Management of hyperthyroidism in pregnancy

Hyperthyroidism in pregnancy is associated with adverse foetal, maternal and obstetrical outcome. Untreated or inadequately treated hyperthyroidism may precipitate pre eclampsia and congestive cardiac failure in mother. It also increases the risk of miscarriage, abruption placentae and premature delivery in such patients. Maintaining euthyroidism in these patients is of utmost importance. Antithyroid medications are used as first line treatment for such patients to restore euthyroid status at the earliest. Radioactive iodine is absolutely contraindicated in pregnancy and surgery often requires pre-treatment with anti thyroid medications. Two drugs are available –carbimazole and propylthiouracil. Use of carbimazole/methimazole in pregnancy is not only associated with increased incidence of scalp defect(aplasia cutis ) in the infants, but some specific congenital malformation like choanal atresia, oesophageal atresia, trachea-oesophageal fistula, patent vitello intestinal duct, omphalocele, dysmorphic facial features and growth retardation do occur. These malformations represent carbimazole /methimazole embryopathy. Due to the association of foetal teratogenicity with carbimazole /methimazole, propylthiouracil is recommended as the drug of choice in first trimester of pregnancy. However, as its use is associated with risk of hepatotoxicity, it should be changed to carbimazole/methimazole thereafter

Thyrotoxic periodic paralysis: a short clinical review

Thyrotoxic Periodic Paralysis (TPP) is a potentially lethal manifestation of hyperthyroidism which is characterized by hypokalemia and muscular weakness. It mainly affects Asian men in the age group of 20 to 40 years. Immediate supplementation with oral or intravenous potassium will help to not only abort the acute attack of paralysis but will also prevent serious and life threatening cardiac arrhythmias. Non selective beta blockers like propranolol can also be used to ameliorate and prevent subsequent paralytic attack. Acetazolamide has no role in the treatment of TPP

Evaluation of severe acute maternal morbidity and mortality at a tertiary referral center of Uttarakhand, India

Background: Maternal mortality is an area of concern for the Governments across the globe. India is signatory to millennium declaration and is committed to achieving the target of millennium development goals by reducing MMR to 100. Known obstacles to reducing the MMR in developing countries, include lack of material and human resources, as well as difficulties in accessing services due to financial, geographical, and cultural limitations.Methods: It was a descriptive cross-sectional study conducted at a tertiary care centre in Uttarakhand for a period of one year. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.Results: During the period of this study there were 2243 total antenatal admissions, 1675 deliveries, 1591 live births and 59 near miss cases. Prevalence of SAMM in the present study is 3.52%. Out of every 9-10 women who survived a life-threatening condition 1 died. Mortality Index is 10.17%. Maternal mortality ratio is 377.12 per 1 lakh live births. A total of 43 patients with potentially life-threatening conditions were admitted in ICU out of which 26 were near miss cases. The leading cause of near miss in this tertiary health facility is obstetric haemorrhage (45.8%).Conclusions: Prompt identification of complications and timed intervention remains the key determinant in making mothers survive a life-threatening complication

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

Managing paediatric Graves’ disease

Graves’ disease is the most common cause of hyperthyroidism in children. Anti-thyroid drug treatment with carbimazole or its active metabolite methimazole is offered as first line initial treatment but it induces remission in only 30%of children. Propylthiouracil is not recommended in children because of its association with severe hepatic toxicity. For those who relapse after ATD, radioactive iodine can be offered as definitive therapy except in cases with severe Graves’ ophthalmopathy or patients with large goitre who are the candidates for surgery. Total (or near total) thyroidectomy  is the surgical procedure of choice for treating paediatric patients with  Graves’ disease as it reduces the risk of recurrent hyperthyroidism which was seen in patients undergoing subtotal or partial thyroidectomy

