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Kumar K, Goel K, Mehra A. Internet Addiction and Its Association with Demographic Variables, Depression, Anxiety, and Psychological Well-being in College Students . Ann Neurosci 2024; 31:21-27. [PMID: 38584979 PMCID: PMC10996870 DOI: 10.1177/09727531231171979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 04/09/2024] Open
Abstract
Background Internet is an integral part of the daily life of everyone. Internet addiction (IA) is one of the major concerns, specifically among young adults. The association between IA, depression, anxiety, and psychological well-being (PWB) is least studied in young adults. Purpose To evaluate IA and its association with psychological morbidity and PWB in a larger sample size. In addition, to examine the factors that are associated with IA. Methods A total of 1287 young students were evaluated in the present study. Participants were evaluated on the Internet Addiction Test (IAT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Psychological Well-Being Index-22. Results The mean age of the study's participants is 19.5 years. The majority were female (68.9%), from nuclear families (61.8%), and belonged to urban localities (61.5%). On IAT, 15.9% had a presence of IA with a cut-off score of 50. 27.4% and 20.5% had a presence of depression and anxiety with a cut-off score of 10 on the PHQ-9 and GAD-7, respectively. Approximately two-thirds (66.7%) reported poor PWB. IA had a significant positive association with depression and anxiety and a negative association with PWB. Male students, the presence of depression, anxiety, and poor PWB were independent factors associated with IA. Conclusion Internet addiction is highly prevalent among college students and has a significant association with anxiety, depression, and poor PWB. There is a need to develop a structured plan, educational strategy, and program to minimize IA in young adults.
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Affiliation(s)
- Krishan Kumar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Satapathy P, Goel K, Sharma V, Sarkar S, Kang M, Dhingra S, Bora I, Kaur K, Arora N, Aggarwal A, Ratho RK. Outbreak investigation of acute febrile illness from the Himalayan foothills: Solving the puzzle of fever. Front Pharmacol 2023; 14:1159377. [PMID: 37954851 PMCID: PMC10637397 DOI: 10.3389/fphar.2023.1159377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/30/2023] [Indexed: 11/14/2023] Open
Abstract
In September 2022, Panchkula Civil Hospital reported an outbreak of acute febrile illness (AFI) in Pinjore, located in the Himalayan foothills, Haryana, North India. There was an upsurge of fever cases. Blood samples were taken from suspected patients (n = 58) with AFI and subjected to serology of dengue, chikungunya, Japanese encephalitis, leptospira and scrub typhus. The samples were also screened for West Nile & Zika virus RNA using real-time PCR. Viral strains were characterized by sequencing. Of the 58 cases of AFI, Dengue could be identified in 45 (77.58%) followed by JE and Chikungunya in 2 cases each (3.44%), respectively. Among Dengue positive cases, 44 had monoinfection (97.77%) and 1 patient had dengue and JE. None were positive for Zika, West Nile, Scrub typhus, and Leptospira with the testing protocol. Four patients developed dengue with warning signs, such as abdominal pain in one patient and recurrent vomiting in the remaining three. The dengue serotype could be determined in 17 samples and revealed serotype 2. Molecular evolution analysis based on the complete envelope gene revealed that all DENV-2 strains (n = 13) circulated in the outbreak area belonged to the DENV-2 cosmopoliton genotype. In the early stages of infection, relying only on clinical manifestations is ineffective, so both molecular and serological assays along with clinical diagnosis are noteworthy for determining the aetiology of AFI.
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Affiliation(s)
- Prakasini Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine & SPH, PGIMER, Chandigarh, India
| | - Vikrant Sharma
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhabrata Sarkar
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mannat Kang
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shefali Dhingra
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ishani Bora
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanwalpreet Kaur
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Arun Aggarwal
- Department of Community Medicine & SPH, PGIMER, Chandigarh, India
| | - Radha Kanta Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mittal N, Goel P, Goel K, Sharma R, Nath B, Singh S, Thangaraju P, Mittal R, Kahkasha K, Mithra P, Sahu R, Priyadarshini RP, Sharma N, Pala S, Rohilla SK, Kaushal J, Sah S, Rustagi S, Sah R, Barboza JJ. Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India. Antibiotics (Basel) 2023; 12:1496. [PMID: 37887197 DOI: 10.3390/antibiotics12101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Parul Goel
- Department of Biochemistry, Shri Atal Bihari Vajpayee Government Medical College, Chhainsa, Faridabad 121004, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rashmi Sharma
- Department of Community Medicine, GMERS Medical College Sola, Ahmedabad 380060, India
| | - Bhola Nath
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raebareli 229405, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur 342001, India
| | | | - Rakesh Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Kahkasha Kahkasha
- Department of Biochemistry, All India Institute of Medical Sciences, Deoghar 814152, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 575001, India
| | - Rajesh Sahu
- Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Raman P Priyadarshini
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bilaspur 174037, India
| | - Star Pala
- Department of Community Medicine, NEIGRIHMS, Shillong 793018, India
| | - Suneel Kumar Rohilla
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Jyoti Kaushal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Sanjit Sah
- Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha 442001, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun 248007, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu 46000, Nepal
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De A, Charak S, Bhagat N, Rathi S, Verma N, Premkumar M, Taneja S, Sharma A, Goel K, Singh V, Duseja A. Efficacy and safety of pan-genotypic sofosbuvir and velpatasvir in patients with hepatitis C and HIV coinfection on dolutegravir-based antiretroviral therapy. J Viral Hepat 2023; 30:740-745. [PMID: 37260083 DOI: 10.1111/jvh.13844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Abstract
Hepatitis C virus (HCV) infection is more prevalent in people living with HIV-AIDS (PLHA) and portends a poorer prognosis. Pharmacokinetic studies suggest the absence of significant interaction between velpatasvir and dolutegravir which has been recently recommended as part of preferred first-line antiretroviral therapy (ART) regimens by WHO. However, clinical data on the use of velpatasvir-based regimen in PLHA taking dolutegavir is lacking. Hence, we aimed to assess the efficacy and safety of sofosbuvir and velpatasvir (SOF + VEL) in HCV and HIV coinfected patients on dolutegravir-based ART. Forty-five consecutive PLHA with HCV coinfection on dolutegravir-based ART were prospectively enrolled. All patients were treated SOF + VEL for 12 weeks. Complete haemogram, liver and renal function tests were assessed at baseline, 4 weeks and at end of treatment. Sustained virological response (SVR) was assessed at 12 weeks after end of treatment. The majority were males (95.5%) with a mean age of 32.8 ± 12.3 years. Cirrhosis was present in 6 (13.3%) patients. All patients completed 12 weeks of therapy with SOF + VEL, but SVR could not be assessed in two patients. Forty-two (97.7%) of the remaining 43 patients attained SVR-12. SVR-12 rate was 97.7% and 93.3% by per protocol and intention to treat analysis, respectively. No grade III/IV adverse events were reported, and there was no worsening of blood counts, liver or renal function test parameters. The pan-genotypic regimen of SOF + VEL is safe and effective in PLHA with HCV coinfection who are on dolutegravir-based ART.
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Affiliation(s)
- Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Charak
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Bhagat
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Goel K, Sen A, Satapathy P, Asumah MN, John OO, Padhi BK, Sah R. Rabies on rise in Africa amid COVID and monkeypox: a global health concern. QJM 2023; 116:594-596. [PMID: 36448691 DOI: 10.1093/qjmed/hcac266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- K Goel
- From the Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Sen
- From the Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M N Asumah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - O O John
- Department of Medical Laboratory Science, Kwara State University, Ilorin, Nigeria
| | - B K Padhi
- From the Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
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Sharma S, Goel K, Kaushal K, Grover GS, Dikid T, Singh GB. An Evaluation of Malaria Surveillance System in Punjab, India, 2020. Indian J Community Med 2023; 48:407-412. [PMID: 37469921 PMCID: PMC10353677 DOI: 10.4103/ijcm.ijcm_305_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/09/2022] [Indexed: 07/21/2023] Open
Abstract
Background India accounted for 6% of global burden of malaria with 95% population residing in malaria endemic areas. However, Punjab is in the malaria elimination phase with annual parasite incidence (API) <1/1000 population. Objectives We evaluated malaria surveillance system in Punjab using CDC's updated guidelines for evaluating public health surveillance systems to provide recommendations for strengthening the existing system and to overcome the challenges in the path of malaria free Punjab. Methods We chose two districts of Punjab, Amritsar (lowest API) and Mansa (highest API), interviewed stakeholders, and performed a retrospective desk review. We evaluated the overall usefulness of the system and assessed seven attributes at state, district, health facility, and village level during July-August 2020. Results In Punjab, there was progressive decline in the malaria cases from 2,955 cases in 2009 to 1,140 in 2019 and no malaria deaths since 2011. Regarding various attributes, overall score for flexibility was good (85.9%); average for simplicity (77%), acceptability (74%), data quality (74%), and timeliness (70%); and poor for representativeness (59%) and stability (57%). Conclusions Malaria surveillance system was useful in analyzing the trends of morbidity and mortality and for generating data to drive policy decisions. To improve stability, representativeness, and acceptability, surveillance staff should not be engaged in supplemental work, and reports from private sector must be ensured. Supportive supervision and regular trainings should be carried out regarding reporting formats, guidelines, and timely epidemiological investigations to improve timeliness, data quality, and simplicity.
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Affiliation(s)
- Sahil Sharma
- National Centre for Disease Control (NCDC), Delhi, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanica Kaushal
- South Asia Field Epidemiology and Technology Network, NCDC, New Delhi, India
| | - Gagandeep S. Grover
- Integrated Disease Surveillance Programme, Directorate Health Services, Department of Health and Family Welfare, Punjab, India
| | - Tanzin Dikid
- Epidemiology Division, National Centre for Disease Control (NCDC), Delhi, India
| | - Gurinder B. Singh
- Directorate Health Services, Department of Health and Family Welfare, Punjab, India
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Goel K, Singh G, Arora Y, Goel P, Aggarwal AK, Sen A, Kumar K, Bhogal RS, Thakur JS, Singh A, Sharma N. Psychological distress and related factors regarding COVID-19 among the ancillary hospital staff: A cross-sectional study. J Family Med Prim Care 2023; 12:694-700. [PMID: 37312788 PMCID: PMC10259555 DOI: 10.4103/jfmpc.jfmpc_1890_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 06/15/2023] Open
Abstract
Background Healthcare workers (HCWs) are at the front line of the Coronavirus disease (COVID-19) outbreak response. They have faced great risks to both physical and mental health. We aimed to assess the psychological effect of COVID-19 among ancillary hospital staff. Methods A cross-sectional study was conducted among 267 on-duty ancillary hospital staff using a semi-structured questionnaire to assess their psychological status and risk perception. In addition, their knowledge, attitude, and practices (KAP) and risk perception were also assessed. The General Health Questionnaire (GHQ-12) was used to screen for psychological distress. Results Among 267 participants, the mean (±SD) age was 33.5 (7.6) years. The majority knew about the symptoms of COVID-19 (88.4%), droplet spread (99.3%), and the importance of isolation (99.3%). About 35.2% were worried about infecting family members, while 26.2% were worried about colleagues at the frontline. Only 38.9% of them had a good knowledge score. Participants with high school and above education level had significantly good knowledge about COVID-19 (OR = 1.99; 95% CI = 1.17- 3.39) than those with primary school or below. Being female (OR 1.99; 95% CI 1.17-3.39) and working with COVID-19 patients (OR 3.88, 95% CI 1.77-8.47, P = 0.001) was associated with psychological distress. Conclusion The ancillary hospital staff had insufficient knowledge regarding the risk factors of COVID-19 but possessed positive attitudes and practices. Continued health education and appropriate psychological interventions may improve understanding and reduce psychological distress.
