdependent on their socio-economic status. The concept of socio-economic status is widely used in medical sociology. The social standing of an individual or a family in the society can be measured by it. Therefore, is an important factor affecting the health condition of an individual or a family. (1)Socio-economic status has been defined as “The position that an individual or family occupies with reference to the prevailing average standards of cultural and material possessions, income and participation in group activity of the community”. The social status may be inherited, but in modern society it is achieved on the basis of occupation, income, type of housing and neighborhood, membership of the certain associations and organizations, material, possessions, etc. (2)In India, several methods or scales have been developed for classifying different populations based on their socio-economic status, viz. Parikh scale 1964, Shirpurkar scale 1967, Jalota scale 1970, Kulsherestha scale 1972, Srivastava scale 1978, Bharadwaj scale 2001. (3-8)Modified BG Prasad’s classification that is used for both urban and rural areas. Modified Kuppuswamy classification is used in urban and peri urban areas which considers the education of the head of family, occupation of head of the family and per capita monthly income.(9,10) Another classification for rural areas is Uday Pareekh classification which takes into account following characteristics namely caste

Are female children more likely to be born to Indian anesthesiologists? – A nationwide survey

Context:

Exposure to medications (prescribed or over-the-counter) or exposure to chemicals (unintentional or occupational) during pregnancy have always been of great scientific concerns.

Aims:

This study aims to ascertain whether the recently documented offspring sex ratio (OSR) skew in medical literature is reproducible among our respondent population and how our respondents' characteristics relate to the OSR skew (if any) in our respondent population.

Settings and Design:

A survey questionnaire uploaded on the SurveyMonkey^® Online Portal.

Subjects and Methods:

The survey was completed by the Indian anesthesiologists about themselves and their spouses during the periconceptional periods of their offspring.

Statistical Analysis Used:

Analysis of variance for means and Chi-square test for proportions with P < 0.05 as statistically significant.

Results:

Respondents (irrespective of gender) who sired first-born or second-born male children were anyway more likely to sire male children as reflected in the personal sex ratios among all offspring sired by them, and similarly respondents (irrespective of gender) who sired first-born or second-born female children were anyway more likely to sire female children. Male parents were significantly more common to have worked in operating rooms around the time of conception of first-born or second-born children. As compared to female anesthesiologists, male anesthesiologists significantly reported that they were practicing inhalational induction of anesthesia more often around the conception of their second-born female children as compared to around the conception of their second-born male children.

Conclusions:

Practice of inhalational induction of anesthesia was reportedly more common among Indian male anesthesiologists during periconceptional period of their second-born female children.

Burden of dermatological manifestations across various age groups of a Hilly State in North India

Background: The dermatological condition accounts for an important public health problem of the global load of disease in low and middle-income countries and places significant pressure on primary healthcare centers. There is heterogeneity in the frequency of diverse skin conditions between different areas (1). Most of the knowledge presently available about various aspects of skin diseases is based on observations made and data collected from secondary and tertiary level hospitals (2). Information on community-based prevalence and pattern of skin diseases would be a better measure of burden due to skin diseases in general population in order to assist in the planning of possible intervention strategies (3). Aims & Objectives: To find out the prevalence, distribution, and determinants of various dermatological manifestations at the community level in Doiwala block of district Dehradun. Material & Methods: This cross-sectional study was conducted over a period of 12 months, the study subjects comprised of individuals of all age groups. A sample size of 834 (416 males & 418 females) was calculated by using current prevalence of skin diseases (43.7% in males & 44.7% in females) in Uttarakhand (1). Results: Nearly half of the studied population (45.8%) had some type of dermatological manifestations. It was slightly higher in females (47.1%) than males (44.5%). Out of 382 symptomatic respondents, 247 (64.7) had infective dermatoses followed by 124 (32.5%) non-infective, 6 (1.5%) others and 5 (1.3%) nutritional deficiency dermatoses. The gender-wise distribution of various types of dermatoses was found to be statistically significant (?2-15.225, df-3, p-0.002). Conclusions: The prevalence of dermatological conditions in district Dehradun is fairly high with increased prevalence in the younger age group that might be an indicator to the fact that the burden of skin diseases may go to rise in the future.

