Treatment efficacy of vitamin C or ascorbate given as co-intervention with iron for anemia - A systematic review and meta-analysis of experimental studies

INTRODUCTION

Iron deficiency anemia (IDA) is one of the leading causes of anemia, globally. Oral vitamin C enhances iron absorption and is commonly prescribed with iron for anemia patients. Considering the lack of evidence to support this practice, we conducted this systematic review and meta-analysis to determine the treatment efficacy of experimental studies where oral vitamin C or ascorbate was given as co-intervention with iron compared to providing only iron among participants with anemia of all ages.

METHODOLOGY

A comprehensive strategy was used to search literature from PubMed, Cochrane and Google Scholar. Experimental studies conducted among participants with lab-confirmed anemia at baseline, with "oral ascorbic acid or vitamin C given as co-intervention with iron" as intervention and "only oral iron" as the comparator, and reported the outcomes hemoglobin or ferritin, were selected. Random-effects model was used to estimate standardized mean differences or odds ratio of outcomes, and sensitivity analyses were done. Sub-group and meta-regression analyses were conducted to evaluate the reasons for heterogeneity (PROSPERO number: CRD42022306612).

RESULTS

Of the total nine studies included in the review, seven studies with 905 participants were included for meta-analysis. The pooled estimate for standardized mean difference (SMD) of hemoglobin (g/dL) and Serum Ferritin (mcg/L) for intervention-type ferrous ascorbate were 0.44 (95% C.I.: -0.30, 1.26) and 0.03 (95% C.I.: -0.68, 0.73) respectively, and were not statistically significant. The pooled estimate for SMD of hemoglobin (g/dL) and Serum Ferritin (mcg/L) for intervention type 'oral iron and vitamin C' was 0.11 (95% C.I.: -0.05, 0.28) and -0.90 (95% C.I.: -1.09, -0.72) respectively, and were not statistically significant.

CONCLUSION

The SMD of hemoglobin or serum ferritin between the intervention group were not significantly favouring the intervention when the intervention group was ferrous ascorbate or oral iron and vitamin C, and the methodological quality of evidence of these effect measures was very low. This necessitates studying the treatment efficacy of oral vitamin C or ascorbate when given with oral iron for participants with anemia in future clinical trials.

202 THE SILVER TRAUMA CLINIC—A MULTIDISCIPLINARY CLINIC FOR FRAIL OLDER PATIENTS FOLLOWING TRAUMATIC INJURY

Background

Increasing numbers of older individuals are presenting to Irish emergency departments following trauma. Advances in the care of chronic diseases have increased the number of older people with active lifestyles, predisposing them to injury. ‘Silver trauma’ has been a relatively neglected despite deficits of traditional trauma care for this vulnerable cohort.

The Silver trauma clinic was developed in conjunction with the Frailty Intervention Team, Geriatric services and HSCP service in May 2021. The goal of the clinic is to provide a comprehensive multidisciplinary management for frail older patients following non operative injuries.

Methods

Frail older patients discharged from the ED can be referred for short interval multidisciplinary trauma review.

A trauma tertiary survey is carried out by an emergency physician with specialist interest in geriatric trauma. Rapid access to imaging ensures timely definitive diagnosis. The service integrates virtually with specialist services, such as spinal orthopaedic services and musculoskeletal interventional radiology.

Physiotherapists initiate a tailored early rehabilitation plan. Consultant geriatrician and frailty ANP screen for complications of injury as well as bone health, falls risk and cognitive screening. The clinic integrates with existing outpatient and community services for older persons.

Results

The clinic has seen 30 patients since commencement in May 2021. Median patient age: 85. Injuries: 25% vertebral fractures, 30% limb fracture, 20% thoracic trauma, 30% pelvic trauma. Mean number assessments: 2. Disposition outcomes: Primary care 50%, Geriatric clinic 30%, Integrated Care Team 10%, specialist clinic 10%.

Conclusion

The Silver trauma clinic is a new approach of patient focused multidisciplinary trauma care for frail older patients following non operative trauma in the Irish health system.

Community-based assessment of postnatal care in Puducherry-A cross-sectional study

Introduction:

Postnatal period is a neglected period compared to the antenatal period. Providing adequate care to infant and mother during this vital period is essential.

Objectives:

To assess the postnatal care (PNC) received by the mothers and newborn children in Puducherry.

Materials and Methods:

Community-based cross-sectional study done among the postnatal mothers under the care of two urban Primary Health Centers (PHC A and PHC B) in Puducherry in 2015–2016. Eligible mothers were contacted at their houses within 4 weeks of completion of their postnatal period to assess the postnatal care.

