The Extent of Delay in Diagnosis, Treatment and their Associated Factors among Tuberculosis Patients Attending Government Hospitals of Rishikesh, Uttarakhand: A Cross-Sectional Study

BACKGROUND

"Tuberculosis (TB) remains a major public health problem" worldwide, affecting almost all age groups. "Early diagnosis and prompt treatment are essential to significantly reducing the TB burden." However, a significant proportion of cases remain undiagnosed and untreated, which plays a vital role in the transmission of the disease and severity of the illness in the community in most developing countries.

AIMS & OBJECTIVES

This study aimed to assess "the extent of delay in diagnosis and treatment of TB patients" and to identify the major factors associated with such delays (whether patient or health system-related) among TB patients in Rishikesh.

METHODS

This descriptive cross-sectional study was conducted in Rishikesh Town, Dehradun District, Uttara khand, India. Total of 130 newly diagnosed TB patients were recruited as study participants who attended the government hospitals of Rishikesh, All India Institute of Medical Sciences, Rishikesh and S P S Government Hospital, Rishikesh. A universal sampling technique was used in this study.

RESULTS

The mean age of the study participant was 36.75 (Standard Deviation (SD), 17.6), and the median age was 34 years. Of the patients, 64.6% were men, and 35.4% were women. The extent of various delays, such as patient delay (median 16 days), diagnostic delay (median 78.5 days), treatment delay (median 4 days), health system delay (43 days), and total delay (median 81 days).

CONCLUSION

The misconception of any chronic disease may lead to a false diagnosis or long treatment for symptomatic relief; the absence of proper diagnostic tests and doctor shopping could be the reasons for the prolonged diagnostic delay. Therefore, by strengthening the collaboration between private and public practitioners in order to meet the expectations of the Government of India to achieve the goals of the "National Strategic Plan for ending TB" in India by providing good quality care for all patients.

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case-control study

Introduction

Exposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.

Methodology

Multicentric case-control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).

Results

A total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29-4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43-3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.

Discussion

The results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Psychometric Properties of the Hindi Version of the World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) Module in Dehradun, India

BACKGROUND

The perception of quality of life (QOL) is a subjective concept; however, attempts have been made to discern the key points and to give a metric view of this concept. The World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) module is an international and cross-cultural tool that quantifies the QOL in older adults.

OBJECTIVES

This study aimed to assess the psychometric properties of the Hindi version of the WHOQOL-OLD module by calculating its reliability and validity among the elderly residing in the Dehradun district of India.

METHODOLOGY

This cross-sectional study was conducted among 440 elderlies from the rural and urban areas of Dehradun by using the Hindi version of the WHOQOL-OLD questionnaire. The mean and standard deviations were calculated for QOL scores. Reliability was checked by calculating Cronbach's alpha (α), and factor analysis was done for the validity of the questionnaire.

RESULTS

Mean (±SD) for total QOL score was 54.3 (±9.3). The death and dying facet had the maximum mean score, whereas the minimum mean score was calculated in the autonomy facet. Cronbach's alpha reliability coefficient for the overall QOL score was calculated as 0.86 which shows good internal consistency of the items in the questionnaire. To measure the construct validity, exploratory factor analysis (EFA) by principal components analysis (PCA) was performed on the 24 items of the WHOQOL-OLD module, and a six-factor model was identified. Satisfactory goodness-of-fit statistics were found on the confirmatory factor analysis (CFA).

CONCLUSION

QOL is a multidimensional concept. The Hindi version of the WHOQOL-OLD module is reliable and valid. QOL in the elderly population can be measured by using the WHOQOL-OLD module in India.

Effect of Electromagnetic Radiation from Mobile Phones on Auditory Brainstem Response

Mobile phones are being used by around 70% of the global population. A simple non-invasive procedure to detect early impairment of the acoustic nerve and auditory pathway is by auditory brainstem response (ABR). It's a response to the sound stimulus generated from the brainstem in the form of electrical impulses. To determine the effect of long-term usage of mobile phones on auditory brainstem responses (ABRs). This Epidemiological, cross-sectional study was undertaken at a tertiary care hospital and includes 865 individuals aged between 18 to 45 years using mobile phone for > 2 years. Users were categorized into various groups according to the minutes of mobile usage per day, years of mobile usage and total duration of mobile phone use in dominant (mobile using) and non-Dominant (non-mobile using) ears. The changes in ABR were studied in each ear to ascertain the effect of EMF exposure due to chronic mobile phone use. Mean age of subjects was 27.01 years. (M: F = 1.57:1.0). Range of mobile phone usage was from 4 to 900 min/day, with mean as 85.94 min/day. No significant differences were seen between dominant and non-dominant ears in regard to amplitudes of wave I, III and V, latencies of wave I and V and Inter peak latency (IPL) of wave I-III, III-V and I-V. No statistically significant difference for I-III, III-V and I-V IPL were found b/w two groups/ears except for usage of mobile phone for > 180 min/day in wave I-V, usage for 0-4 years in wave I-III and I-V and net hours usage for > 1500 h in wave I-V. The mean IPL in all the waves increases with the increase in years of mobile usage and is maximum in all waves in > 12 years mobile users. The long-term exposure to EMF does induce measurable changes in ABRs. Amplitude and IPLs of ABR were found comparable between the dominant and non-dominant ears using mobile phones, except for those using mobile usage for > 180 min/day and with increasing years of usage of mobile phone. Therefore, prudent use of mobile phone should be encouraged for a shorter period of time and for essential purpose only.

Assessment of Organ Dysfunction and Underlying Causes in Maternal Near-miss Cases at Health Care Facilities in Doiwala Block of District Dehradun - A Retrospective Study

INTRODUCTION

The extent of maternal morbidity is a good gauge of a nation's maternal health care system. Maternal near-miss (MNM) cases need to be reviewed because they can indirectly contribute significantly to reducing the maternal mortality ratio in India. MNM cases can provide useful information in this context. Such women who survive these life-threatening conditions arising from complications during pregnancy, childbirth and post partum (42 days) share many commonalities with those who die because of such complications.

AIM

To assess the organ dysfunction and the underlying causes, associated/contributory factors associated with "maternal near-miss" cases in pregnant, in labor, post-partum women (upto42 days) in the health care facilities of Doiwala block, district Dehradun.

MATERIALS AND METHODS

The present study was conducted over a period of 6 months under the Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh. The cross-sectional study included the medical record files of all pregnant women attending the Department of Obstetrics and Gynecology, in the selected healthcare facilities of Doiwala block, district Dehradun. This study was conducted as per the WHO criteria for "near-miss" by using convenience sampling for the selection of healthcare facilities. The medical record files of all women who were pregnant, in labor, or who had delivered or aborted up to 42 days were included from a period of 01.06.2021 - 31.05.2022.