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Affiliation(s)
- Kapil Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurmeet Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Yogesh Arora
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Parul Goel
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, District Ambala, Haryana, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunima Sen
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Krishan Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ranjitpal Singh Bhogal
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - JS Thakur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
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Gandhi AP, Padhi BK, Goel K, Singh A, Kansal OP, Al-Ahdal T. Impact of virtual continued medical education on carbon footprint and awareness of digital sobriety: A retrospective cross-sectional study among public health professionals in India. Front Public Health 2023; 11:1118685. [PMID: 36992884 PMCID: PMC10040747 DOI: 10.3389/fpubh.2023.1118685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundDue to the COVID-19 pandemic, physical meetings and continuing medical education (CMEs) are being conducted in virtual mode. Digital sobriety has been advocated as a strategy for controlling the environmental emission from online events. The present study was undertaken to assess the impact of virtual CMEs on the environment and the participants' perception, knowledge, attitude, and practices of digital sobriety during the CMEs.MethodsA retrospective cross-sectional Google form-based online study was conducted among the 1,311 registrants of 23 virtual CMEs hosted in India. A pre-tested English questionnaire was used to collect the data. The potential carbon footprint of the significant physical CME activities and the carbon emission (CE) of the virtual CMEs were estimated. Among the registrants contacted, 251 consented and participated in the study.ResultsThe CE of the virtual CMEs was 0.787 metric tons of carbon dioxide equivalent (MT CO2 Eq). If the CMEs were conducted physically, the potential CE was estimated to be 290.094 MT CO2 Eq. The awareness rate of digital sobriety was 35%. Most of the participants (58.7%) from the current study preferred the hybrid mode of CMEs.ConclusionsVirtual, digitally sober CMEs have reduced the potential CE by 99.7% compared to physical CMEs in India. The awareness and knowledge about digital sobriety is low in India. Knowledge, networking, social interactions, and overall satisfaction were relatively lower in the virtual mode of CMEs than in the physical mode.
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Affiliation(s)
- Aravind P. Gandhi
- Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India
- *Correspondence: Bijaya Kumar Padhi
| | - Kapil Goel
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India
- Kapil Goel
| | - Amarjeet Singh
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India
| | | | - Tareq Al-Ahdal
- Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Tareq Al-Ahdal
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Goel K, Sen A, Satapathy P, Kumar P, Aggarwal AK, Sah R, Padhi BK. Emergence of rabies among vaccinated humans in India: a public health concern. Lancet Reg Health Southeast Asia 2023; 9:100109. [PMID: 37383039 PMCID: PMC10305982 DOI: 10.1016/j.lansea.2022.100109] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 06/30/2023]
Affiliation(s)
- Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunima Sen
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pawan Kumar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjit Sah
- Department of Clinical Research and Global Health, Harvard Medical School, Boston, MA 02115, USA
- Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Goel K, Sen A, Satapathy P, Kumar P, Aggarwal AK, Sah R, Padhi BK. Human rabies control in the era of post-COVID-19: a call for action. J Travel Med 2023:taad009. [PMID: 36715149 DOI: 10.1093/jtm/taad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Following the COVID-19 pandemic, there has been a sharp increase in rabies cases and deaths. Rabies outbreaks are being reported worldwide. Multiple disruptions in Rabies control occurred during the pandemic, significantly affecting lower-income countries. Countries need to develop specific action plans to become 'rabies free' by 2030.
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Affiliation(s)
- Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunima Sen
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prakasini Satapathy
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pawan Kumar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjit Sah
- Harvard Medical School, Boston, MA 02115, USA
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gandhi P A, Goel K, Gupta M, Singh A. Effect of digitization of medical case files on doctor patient relationship in an Out Patient Department setting of Northern India: A comparative study. Indian J Community Health 2022. [DOI: 10.47203/ijch.2022.v34i04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Digitization of health records and health delivery processes in health care settings may have an impact on the Patient-Physician communication, wait times, that affect the overall patient satisfaction with the health care services. Aim & Objective: We ascertained the effect of digitization of medical case files on the doctor patient relationship (DPR) domain of patient satisfaction at an urban primary health center in India. Settings and Design: Comparative, cross-sectional study in primary health centres. Methods and Material: The patient satisfaction was compared between the patients attending the Public Health Dispensary (PHD) that uses digitized medical case file system and a Civil Dispensary (CD) which follows the conventional paper based medical records, using a Patient Satisfaction Questionnaire (PSQ). Statistical analysis used: Univariate analysis was done by chi-square test and adjusted analysis was done by multiple linear regression. Results: Patient satisfaction in DPR was found to be same between the digitized medical case files based and conventional OPD (p=0.453). Significantly higher overall patient satisfaction was reported in the conventional paper based OPD than the digitized OPD (p<0.001). Conclusions: Patient satisfaction towards the doctor-patient relationship (DPR) was same between paper based OPD and the digitized medical case files based OPD.
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Sharma D, Kiran T, Goel K, Junaid KP, Rajagopal V, Gupta M, Kaundal H, Sharma S, Bahl A. Comprehensive assessment of age-specific mortality rate and its incremental changes using a composite measure: A sub-national analysis of rural Indian women. Front Med (Lausanne) 2022; 9:1046072. [PMID: 36523773 PMCID: PMC9745315 DOI: 10.3389/fmed.2022.1046072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 09/19/2023] Open
Abstract
Background Diverse socio-economic and cultural issues contribute to adverse health outcomes and increased mortality rates among rural Indian women across different age categories. The present study aims to comprehensively assess age-specific mortality rates (ASMR) and their temporal trends using a composite measure at the sub-national level for rural Indian females to capture cross-state differences. Materials and methods A total of 19 states were included in the study to construct a composite age-specific mortality index for 2011 (base year) and 2018 (reference year) and examine the incremental changes in the index values across these years at the sub-national level in India. Sub-index values were calculated for each component age group and were subsequently used to compute the composite ASMR index using the geometric mean method. Based on the incremental changes, the performance of states was categorized into four different typologies. Results Improvement in mortality index scores in the 0-4 years age group was documented for all states. The mortality rates for the 60+ age group were recorded to be high for all states. Kerala emerged as the overall top performer in terms of mortality index scores, while Bihar and Jharkhand were at the bottom of the mortality index table. The overall mortality composite score has shown minor improvement from base year to reference year at all India level. Conclusion An overall reduction in the mortality rates of rural Indian women has been observed over the years in India. However, in states like Bihar and Jharkhand, mortality is high and has considerable scope for improvement. The success of public health interventions to reduce the under-five mortality rate is evident as the female rural mortality rates have reduced sizably for all states. Nevertheless, there is still sizable scope for reducing mortality rates for other component age groups. Additionally, there is a need to divert attention toward the female geriatric (60+ years) population as the mortality rates are still high.
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Affiliation(s)
- Divya Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvi Kiran
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K. P. Junaid
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineeth Rajagopal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Himika Kaundal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saraswati Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankit Bahl
- Plan India, Community Center 1, New Delhi, India
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Padhi BK, Chakrapani V, Gupta M, Sharma N, Patro BK, Kar SS, Singh R, Pala S, Sankhe L, Modi B, Bali S, Rustagi N, Jain L, Vij J, Satapathy P, Goel K, Rajagopal V, Kiran T, Aggarwal AK. Trends in willingness to receive COVID-19 vaccines among healthcare workers in India: Findings from repeated cross-sectional national surveys. Front Public Health 2022; 10:994206. [PMID: 36262227 PMCID: PMC9574381 DOI: 10.3389/fpubh.2022.994206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/14/2022] [Indexed: 01/26/2023] Open
Abstract
Background COVID-19 vaccination of the healthcare workers (HCWs) is a key priority in the fight against the SARS-CoV-2 pandemic. India launched its COVID-19 vaccination program in January 2021. We aimed to understand the trends in willingness to receive COVID-19 vaccines and its associated factors among HCWs in India. Methods Using a repeated cross-sectional survey design, we collected information from HCWs in three critical time points: before (n = 937, October 2020), during (n = 1346, January 2021); and after (n = 812, May 2021) the introduction of COVID-19 vaccines in India. The third survey coincided with the peak of the second wave of COVID-19 pandemic in India. Findings Of the study participants, 43.7, 60.2, and 73.2% were willing to receive COVID-19 vaccines during the first, second and third rounds of surveys, respectively. In multivariable logistic regression analysis, participants who trusted the health care system were more likely to report willingness to receive a COVID-19 vaccine; medical trust emerged as a significant factor in all the three rounds of surveys (First survey-aOR: 2.24, 95% CI: 1.67-2.99; Second survey-aOR: 3.38, 95% CI: 2.64-4.33; Third survey-aOR: 2.54, 95% CI: 1.65-3.91). Having confidence in domestic vaccines (Second survey-aOR: 2.21, 95% CI: 1.61-3.02; Third survey-aOR: 2.05, 95% CI: 1.24-3.37); and high perceived risk of contracting COVID-19 (Second survey-aOR: 1.48, 95% CI: 1.13-1.93; Third survey-aOR: 2.02, 95% CI: 1.31-3.13) were found to be associated with willingness to receive vaccines. Among socio-demographic characteristics, being married (aOR: 1.71, 95% CI: 1.08-2.71) and having high socio-economic status (aOR: 3.01, 95% CI: 1.65-5.51) emerged as significant factors associated with willingness to receive COVID-19 vaccines in the third round of the surveys. Interpretation Willingness to receive COVID-19 vaccine increased with time, as the severity of the pandemic increased. To increase COVID-19 acceptance and coverage among HCWs, it is important to instill confidence in domestic vaccines and assist in accurate assessment of risk toward contracting COVID-19 infection.