Naïve Simplicity: The Overlooked Piece of the Complexity-Simplicity Paradigm

Concepts of simplicity and complexity in modeling have been explored in papers, editorials, and talks. The concept is not well understood because there are at least two flavors of simplicity. Modelers envision simplicity (i.e., elegant simplicity) as the sought-after goal in modeling, but naïve simplicity, which is the focus of this paper, is commonly unrecognized and dangerous. The problem is that naïve or simple ideas are often mistaken for settled science and come with the prospect of being more wrong than right. The concept of the so-called simplicity cycle, in relation to classical problems of carbon-14 age and salinity in closed-basin lakes, is used to illustrate these points. The emerging problems of water-mosquitoes-diseases show the value of mapping new problems to the simplicity cycle. Researchers can "know what they do not know" and avoid the dangers of naïve simplicity.

The 2017 International Joint Working Group White Paper by INDUSEM, the Emergency Medicine Association and the Academic College of Emergency Experts on Establishing Standardized Regulations, Operational Mechanisms, and Accreditation Pathways for Education and Care Provided by the Prehospital Emergency Medical Service Systems in India

The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India.

The case of self-resolving type III achalasia after bilateral lung transplant

BACKGROUND

Post-surgical achalasia has been previously described in large case series but there are limited data on the natural progression of the disease process. In general, achalasia is considered an "incurable" disease as per published guidelines. We present here, the first report of a patient with post-surgical achalasia which resolved spontaneously.

METHODS

This is a retrospective chart review.

KEY RESULTS

A 60-year-old male presented for dysphagia 3 months status post-bilateral lung transplant and was diagnosed with achalasia following positive manometry. Absent any treatment, his repeat manometry showed complete, spontaneous resolution of the achalasia 2 years following lung transplant.

CONCLUSIONS & INFERENCES

To our knowledge, this is the first such case of spontaneously resolving achalasia following bilateral lung transplant. This case warrants further study in to the natural progression of post-surgical achalasia.

Quality of Life (QOL) among the Elderly in Rural Dehradun

Background: The assessment of quality of life (QOL) is a particularly important public health tool for the elderly in an era when life expectancy is increasing. Aims & Objectives: To measure Quality of Life among the elderly and identify its determinants. Material & Methods: This cross-sectional study was conducted on 220 elderly residing in rural areas of Dehradun district after taking written informed consent. Multistage random sampling was done, WHOQOL-OLD questionnaire was used to assess the QOL and data were analyzed by SPSS-22. Results: 55.5% subjects were females and the rest were males. Maximum percentage of respondents were in the age group of 66-75 years (46.4%). The mean (±SD) of transformed total QOL score (TTS) was 57.76 (±10.97). The mean score of facet V (death and dying) was the highest (82.58) and the lowest mean score was observed in facet VI, intimacy (44.83). Overall QOL scores were found to be associated with education and financial dependency. Variation was observed between the determinants of QOL facet scores. Conclusion: Quality of life is a multidimensional concept. Education and financial dependency were found to be the possible determinants of QOL. More extensive studies are recommended to identify other factors affecting QOL.

IAEA Isotope-enabled coupled catchment-lake water balance model, IWBMIso: description and validation

The International Atomic Energy Agency (IAEA) Water Balance Model with Isotopes (IWBMIso) is a spatially distributed monthly water balance model that considers water fluxes and storages and their associated isotopic compositions. It is composed of a lake water balance model that is tightly coupled with a catchment water balance model. Measured isotope compositions of precipitation, rivers, lakes, and groundwater provide data that can be used to make an improved estimate of the magnitude of the fluxes among the model components. The model has been developed using the Object Modelling System (OMS). A variety of open source geographic information systems and web-based tools have been combined to provide user support for (1) basin delineation, characterization, and parameterization; (2) data pre-processing; (3) model calibration and application; and (4) visualization and analysis of model results. In regions where measured data are limited, the model can use freely available global data sets of climate, isotopic composition of precipitation, and soils and vegetation characteristics to create input data files and estimate spatially distributed model parameters. The OMS model engine and support functions, and the spatial and web-based tool set are integrated using the Colorado State University Environmental Risk Assessment and Management System (eRAMS) framework. The IWBMIso can be used to assess the spatial and temporal variability of annual and monthly water balance components for input to water planning and management.