RESULTS

It was found that Out of the women with maternal near-miss (n=91), the majority of women had coagulation /hematological dysfunction (n=45, 49.4%), followed by neurologic dysfunction (n=15, 16.4%), cardio-vascular dysfunction (n=11, 12%). Out of the total women with a maternal near-miss (n = 91), 10 women underwent multiple organ dysfunctions. Of the total 91 maternal near-miss cases, the underlying cause of near-miss was obstetric hemorrhage in almost half the participants (n=45, 49.5%) followed by hypertensive disorders (n=36, 39.5%). Eleven women had a pregnancy with abortive outcomes (12%) and 7 women had pregnancy-related infection. It was also seen that, out of 91 near-miss women, the leading contributory /associated cause was Anemia (n=89, 97.8%) followed by women having a history of previous cesarean section (n=63, 69.2%). Sixteen women had prolonged /obstructed labor (n = 16, 17.58%).

CONCLUSION

Pregnancy should be a positive experience for every woman of childbearing age. A better understanding of pregnancy-related conditions enables early detection of complications and prevents the conversion of mild to moderate maternal morbidity outcomes to severe maternal outcomes with long-term health implications or death. There are already effective measures in place to reduce maternal and newborn mortality and morbidity.

COVID-19 Vaccination status among Health care workers diagnosed with COVID-19 in a tertiary care institute of Uttarakhand: A Cross-sectional Study

Background: Vaccines are considered as the one of the main pillars in halting and ending the presently on-going coronavirus disease (COVID-19 disease) pandemic which has spread globally since it was first detected in Wuhan, China in December 2019. In the absence of specific therapy, infection prevention practices and mass vaccination remains the mainstay in controlling the disease. Objectives: Objective of the study was to assess COVID-19 vaccination status, socio-demographic and clinical profile among healthcare workers diagnosed with COVID-19. Methodology: A cross-sectional survey from 1st March 2021 to 30th June 2021 among healthcare workers who were diagnosed with COVID-19 in a tertiary care institute of Uttarakhand, India was conducted, and universal sampling was used. Institutional Ethics Committee approved this study. Results: Total 662 healthcare workers were diagnosed with COVID-19. 429 (64.8%) of these COVID-19 diagnosed healthcare workers had received either single (129,30%) or both dose (300,70%) of COVID-19 vaccine while remaining 233 (35.2%) belonged to non-vaccinated group. History of exposure to COVID-19 positive patients was higher in vaccinated (66.4%) than in non-vaccinated group (55%) (p = 0.004). Hospitalisation was found to be higher among non-vaccinated (5.6%) than vaccinated group (2.3%) (p = 0.029). Conclusions: This study concludes that being vaccinated against COVID-19 disease provides protection against severe infection and reduces the need for hospitalization.

COVID-19 Infection After Vaccination Among Healthcare Workers at a Tertiary Level Health Care Center in Northern India: A Cross-Sectional Study

Background and aims:

COVID19 vaccines are now accessible to all Indian citizens. Infection with COVID19, on the other hand, continues to spread continuously. Our study aimed to determine the number of persons who had COVID-19 infections despite receiving the recommended number of doses of the COVID 19 vaccination at AIIMS Rishikesh, a tertiary care facility in Uttarakhand, India.

Methods:

We analysed meticulously preserved data regarding COVID-19 vaccination, COVID-19 infection, Clinical symptoms, and RT-PCR testing among all HCWs in our healthcare institution during period from 16 January 2021 to 30th June 2021..

Results:

During this period, 5273 (90.3%) HCWs received two doses of COVID-19 vaccine, while 566 (9.7%) received only one dose. 628 HCWs (10.8%) were BBV152 recipients and 5211(89.2%) AZD1222 (ChAdOx1-S) recipients. 423 HCWs (7.2%,confidence interval of 95% - 13.8, 22.0) reported COVID-19 infections.274(5.19% of total vaccinated HCWs ) breakthrough infections and 149 non-breakthrough COVID-19 infections reported in HCWs who had previously received a single dose of the COVID-19 vaccination. .

Conclusion:

Viral infections sepecially breakthrough infections following adequate vaccination are a cause for concern, but there is a lack of data on these infections in the actual world. Therefore, the primary focus of research should be on the emergence of illness in India following the completion of a full vaccine course.

Does Nutritional Status Affects Oral Health Related Quality of Life Among Elderly? A Cross-Sectional Study at A Tertiary Care Health Centre, Rishikesh, India

Aim: Present study was conducted to evaluate the impact of nutritional status on oral health related quality of life using Geriatric Oral Health Assessment Index (GOHAI) among geriatric population attending outpatient department (OPD) of tertiary health care centre in Rishikesh. Settings and Design: Present cross-sectional study was conducted on geriatric male & female participants attending Outpatients Department (OPD) of tertiary care centre, RISHIKESH. Methods and Material: Nutritional assessment was recorded by using Mini Nutritional Assessment (MNA) tool. Oral health related quality of life was assessed using pre-validated Hindi version of Geriatric Oral Health Assessment Index (GOHAI) questionnaire. Statistical analysis: Kruskal-Wallis and Mann-Whitney U test were applied using SPSS 22.0 Software. Logistic regression analysis was done to find out risk factors. Results: A total of 281 participants completed the questionnaire with mean age of 66.89 ± 6.43 years. About three fourth (73%) of total participants were at risk of malnourishment. A statistically significant difference (P=0.005) was observed when the median GOHAI scores were compared with nutritional status (MNA scores). Conclusions: A statistically significant difference was found between nutritional status and geriatric oral health related quality of life (GOHAI). Nutritional status affects oral health related quality of life among elderly population.

Developing public health capacities of Frontline Public Health Workforce in Uttarakhand

Recent COVID-19 pandemic has highlighted the importance of increase in the ability of public health workforce to detect and respond to the public health threats. For timely implementation of an adequate response and mitigation measure, the standardized and sustainable capacity building programme for frontline public health workforce is the need of hour. National Center for Disease Control (NCDC), Ministry of Health and Family Welfare, in partnership with U.S. Centers for Disease Control and Prevention (CDC), developed a three-month in-service Basic Epidemiology Training programme. This is a tailor-made programme for frontline public health workforce to strengthen epidemiological skills. This training was a practical interactive approach to field epidemiology for three months on the job training for frontline public health workforce that addressed the critical skills needed to conduct surveillance effectively at the local level while focusing on improving disease detection, reporting and feedback. The training also demonstrated the role of learning model in form of interaction between the mentor and the mentees. The importance of handhold support given by the mentors to the mentees in quality outbreak investigations and documentation.