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Affiliation(s)
- Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bilaspur, India
| | - Binod Kumar Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ritesh Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Kalyani, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Lalit Sankhe
- Department of Community Medicine, Grant Medical College, Mumbai, India
| | - Bhavesh Modi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rajkot, India
| | - Surya Bali
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Neeti Rustagi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Lovely Jain
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jatina Vij
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prakasini Satapathy
- Regional Virus Research and Diagnostic Lab, Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvi Kiran
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Goel P, Chakrabarti S, Goel K, Bhutani K, Chopra T, Bali S. Neuronal cell death mechanisms in Alzheimer's disease: An insight. Front Mol Neurosci 2022; 15:937133. [PMID: 36090249 PMCID: PMC9454331 DOI: 10.3389/fnmol.2022.937133] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Regulated cell death (RCD) is an ordered and tightly orchestrated set of changes/signaling events in both gene expression and protein activity and is responsible for normal development as well as maintenance of tissue homeostasis. Aberrant activation of this pathway results in cell death by various mechanisms including apoptosis, necroptosis, pyroptosis, ferroptosis, and autophagy-dependent cell death. Such pathological changes in neurons alone or in combination have been observed in the pathogenesis of various neurodegenerative diseases including Alzheimer's disease (AD). Pathological hallmarks of AD focus primarily on the accumulation of two main protein markers: amyloid β peptides and abnormally phosphorylated tau proteins. These protein aggregates result in the formation of A-β plaques and neuro-fibrillary tangles (NFTs) and induce neuroinflammation and neurodegeneration over years to decades leading to a multitude of cognitive and behavioral deficits. Autopsy findings of AD reveal massive neuronal death manifested in the form of cortical volume shrinkage, reduction in sizes of gyri to up to 50% and an increase in the sizes of sulci. Multiple forms of cell death have been recorded in neurons from different studies conducted so far. However, understanding the mechanism/s of neuronal cell death in AD patients remains a mystery as the trigger that results in aberrant activation of RCD is unknown and because of the limited availability of dying neurons. This review attempts to elucidate the process of Regulated cell death, how it gets unregulated in response to different intra and extracellular stressors, various forms of unregulated cell death, their interplay and their role in pathogenesis of Alzheimer's Disease in both human and experimental models of AD. Further we plan to explore the correlation of both amyloid-beta and Tau with neuronal loss as seen in AD.
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Affiliation(s)
- Parul Goel
- Department of Biochemistry, Shri Atal Bihari Vajpayee Government Medical College Chhainsa, Faridabad, India
| | - Sasanka Chakrabarti
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karanpreet Bhutani
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, India
| | - Tanya Chopra
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, India
| | - Sharadendu Bali
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Ambala, India
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Goel K, Sen A, Goel P, Satapathy P, Jain L, Vij J, Patro BK, Kar SS, Chakrapani V, Singh R, Pala S, Sankhe L, Modi B, Bali S, Rustagi N, Nadda A, Rajagopal V, Kiran T, Aggarwal AK, Gupta M, Padhi BK. Community health workers willingness to participate in COVID-19 vaccine trials and intention to vaccinate: A cross-sectional survey in India. Clinical Epidemiology and Global Health 2022; 17:101113. [PMID: 35935532 PMCID: PMC9338829 DOI: 10.1016/j.cegh.2022.101113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/09/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers’ willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India. Methods A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine. Results Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18–7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51–8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24–4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17–4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12–0.88), p = 0.027]. Conclusions Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.
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Affiliation(s)
- Kapil Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arunima Sen
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Parul Goel
- Department of Biochemistry, Shri Atal Bihari Vajpayee Government Medical College Chhainsa, Faridabad, Haryana, India
| | - Prakasini Satapathy
- Department of Public Health, Utkal University, Bhubaneswar, Odisha, India
- Regional Virus Research & Diagnostic Lab, Department of Virology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160 012, India
| | - Lovely Jain
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jatina Vij
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Binod Kumar Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | | | - Ritesh Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Kalyani, West Bengal, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, (NEIGRIHMS), Mawdiangdiang, Shillong, 793018, Meghalaya, India
| | - Lalit Sankhe
- Grant Medical College & JJ Hospital, Mumbai, Maharashtra, India
| | - Bhavesh Modi
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rajkot, India
| | - Surya Bali
- Department of Community and Family Medicine, All India Institute of Medical Sciences(AIIMS), Bhopal, MP, 462024, India
| | - Neeti Rustagi
- Department of Community Medicine & Family Medicine, AIIMS, Jodhpur, 342005, India
| | - Anuradha Nadda
- Department of Community Medicine, Dr B R Ambedkar Institute of Medical Sciences (AIMS), Mohali, Punjab, India
| | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Tanvi Kiran
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Kiran T, Junaid KP, Sharma D, Jain L, Vij J, Satapathy P, Chakrapani V, Patro BK, Kar SS, Singh R, Pala S, Bali S, Rustagi N, Goel K, Sankhe L, Modi B, Gupta M, Aggarwal AK, Rajagopal V, Padhi BK. Sociodemographic Determinants of Willingness and Extent to Pay for COVID-19 Vaccine in India. Front Public Health 2022; 10:870880. [PMID: 35734756 PMCID: PMC9207713 DOI: 10.3389/fpubh.2022.870880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/12/2022] [Indexed: 01/28/2023] Open
Abstract
Background Responding to the fast transmission rates and increasing fatality rates, countries across the world expedited the development and deployment of the vaccine for coronavirus disease 2019 (COVID-19). Evaluation of individuals' willingness to pay (WTP) would provide pertinent information regarding future demand and financing preferences, which shall help to devise the effective payment strategy for COVID-19 vaccination. Methods A nationwide, cross-sectional, and self-administered online survey using a structured questionnaire was conducted to identify the sociodemographic determinants of willingness and extent to pay for COVID-19 vaccine in India. A non-probability convenience sampling followed by snowball sampling was employed to recruit participants (n = 3,341). The likelihood of sociodemographic determinants to predict willingness and extent to pay was modeled using the multivariate binary logistic regression analysis. Results Out of 3,341 participants, 68% (n = 2,271) were willingness to pay for COVID-19 vaccine. Results showed significantly higher odds for willingness to pay among participants who were single [adjusted odds ratio (aOR) = 1.394, p < 0.01] and having a family size of 4 members (aOR = 1.346, p < 0.01). The adjusted odds ratio sizably increased from 1.396 for participants whose monthly income was between INR 10,000 and 20,000/month to 2.240 for participants whose monthly income was above INR 50,000/month. Further, out of 2,271 of those participants who were willingness to pay for COVID-19 vaccine, majority (n = 1,246, 54.9%) of participants were willingness to pay below 50% of COVID-19 vaccine cost. This study found that those who are single (aOR = 0.688, p < 0.01), having an income between INR 20,000 and 50,000/month (aOR = 0.686, p < 0.05), and those who belonged to socially disadvantaged category (aOR = 0.450, p < 0.01) were estimated to have significantly lower odds of willingness to pay more than 50% of COVID-19 vaccine cost. Conclusion This study observed that majority of those participants who willingness to pay for COVID-19 vaccine were willingness to pay only up to 50% of COVID-19 vaccine and income was observed as a precursor predictor of the willingness and extent to pay for COVID-19 vaccine. The understanding on the willingness and extent to pay for COVID-19 vaccine and its sociodemographic determinants will be helpful for making the strategic decisions related to the financing of COVID vaccine in India.
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Affiliation(s)
- Tanvi Kiran
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K. P. Junaid
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Sharma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lovely Jain
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jatina Vij
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Binod Kumar Patro
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ritesh Singh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Kalyani, India
| | - Star Pala
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Surya Bali
- Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Neeti Rustagi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lalit Sankhe
- Grant Medical College, Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, India
| | - Bhavesh Modi
- Department of Community and Family Medicine, AIIMS-Rajkot, Gujarat, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India,*Correspondence: Vineeth Rajagopal
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Bijaya Kumar Padhi
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Chahal S, Nadda A, Govil N, Gupta N, Nadda D, Goel K, Behra P. Suicide deaths among medical students, residents and physicians in India spanning a decade (2010-2019): An exploratory study using on line news portals and Google database. Int J Soc Psychiatry 2022; 68:718-728. [PMID: 33904322 DOI: 10.1177/00207640211011365] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite having one of the world's largest medical education consortium, India lacks a comprehensive and nationally representative data on suicide deaths among medical students and physicians unlike the one found in most of the developed nations of the world. AIM We aimed to explore the different characteristics of suicide deaths among medical students, residents and physicians in India over a decade (2010-2019). METHODS Content analysis of all suicide death reports among medical students, residents and physicians available from online news portals and other publicly available sites was done. Search was done retrospectively using pertinent search words individually or in combination with language restricted to Hindi and English and timed from January 2010 to December 2019. Reports on completed suicide by allopathic medical students, residents and physicians from India were included. Socio-demographic and suicidological variables were analysed using R software. RESULTS A total of 358 suicide deaths among medical students (125), residents (105) and physicians (128) were reported between 2010 and 2019. Around 7 out of 10 suicides happened before the age of 30 and had mean age 29.9 (±12.2) years. Female residents and physicians were younger than their male counterparts at the time of suicide. Overall maximum suicide deaths were concentrated in South India except the state of Kerala. The specialty of anesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Violent suicide methods were more commonly used by all, with hanging being the most common mean of suicide. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental health problems were the next most common reason in medical students (24%) and physicians (20%) while harassment (20.5%) was in residents. Twenty six percent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons. CONCLUSION Academic stress among medical students and residents, and marital discord in physicians emerged as the key reasons for suicide. However, this preventable domain should be further explored through focused research. This is the first of its kind study from India which attempted to explore this vital yet neglected public health issue using the most feasible and practical method of online news content-based analysis.
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Affiliation(s)
- Savita Chahal
- Department of Psychiatry, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Anuradha Nadda
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikhil Govil
- Department of General Medicine, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Nishu Gupta
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research Satellite Centre, Sangrur, Punjab, Chandigarh, India
| | - Diviyanshu Nadda
- Department of Ophthalmology Command Hospital Chandimandir, Panchkula, Haryana, India
| | - Kapil Goel
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyamadhaba Behra
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Padhi BK, Satapathy P, Rajagopal V, Rustagi N, Vij J, Jain L, Chakrapani V, Patro BK, Kar SS, Singh R, Pala S, Sankhe L, Modi B, Bali S, Kiran T, Goel K, Aggarwal AK, Gupta M. Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India. Front Med (Lausanne) 2022; 9:806702. [PMID: 35665354 PMCID: PMC9159272 DOI: 10.3389/fmed.2022.806702] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India. Methods A cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents. Results Seven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects. Conclusion Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.