Peripheral vascular disease in systemic lupus erythematosus

With increasing longevity of lupus patients, peripheral vascular disease (PVD) has become an important cause of morbidity. With no systematic study of PVD in systemic lupus erythematosus (SLE), this study was undertaken to define the frequency and spectrum of PVD in SLE and factors affecting such an occurrence. All medium-sized peripheral arteries of bilateral upper and lower extremities were studied in 50 SLE patients using Doppler ultrasonography. PVD was defined clinically as one or more of intermittent claudication, absent/unequal pulses, gangrene or ischemic ulcers and sub-clinically as asymptomatic patients with Doppler abnormalities, with ≥50% reduction in diameter considered hemodynamically significant. Mean (SD) age of the patients was 31.6 (10.1) years. Forty-one percent were hypertensive. Dyslipidemia was found in 62%. Fifteen (30%) had Raynaud's phenomenon. Fourteen (28%) patients had PVD, of whom three had positive markers for antiphospholipid antibody (aPL) and six were asymptomatic. Ischemic ulcers were seen in eight (16%), gangrene in three (6%), femoral artery plaques in two (4%), stenosis in four (8%) and intermittent claudication in none. Dyslipidemia was found to independently affect occurrence of PVD (OR = 5.37, [95% CI 1.05—27.5], P = 0.05). The causes of PVD overlap significantly and further studies are needed to ascertain the relative contribution of each. Lupus (2007) 16, 720—723.

Physical activity correlates of overweight and obesity in school-going children of Dehradun, Uttarakhand

BACKGROUND

Physical activity is important for prevention of overweight and obesity in growing children.

OBJECTIVE

The present study aims to explore the association of overweight and obesity in school children of the district of Dehradun with physical activity, sports, and recreation at home and school.

MATERIALS AND METHODS

A cross-sectional survey of 1266 schoolchildren of select private and government schools in urban and rural areas was done.

RESULTS

Overall 15.6% of children were overweight, of which 5.4% were obese. Overweight and obesity were significantly associated with physical inactivity related to passive transport to school, missed opportunities for play during lunch breaks, lack of participation in household work, and excessive viewing of television.

CONCLUSION

We found a significant association between the lack of physical activity and overweight and obesity. There is a need to enhance physical activity, sports, and recreational opportunities at school as well as home to prevent overweight and obesity in children. Family physicians should include counseling for this important and cheap modifiable risk factor in their family care practice.

Co-infection of Central Nervous System by M. Tuberculosis, Cryptococcus and possibly Naegleria fowleri

Co-infection due to Mycobacterium tuberculosis, Cryptococcus and Naegleria fowleri has not been reported till now in literature, to the best of our knowledge. Here we report a curious case of co-infection of the central nervous system due to these three pathogens in an apparently immune-competent, HIV negative boy. The 15 year old boy was a diagnosed case of tubercular meningitis and was on anti-tubercular and anti-epileptic treatment. However, two months later he presented again in the emergency department with sudden loss of consciousness. His CSF showed presence of capsulated budding yeast cells (suggestive of Cryptococcus) and flagellated parasites (resembling the flagellated stage of Naegleria fowleri). CSF was also positive for Cryptococcal antigens by Latex Agglutination test. The boy was HIV negative and apparently immuno-competent. He was subsequently put on amphotericin B therapy for six weeks. Repeat microscopy, done towards the end of amphotericin B course, showed clearing of CSF. However, the patient's condition improved only slightly, owing to neurological damage caused by the pathogens as suggested by brain CT and MRI scans. Thus infection caused by the members of three different kingdoms in an apparently immunocompetent boy highlights the importance of thinking beyond the ordinary causative pathogens, and actively searching for rarer etiologies to ensure timely intervention; especially in nonresponsive cases.

