Clinical profile and outcome of snakebite in children at tertiary care centre in Hyderabad, India: a hospital based prospective observational study

Background: Snakebite is generally considered medical emergencies in many parts of the world, particularly in the rural population, and has been linked with the environmental and occupational conditions. Agricultural workers and pediatric groups are most affected in Southeast Asia especially India. This study was conducted to analyze the clinical profile, complications, and outcome of snakebite that will help in the prevention and treatment intervention in the pediatric population. Methods: The present study was conducted at the pediatric tertiary center, Niloufer Hospital, Osmania Medical College, Hyderabad, India during the period of 1 year from January 2019 to December 2019. A total of 59 cases of snakebite were admitted to the pediatric department during the study period. After obtaining consent, data were analyzed for demographic data and other variables included are the site of the bite, time of the bite, time of arrival to hospital and type of snake, features of hematotoxicity and neurotoxicity, ASV requirement, complications, and outcome. Results: Out of a total of 59 patients, 55.93% were male and most of the Snakebites were seen in the age group of 7-12 years. Clinically 48(81.35%) patients presented with signs and symptoms of envenomation and most of them were bitten during the months of June to July. Greater number of bites were unknown Snakebites and lower limb(57.62%) was the commonest site of the bite. Most of the Snakebites i.e. 23(38.98%) happened during evening time and 15 (25.42%) cases during night time. Most of the patients were primarily treated by medical personnel. Majority of patients (32.03%) developed clinical manifestations in 30 min to 1-hour duration followed by 13 cases (22.03%) within 30 min. Majority of patients (38.98%) arrived at the hospital in 3-6 hours. During hospital treatment, 79.66% of victims received anti-snake venom (ASV). Mechanical ventilation required in 12 cases (20.33%) in which the majority of cases (8.47%) were unknown Snakebites. The most common complication was cellulitis (20.33%) followed by respiratory paralysis/coma (15.25%) and coagulopathy (6.77%). Abdominal pain was observed in 11 (18.64%) cases and Abdominal pain was co-existed with neuromuscular paralysis ( 90.90%). Acute kidney injury was seen in 1 case (1.69%). Conclusion: The most endangered group of children for Snakebites are boys aged more than 6 years. As most of the bites take place in lower limbs during evening hours, avoidance of outdoor activities, and protective clothing may significantly reduce the incidence of Snakebites. The presence of abdominal pain followed by neurotoxicity suggesting that pain abdomen is a potentially early feature of snakebite envenomation. Community education about prevention and first aid treatment, early transport, and admission in a hospital with good equipment will reduce the mortality from the snakebit

Epidemiological investigation of a food poisoning outbreak: a study among hostel dwelling students and resident doctors of a tertiary healthcare facility of India

Background: During second week of February, 2021 several cases of food poisoning were reported from hostels of a tertiary healthcare facility, thus this epidemiological investigation was undertaken, to confirm existence of a food poisoning outbreak, describe cases as per person, place, time and predominant food source, identify the attributes associated with the outbreak. Methods: To investigate the suspected food poisoning outbreak, an online unmatched case control study was conducted among 440 hostel dwelling students and resident doctors of a tertiary healthcare facility of eastern India during February, 2021. Results: The proportion of the study subjects who reported to have experienced food poisoning symptoms was 23.9%. Most of the food poisoning event reported to have occurred during 10th February, 2021 (26.6%). In the multivariable logistic regression model, predominant consumption of food from girls’ hostel mess [adjusted odds ratio (AOR): 7.83 (1.58-38.79)] and canteen 1 [AOR: 4.83 (1.13-20.69)] were found to be multivariable predictors of food poisoning events adjusted with age, gender, designation and residing hostel. Conclusion: One in every four study participants opined to have experienced food poisoning symptoms during the study period. This confirmed the existence of a multi-source food poisoning outbreak in the study population

Does BCG vaccine prevent contract and severity of COVID-19 infection in India? A situational analysis