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Affiliation(s)
- Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neeti Rustagi
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Jatina Vij
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lovely Jain
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Binod Kumar Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ritesh Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Kalyani, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, India
| | - Lalit Sankhe
- Grant Medical College & JJ Hospital, Mumbai, India
| | - Bhavesh Modi
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rajkot, India
| | - Surya Bali
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Tanvi Kiran
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Goel K, Chaudhuri S. India's strategy on surveillance system- A paradigm shift from an Integrated Disease Surveillance Programme (IDSP) to an Integrated Health Information Platform (IHIP). Clinical Epidemiology and Global Health 2022. [DOI: 10.1016/j.cegh.2022.101030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fischer D, Goel K, Andrews R, van Dun C, Wynn M, Röglinger M. Towards interactive event log forensics: Detecting and quantifying timestamp imperfections. INFORM SYST 2022. [DOI: 10.1016/j.is.2022.102039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goel K, Persis J, Kiran T, Rana K, Mohindra R, Padhi B. Predictors of COVID-19 positivity among patients presenting to screening clinic in a dedicated COVID-19 hospital, in chandigarh, India - A cross-sectional study. J Family Med Prim Care 2022; 11:305-311. [PMID: 35309601 PMCID: PMC8930146 DOI: 10.4103/jfmpc.jfmpc_1544_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The aim of this study was to analyze the clinical features of patients attending the screening clinic of a dedicated COVID-19 hospital (DCH), including COVID-19 RT-PCR test positivity rate, symptom predictors for COVID-19 positivity, the proportion of recovery, and the mortality among COVID-19 positive cases. Methods: We conducted a cross-sectional study of the patients who reported in the screening clinic of a DCH. Data were retrieved from medical records. Step-wise binary logistic regression was applied to determine the symptom predictors for determining the likelihood of the suspects turning out to be COVID-19 positive. Results: A total of 573 patients reported to the screening clinic were enrolled, and their median age was 36 ± 14 years. Of the total patients, 237 (41%) were females and 112 (20%) patients were COVID-19 suspects. Fifty (45%) suspects tested COVID-19 positive. The majority of the positives had complaints of cough, fever, and sore throat. Running nose (OR = 7.951) and history of contact with a COVID-19-positive case (OR = 169.9) were found to be statistically significant symptom predictors for COVID-19 positivity. All patients recovered with nil case fatality. Conclusion: Running nose and history of contact with COVID-positive patients were significant predictors for COVID-19 positivity. In this pandemic state, patients who present with any of the upper respiratory infection (URI) symptoms such as cough, sore throat, running nose, headache, and loss of taste/smell should be tested for COVID-19 for early identification and isolation to break the chain of transmission. The public should be encouraged to undergo COVID-19 testing if they develop any of the URI symptoms.
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Gandhi AP, Thakur JS, Gupta M, Kathirvel S, Goel K, Singh T. COVID-19 vaccination uptake and adverse events following COVID-19 immunization in pregnant women in Northern India: a prospective, comparative, cohort study. J Rural Med 2022; 17:228-235. [DOI: 10.2185/jrm.2022-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Aravind P. Gandhi
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - JS Thakur
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Soundappan Kathirvel
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jain L, Vij J, Satapathy P, Chakrapani V, Patro B, Kar SS, Singh R, Pala S, Sankhe L, Modi B, Bali S, Rustagi N, Rajagopal V, Kiran T, Goel K, Aggarwal AK, Gupta M, Padhi BK. Factors Influencing COVID-19 Vaccination Intentions Among College Students: A Cross-Sectional Study in India. Front Public Health 2021; 9:735902. [PMID: 34976911 PMCID: PMC8714761 DOI: 10.3389/fpubh.2021.735902] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Students act as messengers in delivering effective messages for better uptake of health-promoting behavior. Understanding their knowledge about coronavirus disease 2019 (COVID-19), intentions to use the COVID-19 vaccine, and its associated factors will help develop promising strategies in vaccine promotion concerning the current COVID-19 pandemic. Methods: A cross-sectional online survey was carried out among students in the healthcare and non-healthcare sectors to assess their intentions to get vaccinated against the COVID-19. A non-probability snowball sampling technique was used to recruit study participants (N = 655) through social media platforms and emails. Study participants were recruited across the country, including six major geographical regions (Eastern, Western, Northern, Southern, North-east, and Central) in India between November 2020 and January 2021 before the introduction of the COVID-19 vaccine. Descriptive statistics were used to present the sociodemographic, and vaccine-related behaviors of the study participants. Key determinants that likely predict vaccine acceptance among students were modeled using logistic regression analysis. For each analysis, p < 0.05 was considered significant. Results: A total of 655 students were recruited, 323 from healthcare and 332 from non-healthcare sectors, to assess their intentions to receive the COVID-19 vaccine. Of the 655 students, 63.8% expressed intentions to receive the COVID-19 vaccine. The acceptance was higher among non-healthcare students (54.07 vs. 45.93%). At the time of the study, 27.8% of the students indicated that they had been exposed to a confirmed COVID-19 patient. A vast majority (93.4%) of the students knew about the COVID-19 virus, and most (89.3%) of them were aware of the development of a COVID-19 vaccine. The history of vaccine hesitancy was found to be low (17.1%). Only one-third (33.4%) of the students showed concern about contracting COVID-19. Trust in the healthcare system [adjusted odds ratio (aOR): 4.13; (95% CI: 2.83-6.04), p < 0.00] and trust in domestic vaccines [aOR: 1.46; (95% CI: 1.02-2.08), p < 0.05] emerged as the significant predictors of student's intention to get vaccinated. Higher acceptance for vaccine was observed among students in the non-healthcare [aOR: 1.982; 95% CI: 1.334-2.946, p < 0.00]. Conclusion: This study shows that the Indian college students had relatively high levels of positive intentions to receive COVID-19 vaccines, although about one-third were not sure or unwilling to receive the vaccine, highlighting possible vaccine hesitancy. Informational campaigns and other strategies to address vaccine hesitancy are needed to promote uptake of COVID-19 vaccines.
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Affiliation(s)
- Lovely Jain
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Jatina Vij
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | | | | | - Binod Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ritesh Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Kalyani, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, India
| | - Lalit Sankhe
- Grant Medical College, JJ Hospital, Mumbai, India
| | - Bhavesh Modi
- Community Medicine Health & Family Welfare Department, Government of Gujarat, Gandhinagar, India
| | - Surya Bali
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Neeti Rustagi
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Medical Research Public University, Jodhpur, India
| | - Vineeth Rajagopal
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Tanvi Kiran
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Goel K, Sharma N, Bhogal RS, Singh A. Management of a religious mass gathering in North India: Parkash Utsav 550. J Emerg Manag 2021; 19:379-385. [PMID: 34580853 DOI: 10.5055/jem.0627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The 550th Birth Anniversary (Parkash Utsav) celebrations of Shri Guru Nanak Dev Ji, the first Sikh Guru, was celebrated with great devotion and fervor at Sultanpur Lodhi, Punjab, India, from November 1 to 14, 2019. The authors aimed to shed light on the planning and management of the event and the factors that led to its success. METHODS The researchers conducted key informant interviews with authority figures, resource mapping, and observations. The researchers focused on the event's medical lounge. Open-ended questions were asked to gather information regarding various measures taken to organize and execute the event. The data were entered and analyzed using Microsoft Excel 7.0 and SPSS 20.0 (Trial version). RESULTS About three million people attended the Parkash Utsav 550 celebrations. Three tent cities were set up in Sultanpur Lodhi with the consideration for incoming road traffic. The state government deployed 820 medical personnel, including 150 doctors, 470 paramedics, and 200 volunteers. A total of 19,521 patients were seen in the outpatient department of the Medical Lounge. The government made sufficient arrangements for various services, such as drinking water, langar (or community kitchens), sanitation, and security. Approximately 37 langar halls were constructed in the town to provide healthy food to the devotees. An integrated command and control center was set up for surveillance and monitoring. For the convenience of the devotees, 1,908 toilets, 1,476 urinals, and 132 bathing units were installed. The District Administration of Kapurthala launched an event-specific mobile application, "Par-kash Utsav 550," for the use of pilgrims as well as government officials. No stampedes, outbreaks, and fire incidents were reported. CONCLUSIONS Parkash Utsav 550 was successfully celebrated. Studying the Parkash Utsav 550 presented a unique opportunity to generate an evidence base for the development of solutions and recommendations for the prevention, management, and control of infectious diseases, stampedes, and fire incidents during mass gatherings. In-depth studies of the Parkash Utsav in the future are required to produce evidence for context-specific measures for addressing the complex health challenges of mass gatherings.
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Affiliation(s)
- Kapil Goel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Nikita Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Sharma S, Goel K, Kurup KK, Grover GS, Bhaskar R. COVID-19 in Punjab, India: Epidemiological patterns, laboratory surveillance and contact tracing of COVID-19 cases, March-May 2020. Clin Epidemiol Glob Health 2021; 11:100769. [PMID: 33997478 PMCID: PMC8105128 DOI: 10.1016/j.cegh.2021.100769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background In Punjab, first COVID-19 case was detected on March 5, 2020 followed by multiple clusters. Understanding the epidemiology of reported COVID-19 cases helps decision makers in planning future responses. We described the epidemiological patterns, laboratory surveillance and contact tracing of COVID-19 cases in Punjab. Methods We analysed state's COVID-19 data from March-May 2020 to describe time, place and person distribution. We analysed the laboratory surveillance and contact tracing reports to calculate frequency of testing, sample positivity rate (PR) and contacts traced per case. Findings A total of 2256 cases were reported from March-May 2020 (attack rate 75 cases/million and case fatality rate 2%). Attack rate was higher among males (81 cases/million males) and maximum affected age group was 60-69 years (164∙5 cases/million). Five of 22 districts reported almost half cases in May's first week. Mortality rate was highest among individuals >60 years (six deaths/million) and males (two deaths/million males). Of 45 deaths, 41 reported comorbidities [(hypertension (42%), diabetes (40%)]. COVID-19 testing increased from 46 samples/day (PR: 2%) in March's first week to 4000 samples/day (PR: 2∙5%) by May's end (2752 tests/million). Amritsar conducted 2035 tests/million (highest PR: 6∙5%) while Barnala conducted 4158 tests/million (lowest PR: 1%). For 2256 cases, 19,432 contacts were traced (nine contacts/case) with 11% positivity rate. Interpretation COVID-19 in Punjab mostly affected males, >60 years of age and individuals with comorbid conditions. Many districts with less testing and contact tracing had higher positivity rate. We recommended to implement and ensure adequate testing and contact tracing in all the districts of Punjab.
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Affiliation(s)
- Sahil Sharma
- National Centre for Disease Control (NCDC), Delhi, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Dutta U, Sachan A, Premkumar M, Gupta T, Sahoo S, Grover S, Sharma S, Lakshmi PVM, Talati S, Biswal M, Suri V, Singh MP, Ghai B, Chhabra R, Bharti B, Samanta J, Arora P, Mohindra R, Malhotra S, Singh G, Guru RR, Pandey N, Koushal V, Kumar A, Bhogal RS, Aggarwal AK, Goel K, Malhotra P, Yaddanapudi N, Mahajan P, Thakur JS, Sehgal R, Ghosh A, Sehgal IS, Agarwal R, Jayashree M, Bhalla A, Jain S, Kochhar R, Chakrabarti A, Puri GD, Ram J. Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study. BMJ Open 2021; 11:e043837. [PMID: 33619195 PMCID: PMC7902325 DOI: 10.1136/bmjopen-2020-043837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.