Combating COVID-19 with Proficiency and Precision

It has been two years since the first case of Coronavirus Disease-2019 (COVID-19) was detected in India in the state of Kerala in March 2020. (1) The Government and the citizens of India have united together to combat the virus since then. India is the largest democracy in the world and the second highest populous country with an estimated 1.36 billion population. The country has witnessed three major waves of the COVID-19 pandemic in the past 3 years, the second being the worse. In the month of June 2022, India has reported a cumulative total of approximately 4.34 crore confirmed cases of COVID-19 and 511,903 deaths. The state of Maharashtra has been the worst effected in all three waves. Presently the recovery rate from COVID-19 in India has crossed 98%. (2)

A perspective on Master of Public Health (MPH) Graduates in India: Current role and way head

The public health sector of any country deals on the forefront and utilizes the multidisciplinary approach. In India the Masters of Public Health graduates are trained in unstandardized manner and lack a regulatory body. The gap created in serving the unserved can easily be fulfilled by utilization of this workforce in systematic manner, The emerging competition in the field, undervalued sector in terms of monitory benefits, poor demand and limited training institutions for MPH graduates along with the contribution of MPH during COVID 19 pandemic has been emphasized in the article. The perception of those working in the field has been highlighted with the way ahead of MPH program in India.

Study of Diagnostic Delay among Symptomatic Breast Cancer Patients in Northern India: A Mixed-Methods Analysis from a Dedicated Breast Cancer Centre

OBJECTIVE

We conducted this study to understand the factors that contribute to the delay in diagnosis of symptomatic breast cancer patients.

METHODOLOGY

We did a prospective analytical study with both quantitative and qualitative components over 14 months. The total delay in diagnosis of breast cancer from first symptom onset was defined as diagnostic delay. Presentation delay was defined as the time duration between the first symptom and the first visit to a health care provider. Provider delay was defined as the time duration between the presentation to a health care provider and the final diagnosis. Three hundred female breast cancer patients with a diagnostic delay of at least 3 months were interviewed using a pre-tested semi-structured questionnaire.

RESULTS

We found that more than 50% of patients with delayed presentation were between 30-50 years of age. Painless breast lump was the most common initial symptom. More than 70% of patients presented with locally advanced and metastatic disease. The patient-related delay was more common than provider delay. Breast cancer awareness (p = 0.040) and reasons for delay (p = 0.014) were found to significantly influence the delay. More than 70% of patients reported their symptoms to male members of their families.

CONCLUSION

Breast cancer awareness is the single most important determinant influencing diagnostic delay among symptomatic patients.

Assessment of child health services under Reproductive, Maternal, Neonatal, Child and Adolescent (RMNCH+A) strategy at primary health care level in Doiwala block of Dehradun District, Uttarakhand, India - A cross – sectional study

Background

The reproductive, maternal, newborn, child + adolescent health (RMNCH+A) strategy was launched by the Indian government in the year 2013 to remain in the lead of the global war against child and maternal mortality and morbidity. Under RMNCH+A program in Uttarakhand state, according to the State public health policy, various provisions are needed to be done for maintenance of downtrend in infant mortality rate (IMR). There are various thrust areas under the child health program. The purpose of our study is to monitor the program implementation in terms of Input and Process indicators and to identify if there are any gaps in the child health services provided by RMNCH+A in the PHCs and subcentres of Doiwala block of Dehradun district, Uttarakhand.

Aim

To evaluate Input and the process indicators of child health services under RMNCH+A strategy at Primary health care level in Doiwala block of Dehradun district, Uttarakhand.

Methods

This Cross-sectional study was carried out in Doiwala Block of Dehradun district, Uttarakhand in 3 randomly selected Primary health centres (PHCs) and their 6 subcentres using a validated standard checklist for PHCs and subcentres.

Results

In PHCs, mean obtained score for Input indicators was 56% and for Process indicators was 35%. The mean obtained score in subcentres for Input indicators and Process indicators was 53% and 51%, respectively.

Conclusions

Both the input and the process indicators for child health services in PHCs and subcentres of Dehradun district were inadequate. Most indicators scored less than 50% at both the PHCs and subcentres.

Village health, sanitation, and nutrition committee: Do the village level functionaries aware of their roles?

Background:

National Health Mission intended to achieve decentralization and community participation through creating and supporting Village Health Sanitation and Nutrition Committees (VHSNCs). The services offered through VHSNC include maternal and child health, family planning, sanitation, communicable diseases and health promotion, and nutrition. The study was carried out to assess awareness on the implementation of the functioning of VHSNC implementation among village-level functionaries in the Dehradun district.

Methods:

A community-based cross-sectional study was conducted in the Doiwala and Raipur blocks of Dehradun district from June 2019 to July 2019. Members of VHSNC with at least 3 months of membership were included in the study. A pretested semi-structured questionnaire was used to collect sociodemographic variables and questions about their awareness and responsibilities in implementing VHSNC. Data were collected by personal interviews using Epi-Collect and analyzed by SPSS 23.

Result:

Out of 69 members, 64 (92.4%) had formal education until high school. Only around 50% of members knew about the essential documents related to the VHSNC. Sixty-five members (98.48%) believed that the committee had the primary role in health-related services in the village, 54 (81.82%) members also marked providing safe drinking water as a function, 48 (72.73%) were in favor of access to clean public toilet and sanitation facilities while some others added role in Public Distribution System.

Conclusion:

Around half of the members were partially or completely aware of the functioning of VHSNCs. Providing them with further awareness is required.

Second hand smoke exposure in pregnant women in Dehradun, Uttarakhand: A cross sectional study

Aim:

The aim of this study was to estimate the percentage and sources of secondhand smoke (SHS) exposure among non-smoking pregnant women. It was a cross-sectional study conducted among the non-smoking pregnant women registered at the primary health center (PHC) under the All India Institute of Medical Science (AIIMS), Rishikesh.

Materials and Methods:

All registered pregnant women at sub-center in the field practice area (Raiwala) of the Department of Community and Family Medicine, AIIMS Rishikesh were recruited in the study. In this study, a questionnaire was used for measuring the exposure of SHS. Mean and standard deviation (SD), median, minimum, and maximum were used for continuous variables. A Chi-square test was used to compare the association of categorical variables.

Results:

Out of the total participants, 62% were exposed to SHS. 33% of participants were exposed to SHS at home only, 24% at public places only, and 5% were the ones exposed both at home and public places. More than half (69%) of the participants were having inadequate knowledge about the harms caused by SHS.

Conclusions:

More than half of the participants were exposed to SHS. Inadequate knowledge among the participants about adverse effects of SHS exposure and insufficient practices and action were observed.

Health budget in light of pandemic: Health reforms from mirage to reality

The outbreak of coronavirus disease (COVID-19) has triggered changes and reforms in the health sector in India. As the pandemic points to a gap in the industry, it has led to the creation of new opportunities to solve problems. To help the country repair the damage caused by the virus pandemic, the Government of India announced that in the health budget 2021, promotion of health and well-being will be one of the six pillars. Investment in health infrastructure in the 2021 budget has increased significantly to welcome the much-needed increase in budget allocations of Rs. 2.3 lakh crore. Three areas will also be strengthened, including preventive health care and therapeutic health care. Special emphasis is placed on prevention, treatment, and health care. To promote primary health care, the country will establish 17,000 rural and 11,000 urban health care centers. Provision of affordable quality medical insurance will be provided by the government. The integrated and collaborative model of the public and private sectors in the provision of health services has led to a rapid expansion of work. This is an attempt to demonstrate the planned reforms in the health budget, especially during the COVID-19 pandemic. The budget of 2022-23 is about to be announced soon. It is to be seen how the financial allocation for the health sector impacts the health of the Indian people.

