Rare Coinfection of Scrub Typhus and Malaria in Immunocompetent Person

Scrub Typhus, or tsutsugamushi disease is a febrile illness caused by bacteria of the family Rickettsiaceae and named Orientia tsutsugamushi. Recently it has been found to endemic in Subhimalayan region of India.Malaria is highly endemic in rest of India but its prevalence is low in Subhimalayan region because of the altitude. We report a rare case of a patient having coinfection with scrub typhus and malaria

Association of maternal plasma or serum zinc concentration with the birth weight of the child

Background: Zinc is a divalent cation first isolated in 1509 and since then its importance has been increasingly recognised in human health and nutrition. Present study has been undertaken to confirm the association between maternal plasma or serum zinc concentration and birth weight.Methods: Present study was cross-sectional study conducted in tertiary care hospital. Newborns with a birth weight of < 2.5kg and their mothers labelled as study group while newborns with a birth weight of > 2.5kg and their mothers were considered as control group. The analysis for the serum concentration of zinc was done using the Atomic Absorption Spectrophotometric method (AAS), this method analytically the most reliable for routine assessment of serum zinc levels. The results deduced from the analysis were accordingly grouped to the study group / control group. We had a sub-group analysis based on the gestational age, as Preterm and Term.Results: Maternal serum levels of zinc 67.04 μg /dl±16.66, in the study group, was less as compared to the maternal serum levels of zinc in the control group with a mean level of 75.39 μg/dl±17.89. The results show a significant association between zinc levels and birth weight. Mean Maternal serum levels of zinc 67.04 μg /dl±16.66, in the study group, was less as compared to the maternal serum levels of zinc in the control group with a mean level of 75.39 μg/dl±17.89. The results show a significant association between zinc levels and birth weight.Conclusions: Present study showed a positive correlation of maternal zinc levels with birth weight and prematurity. Hence, we recommend routine zinc supplementation could be included with other nutritional supplements during pregnancy

Occupational stress among community health workers in a rural field practice area of Belagavi

Introduction: Community health workers (CHW) are the first level of contact between the health system and the community. This study aimed to find out the level and areas of occupational stress among CHWs so that they can be addressed accordingly. Methods: This study was carried out among 105 CHWs in a rural field practice area of Belagavi. A pre-tested, structured, standard questionnaire was provided to them. After obtaining informed consent, they were asked to fill in the questionnaire. The collected data was entered and analysed through SPSS Version 26. Results: The mean age of the participants was 41.91 years. Majority were Hindu (79.1%). Most of the participants had completed high school (51.4%). 25.7% of the participants belonged to socioeconomic class IV, 34.3% said that theirs is the only income in the family, and 22.9% said that salary is the motivation for them to continue working. Among the participants, 16.19% had low stress, 80.95% moderate stress, and 2.85% high stress. The major area of stress was role overload (18.3%). Conclusion: CHWs are vital for the efficient functioning of primary health services at community level and their role in healthcare and the delivery of various national health programmes is indispensable, so their health and proper work environment should be ensured and safeguarded

Crisis Management: A comparative study from a board level perspective

ABSTRACT Numerous studies have been conducted on the impact of top team management characteristics on firm performance. However few studies shed light on the impacts of top team management characteristics on human induced crisis. In tandem with the works of Greening & Johnson (1996), I seek to investigate the role played by individual and organisational characteristics with respect to a crisis. Information on the characteristics of the board of directors was collected from three banks and two building societies that failed a crisis, and similarly for three banks and two building societies that survived the crisis. Averages were computed on the characteristics and a comparative study was undertaken. It was found that a particular characteristic of the board was not responsible for it failing or surviving a crisis, but it was a blend of the boards’ characteristics that was the telling factor, with particular characteristics standing out as opposed to the ones that did not

An Experimental and Computational Study of 2-(3-Oxo-3H-benzof chromen-1-ylmethoxy)-Benzoic Acid Methyl Ester

The various methods for studying polarities are based on the use of probe molecules, whose molecular spectral profile is significantly affected by the polarity of the medium. The absorption and emission spectra and dipole moments (µg and µe) of 2-(3-oxo-3H-benzofchromen-1-ylmethoxy)-benzoic acid methyl ester (2BME) are studied in solvents of different polarities at room temperature. The determination of dipole moments by solvatochromic shift using various relations and the change in dipole moment (�µ) were determined using Stokes shift with the variation of the solvent polarity parameter (ET N). The value of µe greater than µg indicating that the probe is more polar in the higher state. DFT and TDDFT theoretical analysis of dipole moment in the vacuum and with solvent, solvent accessible surface (SAS) and molecular electrostatic potential (MEP) are also performed. © 2017, Springer Science+Business Media, LLC