Overweight and Obesity in School Children of a Hill State in North India: Is the Dichotomy Urban-Rural or Socio-Economic? Results from a Cross-Sectional Survey

INTRODUCTION

Overweight and obesity are a public health problem in India not only in adults but also in children. The authors sought to estimate the prevalence of overweight and obesity in school-going children of 6-17 years of age and examine its demographic and dietary correlates in context of their urban-rural status and socio-economic status.

METHODS

In this cross-sectional survey height and weight were measured in 1266 school children in government and private schools of urban and rural areas. Dietary assessment was done using single day 24-hour dietary recall method. The data were analyzed using SPSS (IBM SPSS Statistics Version 19) and WHO AnthroPlus Software. Factorial ANOVA was used for testing interaction within and between subgroups for continuous variables and Chi-square test was used for categorical variables.

RESULTS

It was found that the overall prevalence of overweight was 15.6% of which 5.4% were obese, with maximum prevalence in boys attending urban private schools. The mean caloric intake in the study population with 24-hour dietary recall method was 1558.2 kilocalories (SD: 428 kilocalories).

CONCLUSION

Overweight and obesity is a significant problem in school-going children. Higher socio-economic status continues to remain an important driver of this epidemic in the younger generation and affects demographic and dietary determinants of this problem.

Application of WHO 'Near-Miss' Tool Indicates Good Quality of Maternal Care in Rural Healthcare Setting in Uttarakhand, Northern India

INTRODUCTION

Women who experienced and survived a severe health condition during pregnancy, childbirth or postpartum are considered as 'near-miss' or severe acute maternal morbidity (SAMM) cases. Women who survive life-threatening conditions arising from complications related to pregnancy and childbirth have many common aspects with those who die of such complications.

AIM

To evaluate health-care facility preparedness and perfor-mance in reducing severe maternal out comes at all levels of health care.

MATERIALS AND METHODS

The present study was carried out over a period of 12 months under the Department of Community Medicine. The cross-sectional study included all the women (937) attending health-care facilities, at all levels of health care i.e. Primary, Secondary & Tertiary level in Doiwala block of Dehradun district. This study was conducted as per the WHO criteria for 'near-miss' by using probability sampling for random selection of health facilities. All eligible study subjects visiting health-care facilities during the study period were included, i.e. who were pregnant, in labour, or who had delivered or aborted up to 42 days ago.

RESULTS

It was found that all women delivering at the THC received oxytocin to prevent postpartum haemorrhage. Treatment of severe post-partum haemorrhage by removal of retained products was significantly associated with levels of health care. Majority (94.73%) women who had eclampsia received magnesium sulfate as primary treatment.

CONCLUSION

Application of WHO 'near-miss' tool indicates good quality of maternal care in rural healthcare setting in Uttarakhand, North India. The women would have otherwise died due to obstetrics complications, had proper care not been provided to them in time.

Indicators of maternal ‘near miss’ morbidity at different levels of health care in North India: A pilot study

Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Lie Threatening Conditions (PLTC) and ‘near miss’ obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for ‘near miss’. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal ‘near-miss’ and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal ‘near miss’ Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO ‘near miss’ approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.254-257

Tobacco Smoking Status as Assessed by Oral Questionnaire Results 30% Under-reporting by Adult Males in Rural India: A Confirmatory Comparison by Exhaled Breath Carbon Monoxide Analysis

Background:

The authenticity and true status of tobacco use, especially in the form of smoking among the patient clientele is always a matter of concern for their physicians.

Objectives:

The purpose of this study was to assess the authenticity of self-reported habit of tobacco smoking among a population sample of male respondents in rural India. Methods: Respondents were asked to complete oral questionnaires that assessed their status of tobacco smoking (if any) as well as duration of tobacco smoking, type of tobacco smoking, and frequency of tobacco smoking. Subsequently, exhaled breath carbon monoxide analysis was performed to detect their amounts of exhaled carbon monoxide.