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Affiliation(s)
- Usha Dutta
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Anurag Sachan
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Madhumita Premkumar
- Department of Gastroenterology, PGIMER, Chandigarh, India
- Department of Hepatology, PGIMER, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, PGIMER, Chandigarh, India
| | | | | | - Sugandhi Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Shweta Talati
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Vikas Suri
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Babita Ghai
- Department of Anesthesia, PGIMER, Chandigarh, India
| | | | | | | | - Pankaj Arora
- Department of Hospital Administration, PGIMER, Chandigarh, India
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Gurmeet Singh
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Navin Pandey
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Vipin Koushal
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Ashok Kumar
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Arun K Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Pranay Mahajan
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - J S Thakur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rakesh Sehgal
- Department of Parasitology, PGIMER, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, PGIMER, Chandigarh, India
| | | | | | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | | | | | - Jagat Ram
- Department of Ophthalmology, PGIMER, Chandigarh, India
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Goel K, Sharma S, Baral DD, Agrawal SK. Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal. BMC Oral Health 2021; 21:66. [PMID: 33579264 PMCID: PMC7881591 DOI: 10.1186/s12903-021-01416-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/28/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Tobacco products are considered significant, but preventable factors related to initiation and progression of periodontal diseases. We assessed the prevalence of periodontitis and evaluated its association with tobacco use and other factors amongst the adult population of Sunsari district in eastern Nepal. METHODS A community-based, cross-sectional study was conducted in rural municipalities in the province one of eastern Nepal. A total of 440 adults were interviewed with a set of a pre-tested semi-structured questionnaire. Data on social demographics, adverse oral habits followed by periodontal clinical examination were recorded. Prevalence of periodontitis was assessed by a case definition provided by CDC-AAP. Univariate and multivariate logistic regression analysis was done to measure the association between tobacco use and other factors with periodontitis. RESULTS The overall prevalence of periodontitis was found to be 71.6%. Majority (85.4%) of tobacco users had periodontitis and they were significantly associated with the disease and its severity. The study identified age groups, 45-65 years (AOR = 7.58, 95% CI 3.93-14.61), plaque accumulation (AOR = 1.01, 95% CI 1.00-1.02), smoking (AOR = 3.14, 95% CI 1.36-7.27), khaini users (smokeless tobacco, AOR = 2.27, 95% CI 1.12-4.61) and teeth loss (AOR = 2.02, 95% CI 1.21-3.38) as the significant factors associated with periodontitis. CONCLUSION The prevalence of periodontitis is high in the surveyed rural adult population. Cigarette smoking along with the use of smokeless tobacco in the form of khaini were identified as significant factors associated with periodontitis.
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Affiliation(s)
- K Goel
- Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal.
| | - S Sharma
- Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal
| | - D D Baral
- School of Public Health and Community Medicine, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal
| | - S K Agrawal
- Department of Public Health Dentistry, College of Dental Surgery, B.P Koirala Institute of Health and Sciences, Dharan, 56700, Nepal
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Goel K, Arora A, Rehman T, Angchuk P, Samphel R, Kiran T, Padhi BK, Rajagopal V, Thakur JS. The successful containment of COVID-19 outbreak in Union Territory of Ladakh, India, 2020. J Family Med Prim Care 2021; 9:5574-5579. [PMID: 33532397 PMCID: PMC7842471 DOI: 10.4103/jfmpc.jfmpc_1413_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 11/11/2022] Open
Abstract
Objectives: A three-member central Rapid Response Team (RRT) was deputed to Union Territory of Ladakh on 26th March 2020, to assess the situation and support the preparedness measures including implementation of cluster containment plan and social distancing measures for coronavirus disease 2019 (COVID-19). Methods: Central RRT addressed the panchayat sarpanch and religious leaders, sensitized doctors and paramedical staff on COVID-19 situation; conducted situational analysis, review of records and logistics, key informant interviews of senior administrative and healthcare officials, focus group discussions with local community people and field visits to various hospitals, isolation centers, quarantine facilities, and containment zones. Results: A total of 14 COVID-19 cases with no deaths were reported and nine patients had recovered till 4 April 2020. The median (range) age of positive cases was found to be 32.5 (6 months–76 years) years and overall attack rate was 1.65 per 1000 population. Ladakh Government declared Chuchot Gongma, Yokma and Sankoo as the containment zones and deputed surveillance teams. A total of 2397 persons were quarantined and 496 samples were tested from Ladakh. COVID-19 sample testing, Srinagar-Leh highway opening and Iran pilgrimage returnees were the major challenges identified. Conclusions: The Ladakh government must continue the robust surveillance system and stringent strategies in key areas for management of COVID-19 namely – aggressive screening and testing, isolation, quarantine, hand hygiene, respiratory etiquettes and social distancing.
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Affiliation(s)
- Kapil Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Arora
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tanveer Rehman
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | - Tanvi Kiran
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jarnail S Thakur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Goel P, Malik G, Prasad S, Rani I, Manhas S, Goel K. Analysis of performance of clinical biochemistry laboratory using Sigma metrics and Quality Goal Index. Pract Lab Med 2021; 23:e00195. [PMID: 33392370 PMCID: PMC7773579 DOI: 10.1016/j.plabm.2020.e00195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Unreliable and ingenuine results issued by clinical laboratories have serious consequences for the patients. Sigma metrics is a standardized tool for Quality assessment for test performance in a laboratory. Objective To evaluate the performance of routine biochemistry laboratory at MMIMSR, Mullana in terms of Sigma metrics and Quality Goal Index. Material and methods This cross sectional study evaluated performance of 14 routine chemistry parameters using retrospective Internal Quality Control data of two levels on Siemens Dimension Rxl from Feb to Jul 2019 for CV% and EQAS reports from CMC, Vellore for Bias%. Sigma metrics was calculated using total allowable error targets as per CLIA and Biological Variability database guidelines. Results For level-2 IQC; TG, Chol, ALP showed excellent performance with σ > 6 while σ < 3 was observed for AST, Total Protein, Glucose, BUN and ALT using CLIA guidelines while in IQC Level-3 poor performers were only BUN and ALT with Ca, TG and Chol showing σ > 6. Further by using Biological Variability data guidelines; 10 parameters of IQC Level-2 and 5 of IQC level-3 were poor performers with σ < 3. Conclusion Sigma metrics is an excellent tool for performance analysis of tests performed in a clinical laboratory. Lack of precision in terms of CV% was seen for majority of the poor performers. Total allowable error targets using Biological Variability data revealed σ < 3 for 10 parameters while using CLIA guidelines σ < 3 was seen for only 5 parameters of IQC level-2.
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Affiliation(s)
- Parul Goel
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, India
- Corresponding author.
| | - Gagandeep Malik
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, India
| | - Suvarna Prasad
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, India
| | - Isha Rani
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, India
| | - Sunita Manhas
- Department of Biochemistry, Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, India
| | - Kapil Goel
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, 160012, India
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Dikid T, Chaudhary S, Goel K, Padda P, Sahu R, Kumar T, Jain SK, Singh SK, Narain JP. Responding to COVID-19 pandemic: Why a strong health system is required. Indian J Med Res 2020; 151:140-145. [PMID: 32317411 PMCID: PMC7366545 DOI: 10.4103/ijmr.ijmr_761_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tanzin Dikid
- National Centre for Disease Control, South Delhi Municipal Corporation, New Delhi 110 022, India
| | | | - Kapil Goel
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Preeti Padda
- Department of Community Medicine, Government Medical College, Amritsar 143 001, Punjab, India
| | - Rajesh Sahu
- Department of Community Medicine, Armed Forces Medical College, Pune 411 040, Maharashtra, India
| | - Tripurari Kumar
- Tuglakabad Health Centre, South Delhi Municipal Corporation, New Delhi 110 022, India
| | - S K Jain
- National Centre for Disease Control, South Delhi Municipal Corporation, New Delhi 110 022, India
| | - S K Singh
- National Centre for Disease Control, South Delhi Municipal Corporation, New Delhi 110 022, India
| | - Jai Prakash Narain
- Former Director, Communicable Diseases, World Health Organization Regional Office for South-East Asia, New Delhi 110 002, India
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Amancherla K, Menachem J, Laws J, Goel K, Ellis C, Shah A, O'Leary J. A Single-Center Experience with Balloon Atrial Septostomy as an Unloading Strategy in Patients on ECMO. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kumar Rastogi N, Goel K, Jain T, V Sodha S, Yadav R, Shekhar Aggarwal C, Dhariwal A. Evaluation of National Injury Surveillance Centre, India, 2015-16. Indian J Community Health 2020. [DOI: 10.47203/ijch.2020.v32i01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Globally, injuries accounts for 9% of all deaths, but India account for 11%. Due to limited data on injury characteristics, National Injury Surveillance Centre (NISC) was established in 2014 in New Delhi. Aim & Objectives: To evaluate attributes of NISC and make evidence-based recommendations. Methods and Material: We conducted cross-sectional study and used US Centers for Disease Control and Prevention guidelines to assess simplicity, flexibility, acceptability, stability, timeliness, representativeness, usefulness, and data quality. We reviewed 2015 records and interviewed 20 key-informants. We used Epi-Info7 for analysis. Results: NISC captured 4043 injuries in 2015 from one hospital. Among five data entry operators, four reported lengthy format, but all reported it easy. Among ten relevant key-informants, all reported data-management software easy. System demonstrated flexibility in three variables. All 20 staff reported willingness to participate, and 90% felt quarterly reporting acceptable. Regarding stability, data was collected for 361/365 days. Quarterly reports were available but only submitted annually. Regarding usefulness, all WHO-recommended variables included. Regarding data quality, 17% data-fields were missing. Conclusion: NISC is simple, flexible, stable, acceptable and potentially useful based on data captured. Timeliness based on annual reporting is high, can be improved to quarterly. We recommend training to improve data quality and integration of additional hospitals to improve representativeness.
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Goel K, Mukherji J, Kumar M, Kumar A. Paraneoplastic syndromes: Varied neurological presentations. A prospective case collection. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lindman BR, Goel K, O'leary JM, Barker CM, Rajagopal V, Makkar RR, Bajwa T, Kleiman N, Linke A, Kereiakes DJ, Waksman R, Allocco DJ, Rizik DG, Reardon MJ. P1854Clinical implications of physical function and resilience in patients undergoing transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Gait speed, as a measure of physical function and marker of frailty, is now routinely screened when evaluating patients with aortic stenosis (AS) for transcatheter aortic valve implantation (TAVI). Assessment of physical function is important to identify patients for whom TAVI may be futile and to assign patients to a procedural risk category. After TAVI, patients may exhibit physical resilience (improvement in physical function) or vulnerability (worsening). Characterizing the trajectory and clinical consequences of physical function after TAVI represent knowledge gaps in the field.
Purpose
Evaluate associations between physical resilience (improved gait speed) vs vulnerability (decline) after TAVI and subsequent death/hospitalization.
Methods
The REPRISE III trial compared a mechanically-expanded vs a self-expanding valve in 912 high/extreme risk patients with symptomatic AS. Patients (n=587) who underwent valve implantation and who had a gait speed recorded both pre- and 1-year post-TAVI were analyzed. Gait speed is based on the 5m walk test (slow: 5m in >6s, <0.83m/s; normal: ≥0.83m/s). Trajectory of physical function after TAVI was characterized in 2 ways. Model 1 examined 4 groups based on slow or normal gait speeds at baseline and 1-year post-TAVI. Model 2 examined gait speed change pre-TAVI to 1 year (adjusted for baseline gait speed). Using a landmark approach, the relationships between baseline and 1-year gait speed were evaluated in multivariable Cox PH models of outcomes between 1 and 2 years post-TAVI.