Results:

Out of 227 postnatal mothers in the study, only 37.4% (85) (95%CI 31.3–43.9) of the mothers had received adequate counselling services on topics of nutrition, hygiene, contraception, essential newborn care, breastfeeding, and immunization. Cord care was given for 99.1% of the babies and breastfeeding position was checked for 88.5% of the babies. Among the mothers who had normal deliveries, 48.1% (76) (95% CI 40.4–55.9) of the mothers had initiated breastfeeding within 1 h of normal delivery and within 4 h of delivery for 72.4% (50) (95% CI 61.1–82.0) among the mothers who had a cesarean section. Only 20.7% (47) (95%CI 15.8–26.3) of the mothers and newborns had received at least one postnatal home visit and none of the mothers had received adequate postnatal home visits as per Indian Public Health Standards guidelines. Out of the 126 eligible mothers for JSY benefits, only 46% (58) (95% CI 37.5–54.8) of them had registered. Among those who were not registered, 20.6% had reported that they were unaware of the scheme. Out of 227 births, 14.1% (32) of them were of low birth weight (<2.5 kg) and 1.3% (3) were of very low birth weight (<1.5 kg) category.

Conclusion:

Although the antenatal care is satisfactory in the study setting, implementation of PNC needed further attention and active guidance via health system strengthening.

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study

OBJECTIVE

Identifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of 'Zero Deaths' by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years.

STUDY DESIGN

We performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis).

SETTING

Revised TB Control Program (RNTCP) in three districts of South India.

PARTICIPANTS

The cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014-2018 in three districts of southern India. Information on death was collected at homes by trained project staff.

PRIMARY OUTCOME MEASURES

We calculated 'all-cause mortality' during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI.

RESULTS

The mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0-5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24-4.15), male gender (RR 3.98; 95% CI: 1.25-12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07-3.87), tobacco use (RR 1.87; 95%CI: 1.05-3.36) and severe anaemia (RR 3.53: 95%CI: 1.34-9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts.

CONCLUSION

Though deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.

Tuberculosis screening among pregnant women attending a tertiary care hospital in Puducherry, South India: is it worth the effort?

Background: The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018.

Objective: To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers’ perspective.

Methods: We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted ‘presumptive TB’: any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes.

Results: Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision.

Conclusions: The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process.

High prevalence of anemia among postnatal mothers in Urban Puducherry: A community-based study

BACKGROUND

Anemia is a common problem across all life stages and ages with a higher burden among women. The postnatal period is an often-neglected period for the provision of effective care to the mothers. Anemia burden is also high during this period, which leads to many morbidities and poor quality of life.

METHODS

A community-based cross-sectional study was done in the field practice area of two Urban Primary Health Centres (PHCs) in Puducherry between March 2015 and February 2016. A total of 227 postnatal mothers were selected by simple random sampling from the list of mothers delivered from the field practice area. House visit was done within 4 weeks of completion of their postnatal period. Socio-demographic details and third-trimester hemoglobin levels were collected using a pretested questionnaire. Hemoglobin level during post-partum was measured using Sahli's Hemoglobinometer. Paired t-test is done to assess the difference in hemoglobin antepartum and post-partum. Multiple Logistic Regression is done to identify factors associated with postpartum anemia.

RESULTS

The mean (SD) hemoglobin during postpartum was 10.95 (1.1) gm% ranging from 7.4 gm% to 13.8 gm%. The prevalence of anemia among postnatal mothers is 76.2% (n = 173, 95% CI: 70.4%-81.4%). Around 26% (59) had mild anemia, 49.8% (113) had moderate anemia and 0.4% (1) had severe anemia. One-fourth of the mothers who had a normal hemoglobin level in their third trimester had developed anemia in the postnatal period. There was a significant difference in mean hemoglobin during postpartum and that of third trimester (10.95 vs 10.69 gm%, t = 3.4, df 226, P = 0.001). Birth order of two or more is significantly associated with postpartum anemia (aOR 2.2, 95% CI: 1.07-4.39).

CONCLUSIONS

The prevalence of anemia among postnatal mothers is high. Routine hemoglobin estimation, advice on consumption of iron-rich foods and Iron and Folic Acid (IFA) supplementation have to be provided to postnatal mothers to improve this situation.

Depression, anxiety, and bodily pain independently predict poor sleep quality among adult women attending a primary health center of Puducherry, India

Background:

Sleep disorders and mental health problems are common diagnoses in primary care settings. The objective of this study was to estimate the magnitude of poor sleep, depression, and anxiety through opportunistic screening and to find out the independent predictors of poor sleep quality among female participants.