Steroids use in non-oxygen requiring COVID-19 patients: a systematic review and meta-analysis

BACKGROUND

Corticosteroids have become the mainstay treatment in severe COVID-19. However, its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis were conducted to assess effect of steroids in mild COVID-19 patients.

METHODS

PubMed, EMBASE, Web of Science and medRxiv were searched from 31 December 2019 to 14 May 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay (LOHS). Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane's ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method.

RESULTS

A total of 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (involving 2214 non-oxygen requiring COVID-19 patients) were included and analysed. Overall odds of progression to severe disease among the non-oxygen requiring COVID-19 patients receiving steroids was 5.97 [95% confidence interval (CI): 1.27-27.99, I2 = 0%] and odds of death (OR: 1.35, 95% CI: 1.01-1.79; I2 = 0%) as compared to the patients not receiving steroids. Mean duration of fever (7.4 days), duration to viral clearance (18.9 days) and LOHS (20.8 days) were significantly higher in the steroid arm, as compared to that in no-steroid arm (6.7, 16.5 and 15.2 days, respectively).

CONCLUSION

Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial.

PROTOCOL REGISTRATION

The study was prospectively registered in PROSPERO (CRD 42021254951).

COVID-19-associated mucormycosis presenting to the Emergency Department-an observational study of 70 patients

BACKGROUND

Mucormycosis (MM) is a deadly opportunistic fungal infection and a large surge in COVID-19-associated mucormycosis (CAM) is occurring in India.

AIM

Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED).

DESIGN

This was a retrospective, single-centre, observational study.

METHODS

We included patients who presented with clinical features or diagnosed MM and who were previously treated for COVID-19 in last 3 months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected.

RESULTS

Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6 May 2021 and 1 June 2021, were included. A median duration of 20 days (interquartile range: 13.5-25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. Ninety-three percent patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned.

CONCLUSION

COVID-19 infection along with its medical management have increased patient susceptibility to MM.

Effect of mHealth Interventions on Glycemic Control and HbA1c Improvement among Type II Diabetes Patients in Asian Population: A Systematic Review and Meta-Analysis

INTRODUCTION

Due to the high prevalence of diabetes mellitus, it is pertinent to educate and inform diabetes patients about their self-management. It can be done effectively using innovative methods like mobile health (mHealth), which includes mobile applications, phone calls, and text messages. Thus, this meta-analysis was conducted to summarize the effectiveness of mHealth interventions for the management of diabetes compared with usual care in the Asian population.

MATERIALS AND METHODS

Searches were performed in electronic databases, namely PubMed, Scopus, Embase, and Cochrane Library, in August and September 2020. Search terms used were "Diabetes Mellitus," "mHealth," "glycemic control", "HbA1c levels," and "Blood glucose levels." The primary outcome was glycated hemoglobin and blood glucose levels. Trials were pooled, and heterogeneity was quantified using the I² statistic.

RESULTS

The search yielded 3980 abstracts, of which 18 trials met the inclusion criteria. Lowering of Hba1c levels was reported in the majority of trials, which aided in Glycemic control. For post prandial blood glucose (PPBG) levels, a statistically significant reduction of value -20.13 (95%CI -35.16 to -5.10, P = 0.009, I² = 59%) was seen in the mean in the intervention group, whereas for HbA1c levels the mean reduction in the intervention group was -0.44 (95%CI, -0.79 to 0.10, P = 0.01, I² = 87%). Although these interventions proved beneficial for these outcomes, there was a difference in the amount of effects caused by different mHealth interventions.

CONCLUSION

This study acknowledged the effects of different mHealth interventions as per their accessibility and availability in recent years. There is a need to include more studies in future reviews to generate a larger body of evidence for the reported outcomes. The researchers should give the utmost priority to the transparency while reporting the interventions for effective interpretation of the retrieved data.

Deceleration and Trapping of SrF Molecules

We report on the electrostatic trapping of neutral SrF molecules. The molecules are captured from a cryogenic buffer-gas beam source into the moving traps of a 4.5-m-long traveling-wave Stark decelerator. The SrF molecules in X^{2}Σ^{+}(v=0,N=1) state are brought to rest as the velocity of the moving traps is gradually reduced from 190  m/s to zero. The molecules are held for up to 50 ms in multiple electric traps of the decelerator. The trapped packets have a volume (FWHM) of 1  mm^{3} and a velocity spread of 5(1)  m/s, which corresponds to a temperature of 60(20) mK. Our result demonstrates a factor 3 increase in the molecular mass that has been Stark decelerated and trapped. Heavy molecules (mass>100  amu) offer a highly increased sensitivity to probe physics beyond the standard model. This work significantly extends the species of neutral molecules of which slow beams can be created for collision studies, precision measurement, and trapping experiments.

1476Assessment of Compliance to Indian Tobacco Control Legislation in Northern Hilly State of India

Background

Parliament of India enacted an act to prohibit advertisement of, and to provide for the regulation of trade and commerce in, and production, supply and distribution of cigarettes and other tobacco products – COTPA. It has been now more than 15 years of this act is in place and there is need to evaluated compliance of COTPA throughout India, this will help stakeholders and policy makers to understand current implementation status. Aim & Objective: To assess the compliance to COTPA across all districts of a Northern Hilly State of India, Uttarakhand.

Methodology

Study Setting: All 13 districts of a Northern Hilly State of India, Uttarakhand.

Study Design: Sequential mixed methods study design.

Study Period: 06 months (March – August 2019).

Geographical Scope (Venues of visit) and Study Population:

For Section 4: All the potential public places in each district were divided into 5 broad categories: Eateries; Offices/banks; Educational Institutions; Health Care Facilities; Transit Stations

For Section 5, 6 (a), 7, 8 &9: All the points of sale; For Section 6 (b): all educational institutions

Quantitative - School going adolescent's students aged 14 – 16 years (class 8th to 10th) enrolled in educational institutions and tobacco product point of sale and its vendors near the educational institution.

Survey Tools: Total six survey checklist were used in the survey along with a semi structured questionnaire for students in educational institutions regarding their tobacco use status.

A Global Positioning System (GPS) tool to geolocate educational institute and POS within 500 meters of educational institution.

All the study tools from 1-6 were created using Open Data Kit (University of Washington) software or EpiCollect5 software and data collection was done using tablets.

Ethical Consideration: This survey was an unobtrusive observational study. Hence no prior informed consent from the vendors was taken for making the observation. Along-with, the prior permission was taken from the concerned health authorities (in this case State Tobacco Control Society) for conduction of this survey.