Results
A clinically-meaningful improvement (≥0.1m/s), no change (±0.1m/s), or decline (≥0.1/ms) in gait speed 1 year after TAVI was observed in 39%, 36%, and 26% of patients, respectively. Among the 4 groups defined by pre- and 1-year post-TAVI gait speeds, 1 to 2 year mortality or hospitalization rates were: 6.6% (normal/normal), 20.9% (normal/slow), 8.0% (slow/normal), and 21.5% (slow/slow). Adjusted hazard ratios of the 2 models are shown (Table).
Table. Outcome by Change in Gait Speed Death/Hospitalization P-value Death P-value Hospitalization P-value Adjusted HR [95% CI] Adjusted HR [95% CI] Adjusted HR [95% CI] Model 1: Baseline/1 year Gait Speed (Normal/Normal (n=150) [referent]) Normal/Slow (n=59) 3.82 [1.61, 9.08] <0.01 2.75 [0.96, 7.86] 0.06 7.31 [1.94, 27.58] <0.01 Slow/Normal (n=114) 1.39 [0.53, 3.59] 0.50 1.44 [0.50, 4.12] 0.50 1.69 [0.38, 7.60] 0.49 Slow/Slow (n=253) 3.88 [1.91, 7.91] <0.01 2.36 [1.02, 5.46] 0.045 3.89 [1.14, 13.27] 0.03 Model 2: Gait speed change Baseline to 1 year per 0.1m/s increase 0.83 [0.74, 0.92] <0.01 0.92 [0.80, 1.04] 0.19 0.75 [0.64, 0.88] <0.01
Conclusion
These data reveal there is marked heterogeneity in the trajectory of physical function after TAVI and that this trajectory–more so than baseline physical function–is clinically consequential. Identifying and optimizing factors associated with physical resilience after TAVI may improve outcomes.
Acknowledgement/Funding
Boston Scientific
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Affiliation(s)
- B R Lindman
- Vanderbilt University, Structural Heart and Valve Center, Nashville, United States of America
| | - K Goel
- Vanderbilt University, Structural Heart and Valve Center, Nashville, United States of America
| | - J M O'leary
- Vanderbilt University, Structural Heart and Valve Center, Nashville, United States of America
| | - C M Barker
- The Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center, Houston, United States of America
| | - V Rajagopal
- Piedmont Heart Institute, Atlanta, United States of America
| | - R R Makkar
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - T Bajwa
- Aurora St. Luke's Medical Center, Milwaukee, United States of America
| | - N Kleiman
- The Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center, Houston, United States of America
| | - A Linke
- University Hospital Dresden, Dresden, Germany
| | - D J Kereiakes
- The Christ Hospital Heart and Vascular Center/The Lindner Research Center, Cincinnati, United States of America
| | - R Waksman
- Washington Hospital Center, Washington, United States of America
| | - D J Allocco
- Boston Scientific, Marlborough, United States of America
| | - D G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale, United States of America
| | - M J Reardon
- The Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center, Houston, United States of America
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O'leary J, Clavel MA, Chen S, Goel K, O'neill B, Elmariah S, Crowley A, Alu M, Thourani V, Leon M, Pibarot P, Lindman B. P4666Higher BNP levels after transcatheter aortic valve implantation are associated with increased mortality and hospitalizations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Among patients with aortic stenosis (AS), the adverse association between increased B-type natriuretic peptide (BNP) levels and worse clinical outcomes, including mortality and hospitalization after valve replacement, has been demonstrated. However, little attention has been paid to the clinical consequences of BNP levels after valve replacement, which may have implications for medical therapy prescribed after the procedure.
Purpose
Evaluate the association between BNP levels after transcatheter aortic valve implantation (TAVI) and subsequent mortality and hospitalizations.
Methods
Among intermediate, high, and extreme risk patients with severe symptomatic AS who received TAVI for native valve AS in the PARTNER II and S3 clinical trials or registries, we included 3260 patients who had BNP measured at baseline. Patients from sites which measured NTproBNP were excluded. To account for factors that influence BNP levels, we developed a regression equation–including age, sex, BMI, creatinine, study site, and the upper limit of normal of the BNP assay used for a given measurement–to determine expected BNP. BNP ratio was determined pre-TAVR and at discharge, 30 days, and 1 year and calculated as the actual BNP/expected BNP. Using a landmark approach, the relationships between (1) BNP ratio at 30 days or (2) delta BNP ratio between discharge and 30 days and subsequent outcomes between 30 days and 1 year were assessed. The primary outcome was a composite of cardiovascular (CV) mortality or hospitalization. Adjustment was made for 20 baseline and post-procedural factors known to influence outcomes.
Results
Higher BNP ratio at 30 days was associated with higher CV mortality or hospitalization between 30 days and 1 year (adjusted hazard ratio [aHR] 1.07 per increase of 1 in the BNP ratio, 95% CI 1.04–1.10, p<0.001), whereas baseline BNP ratio was not (p=0.38). A similar relationship was shown for the components of this composite: CV mortality (aHR 1.08, 95% CI 1.04–1.12, p<0.001) and hospitalizations (aHR 1.04, 95% CI 1.01–1.08, p=0.01). Adjusted for discharge BNP ratio and other factors, a greater decrease in BNP ratio between discharge and 30 days was also associated with lower CV mortality or hospitalization between 30 days and 1 year (aHR 0.95 per decrease of 1 in the BNP ratio, 95% CI 0.92–0.99, p=0.006). Similar relationships were observed for all-cause mortality and when examining the relationship between 1 year BNP ratio and outcomes between 1 and 2 years.
Conclusion
Higher BNP ratio after TAVI is associated with higher subsequent all-cause and CV mortality and hospitalizations, whereas baseline BNP ratio was not. Greater decrease in BNP ratio between discharge and 30 days is associated with better outcomes. Further investigation is warranted to understand these findings and determine whether intensification of medical therapy to decrease BNP after TAVR may improve patient outcomes.
Acknowledgement/Funding
The PARTNER 2 Trial was funded by Edwards Lifesciences
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Affiliation(s)
- J O'leary
- Vanderbilt University, Nashville, United States of America
| | - M.-A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - S Chen
- Cardiovascular Research Foundation, New York, United States of America
| | - K Goel
- Vanderbilt University, Nashville, United States of America
| | - B O'neill
- Temple University Hospital, Philadelphia, United States of America
| | - S Elmariah
- Massachusetts General Hospital, Boston, United States of America
| | - A Crowley
- Cardiovascular Research Foundation, New York, United States of America
| | - M Alu
- Columbia University Medical Center, New York, United States of America
| | - V Thourani
- Medstar Research Institute, Washington, United States of America
| | - M Leon
- Columbia University Medical Center, New York, United States of America
| | - P Pibarot
- Quebec Heart and Lung Institute, Quebec, Canada
| | - B Lindman
- Vanderbilt University, Nashville, United States of America
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Chowdhury M, Lindenfeld J, Shah A, Schlendorf K, Fredi J, Balsara K, Goel K, Danter M, Brinkley M, Wigger M, Ooi H, Punnoose L, Brown S, Menachem J, Zalawadiya S. Safety and Efficacy of Percutaneous Ventricular Assist Device Exclusion; a Review of Ten Cases. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dumpa N, Goel K, Guo Y, McFall H, Pillai AR, Shukla A, Repka MA, Murthy SN. Stability of Vaccines. AAPS PharmSciTech 2019; 20:42. [PMID: 30610415 DOI: 10.1208/s12249-018-1254-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/03/2018] [Indexed: 12/17/2022] Open
Abstract
Vaccines are considered the most economical and effective preventive measure against most deadly infectious diseases. Vaccines help protect around three million lives every year, but hundreds of thousands of lives are lost due to the instability of vaccines. This review discusses the various types of instability observed, while manufacturing, storing, and distributing vaccines. It describes the specific stability problems associated with each type of vaccine. This review also discusses the various measures adopted to overcome these instability problems. Vaccines are classified based on their components, and this review discusses how these preventive measures relate to each type of vaccine. This review also includes certain case studies that illustrate various approaches to improve vaccine stability. Last, this review provides insight on prospective methods for developing more stable vaccines.
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Goel K, Naithani S, Bhatt D, Khera A, Sharapov UM, Kriss JL, Goodson JL, Laserson KF, Goel P, Kumar RM, Chauhan LS. The World Health Organization Measles Programmatic Risk Assessment Tool-Pilot Testing in India, 2014. Risk Anal 2017; 37:1063-1071. [PMID: 27088758 DOI: 10.1111/risa.12615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 06/05/2023]
Abstract
Measles is a leading cause of child mortality, and reduction of child mortality is a key Millennium Development Goal. In 2014, the World Health Organization and the U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool to support country measles elimination efforts. The tool was pilot tested in the State of Uttarakhand in August 2014 to assess its utility in India. The tool assessed measles risk for the 13 districts of Uttarakhand as a function of indicator scores in four categories: population immunity, surveillance quality, program delivery performance, and threat. The highest potential overall score was 100. Scores from each category were totaled to assign an overall risk score for each district. From this risk score, districts were categorized as low, medium, high, or very high risk. Of the 13 districts in Uttarakhand in 2014, the tool classified one district (Haridwar) as very high risk and three districts (Almora, Champawat, and Pauri Garhwal) as high risk. The measles risk in these four districts was largely due to low population immunity from high MCV1-MCV2 drop-out rates, low MCV1 and MCV2 coverage, and the lack of a supplementary immunization activity (SIA) within the past three years. This tool can be used to support measles elimination in India by identifying districts that might be at risk for measles outbreaks, and to guide risk mitigation efforts, including strengthening routine immunization services and implementing SIAs.