Materials and Methods:

A hospital-based study was conducted in the outpatient department (OPD) of an urban primary health center of Puducherry. Patients and accompanying healthy attendants ≥ 18 years of age who visited the OPD for any reason were included. Those with serious acute illness, previously diagnosed mental illness, pregnant women, and women in postpartum period (upto 6 weeks) were excluded. Systematic random sampling was used to select the participants. A semi-structured questionnaire was used to collect sociodemographic and clinical details along with the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale. Height and weight were also measured.

Results:

A total of 301 participants were recruited. Mean age of the participants was 49.4 (standard deviation 15.2) years. Magnitude of poor sleep (PSQI score > 5), abnormal anxiety, and abnormal depression were 118 (39.2%), 60 (19.9%), and 28 (9.3%) respectively. Multivariate logistic regression analysis showed that history of pain [odds ratio (OR) 3.2 (1.6–6.5), P = 0.001], abnormal anxiety [OR 2.5 (1.2–5.6), P = 0.021], and abnormal depression [OR 4.3 (1.4–13.2), P = 0.01] independently predicted poor sleep quality among females.

Conclusion:

OPD-based opportunistic screening for sleep and mental health problems should be routinely conducted by primary care and family physicians.

Felt needs and expectations of adolescents regarding sexual and reproductive health from schools and health systems: A descriptive study

Background:

Much focus has been given to find ways to overcome the barriers that exist among adolescents in the utilization of sexual and reproductive health (SRH) services. This study attempts to explore the felt needs of adolescents regarding SRH education at schools and their expectations regarding SRH care from a health system.

Methodology:

A cross-sectional study was conducted among 400 1^st-year arts and science college students in Puducherry, India. Data collection and analysis were done from January 2015 to February 2015. Data were captured using a self-administered pretested questionnaire.

Results:

Seventy percent participants felt that it is necessary to have educational contents on SRH at schools and 33.5% felt that the current SRH education is inadequate. About 28.9% felt uncomfortable to discuss their doubts on SRH with teachers. Almost 90% preferred schools as the source of SRH education in the community. Nearly 42% of adolescents thought that they would consult a doctor in the instance of a sexual illness. Thirty-nine percent preferred specialized SRH clinics. More than half expected privacy and confidentiality and the presence of a same sex doctor as the most important feature of an SRH-care facility. The least preferred SRH-care facility was government clinics (18%), and the major reasons for not preferring government facilities were lack of quality (43%) and overcrowding (43%).

Conclusion:

It is important to conceive schools as the foundation for providing SRH education among the adolescents supported by a friendly and responsive health system.

Knowledge, attitude, and practice regarding organ donation among adult population of urban Puducherry, South India

BACKGROUND

India is currently having a deceased donation rate of 0.05-0.08 per million population. The National Organ and Tissue Transplant Programme have planned strategies to improve organ donation by creating awareness and capacity building. There is great need to assess the knowledge regarding organ donation among general population.

OBJECTIVE S

Among the adult population (≥18 years) residing in urban slum of Puducherry to determine the knowledge, attitude, and practice regarding organ donation.

MATERIALS AND METHODS

Community-based cross-sectional study was conducted during April to May 2017 among 257 randomly selected participants in selected wards of urban Puducherry. Data regarding knowledge, attitude, and practice were collected through pretested semi-structured questionnaire.

RESULTS

Mean (standard deviation) age of the study participants was 45 (15) years and majority (57%) were female, 41% of them were educated more than secondary. Almost 90% of the study participants have heard about organ donation. However, only 28% (95% confidence interval [CI]: 22.9-33.8) had adequate knowledge regarding organ donation. 58% (95% CI: 51.5-63.5) had positive attitude toward organ donation. Practice regarding registration for organ donation was only 2.3%. Knowledge regarding organ donation was more among joint family (odds ratio [OR] = 1.86, P = 0.02) and middle socioeconomic status (OR = 2.40, P = 0.01). Positive attitude was more among those who were educated above secondary (OR = 3.47, P = 0.001) and less among Muslim/Christian religion (OR = 0.49, P = 0.03).

CONCLUSION

Less than one-third of the study population had adequate knowledge regarding organ donation. Even though more than half of them had positive attitude toward organ donation only six individuals registered for organ donation.