Result

The overall compliance to all Sections of COTPA (based upon mean of major compliance indicators) - 75.1. The mean compliance to major indicators of Section 4 of COTPA – 59.4%; Section 5 of COTPA -93.8%; Section6(a) of COTPA -83.2%; Section6(b) of COTPA -66.6%; Section 7,8,9 of COTPA -72.3%. Compliance to health warning present on packs were recognized in most of the packs in rural areas (82.2%) and urban areas (81.4%). Compliance with display of no promotional messages was 15.4% in rural.

Among different type of tobacco products (PoS), Foreign Made Cigarettes were found to be more compliant (87.0%) while Foreign Made Cigars of tobacco was least compliant (45.8%) to major compliance indicators of Section 6 (a) of COTPA.

Conclusions

Overall compliance to COPTA was above 80%.

Keywords

Prevention and Care - Policy and Community Interventions

This survey has been funded by State Tobacco Control Cell, Government of Uttarakhand.

Hacking Covid-19 with Technology

The development, implementation and advancement of technology solutions aimed at combating the COVID-19 outbreak are rapidly taking shape in India. Governments, Venture Capitalists, Academic Institutions, Incubators, Start-ups, and businesses large and small are all doing their part to deploy new innovative solutions as quickly as possible. Various databases were searched to look for different advancements in technology during the current coronavirus pandemic. It is seen that on one end nonpharmacological measure (social distancing, self-isolation, clean hands, and face masks) are time-tested and low-tech ways to help mitigate the viral spread. On the other end, Science and technology sector constituting of data science, machine learning, rapid diagnostic tests, mobile-first telehealth and computational simulation systems for drug development, artificial intelligence, virtual collaboration, and data tracking are complex ways of using the technology that have strengthened our pandemic response.

P–460 Impact of various cancers on semen parameters in a tertiary onco-fertility unit in India

Study question

This study evaluated differences in semen parameters in male cancer patients in our ethnic population who banked their sperms prior to cancer treatment

Summary answer

We found significant differences in semen concentration, motility and morphology between different types of cancers, especially testicular cancers

What is known already

Impaired spermatogenesis and abnormal semen parameters in cancer patients has been noted, however certain cancer types are more damaging than others. In testicular cancer, spermatogenesis impairment is more quantitative than qualitative with sperm morphology being the most affected parameter. Among non testicular cancers, lymphoma cases usually show the most significantly impaired semen parameters

Study design, size, duration

We conducted a retrospective study analyzing semen parameters in 49 cancer patients between October 2014 to January 2020 who presented to the onco-fertility unit, Max Multispeciality Hospitals, New Delhi.

Furthermore, we did our analysis based on total of 101 samples and were broadly divided into testicular (37 samples) and non testicular cancers (64 samples). Patients who had previously received any form of cancer treatment including chemotherapy or radiotherapy were not included in this study

Participants/materials, setting, methods

Testicular Cancer(TC) group was further subcategorized into Seminoma and Non Seminoma groups whereas Non Testicular Cancer (NTC) group was subcategorized into Lymphoma and Non Lymphoma groups. Semen was collected by masturbation and analysis was performed in keeping with the WHO criteria. Statistical analyses was performed using SPSS software. p values <0.05 were considered to indicate statistical significance.

Main results and the role of chance

In Testicular cancer (TC), 92% samples (34/37) had abnormal semen parameters whereas only 24.4% samples (22/64) were abnormal in Non Testicular cancer (NTC). Additionally, there were significant differences in sperm concentration, motility and morphology between TC and NTC groups.

Individually,

TC: Oligozoospermia was seen in 73% (27/37) with subdivision between Seminoma and Non Seminoma groups being 81.3% (13/16) and 61.9% (13/21).

Asthenozoospermia was seen in 86.5% (32/37) samples with subdivision between Seminoma and Non Seminoma groups being 87.5% (14/16) and 81% (17/21).

Teratozoospermia was seen in 59.5% (22/37) samples with subdivision between Seminoma and Non Seminoma groups being 75% (12/16) and 42.86% (9/21).

Combined OATS observed in 59.5% (22/37) samples with subdivision between Seminoma and Non Seminoma groups being 75% (12/16) and 42.86% (9/21)

NTC: Oligozoospermia was seen in 18.8% (12/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 26.92% (7/26) and 26.32% (10/38).

Asthenozoospermia was seen in 32.8% (21/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 34.62% (9/26) and 34.21% (13/38).

Teratozoospermia was seen in 17.2% (11/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 26.9% (7/26) and 23.68% (9/38).

Combined OATS observed in 17.2% (11/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 26.9% (7/26) and 23.68% (9/38).

Limitations, reasons for caution

Study was conducted in a single institution with lesser overall number of patients. Duration, staging and grading of cancers were also not individually assessed, which could be a further limiting factor.

Wider implications of the findings: Testicular cancers, especially seminomas, have the most severe effect upon semen parameters. Among NTC patients, lymphomas have the worst impact. Knowing the varying effect of different cancers on semen parameters in our ethnic population helps ART specialists and oncologists to appropriately modify patient counseling and improve fertility outcomes.

Trial registration number

RMO13019

Revisiting Global Health Security Measures in COVID 19 Pandemic

As the world has become a global village with increasing socio-economic interdependence, health, security and stability issues are imposing interrelated global impacts. Thus, activities supporting epidemic and pandemic preparedness are needed to minimize vulnerability to acute public health events. Coordination mechanisms must be pre-established for diagnostics, therapeutics and research as emergencies often lead to competition and shortage of resources. This paper attempts to discuss the available global health security measures at the time of COVID 19 pandemic.

Rapid Workforce Development to Combat the COVID-19 Pandemic: Experience From a Tertiary Health Care Centre in North India

Introduction During a large-scale disease outbreak, one needs to respond to the situation quickly towards capacity building, by identifying areas that require training and planning a workable strategy and implementing it. There are limited studies focused on fast-track workforce creation under challenging circumstances that demand mandatory social distancing and discouragement of gatherings. This study was conducted to analyze the planning process and implementation of fast-track training during the Coronavirus disease (COVID-19) pandemic, and evaluate its effectiveness in building a rapid, skilled, and massive workforce. Methods A cross-sectional study was conducted to evaluate rapid preparedness training delivered from March to June 2020, based on documents and data regarding the process, planning, and implementation for large-scale capacity building. Pre-test and post-test scores were compared to assess the effectiveness of training. The number of personnel trained was evaluated to determine the efficiency of the training program. Data on COVID-19 among health care workers (HCWs) were analyzed. Results The Advanced Center of Continuous Professional Development acted as the central facility, quickly responding to the situation. A total of 327 training sessions were conducted, including 76 online sessions with 153 instructors. The capacity-building of 2,706 individuals (913 clinicians and 1,793 nurses, paramedics, and non-medical staff) was achieved through multiple parallel sessions on general precautionary measures and specialized skills within four months. The rate of hospital staff infected with COVID-19 was found to be 0.01% over five months. Conclusions A fast-track, efficient, large-scale workforce can be created through a central facility even under challenging circumstances which restrict gatherings and require physical distancing. A training action plan for disease outbreaks would be a useful resource to tackle such medical emergencies affecting substantial populations in future.