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Affiliation(s)
- Kapil Goel
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | | | | | - Ajay Khera
- Ministry of Health & Family Welfare, Immunization & Child Health, Delhi, India
| | - Umid M Sharapov
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - Jennifer L Kriss
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - James L Goodson
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - Kayla F Laserson
- India Centers for Disease Control and Prevention, Division of Global Health Protection, Delhi, India
| | - Parul Goel
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | - R Mohan Kumar
- India Epidemic Intelligence Service, India Centers for Disease Control and Prevention, Delhi, India
| | - L S Chauhan
- National Center for Disease Control, Delhi, India
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Shrivastava A, Kumar A, Thomas JD, Laserson KF, Bhushan G, Carter MD, Chhabra M, Mittal V, Khare S, Sejvar JJ, Dwivedi M, Isenberg SL, Johnson R, Pirkle JL, Sharer JD, Hall PL, Yadav R, Velayudhan A, Papanna M, Singh P, Somashekar D, Pradhan A, Goel K, Pandey R, Kumar M, Kumar S, Chakrabarti A, Sivaperumal P, Kumar AR, Schier JG, Chang A, Graham LA, Mathews TP, Johnson D, Valentin L, Caldwell KL, Jarrett JM, Harden LA, Takeoka GR, Tong S, Queen K, Paden C, Whitney A, Haberling DL, Singh R, Singh RS, Earhart KC, Dhariwal AC, Chauhan LS, Venkatesh S, Srikantiah P. Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study. Lancet Glob Health 2017; 5:e458-e466. [PMID: 28153514 DOI: 10.1016/s2214-109x(17)30035-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 11/22/2016] [Accepted: 12/09/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur, the country's largest litchi cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness. METHODS In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses). FINDINGS Between May 26, and July 17, 2014, 390 patients meeting the case definition were admitted to the two referral hospitals in Muzaffarpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9·6 [95% CI 3·6 - 24]) and absence of an evening meal (2·2 [1·2-4·3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7·8 [95% CI 3·3-18·8], without evening meal; OR 3·6 [1·1-11·1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 controls; 72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12·4 μg/g to 152·0 μg/g and MCPG ranged from 44·9 μg/g to 220·0 μg/g. INTERPRETATION Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Aakash Shrivastava
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Anil Kumar
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Jerry D Thomas
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kayla F Laserson
- Global Disease Detection Program, India, US Centers for Disease Control and Prevention, Embassy of the United States, Shanti Path, Chanakyapuri, New Delhi, India; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gyan Bhushan
- Muzaffarpur District Health Department, Government of Bihar, Sadar Hospital, Muzaffarpur, Bihar, India
| | - Melissa D Carter
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mala Chhabra
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Veena Mittal
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Shashi Khare
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - James J Sejvar
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mayank Dwivedi
- Global Disease Detection Program, India, US Centers for Disease Control and Prevention, Embassy of the United States, Shanti Path, Chanakyapuri, New Delhi, India
| | - Samantha L Isenberg
- Battelle at the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rudolph Johnson
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James L Pirkle
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jon D Sharer
- Department of Human Genetics, Emory University, Decatur, GA, USA
| | - Patricia L Hall
- Department of Human Genetics, Emory University, Decatur, GA, USA
| | - Rajesh Yadav
- Global Disease Detection Program, India, US Centers for Disease Control and Prevention, Embassy of the United States, Shanti Path, Chanakyapuri, New Delhi, India; India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Anoop Velayudhan
- Global Disease Detection Program, India, US Centers for Disease Control and Prevention, Embassy of the United States, Shanti Path, Chanakyapuri, New Delhi, India; India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Mohan Papanna
- Global Disease Detection Program, India, US Centers for Disease Control and Prevention, Embassy of the United States, Shanti Path, Chanakyapuri, New Delhi, India; India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Pankaj Singh
- India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - D Somashekar
- India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Arghya Pradhan
- India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Kapil Goel
- India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Rajesh Pandey
- India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Mohan Kumar
- India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Satish Kumar
- India Epidemic Intelligence Service, National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Amit Chakrabarti
- National Institute of Occupational Health, Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India, Meghani Nagar, Ahmedabad, Gujarat, India
| | - P Sivaperumal
- National Institute of Occupational Health, Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India, Meghani Nagar, Ahmedabad, Gujarat, India
| | - A Ramesh Kumar
- National Institute of Occupational Health, Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India, Meghani Nagar, Ahmedabad, Gujarat, India
| | - Joshua G Schier
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arthur Chang
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leigh Ann Graham
- Battelle at the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas P Mathews
- Battelle at the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Darryl Johnson
- Oak Ridge Institute for Science and Education Fellow at the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Liza Valentin
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathleen L Caldwell
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeffery M Jarrett
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leslie A Harden
- Western Regional Research Center, US Department of Agriculture, Albany, CA, USA
| | - Gary R Takeoka
- Western Regional Research Center, US Department of Agriculture, Albany, CA, USA
| | - Suxiang Tong
- National Center for Immunizations and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krista Queen
- National Center for Immunizations and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clinton Paden
- National Center for Immunizations and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne Whitney
- National Center for Immunizations and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana L Haberling
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ram Singh
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Ravi Shankar Singh
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Kenneth C Earhart
- Global Disease Detection Program, India, US Centers for Disease Control and Prevention, Embassy of the United States, Shanti Path, Chanakyapuri, New Delhi, India; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A C Dhariwal
- National Vector Borne Disease Control Programme, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Nirman Bhavan, New Delhi, India
| | - L S Chauhan
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - S Venkatesh
- National Centre for Disease Control, India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, Delhi, India
| | - Padmini Srikantiah
- Global Disease Detection Program, India, US Centers for Disease Control and Prevention, Embassy of the United States, Shanti Path, Chanakyapuri, New Delhi, India; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Shrivastava A, Srikantiah P, Kumar A, Bhushan G, Goel K, Kumar S, Kumar T, Mohankumar R, Pandey R, Pathan P, Tulsian Y, Pappanna M, Pasi A, Pradhan A, Singh P, Somashekar D, Velayudhan A, Yadav R, Chhabra M, Mittal V, Khare S, Sejvar JJ, Dwivedi M, Laserson K, Earhart KC, Sivaperumal P, Kumar AR, Chakrabarti A, Thomas J, Schier J, Singh R, Singh RS, Dhariwal A, Chauhan L. Outbreaks of unexplained neurologic illness - Muzaffarpur, India, 2013-2014. MMWR Morb Mortal Wkly Rep 2015; 64:49-53. [PMID: 25632950 PMCID: PMC4584556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Outbreaks of an unexplained acute neurologic illness affecting young children and associated with high case-fatality rates have been reported in the Muzaffarpur district of Bihar state in India since 1995. The outbreaks generally peak in June and decline weeks later with the onset of monsoon rains. There have been multiple epidemiologic and laboratory investigations of this syndrome, leading to a wide spectrum of proposed causes for the illness, including infectious encephalitis and exposure to pesticides. An association between illness and litchi fruit has been postulated because Muzaffarpur is a litchi fruit-producing region. To better characterize clinical and epidemiologic features of the illness that might suggest its cause and how it can be prevented, the Indian National Centre for Disease Control (NCDC) and CDC investigated outbreaks in 2013 and 2014. Clinical and laboratory findings in 2013 suggested a noninflammatory encephalopathy, possibly caused by a toxin. A common laboratory finding was low blood glucose (<70 mg/dL) on admission, a finding associated with a poorer outcome; 44% of all cases were fatal. An ongoing 2014 investigation has found no evidence of any infectious etiology and supports the possibility that exposure to a toxin might be the cause. The outbreak period coincides with the month-long litchi harvesting season in Muzaffarpur. Although a specific etiology has not yet been determined, the 2014 investigation has identified the illness as a hypoglycemic encephalopathy and confirmed the importance of ongoing laboratory evaluation of environmental toxins to identify a potential causative agent, including markers for methylenecyclopropylglycine (MCPG), a compound found in litchi seeds known to cause hypoglycemia in animal studies. Current public health recommendations are focused on reducing mortality by urging affected families to seek prompt medical care, and ensuring rapid assessment and correction of hypoglycemia in ill children.
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Affiliation(s)
- Aakash Shrivastava
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India,Corresponding authors: Padmini Srikantiah, , +91-11-2419-8876, Aakash Shrivastava, , +91-11-23909242
| | - Padmini Srikantiah
- Global Disease Detection Program, CDC, New Delhi, India,Division of Global Health Protection, Center for Global Health, CDC,Corresponding authors: Padmini Srikantiah, , +91-11-2419-8876, Aakash Shrivastava, , +91-11-23909242
| | - Anil Kumar
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Gyan Bhushan
- Muzaffarpur District Health Department, Government of Bihar, Muzaffarpur, India
| | - Kapil Goel
- India Epidemic Intelligence Service Cohort 1, National Centre for Disease Control, New Delhi, India
| | - Satish Kumar
- India Epidemic Intelligence Service Cohort 1, National Centre for Disease Control, New Delhi, India
| | - Tripurari Kumar
- India Epidemic Intelligence Service Cohort 1, National Centre for Disease Control, New Delhi, India
| | - Raju Mohankumar
- India Epidemic Intelligence Service Cohort 1, National Centre for Disease Control, New Delhi, India
| | - Rajesh Pandey
- India Epidemic Intelligence Service Cohort 1, National Centre for Disease Control, New Delhi, India
| | - Parvez Pathan
- India Epidemic Intelligence Service Cohort 1, National Centre for Disease Control, New Delhi, India
| | - Yogita Tulsian
- India Epidemic Intelligence Service Cohort 1, National Centre for Disease Control, New Delhi, India
| | - Mohan Pappanna
- India Epidemic Intelligence Service Cohort 2, National Centre for Disease Control, New Delhi, India
| | - Achhelal Pasi
- India Epidemic Intelligence Service Cohort 2, National Centre for Disease Control, New Delhi, India
| | - Arghya Pradhan
- India Epidemic Intelligence Service Cohort 2, National Centre for Disease Control, New Delhi, India
| | - Pankaj Singh
- India Epidemic Intelligence Service Cohort 2, National Centre for Disease Control, New Delhi, India
| | - D. Somashekar
- India Epidemic Intelligence Service Cohort 2, National Centre for Disease Control, New Delhi, India
| | - Anoop Velayudhan
- India Epidemic Intelligence Service Cohort 2, National Centre for Disease Control, New Delhi, India
| | - Rajesh Yadav
- India Epidemic Intelligence Service Cohort 2, National Centre for Disease Control, New Delhi, India
| | - Mala Chhabra
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Veena Mittal
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Shashi Khare
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | | | - Kayla Laserson
- Global Disease Detection Program, CDC, New Delhi, India,Division of Global Health Protection, Center for Global Health, CDC
| | - Kenneth C. Earhart
- Global Disease Detection Program, CDC, New Delhi, India,Division of Global Health Protection, Center for Global Health, CDC
| | - P. Sivaperumal
- National Institute of Occupational Health, Indian Council of Medical Research, Ahmedabad, India
| | - A. Ramesh Kumar
- National Institute of Occupational Health, Indian Council of Medical Research, Ahmedabad, India
| | - Amit Chakrabarti
- National Institute of Occupational Health, Indian Council of Medical Research, Ahmedabad, India
| | | | | | - Ram Singh
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ravi Shankar Singh
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - A.C. Dhariwal
- National Vector Borne Disease Control Programme, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - L.S. Chauhan
- National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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Barman KD, Madan A, Garg VK, Goel K, Khurana N. Unusual Presentation of Necrotic Erythema Nodosum Leprosum on Scalp: A Case Report. Indian J Lepr 2015; 87:23-26. [PMID: 26591847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Lepra reactions are acute episodes occurring during the disease process of leprosy and are of 2 types: type 1 or reversal reaction and type 2 reaction or erythema odosumleprosum (ENL). In the episodes of lepra reaction several parts are affected including face and extremities like oral cavity. In the present case report we reported a rare case of lepromatous leprosy with necrotic ENL involving scalp apart from the usual sites. A 58 year old married male presented to us with complaints of spontaneous onset, recurrent eruption of multiple reddish raised painful lesions. Biopsy from the infiltrated skin over the back showed atrophic epidermis, free Grenz zone, diffuse and periadnexal macrophage granulomas with predominant mononuclear infiltrate, appandageal atrophy, fibrosis around the neural structures and leukocytoclastic vasculitis. Fites stain showed strong positivity for M. leprae. His routine blood investigations showed anemia (Hb = 7.8 gm%), neutrophil leukocytosis (TLC = 17,600, DLC = P66L28M4E2) and raised ESR (80 mm in the first hour). These bullous and necrotic lesions in leprosy may be a manifestation of severe type II reactions in patients with very high bacillary load.