Blood pressure thresholds in pregnancy for identifying maternal and infant risk: A secondary analysis of community-level interventions for pre-eclampsia (CLIP) trial data

Background: Blood pressure measurement is a marker of antenatal care quality. In well resourced settings, lower blood pressure cutoffs for hypertension are associated with adverse pregnancy outcomes. We aimed to study the associations between blood pressure thresholds and adverse outcomes and the diagnostic test properties of these blood pressure cutoffs in low-resource settings.Methods: We did a secondary analysis of data from 22 intervention clusters in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials (NCT01911494) in India (n=6), Mozambique (n=6), and Pakistan (n=10). We included pregnant women aged 15-49 years (12-49 years in Mozambique), identified in their community by trained community health workers, who had data on blood pressure measurements and outcomes. The trial was unmasked. Maximum blood pressure was categorised as: normal blood pressure (systolic blood pressure [sBP] [dBP] Hg), elevated blood pressure (sBP 120-129 mm Hg and dBP Hg), stage 1 hypertension (sBP 130-139 mm Hg or dBP 80-89 mm Hg, or both), non-severe stage 2 hypertension (sBP 140-159 mm Hg or dBP 90-109 mm Hg, or both), or severe stage 2 hypertension (sBP ≥160 mm Hg or dBP ≥110 mm Hg, or both). We classified women according to the maximum blood pressure category reached across all visits for the primary analyses. The primary outcome was a maternal, fetal, or neonatal mortality or morbidity composite. We estimated dose-response relationships between blood pressure category and adverse outcomes, as well as diagnostic test properties.Findings: Between Nov 1, 2014, and Feb 28, 2017, 21 069 women (6067 in India, 4163 in Mozambique, and 10 839 in Pakistan) contributed 103 679 blood pressure measurements across the three CLIP trials. Only women with non-severe or severe stage 2 hypertension, as discrete diagnostic categories, experienced more adverse outcomes than women with normal blood pressure (risk ratios 1·29-5·88). Using blood pressure categories as diagnostic thresholds (women with blood pressure within the category or any higher category vs those with blood pressure in any lower category), dose-response relationships were observed between increasing thresholds and adverse outcomes, but likelihood ratios were informative only for severe stage 2 hypertension and maternal CNS events (likelihood ratio 6·36 [95% CI 3·65-11·07]) and perinatal death (5·07 [3·64-7·07]), particularly stillbirth (8·53 [5·63-12·92]).Interpretation: In low-resource settings, neither elevated blood pressure nor stage 1 hypertension were associated with maternal, fetal, or neonatal mortality or morbidity adverse composite outcomes. Only the threshold for severe stage 2 hypertension met diagnostic test performance standards. Current diagnostic thresholds for hypertension in pregnancy should be retained.Funding: University of British Columbia, the Bill & Melinda Gates Foundation

Causes and circumstances of maternal death: A secondary analysis of the community-level Interventions for pre-eclampsia (CLIP) trials cohort