Clinical characteristics and disease burden in prurigo nodularis

BACKGROUND

Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by intense pruritus, but information on patient experience and impact on quality of life (QoL) remains understudied.

AIM

To characterize disease characteristics and QoL in a global sample of patients with PN.

METHODS

An anonymous survey was distributed via patient support groups for PN.

RESULTS

In total, 231 members responded to the survey. The majority of respondents reported itch localized both to nodules and to intervening skin (67.0%). Associated symptoms included prickling, pain, stinging and burning. The extensor lower legs (69% right, 67.3% left) and flexor forearms (66.1% right, 62% left) were the most common sites of itch. Participants reported frequent healthcare utilization, with 36.3% visiting a doctor ≥ 10 times in the past year. Physician-diagnosed anxiety (45.4%), depression (16.4%) and the atopic triad (18.7%) were commonly reported. Patients with PN had mean scores of 16.4, 11.6 and 16.8 on the Dermatology Life Quality Index, Pittsburgh Sleep Quality Index and 5-Dimensions Itch, respectively.

CONCLUSIONS

Severe pruritus with accompanying pain, stinging and burning is characteristic of PN, with the majority of patients experiencing itch in both nodular and interlesional skin. Patients further report decreased QoL scores and impaired sleep. Patient experiences should guide future management of PN.

Predictors of no-reflow phenomenon following percutaneous coronary intervention for ST-segment elevation myocardial infarction

OBJECTIVES

No reflow during percutaneous coronary intervention (PCI) is a complex issue with serious outcomes. Multiple studies have studied predictors of no-reflow during primary PCI, but data on patients with the late presentation is sparse, which constitutes the majority of patients in peripheral centers. This study aimed to determine predictors of no-reflow during PCI in patients with ST-segment elevation myocardial infarction (STEMI) in 7 days.

METHODS

It was a single-center prospective case-control study performed at a tertiary care center and included 958 patients with STEMI who underwent PCI within 7 days of symptom onset. Baseline and angiographic data of patients undergoing PCI were recorded and patients divided into reflow and no-reflow group.

RESULTS

Of 958 who underwent PCI, 182 (18.9%) showed no-reflow by myocardial blush grade (MBG)<2. No-reflow group had a higher mean age (66.46±10.71 vs. 61.36±9.94 years), lower systolic blood pressure (SBP) on admission (100.61±26.66 vs. 112.23±24.35, P<0.0001), a higher level of peak Troponin I level (9.37±2.81 vs. 7.66±3.11ng/dL, P<0.0001), low left ventricular ejection fraction (36.71±3.89 vs. 39.58±4.28% respectively P<0.0001). Among angiographic data and procedural features, multivariable logistic regression analysis identified that advanced age, reperfusion time>6hours, SBP<100mmHg on admission, functional status of Killip class for heart failure≥3, lower EF (≤35%), low initial myocardial blush grade (≤1) before PCI, long target lesion length, larger reference diameter of vessel (>3.5mm) and high thrombus burden on angiography were found to be independent predictors of no-reflow (P<0.05).

CONCLUSION

No-reflow phenomenon after PCI for STEMI is complex and multifactorial and can be identified by simple clinical, angiographic, and procedural features. Preprocedural characters of the lesion and early perfusion decides the fate of the outcome.

COVID-19 Sample Collection Kiosk in AIIMS Rishikesh: A safe and efficient model

Introduction:  Following the pandemic, screening suspected individuals on a large scale is imperative to curtail the disease's spread to enormous proportions. The walk-in kiosk is an ideal example of an innovation that is time and labour efficient and safe to use. Methodology and review of literature: Embase, Google Scholar, and Pubmed were used to extract scholarly articles about the subject published worldwide. The Walk-in kiosk concept was an idea taken from the biosafety chamber used in the advanced microbiology laboratories. Results: This ergonomic design enables the HCW to perform better without bending forwards or reaching out for the oropharyngeal or nasopharyngeal swab. It avoids a great deal of inconvenience for both the HCW and the patient.

Digital Warfare Against COVID-19: Global Use of Contact-Tracing Apps

The current COVID-19 (coronavirus disease 2019) pandemic has perpetuated a worldwide tussle to control this infection and minimizing death toll and economic damages. The year 2020 would always be remembered as a year of war against a virus, but it would also be marked as a year showing upsurge of technology evolution to deal with infections. Contact tracing has emerged as a new buzzword. Contact tracing digital tools have been introduced worldwide to prevent transmission. In this article, we have outlined various contact tracing apps being used globally, which are rated according to their safety, privacy, and efficacy.

A supersonic laser ablation beam source with narrow velocity spreads

A supersonic beam source for SrF and BaF molecules is constructed by combining the expansion of carrier gas (a mixture of 2% SF₆ and 98% argon) from an Even-Lavie valve with laser ablation of a barium/strontium metal target at a repetition rate of 10 Hz. Molecular beams with a narrow translational velocity spread are produced at relative values of Δv/v = 0.053(11) and 0.054(9) for SrF and BaF, respectively. The relative velocity spread of the beams produced in our source is lower in comparison with the results from other metal fluoride beams produced in supersonic laser ablation sources. The rotational temperature of BaF is measured to be 3.5 K. The source produces 6 × 10⁸ and 10⁷ molecules per steradian per pulse in the X²Σ⁺ (ν = 0, N = 1) state of BaF and SrF molecules, respectively, a state amenable to Stark deceleration and laser cooling.

Book Review: ‘Till We Win - India’s fight against the COVID-19 Pandemic’

‘Till We Win’ is a book which provides a comprehensive overview of India’s journey. It deliberates how India, as a nation, fought and continue to fight against the novel coronavirus, SARS CoV-2. It documents and analyses the COVID-19 pandemic responses and provides lessons for health systems strengthening. The book has four section and eleven chapters. The first section focuses upon why viruses are likely to cause pandemic and how human activities are increasing the risks of outbreaks and epidemics. The next section deliberates on India’s pandemic response and how the policies had evolved with every new emerging condition. The authors argue that none of the country was fully prepared for the pandemic of the such a magnitude which eventually had disrupted even ‘so called’ better performing health system.

Is higher power shorter duration radiofrequency energy is better than lower power longer duration strategy in catheter ablation of atrial fibrillation A meta-analysis

Background

An ideal strategy for radiofrequency ablation (RFA) of atrial fibrillation (AF) in the left atrium should be efficient enough to achieve transmural lesions in left atrium with no or minimal collateral tissue damage. Resistive heating of high power short duration (HPSD) RFA has been found to result in lesions larger in width but lesser in depth compared to lower power longer duration (LPLD) RFA in some experimental studies.