Beneficiary Satisfaction Regarding Old Age Pension Scheme and Its Utilization Pattern in Urban Puducherry: A Mixed Methods Study

INTRODUCTION

National Old Age Pension Scheme (NOAPS) was aimed at providing a safety net for India's aging population in terms of social, economical and moral support by helping eligible elderly citizens with direct cash benefit.

AIM

To assess the beneficiary satisfaction and utilization pattern of the monetary benefit received under the old age pension scheme and to explore the perception of the stakeholders regarding delivery of the pension.

MATERIALS AND METHODS

This is a mixed method research consisting of both quantitative surveys and qualitative in-depth interviews. The survey was conducted among 205 randomly selected beneficiaries of old age pension scheme belonging to urban Puducherry. Around 12 qualitative interviews were conducted with beneficiaries, family members and Anganwadi workers.

RESULTS

The mean age of the study participants was 71 years. Almost 80% of participants avail pension from banks. Majority of participants (98%) were satisfied with the overall scheme, though half of them expressed their dissatisfaction with the amount of pension received. Among the study subjects, 65% were satisfied regarding the mechanism of delivery of old age pension. Anganwadi was the preferred mode of payment in 80% subjects. Around 85% of them spent the entire pension amount for their own use (health needs, travel, daily activities and social needs) while the remaining gave some economic support to their family. Half of them (55%) felt that they possess financial autonomy in planning their expenditure. Majority felt that receiving pension had given them economic empowerment, self-esteem and renewed confidence in life.

CONCLUSION

Financial assistance to the elderly empowers them and improves their social status, independence, self-esteem and overall quality of life. With increasing proportion of elderly in Indian population, it is important to study the effectiveness of such schemes so that corrective measures can be taken to facilitate its access to the disadvantaged section of the society.

Papillary carcinoma thyroid - A 11 year epidemiological study with histopathological correlation in a tertiary care centre in South Malabar Region in Kerala, India

Background: Thyroid cancer is the commonest endocrine malignancy. Based on recent data, thyroid cancer is the fifth most common cancer in women. To our knowledge the  present study  is the first of its kind, correlating epidemiological and histomorphological data so as to assess the  major cause hypothesis for thyroid cancers, focusing more on  papillary  carcinoma and its variants, comparing it with each other and with other  thyroid carcinomas and also correlating with gender, life style and religion.Materials and methods: This study was conducted in the Department of Pathology, MES Medical College, Perinthalmanna, Kerala, India, from January 2004 to June 2015.Two thousand and fifty thyroidectomy cases were studied.Results: Out of the total 2050  cases, thyroid cancers constituted  295 (14.39%);  of which 10.1% (208 cases) were Papillary carcinoma thyroid (PCT) and its variants; 165 cases were seen in females (79.33%) and  the incidence in males were only 20.68% (43 cases).The commonest variant encountered was classical papillary carcinoma (113 cases, 54.32%).Conclusion: Our study of papillary thyroid carcino

High prevalence of cardiovascular risk factors among policemen in Puducherry, South India

BACKGROUND

Diabetes mellitus and hypertension (HT) are common diseases in adulthood, pre-disposing to many cardiovascular complications, posing a major public health challenge. Few studies have reported increased prevalence of cardiovascular disease risk factors and type 2 diabetes in policemen. Hence, this study aims to assess the prevalence of cardiovascular risk factors such as diabetes, HT, smoking, alcohol intake, and obesity among policemen.

MATERIALS AND METHODS

A cross-sectional study was carried out in 2008-2009 among 256 policemen in Puducherry, South India. Policemen were selected by simple random sampling. Socio-demographic details and some of the risk factors such as alcohol intake and smoking history were obtained using a pre-tested, structured questionnaire. Presence of stress was measured using the professional life stress score questionnaire. Blood pressure, waist circumference, and hip circumference were measured by standard methods. Fasting blood sugar was estimated using a glucometer. Serum cholesterol was also measured. Lipid profile was measured for a randomly chosen subgroup of 50 participants.

RESULTS

Mean age of study participants was 40.9 years (SD ± 10.9). Out of the study subjects, 23% (n = 60) were known diabetic and 16.8% (n = 43) were known hypertensive. Prevalence of diabetes among study participants was 33.6% (CI: 27.8%-39.6%). Prevalence of HT among study participants was 30.5% (CI: 24.9%-36.5%). Seventy percent (n = 178) had at least moderate range of stress in their life related to their profession and 4% (n = 11) had stress as a "problem" in their life.

CONCLUSIONS

Burden of cardiovascular risk factors such as diabetes and HT was high among police personnel of Puducherry.