Background: Incomplete vital registration systems mean that causes of death during pregnancy and childbirth are poorly understood in low-income and middle-income countries. To inform global efforts to reduce maternal mortality, we compared physician review and computerised analysis of verbal autopsies (interpreting verbal autopsies [InterVA] software), to understand their agreement on maternal cause of death and circumstances of mortality categories (COMCATs) in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials.Methods: The CLIP trials took place in India, Pakistan, and Mozambique, enrolling pregnant women aged 12-49 years between Nov 1, 2014, and Feb 28, 2017. 69 330 pregnant women were enrolled in 44 clusters (36 008 in the 22 intervention clusters and 33 322 in the 22 control clusters). In this secondary analysis of maternal deaths in CLIP, we included women who died in any of the 22 intervention clusters or 22 control clusters. Trained staff administered the WHO 2012 verbal autopsy after maternal deaths. Two physicians (and a third for consensus, if needed) reviewed trial surveillance data and verbal autopsies, and, in intervention clusters, community health worker-led visit data. They determined cause of death according to the WHO International Classification of Diseases-Maternal Mortality (ICD-MM). Verbal autopsies were also analysed by InterVA computer models (versions 4 and 5) to generate cause of death. COMCAT analysis was provided by InterVA-5 and, in India, by physician review of Maternal Newborn Health Registry data. Causes of death and COMCATs assigned by physician review, Inter-VA-4, and InterVA-5 were compared, with agreement assessed with Cohen\u27s κ coefficient.Findings: Of 61 988 pregnancies with successful follow-up in the CLIP trials, 143 maternal deaths were reported (16 deaths in India, 105 in Pakistan, and 22 in Mozambique). The maternal death rate was 231 (95% CI 193-268) per 100 000 identified pregnancies. Most deaths were attributed to direct maternal causes (rather than indirect or undetermined causes as per ICD-MM classification), with fair to good agreement between physician review and InterVA-4 (κ=0·56 [95% CI 0·43-0·66]) or InterVA-5 (κ=0·44 [0·30-0·57]), and InterVA-4 and InterVA-5 (κ=0·72 [0·60-0·84]). The top three causes of death were the same by physician review, InterVA-4, and InterVA-5 (ICD-MM categories obstetric haemorrhage, non-obstetric complications, and hypertensive disorders); however, attribution of individual patient deaths to obstetric haemorrhage varied more between methods (physician review, 38 [27%] deaths; InterVA-4, 69 [48%] deaths; and InterVA-5, 82 [57%] deaths), than did attribution to non-obstetric causes (physician review, 39 [27%] deaths; InterVA-4, 37 [26%] deaths; and InterVA-5, 28 [20%] deaths) or hypertensive disorders (physician review, 23 [16%] deaths; InterVA-4, 25 [17%] deaths; and InterVA-5, 24 [17%] deaths). Agreement for all nine ICD-MM categories was fair for physician review versus InterVA-4 (κ=0·48 [0·38-0·58]), poor for physician review versus InterVA-5 (κ=0·36 [0·27-0·46]), and good for InterVA-4 versus InterVA-5 (κ=0·69 [0·59-0·79]). The most commonly assigned COMCATs by InterVA-5 were emergencies (68 [48%] of 143 deaths) and health systems (62 [43%] deaths), and by physician review (India only) were health systems (seven [44%] of 16 deaths) and inevitability (five [31%] deaths); agreement between InterVA-5 and physician review (India data only) was poor (κ=0·04 [0·00-0·15]).Interpretation: Our findings indicate that InterVA-5 is less accurate than InterVA-4 at ascertaining causes and circumstances of maternal death, when compared with physician review. Our results suggest a need to improve the next iteration of InterVA, and for researchers and clinicians to preferentially use InterVA-4 when recording maternal deaths.Funding: University of British Columbia (grantee of the Bill & Melinda Gates Foundation)

The feasibility of community level interventions for pre-eclampsia in South Asia and sub-saharan Africa: A mixed-methods design

Background: Globally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials prior to implementation. Failure to fully understand the study context risks the effective implementation of the intervention and limits the likelihood of post-trial scale-up. Therefore, it was imperative to conduct community-level feasibility assessments for a trial of this magnitude.Methods: A mixed methods design guided by normalization process theory was used for this study in Nigeria, Mozambique, Pakistan, and India to explore enabling and impeding factors for the CLIP Trial implementation. Qualitative data were collected through participant observation, document review, focus group discussion and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility assessments, self-administered community health worker surveys, and household demographic and health surveillance.Results: Refer to CLIP Trial feasibility publications in the current and/or forthcoming supplement.Conclusions: Feasibility assessments for community level interventions, particularly those involving task-shifting across diverse regions, require an appropriate theoretical framework and careful selection of research methods. The use of qualitative and quantitative methods increased the data richness to better understand the community contexts

Economic and cost-effectiveness analysis of the community-level interventions for pre-eclampsia (CLIP) trials in India, Pakistan and Mozambique

Background: The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014-2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.Methods: Included were all women enrolled in the three CLIP trials who had delivered with known outcomes by trial end. According to the number of POM-guided home contacts received (0, 1-3, 4-7, ≥8), costs were collected from annual budgets and spending receipts, with inclusion of family opportunity costs in Pakistan. A decision tree model was built to determine the cost-effectiveness of the intervention (vs usual care), based on the primary clinical endpoint of years of life lost (YLL) for mothers and infants. A probabilistic sensitivity analysis was used to assess uncertainty in the cost and clinical outcomes.Results: The incremental per pregnancy cost of the intervention was US$12.66 (India), US$11.51 (Pakistan) and US$13.26 (Mozambique). As implemented, the intervention was not cost-effective due largely to minimal differences in YLL between arms. However, among women who received ≥8 CLIP contacts (four in Pakistan), the probability of health system and family (Pakistan) cost-effectiveness was ≥80% (all countries).Conclusion: The intervention was likely to be cost-effective for women receiving ≥8 contacts in Mozambique and India, and ≥4 in Pakistan, supporting WHO guidance on antenatal contact frequency.Trial registration number: NCT01911494