Purpose

This meta-analysis was performed to compare procedural, short-term and long-term outcomes of HPSD versus LPLD RFA of AF.

Methods

PubMed, Embase and Cochrane databases were systematically reviewed. Five observational studies meeting criteria were included in the meta-analysis. All the studies scored six or more points in the New-castle Ottawa scale. There were considerable variations in the ablation strategies across the studies. However, radiofrequency power more than 40W was considered as high power. Hypergeometric model with exact likelihood function was utilized for statistical analysis.

Results

Baseline parameters and ablation details have been depicted in Table 1. 740 patients with HPSD and 287 patients with LPLD ablation strategies, were followed up from 6 to 30 months. Total procedural time (P value &lt;0.0001) and ablation time (P value &lt;0.0001) were significantly lower in the HPSD group than LPLD group. However, the fluoroscopy time was similar (P value = 0.09) in both the groups (Table 2). There were no occurrences of atrio-esophageal fistula or pulmonary venous stenosis in any of the studies. Cardiac tamponade (P value = 0.56), stroke (P value = 0.70) and AF recurrences (P value = 0.81), were similar in both groups (Table 2).

Conclusion

Newer HPSD and conventional LPLD RFA, both the strategies are very safe procedure for treatment of RFA with low to no procedural complications. AF recurrence rates were reasonably high irrespective of ablation strategies, however, no strategy scored statistically better over the other one. Large randomized multi-centric studies with long-term follow up are needed to test the theoretical advantage of HPSD ablation over the traditional ablation strategy of AF.

Funding Acknowledgement

Type of funding source: None

Lifestyle behavior of budding health care professionals: A cross-sectional descriptive study

Background:

College life is a crucial period and at this age, students are more likely to get involved in unhealthy lifestyle behavior like poor dietary habits, physical inactivity, and use of substances, etc.

Objectives:

Study objectives were to determine the lifestyle behavior of budding healthcare professions and to determine the association of bio-physical profiles with their personal profile, activity, sleep, and dietary pattern.

Settings and Design:

The current study adopted a cross-sectional design and carried out during May - June 2019 among 284 participants of tertiary care institute.

Methods and Material:

Participants were selected through a proportionate stratified sampling technique. Self-structured questionnaire and Likert scale were used to assess the lifestyle behavior of participants. Descriptive and inferential statistics were used for data analysis.

Results:

Majority of participants (70.7%) preferred junk food as a substitute of meal. Significant number (68.3%) of students did not exercise regularly and 30.9% have disturbed sleep pattern. One-third of them (34.5%) were in pre-hypertensive stage and alarming number of them having unacceptable body mass index (BMI) (24.7%) and waist hip ratio (28.5%). Increased BMI was significantly associated with male gender (P = 0.01) and sleep deprivation (P = 0.03). Significantly more male participants were hypertensive and pre-hypertensive (P = 0.001).

Conclusions:

Study data indicated that having knowledge regarding health is not enough to ensure that health professionals will follow healthy lifestyle and it is important to motivate budding health care professionals to practice healthy lifestyle with an aim of health promotion and prevention of diseases.

Tobacco Cessation Counseling: A Humanistic Approach by Non-Human

“Counselling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. It’s a type of applied psychology”. When used for helping an individual in quitting a habit it requires using cognitive therapies. Artificial Intelligence (AI) has been increasingly used in the healthcare sector, but its use for counseling purposes is still questionable.  Recently a virtual health worker has been introduced by World Health Organization (WHO) representing increased use of AI in healthcare. This article also explores the features of this virtual health worker and how the counseling process is done by a human health professional and what is different in counseling done by a virtual health worker.Counselling 

Awareness and readiness of health care workers in implementing Pradhan Mantri Jan Arogya Yojana in a tertiary care hospital at Rishikesh

Background

Right to health is one among the important components of basic human rights. The Government of India had announced “Ayushman Bharat for a new India-2022”, during 2018-19 parliament budget sessions with two components namely, Health and wellness centers for strengthening primary care and national health protection scheme now known as “Pradhan Mantri Jan Arogya Yojana (PMJAY)” for enabling access to secondary and tertiary healthcare services. Current study was conducted to assess awareness and readiness of the health care workers in implementation of Pradhan Mantri Jan Arogya Yojana

Materials and Methods

A hospital based cross sectional study was conducted with estimated sample size calculated of 236, with treating consultants and residents as study participants. Participants filled a self-administered pretested semi-structured questionnaire to assess the level of awareness and readiness in implementing PMJAY. Data was entered and analyzed using EPI Info 7 software.

Results

Total number of participants were 181. Mean awareness score was 4.5±1.96 and mean readiness score was 16±5. Mean awareness and readiness score among medical and surgical branches was not statistically significant. There was significantly high awareness score among faculty as compared to senior residents. Relationship between awareness and readiness was found to be correlated with Pearson’s correlation of 0.206 and was statistically significant. Linear regression model demonstrated an increase of 0.531 units in readiness for every unit increase in awareness score.

Conclusion

Mean awareness score of doctors was just around half of maximum possible score. Awareness is more among faculty members than residents. With increase in awareness there is an increase in readiness among the study population. There is a need to organize workshops on PMJAY for stakeholders.

Moving Out of Shadows: Depression among the Elderly in Dehradun District of Uttarakhand, India

Background

Depression, a stigma swept under the rug, has morphed to be tabbed as the theme of World Health Day 2017 by the World Health Organization (WHO). Depression in old age is stereotypically tethered to the ageing process but it is a medical problem that has been under-researched. This study was conducted to estimate the point prevalence of depression among the elderly in Dehradun district of Uttarakhand and to identify its predictor variables.

Methods

It was a cross-sectional study conducted in Dehradun district of Uttarakhand (India) among 660 elderlies (≥60 years) from three strata (rural, urban and special groups). The Hindi version of long form of Geriatric Depression Scale (GDS-H) was used to identify mild and severe depression. All statistical analyses were carried out by SPSS software (version 22) at 5% level of significance.

Results

The arithmetic mean (±SD) of GDS scores was 10.62 (±6.1). 55% elderly were found to be suffering from depression (46.8% mild and 8.2% severe depression). Bivariate analysis showed significant association of depression with increasing age, female gender, place of residence, type of family, living without spouse, financial dependency, involvement in any kind of substance abuse and suffering from some chronic morbidities like osteoarthritis, chronic respiratory illness, skin diseases, visual impairment or hearing impairment. These predictor variables were further subjected to multivariate analysis.

Conclusion

The high prevalence of depression in old age and its multifactorial association tags it as a public health problem in this age group which should be recognized and managed before it becomes a health menace.