Level of awareness about tuberculosis in urban slums: Implications for advocacy and communication strategy planning in the National program

Background:

Tuberculosis (TB) remains as an important public health problem in India. Awareness about the disease, its diagnosis, and treatment among public will help in controlling the killer disease. This study aims at arriving at an educational diagnosis about TB in an urban poor community.

Materials and Methods:

A cross-sectional study was conducted in an urban slum in South India using a structured, pretested questionnaire. Domains identified were knowledge about TB, symptoms, spread, diagnosis, treatment, and prevention of TB.

Results:

A total of 395 households were interviewed. Of them, 370 (94%) respondents had heard about TB. Regarding the symptoms of TB, 82% were aware that cough is a symptom of TB. Among the 79% of study subjects who reported any test to diagnose TB, sputum examination as a method of diagnosis was known to only 40%. However, 84% of the subjects were aware of the free treatment available for TB under National program.

Conclusion:

Level of awareness about TB among urban poor in a slum area is good. Knowledge about “free treatment” and “duration of treatment” has to be stressed during health education activities.

SU-E-T-615: Quantifying the Benefit of Adaptive Fractionation

PURPOSE

To quantify the benefit of adaptive fractionation, through both theoretical test cases and patient data.

METHODS

We consider the effect of delivering a different fraction size based on the changes observed in the patient anatomy. Given that a fixed prescription dose must be delivered to the tumor over the course of the treatment, we find that adaptively varying the fraction size results in a lower cumulative dose to a primary organ-at-risk (OAR). We construct a one dimensional theoretical example by randomly varying the distance between the tumor and OAR, and simulate the benefit of adaptive fractionation in such a setting. Next, we test our methodology using contoured daily CT images from 5 prostate patients.

RESULTS

For the theoretical example, we found about a 10% decrease in dose to the OAR when using a uniformly distributed motion model and a 20% daily fraction size deviation. In general, the amount of decrease in dose to the OAR varied significantly (5-85%) for these theoretical test cases depending on the amount of motion in the anatomy, the number of fractions, and the range of fraction sizes allowed. Preliminary results from the prostate patients indicate an average reduction in dose to the rectum of 1.4%, 3.5%, and 7.0% when using 20%, 50%, and 100% daily fraction size deviations, respectively.

CONCLUSIONS

Qualitatively, the theoretical example indicates that adaptive fractionation is beneficial for disease sites in which there is significant inter-fractional motion. We also expect greater benefit when using many fractions and allowing for large daily fraction size deviations. For the prostate disease site in particular, we find that adaptive fractionation is beneficial only when allowing large daily fraction size deviations. Further research quantifying the gain for disease sites that exhibit significant inter-fractional motion, such as rectal and cervical cancers, would be useful. Partially supported by Siemens.

Simian hepatitis A virus derived from a captive rhesus monkey in India is similar to the strain isolated from wild African green monkeys in Kenya

A simian hepatitis A virus (HAV) was identified retrospectively in a faecal sample from a rhesus monkey in India, inoculated in 1995 with a faecal suspension from a suspected patient of non-A to E hepatitis. The monkey was in captivity for 2 years in one of the experimental primate facilities in western India before being moved to the National Institute of Virology, Pune for experimentation. Phylogenetic analysis based on a partial sequence of the 5' noncoding region placed this virus in genotype V, the only other member being the AGM-27 strain recovered in 1986 from African green monkeys in Kenya. The source of infection of the monkey remains unclear. The full genome was amplified in nine fragments and sequenced. The genome of the Indian simian HAV (IND-SHAV) is 7425 nucleotides long including the poly-A tail of 14 nucleotides at the 3' end. At the nucleotide and amino acid levels, IND-SHAV was 99.8 and 100% identical with AGM27, respectively.

Dot blot hybridization assay for the detection of duck hepatitis B virus DNA among healthy Indian country ducks

A DNA molecular hybridization technique employing Duck Hepatitis B Virus (DHBV) DNA of 3.0 kilobase pairs as a probe was used to screen for the presence of DHBV DNA in blood samples, collected from 90 apparently healthy Indian country ducks. Six out of 90 ducks showed positivity for DHBV DNA in serum (5.4%) and only 4 out of 6 DHBV DNA positive ducks answered in Counter Immuno Electrophoresis (CIEP) using specific antibody against DHBV surface antigen raised in Guinea pig. The results indicate the pilot observation that (a) DHBV carrier status exists to a tune of 5.4% among apparently healthy Indian country ducks also and (b) DHBV probe can be employed as a sensitive and reliable assay for DHBV DNA detection in DHBV infected ducks.