HEALTH STATUS OF CHILDREN UNDER SCHOOL HEALTH SERVICES IN DOIWALA BLOCK, DEHRADUN

Background -The introduction of school health services in India dates back to 1909, when school children in the city of Baroda were given the first medical examination. School Health programme ,promoting basic check up of school children for a variety of health related problems, is a systematic effort in raising awareness about health issues among school children and their families. Good health increases enrollment and reduces absenteeism. It also ensures attendance of the poorest and most disadvantaged children to school, many of whom are girls. Aim- To study the morbidity status of the school children & elicit relationship of healthy habits with morbidity pattern. Study Type- Observational study Methodology- A cross sectional survey to find out the morbidity pattern was conducted on 757 school children (340 boys and 417girls), aged 5-16 years studying in class I-VIII in five different schools of Doiwala, Dehradun under Rural Health training centre, Rajeev Nagar. Results- Overall students attendance was 78.2%. Clinical anaemia was higher in Girls (46.7%) as compared to Boys (34.1%). Worm infestation was higher in boys (65.1%) as compared to Girls(57.3%). Over all abnormal Visual acquity(8.5%) or eye abnormality (14%) was noticed among study subjects. Dental Caries (53.1%) and dermatitis (16.3%) were more in boys. Healthy habits like daily bathing (82.6%), daily teeth brushing (61.1%), mouth rinsing after meal (53%) and hair clean/combed (80.2%) were more in girls as compared to boys while trimmed nail was equally (55%) noticed among both the groups. Conclusion- Morbidities found amongst students are basically due to low awareness & negligent behaviour about personal hygiene are the key areas of concern and by active involvement of school teachers improvement in personal hygiene of school children and reduction in related morbidities can be achieved

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

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

Legal Framework for Implementation of Trans-fat Regulations in India

Background: The widespread consumption of trans-fats across the world represents a worrying scenario, as it is directly responsible for coronary heart disease and related mortality. Recognizing its dangers, the WHO has set an agenda to eliminate trans-fats by 2023. In India, the Food Safety And Standards Authority ensures safe and wholesome food consumption. In light of the WHO’s standards for the elimination of trans-fats, the FSSAI recently notified limits of trans-fatty acids to not more than 3% in all fats and oils by January 2021 and 2% by January 2022, as well as a limitation on all food products in which edible oils and fats are ingredients to not contain trans-fatty acids of more than 2% mass of total oils/fats in the product by January 2022. Objective: Given the need to eliminate the consumption of trans-fats, it is necessary to assess the implementation of trans-fat regulations in India in order to determine the current status of enforcement and suggest measures for improvement. Methods: Empirical research was conducted through a questionnaire to analyze India’s current status and difficulties in enforcing trans-fat regulations. Results: Although all states have included compliance of trans-fat regulation in the agenda of the State Surveillance Plan but are facing some implementation challenges such as lack of lab infrastructure, lack of trained manpower, unsupportive FBOs, insufficient budget, lack of testing kits, and excluding proprietary food from compliance with trans-fat regulations. Further, all states have felt the need to develop a guideline/manual to facilitate enforcement of the trans-fat regulations. In light of this, the article has critically analyzed the Legal framework for implementing Trans-fat Regulations in India to identify specific implementation challenges due to scattered regulations and recommend suggestive measures for developing the guidelines/manual to facilitate effective implementation of the said regulation

ASSESSMENT OF EFFECTIVENESS OF TB POSTING DURING THE COMPULSORY ROTATORY RESIDENTIAL INTERNSHIP (CRRI) PROGRAMME

Research Question: What is the effectiveness of TB posting during the Compulsory Rotatory Residential Internship (CRRI) programme? Objectives: To assess the effectiveness of TB posting during the CRRI programme. To find out the need of making Tuberculosis & Respiratory Diseases Department posting mandatory during CRRI Programme. Study Design: Cross Sectional study. Study Duration: 12 months i.e. 01st April 2009 till 31st March 2010 Participants: 90 students who joined the CRRI programme formed the study group. Out of these 90 interns only 57 (64%) of them joined their two months Compulsory Rotatory Internship in the Department of Community Medicine and these were posted in Tuberculosis & Respiratory Diseases Department for 15 days. Methodology: A pre-designed pre-tested self-administered questionnaire was administered to the participants on the first day and last day of their posting in Tuberculosis & Respiratory Diseases Department. The results were analysed by using suitable statistical package. Results: The mean pre-test score was 28 (49.6%) and the mean post-test score was 38 (61.5%). It was observed that there was a 27% improvement in the knowledge of the participants when the question about the year of launching of RNTCP programme in India was asked. A remarkable improvement (46%) was found in the difference between pre and post-test knowledge of the participants when the questions like “Who are the DOTS providers” and “What is the colour coding of boxes for different categories of patients” were asked. A significant difference in the knowledge was found in the pre and post-test assessment in reference to Tuberculosis and its National Program