Background: The COVID-19 pandemic has created worldwide emergency with morbidities, mortality and panic. The BCG vaccine, usually given to prevent childhood tuberculosis, surfaced as an option as suggested by some ecological observations. However, some others studies could not establish and explain the protective effects of BCG vaccination against COVID-19 pandemic. India is one country with high BCG vaccination coverage and is among the countries with lowest COVID-19 case fatality rate. Aims and Objectives: We examine the relationship between the BCG coverage and COVID-19 burden in various states/UTs of India. Materials and methods: The information on BCG coverage and morbidity and mortality of COVID-19 was obtained from NFHS and www.covid19India.org respectively. Results: The analysis suggested very weak positive relationship of BCG coverage with cases and deaths due to COVID-19. Moderate positive relationship was observed between BCG coverage and COVID-19 case fatality rate even after adjusting for health system performance. Conclusion: The conclusion of the study is against the role of BCG vaccination in containing the COVID-19 pandemic. The positive correlation which is not significant may be spurious and affected by many confounding factors like co-morbid conditions, testing strategies, population level immunity for other viral infections etc. Hence, the states and UTs should not be complacent by the hypothesized role of BCG vaccine in COVID-19 control. Rather, they should continue with the principles of social distancing, contact tracing, treating and surveillance of COVID-19

Pattern of Tobacco Use and Perceived Risk of COVID-19 Following Tobacco Use among the COVID-19 Patients of a Tertiary Health Care Institution in Eastern India

Background: COVID-19 presented an unprecedented situation in which behavioural factors including tobacco use were believed to increase the risk of morbidity and mortality. The objective of the present study was to find the tobacco use pattern among the COVID-19 patients and the perceived risk of developing severe COVID-19 following tobacco use.Methods: This hospital-based, cross-sectional, analytical study was conducted among 300 COVID-19 patients at the All India Institute of Medical Sciences (AIIMS), Patna, India, during November and December 2020 using a semi-structured, pretested questionnaire. Descriptive and univariate analyses were performed using statistical software and the results were presented as proportion and percentage.Findings: About 27% and 16% of the COVID-19 patients were ever and current tobacco users, respectively. Quit attempts were found to have increased during the COVID-19 pandemic. A majority (65%) of current tobacco users had reduced their amount of tobacco use. Nearly 2 in every 3 patients perceived high risk of developing severe COVID-19 following tobacco use. Perceived risk was significantly higher among tobacco non-users, patients who were aware of the ill health effects of tobacco use, and patients who had noticed anti-tobacco messages or had been advised to quit tobacco. Among the current tobacco users, a significantly higher proportion of patients who perceived high risk of developing severe COVID-19 following tobacco use had made quit attempts or had reduced tobacco consumption during the pandemic (76.7% vs. 40%; P = 0.032).Conclusion: A high proportion of COVID-19 patients believed that tobacco use aggravated the COVID-19 condition. Increased quit attempts and reduction in tobacco consumption during this pandemic is a positive sign for tobacco contro

Capacity building among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs): Findings of an implementation study from Bihar, India

Background: Community-based screening is one of the key preventive strategies to tackle the ever-rising burden of non-communicable diseases (NCDs) under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Objective: The current study was aimed to build capacity among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs) under NPCDCS in the selected districts of Bihar state. Methodology: This was an implementation study with follow-up components, conducted among 75 FHWs [14 auxiliary nurse midwives (ANMs) and 61 accredited social health activists (ASHAs)] from 15 primary healthcare facilities across four districts of Bihar state from October 2019 to September 2021. The selected FHWs were initially trained on NPCDCS for a day, including pre- and post-training knowledge assessment. Then, supportive supervision (SS) visits using a predesigned questionnaire were done. Results: The pre- and post-training mean knowledge scores of the FHWs were 12.9 and 22.1, respectively, with an overall effect size of 2.5. During SS visits, only 20.0% of the visited primary healthcare facilities had all the required logistics to conduct weekly NCD screening clinics for CVDs. Considering different measurements and operative skill proficiencies of FHWs, waist circumference skills (41.7% for ANMs and 50.8% for ASHAs), followed by blood pressure (BP) (41.7%) and random blood sugar (RBS) measurement (25.0%), were found to be the most deficient skills (among ANMs). Moreover, the quality of initial and follow-up home visits was found to be satisfactory for only 54.1% of the ASHAs. The reported barriers of NCD screening were reported to be non-cooperation, unawareness among community dwellers, lack of knowledge and skill of FHWs, logistic constraints and delayed honorarium credit. Conclusion: One-day training on NCDs for FHWs was quite effective. However, for translating all the desired skills for CVD screening into action, periodic training needs assessment, and SS of FHWs might be fruitful