Results:

In 175 respondents, the Smoke Check color indicators were significantly different (P < 0.0001) in the respondents who were diagnosed smokers per oral questionnaires (n = 92) versus diagnosed nonsmokers per oral questionnaires (n = 83). The probability statistics of authenticity of oral questionnaires for assessing smoking status showed that self-reporting was only 75% sensitive and 76% specific with 80% positive predictive value and 70% negative predictive value.

Conclusion:

True status of tobacco smoking with exhaled breath carbon monoxide analysis can be an easy clinical maneuver with community health screening and health promotion implications among patient populations in rural India.

ZargisCardioscan™ Aided Heart Murmurs Recognition has high negative predictive values when correlated and validated with Echocardiography: A Potential Dawn for Valvular Heart Disease Prevalence Studies in Rural India

Background  The purpose of this open-label study was to correlate the auscultation findings of ZargisCardioscan™ with the echocardiographic findings in our patient population who were referred for echocardiography so as to investigate and ensure the validity of this technology before instituting its applicability in community health events among rural Indian population. Materials and Methods This was a double blinded prospective correlation study in outpatients presenting for echocardiography. Methods: One hundred patients, who had presented for echocardiography at Cardiology Center of an academic university hospital in rural India, were enrolled in this double blinded prospective correlation study. Principal investigator who is a community medicine physician performed the auscultation of patients’ hearts in sitting position. Subsequently, the ZargisCardioscan™ software was used to analyze the heart sounds auscultated by the 3M™ Littmann® Model 3200 stethoscope. Thereafter, the scheduled echocardiography for which the patient had presented to hospital was performed by co-investigator cardiologist who was blinded to the results obtained by the ZargisCardioscan™.Finally, all these data were statistically analyzed by blinded investigator for the presence of correlation between the two modalities. Results The most important finding was the high 90s negative predictive values when the stethoscope-software combination was used for auscultation and analysis of heart murmurs. Additionally, presence of isolated systolic murmurs had higher incidence of appreciable significant valvular lesions and presence of isolated diastolic murmurs primarily had underlying minimal-mild regurgitant valvular lesion, if any. The Bland-Altman Plot confirmed good correlation between stethoscope-echocardiography findings.     Conclusion Stethoscope-software combination, 3M™ Littmann® Model 3200 and ZargisCardioscan™, accurately predicts the absence of valvular heart disease on echocardiography.DOI: http://dx.doi.org/10.3126/nje.v4i3.10665 Nepal Journal of Epidemiology 2014; 4(3): 363-369

Magnetically retained silicone facial prosthesis

Patients with orocutaneous fistulas suffer from discomfort in terms of facial esthetics, food spill over and lack of psychological confidence to present them socially. Prosthetic camouflaging of facial defects and use of silicone maxillofacial material are the alternatives to the surgical retreatment. Silicone elastomers provide more options to clinician for customization of the facial prosthesis which is simple, esthetically good when coupled with bio magnets for retention.

Do women presenting for first and second-trimester abortion differ socio-demographically?

Background:

To identify the socio-demographic differences between a sample of women who present for first-trimester and second-trimester abortion.

Aim:

To determine whether women presenting late (in the second trimester) for abortion differ socio-demographically from those presenting early (in the first trimester).

Materials and Methods:

Data over 4 years for women presenting for second-trimester abortion were collected from the records of Family Planning Clinic at a public tertiary level teaching hospital in India. Eighty-four cases were analysed. The case presenting for first-trimester abortion after each second-trimester abortion was included for comparison. Information was gathered concerning age, parity, educational background, employment status, educational background of the husband, family expenditure and religion. Data were statistically analysed and significance determined using logistic regression analysis.

Results:

Second-trimester abortions represented 2% (84/4254) of all abortions in the study period. More women of higher age (P = 0.03) and parity (P = 0.02) and higher educational status (P = 0.04) presented for second-trimester abortion as compared to first-trimester abortion. The occupational status of the woman, husband's educational background, monthly family expenditure per person and religion did not significantly influence the time of presentation for abortion.

Conclusion:

Second-trimester abortions are associated with both increasing age and parity and higher education. This group of educated, older and multiparous women should be one of those targeted for counseling to reduce the risks associated with second trimester abortion.