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Goel P, Kahkasha, Narang S, Gupta BK, Goel K. Evaluation of serum prolactin level in patients of subclinical and overt hypothyroidism. J Clin Diagn Res 2015; 9:BC15-7. [PMID: 25737975 PMCID: PMC4347066 DOI: 10.7860/jcdr/2015/9982.5443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prolactin secretion is controlled by prolactin inhibitor factor that is secreted from hypothalamus; factors like vasoactive inhibitory peptide (VIP) and thyroid releasing hormone (TRH) lead to increase in prolactin secretion. Hyperprolactinemia is a common condition that can result from a number of causes including hypothyroidism. Objective of the study was to determine correlation between serum levels of prolactin and thyroid hormones in euthyroid, subclinical and overt hypothyroid cases. MATERIALS AND METHODS Consecutive patients presenting for various thyroid related problems were segregated into two groups subclinical and overt hypothyroidism according to their diagnosis based on history and clinical examination, laboratory reports, inclusion and exclusion criteria. Newly diagnosed 75 patients in each group were finally enrolled. Similar number of age and sex matched controls were selected. All subjects filled a predesigned questionnaire for the evaluation of hypothyroid symptoms. Thyroid profile for T3, T4 (total and free), TSH and prolactin were determined in all the subjects and analyzed. RESULTS Prolactin elevation was found in 16 patients (21.33 %) with overt hypothyroidism, and in six patients (8%) with subclinical hypothyroidism. The control group and subclinical hypothyroid patients exhibited no significant difference in terms of total and free T3, total and free T4. For TSH and prolactin on the other hand, a statistically significant elevation was found in patients with overt hypothyroidism when compared with subclinical hypothyroidism; and in patients with subclinical hypothyroidism when compared to the controls. A significant statistical difference was observed between the two groups of hypothyroid patients for all hypothyroid symptoms except alopecia and hirsuitism. CONCLUSION The incidence of hyperprolactinemia in hypothyroidism was found to be higher when compared with normal controls. Serum prolactin assessment should be performed on all patients with hypothyroidism (overt and subclinical) before performing further tests.
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Affiliation(s)
- Parul Goel
- Assistant Professor, Department of Biochemistry, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Kahkasha
- Assistant Professor, Department of Biochemistry, Hamdard Institute of Medical Science and Research, Hamdard University, New Delhi, India
| | - Shveta Narang
- Senior Resident, Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Bharat K Gupta
- Professor, Department of Biochemistry, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India
| | - Kapil Goel
- EIS Officer, National Center for Disease Control (NCDC), New Delhi, India
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Katyal R, Bansal R, Agrawal V, Goel K, Chaudhary V. Cross-sectional Study to Acknowledge the Independent Association of the Socio-demographic Determinants of Alcohol Use in an Urban Slum of North India. Int J Prev Med 2014; 5:749-57. [PMID: 25013695 PMCID: PMC4085928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 02/14/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To seek pleasure is man's innate nature. In his search for gratification, man has discovered a world of substances that intoxicated him. Those who fell within its trap, their life changed, their families aggrieved and they shrank from company. The addiction remained alone in the end. To many death was a relief. METHODS A community based cross- sectional study was conducted in the Catchment area of UHTC (Urban Health and training Centre) where all males aged ≥15 years residing in the study area were included. Data was collected by home visit using WHO questionnaire ( AUDIT Alcohol use disorder identification test) Modified Kuppuswamy scale was used to assess the socio-economic status of the families. Data was analyzed by appropriate test using SPSS 20.0 version. Logistic regression was applied to the positively associated results. RESULTS According to the AUDIT score, Hazardous, Dependent and harmful drinkers were 7.7%, 9.2% and 2.4% respectively. Age, marital status, education of the head of the family, occupation of the respondent, caste, family history of alcohol use had statistically significant association (P < 0.05, 95% confidence interval). Logistic regression was applied and marital status, family history of alcohol use and caste retained their statistical significance (P < 0.05, 95% confidence interval). CONCLUSIONS It can be concluded that being young, being low educated, being married and having a family history of alcohol use are more at risk to it. This indicates the dire necessity to consider the above factors in order to combat with this evil of alcohol use.
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Affiliation(s)
- Rashmi Katyal
- Department of Community Medicine, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India
| | - Rahul Bansal
- Department of Community Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Vijender Agrawal
- Department of Community Medicine, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India
| | - Kapil Goel
- Department of Community Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Varsha Chaudhary
- Department of Community Medicine, Rohilkhand Medical College, Bareilly, Uttar Pradesh, India
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Tripathi A, Winek NC, Goel K, D'Agati D, Gallegos J, Jayaram G, Nguyen T, Vaidya P, Zandi P, Trivedi JK, Reti IM. Electroconvulsive therapy pre-treatment with low dose propofol: comparison with unmodified treatment. J Psychiatr Res 2014; 53:173-9. [PMID: 24602447 DOI: 10.1016/j.jpsychires.2014.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/08/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whilst electroconvulsive therapy (ECT) is routinely administered under anesthesia in developed nations, in many developing countries, ECT is still administered unmodified. This practice has attracted considerable scrutiny with calls to ban unmodified ECT. However, there are no affordable alternatives for many poor, acutely ill psychiatric patients. We evaluated whether administration of intravenous propofol 0.5 mg/kg for sedation by the ECT psychiatrist just prior to otherwise unmodified treatment improved acceptance of and reduced anxiety surrounding the treatment. METHOD We conducted an open label trial at The King George's Medical University in Lucknow, India. Forty-nine patients received propofol pre-treatment and 50 patients received unmodified treatment as usual. RESULTS Socio-demographic profiles, diagnoses and clinical responses were comparable. Patients who received propofol experienced less anxiety monitored by the State-Trait Anxiety Inventory just prior to ECT (p < 0.001), and had a more favorable attitude towards treatment assessed by an established questionnaire (Freeman and Kendell, 1980). Propofol patients were less likely to experience post-ictal delirium monitored by the CAM-ICU (p = 0.015) and had fewer cognitive side-effects on the MMSE (p = 0.004). There were no adverse events associated with propofol administration. CONCLUSION Whilst unmodified ECT should never be used when modified ECT under anesthesia is available, we have found low dose propofol can be safely administered by the ECT psychiatrist to sedate patients pre-treatment who would otherwise receive completely unmodified treatment. The intervention was associated with reduced anxiety and a more positive attitude towards ECT, without compromising efficacy. A randomized double blind controlled study is necessary to confirm these benefits.
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Affiliation(s)
- Adarsh Tripathi
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Nathan C Winek
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kapil Goel
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Douglas D'Agati
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jesus Gallegos
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetha Jayaram
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thai Nguyen
- Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Punit Vaidya
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Zandi
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jitendra K Trivedi
- Department of Psychiatry, The King George's Medical University, Lucknow, India
| | - Irving M Reti
- Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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46
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Barman KD, Goel K, Agarwal P, Chukh S, Garg VK, Khurana N. Lepromatous leprosy with an uncommon presentation: a case report. Indian J Lepr 2013; 85:27-31. [PMID: 24046912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
28 yr old male presented with asymptomatic nodules and few well to ill defined papules on ears, asymmetrical nerve enlargement and evanescent tender nodules on the extremities without any infiltration of the skin and madarosis. Slit skin smear done from normal skin was BI 6+. Skin biopsy showed features of lepromatous leprosy.
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47
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Abstract
Evidence for the link between periodontal disease and several systemic diseases is growing rapidly. Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life causing morbidity and mortality. Periodontitis, one of these complications, is a chronic infection associated with substantial morbidity in the form of tooth loss and that affects the quality of life directly. The association between diabetes and inflammatory periodontal disease has been studied extensively. The relationship between these two conditions appears bidirectional. The presence of one condition tends to promote the other and the meticulous management of either may assist treatment of the other. It also provides a perfect example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and once the oral infection is established, it exacerbates the systemic disease. This review focuses to explain the interrelationship between the two based on information in the literature and the potential common immunoregulatory connections involved, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes. Keywords: Diabetes mellitus; inflammation; insulin resistance; periodontitis.
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Pradhan S, Goel K. Interrelationship between diabetes and periodontitis: a review. JNMA J Nepal Med Assoc 2011; 51:144-153. [PMID: 22922863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Evidence for the link between periodontal disease and several systemic diseases is growing rapidly. Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life causing morbidity and mortality. Periodontitis, one of these complications, is a chronic infection associated with substantial morbidity in the form of tooth loss and that affects the quality of life directly. The association between diabetes and inflammatory periodontal disease has been studied extensively. The relationship between these two conditions appears bidirectional. The presence of one condition tends to promote the other and the meticulous management of either may assist treatment of the other. It also provides a perfect example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and once the oral infection is established, it exacerbates the systemic disease. This review focuses to explain the interrelationship between the two based on information in the literature and the potential common immunoregulatory connections involved, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes.
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Affiliation(s)
- S Pradhan
- Department of Dental Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
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49
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Abstract
INTRODUCTION Injuries of the hand have an enormous impact on hand function and on quality of life. Occupational injuries are a major cause of morbidity and mortality in India and their incidence has been steadily increasing. Sugarcane crushers produce juice using dangerous procedures. OBJECTIVE The objective of this study was to determine the knowledge, attitudes, and practices among sugarcane crushers in India and thus assist in the formulation of effective preventive strategies. SETTING A block (area) in the Vellore District, South India (population 100 000). SUBJECTS AND METHODS All sugarcane crushers living in this area (n = 32) were included. A single observer, using a questionnaire, conducted personal on-site interviews. RESULTS Carelessness was involved in 63% of injuries. Sixteen per cent felt that machines with improved safety features are required; 40% supported the use of special gloves, although 19% considered them a hindrance. Eighty eight per cent did not consider the long duration of work as a risk factor and 38% were fatalistic (God's will); 50% thought the injuries were due to "bad luck". CONCLUSION Sugarcane crushers do not perceive the need for safer equipment. To overcome fatalistic views, and persuade this group to take other safety measures, safety education will need to take into consideration their socioeconomic and educational status.
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Affiliation(s)
- S S David
- Department of Accident and Emergency Medicine, Christian Medical College and Hospital, Vellore, India.
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Murthi GV, Azmy A, Carachi R, Goel K. Musculoskeletal manifestations of neuroblastoma at diagnosis. Med Pediatr Oncol 2001; 36:671. [PMID: 11344507 DOI: 10.1002/mpo.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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