Assessment of quality of life in children with nephrotic syndrome at a teaching hospital in South India

This study was conducted to assess the quality of life (QOL) in children between 2 and 18 years of age with primary idiopathic nephrotic syndrome (NS) using Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core Scales). This cross-sectional comparative study was conducted at a tertiary care hospital in South India between December 2014 and February 2015. In this questionnaire-based study, 50 children with primary idiopathic NS and an equal number of age-matched controls with other chronic ailments were recruited. Their clinical and demographic details were recorded, and QOL was assessed using PedsQL 4.0 Generic Core Scales. The median (interquartile range) total QOL score in children with NS [65 (59–68.75)] was found to be higher compared to controls [62.19 (58.05–65.78)] (P = 0.012). Children with NS had significantly higher QOL scores in physical (P = 0.004), emotional (0.029), and social functioning (0.010) domains as compared to controls; however, the school performance was not different from controls. The QOL scores did not significantly differ between the various clinical pheno- types of NS. Demographic details such as age, gender, duration of illness, and steroid resistance did not significantly influence the total QOL scores among the nephrotic children. The present study shows that the overall QOL in children with NS was better than in children with other chronic illnesses. Further studies are needed to confirm these findings and explore the underlying cause of poor school performance

Level of tobacco dependence among tobacco users in an urban slum of Puducherry: A pilot study

Context: Successful tobacco quit by the tobacco users can avoid millions of premature death. However, the physical dependence on tobacco use results in frequent relapse most commonly due to withdrawal symptoms. Aims: The aim of this study was to study the level of tobacco dependence among tobacco users in an urban slum of Puducherry. Materials and Methods: This facility-based descriptive pilot study was conducted among patients aged 15 years or above attending an urban health and training center in an urban slum of Puducherry. A total of 90 consecutive current tobacco users were included after obtaining verbal informed consent and interviewed using a pretested questionnaire. The information on tobacco dependence was collected using Fagerstrom Addiction Scale for smokers and smokeless tobacco users separately. Results: Of the 90 current tobacco users, 95% were daily tobacco users. Of the current tobacco users, 48.8%, 45.6%, and 5.6% were smokers, smokeless tobacco users, and dual users, respectively. Majority of the smokers (61%) and most of the smokeless tobacco users (41%) had medium dependence for tobacco use. However, physical dependence was much higher among smokeless tobacco users (41.3%) than smokers (20.4%). Conclusion: Proportionately high physical dependence on tobacco is a concern in the study population. Community-based interventions are required to curb the problem; however, study with representative sample should be carried out before that

Willingness to quit tobacco smoking and its correlates among Indian smokers - findings from GATS India, 2009 - 10

Background In the behavioural change model for smoking cessation 'willingness to quit' forms the starting point. Identifying these sects of smokers who are willing to quit can lead to important policy development and program implementation in any country. To determine the prevalence and correlates of willingness to quit among smokers in India from Global Adult Tobacco Survey (GATS), 2009-10. Methods Secondary data analysis of GATS, 2009-10 was done to find the correlates of willingness to quit among smokers. All the socio-demographic variables, smoking related factors like frequency, previous attempt to quit and also effect of anti-tobacco messages delivered to various media were tested for association using multivariate analysis. Prevalence rate ratio with 95% CI was used to report the risk. Results Of the 9627 current smokers analysed, 50.9% (95% CI: 49.9% to 51.9%) were willing to quit smoking. Among these; 25.1% and 26.0% were willing to quit within the next month and within next 12 months respectively. Multivariate analysis showed that younger age, individuals who have their first smoke after 60 minutes of wakeup, those living in a house with smoking restriction, those who received advice to quit from doctor, those who attempted to quit in the past 12 months, having knowledge about illness caused due to smoking and those who have noticed anti-smoking messages in billboards / hoardings were willing to quit smoking compared to their counterparts. Conclusions About one in two smokers were willing to quit smoking and, among those who were willing to quit, half of them were willing to do so within the next one year. Targeted interventions can be planned in the sub-groups identified