Undernutrition and associated common comorbidities among 6 -59 months old children

Background: Undernutrition has long been a major public health concern in developing country like India as a leading cause of child morbidity and mortality.  Aim & Objectives: To assess undernutrition in under five children and various associated factors affecting it. Methods and Material: A community based cross sectional study was conducted among 400 under five children in Rishikesh. Results: The prevalence of underweight was 37.3%, stunting was 43.3% and wasting was 24.5% respectively. Common morbidity emerged as significant predictors of under nutrition. Conclusion: The burden of common morbidities and prevalence of malnutrition among under-five children in this community is very high.

Assessment of Activities of Daily Living (ADL) in elderly population

Introduction: Most of the developing country facing growing number of elderly population because of decrease in fertility and increase in longevity. Elderly age (≥ 60 years) is a period in which people are prone to chronic diseases and their functional independency is probably restricted by physical and mental disabilities. Aim & Objectives: To find out the prevalence of physical dependency among elderly in Uttarakhand, India. Material & Methods: Activities of daily living (ADL) comprise the basic actions that involve caring for self and body, including personal care, eating and mobility. Results: In the present study population of 400, 112 (28%) study population were found to be physically dependent for their daily activities and out of them 63.39 % had moderate to severe dependency. Conclusion: High level of physical dependency in this study population need urgent attention towards good quality home care and geriatric health care services in India at primary, secondary and tertiary level.

Concise Information for the Frontline Health care workers in the era of COVID-19

Background: COVID-19, a disease caused by SARS-CoV-2 has become a public health emergency of worldwide concern. Originated in Wuhan District of China, it has spread globally at a very rapid rate causing millions of deaths worldwide. Aims and Objectives: To summarize findings from all the current literature available from different databases regarding the epidemiological, clinical characteristics, laboratory diagnosis, treatment, prevention and control of the SARS-CoV-2. This will help out the reader to have a fine gist of all the data available on SARS-CoV-2 in an effective manner. Methods: All the research literature from Jan-March 2020 and available on the following online databases: bio-Rxiv, PubMed, Google Scholar, Embase as well as CNKI and Wang Fang data were included in the review. The keywords used for data search were “coronavirus,” “nCoV,” “2019-nCoV,” and “COVID-19.” Conclusion: After undergoing extensive literature search, it can be concluded that it mainly effects elderly male population. Mode of transmission is droplet transmission and human to human transmission is present. The main diagnostic modality remains molecular assays though several rapid testing methods are on the way. Due to lack of specific treatment guidelines, Infection control and supportive treatment remain the mainstay. Plethora of experiments are under trails for development of effective vaccine which can be a ray of hope in future.

Prevalence of Diabetes Mellitus and its associated risk factors

Background: Type 2 diabetes mellitus (T2DM) is a chronic, debilitating non communicable diseases (NCDs) which has emerged as a leading global health problem. Aim & Objective: To find out the prevalence of known cases of diabetes mellitus and associated risk factors in the study area. Material & Methods: Community-based cross-sectional study was conducted among people living in Barrage colony of Rishikesh, Uttarakhand for a period of 3 months from December 2018 to February 2019. House to house survey was done in all the four blocks (A, B, C, D) of Barrage colony. Total of 815 study participants (both male and female) ≥ 20 years of age were surveyed. Data collected was entered into Microsoft Excel and analyzed using epi info software version 7. Results: The prevalence of DM was found to be high i.e 5.6% among the study participants. Prevalence was significantly more among females as compared to males and significantly increased by aging in both genders. Conclusions: It seems that the prevalence of diabetes is increasing in our region as well as our country and the world. To control DM public health education regarding consumption of balanced diet, increasing physical activity and leading a stress-free life is needed.

COVID–19: Guidance Outlines on Infection Prevention and Control for Health Care Workers

Coronavirus are a common family of viruses and there are seven different types of coronaviruses including this new member of coronavirus i.e. 2019 novel coronavirus, which can make the people infected and sick. Some strains of this family of virus cause mild to moderate disease symptoms like common cold while other strains cause very severe disease like Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS).(1,2) In late December, in Wuhan Hubei Province, China a number of people suffered with severe respiratory illness including a cluster of pneumonia cases. On 31 December 2019, China notified the World Health Organization (WHO) about cluster of patient with symptoms of respiratory illness of unknown cause, which were connected to an open seafood and animal market of Wuhan city, China.(3)

A study to assess prevalence of anaemia among beneficiaries of Anaemia Mukt Bharat Campaign in Uttarakhand

Context:

Anaemia is defined as a decreased concentration of blood haemoglobin. It is one of the most common nutritional deficiency diseases observed globally affecting both developing and developed countries.

Aims:

To find out the prevalence of anaemia among the beneficiaries of Anaemia Mukt Bharat and its association with age and gender.

Settings and Design:

A cross-sectional study was conducted in Uttarakhand by AIIMS Rishikesh in a month-long campaign including 5,776 beneficiaries. Camps were organized at the hospital campus, schools, district hospitals, Community Health Centre (CHC), Primary Health Centre (PHC), subcentres (SC), Anganwadi Centres (AWCs), slum areas, adolescent health day celebration sites and Village Health and Nutrition Day (VHND) sites.

Methods and Material:

Data on age and gender along with haemoglobin level using HemoCue Haemoglobinometer was collected.

Statistical Analysis Used:

These data were entered into Microsoft Excel and analysed to calculate the prevalence of anaemia and its association with age and gender using Epi Info software version 7. Pearson's Chi-square test was applied. P value <0.05 was considered as significant.

Results:

Out of 5,776 participants 53.2% were anaemic. Females (54.6%) were more anaemic than males (45.1%). 33.5% of pregnant females were found to be anaemic.

Conclusions:

Prevalence of anaemia was very high among the study participants. It shows that anaemia is a major public health problem so efforts should be taken to reduce the prevalence of anaemia and promote the health of an individual, community as well as the country.

A step towards real-time implementation of GDM guidelines in India: Review of Gaps in RCH Programme

Gestational Diabetes Mellitus (GDM) risks the affected mother-child duos not only with respect to adverse perinatal outcomes but also for chronic diseases later in life. Therefore, in 2014, the Government of India (GoI) mandated universal GDM screening for all pregnant women as a part of essential obstetric care within the Reproductive and Child Health (RCH) programme. Later in 2018, the domain experts from GoI envisaged pan India implementation of GDM screening services within its RCH framework by 2023. As Uttarakhand—a hilly, EAG state of north India—would also be part of this nation-wide drive; prior identification of RCH services coverage in the State assumes paramount importance, as it reflects probable executability of GDM screening services within its delivery platform. Therefore, the present review aims to assess the readiness of Uttarakhand maternal health functionary system in view of GDM national guidelines implementation at both state and district levels. In this regard, freely accessible, full-text GoI documents pertaining to GDM implementation guidelines and maternal health program of India and Uttarakhand available in public domain in English language were reviewed. The present review favors the pilot implementation in district Dehradun prior to implementing in all districts of the state. It may, however, require overall improvement in maternal health programmatic services in all parts of the State for much efficient service delivery. Effective implementation of GDM guidelines requires urgent correction in the background performance of RCH program.