Perspective of self-help groups, Panchayati Raj institution and adolescents on implementing COVID appropriate behavior in the community in rural settings

The vaccination drive in India brought cheers to the country's people, only to be eroded by the unpredictable twitch of the COVID-19 second wave. The best way to tackle the pandemic has been to adopt appropriate practices, thereby breaking the chain of transmission. The second wave in India has already created havoc both on the people and health system, questioning and challenging our capabilities to handle any heave of sudden cases, particularly in rural areas. Time has arrived to inflate our horizon by including groups of society close to the people, particularly in the rural community. Like the previous wave, COVID appropriate behavior was very much instrumental in slowing the pace. Adolescents’ self-help groups in coalition with Panchayat Raj Institutions (PRI) will be the main stand in the fight against the dreadful virus. Their main role is to translate the prevailing preventive measures into action among the very people they live around. Passing the right message through IEC/BCC to the right people will bring about dramatic changes in the attitude, belief, and exercise they do in their day-to-day life. PRIs members would utilize their powers to execute optimum administrative services. A decentralized approach involving these stakeholders will spearhead the fight against the pandemic. This trifold power shall bear the torchbearer in preventing the disastrous consequences of any upcoming wave, if any, in a holistic manner

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Role of self-directed learning in pedagogy – Current scenario of competency-based medical education

Self-directed learning (SDL) is a learning procedure among participants where they understand their learning goals, formulate them, and identify resources for learning. There are four key steps of SDL. SDL allows learners to be more effective learners and social beings through peer group discussions. Hence, it helps develop innovative ideas and valuable insights. The COVID-19 pandemic has caused a significant paradigm shift in teaching–learning methods. The self-paced online courses are appeared to be a crucial part in learning during the pandemic. Those courses are somehow interlinked with the principles of SDL, thus SDL can be a boon in the current scenario with the COVID-19 pandemic. However, lack of independence and self-motivation forms a major barrier to SDL learning. The lack of a healthy relationship between the teachers/instructors and students and adequate technology might also affect the adoption of SDL. SDL will attain a massive success with the availability of adequate resources and technology and their effective utilization

Theory and practice of learning through the family adaptation and field visits in medical school: A reflective perspective

The major purpose of posting MBBS students in community medicine is to understand the ground realities of different existing problems leading to the disease. The students chalk out possible solutions using the available resources and transform the solution to an intervention explicitly designed for the family or individual. Family Health Advisory Services provides a platform to learn the above intent, make family visits in the community, reach a community diagnosis associated with various prevailing and contributing factors, and finally formulate a structured and specific elucidation to root out the disease or health condition. The village visit during the posting in the department of community medicine is crucial for making the preventive and promotive steps before the arrival of ill-health conditions. It also thrills the motive of different schemes and programs by state and central government in their approach and consequence if appropriately and adequately implemented in the anticipated circumstance and situation. The current article explores how a student utilizes community posting to go deep into a family's running and prevailing problems, identify the responsible and probable causes, and find a feasible and possible solution concerning the family's affordability, accessibility, and acceptability

Antibacterial Activity and Anticorrosive Efficiency of Aqueous Methanolic Extract of Artemisia pallens (Asteraceae) and its major Constituent

An aqueous-methanolic [methanol:water (1:1)1 extract of the whole plant of Artemisia pallens (Family: Asteraceae) has shown good antibacterial activity against Pseudomonas aeruginosa and Shigella flexneri at the concentration of 100 mg/mL. The activity-guided fractionation has led to isolation of compound 4-hydroxyphenyl-/3-D-glucopyranoside (which is known as arbutin), as a major constituent and exhibited the same antibacterial activity at a concen-tration of 17 mg/mL. Both the crude extract and arbutin also showed 94% anticorrosive efficiency against mild steel in 1M HC1 at concentration of 200 mg/L

Characteristics and predictors of Long COVID among diagnosed cases of COVID-19.

BackgroundLong COVID or long-term symptoms after COVID-19 has the ability to affect health and quality of life. Knowledge about the burden and predictors could aid in their prevention and management. Most of the studies are from high-income countries and focus on severe acute COVID-19 cases. We did this study to estimate the incidence and identify the characteristics and predictors of Long COVID among our patients.MethodologyWe recruited adult (≥18 years) patients who were diagnosed as Reverse Transcription Polymerase Chain Reaction (RTPCR) confirmed SARS-COV-2 infection and were either hospitalized or tested on outpatient basis. Eligible participants were followed up telephonically after four weeks and six months of diagnosis of SARS-COV-2 infection to collect data on sociodemographic, clinical history, vaccination history, Cycle threshold (Ct) values during diagnosis and other variables. Characteristics of Long COVID were elicited, and multivariable logistic regression was done to find the predictors of Long COVID.ResultsWe have analyzed 487 and 371 individual data with a median follow-up of 44 days (Inter quartile range (IQR): 39,47) and 223 days (IQR:195,251), respectively. Overall, Long COVID was reported by 29.2% (95% Confidence interval (CI): 25.3%,33.4%) and 9.4% (95% CI: 6.7%,12.9%) of participants at four weeks and six months of follow-up, respectively. Incidence of Long COVID among patients with mild/moderate disease (n = 415) was 23.4% (95% CI: 19.5%,27.7%) as compared to 62.5% (95% CI: 50.7%,73%) in severe/critical cases(n = 72) at four weeks of follow-up. At six months, the incidence among mild/moderate (n = 319) was 7.2% (95% CI:4.6%,10.6%) as compared to 23.1% (95% CI:12.5%,36.8%) in severe/critical (n = 52). The most common Long COVID symptom was fatigue. Statistically significant predictors of Long COVID at four weeks of follow-up were-Pre-existing medical conditions (Adjusted Odds ratio (aOR) = 2.00, 95% CI: 1.16,3.44), having a higher number of symptoms during acute phase of COVID-19 disease (aOR = 11.24, 95% CI: 4.00,31.51), two doses of COVID-19 vaccination (aOR = 2.32, 95% CI: 1.17,4.58), the severity of illness (aOR = 5.71, 95% CI: 3.00,10.89) and being admitted to hospital (Odds ratio (OR) = 3.89, 95% CI: 2.49,6.08).ConclusionA considerable proportion of COVID-19 cases reported Long COVID symptoms. More research is needed in Long COVID to objectively assess the symptoms and find the biological and radiological markers

Clinical features and management of acute illness of COVID-19 among participants (n = 487).

Clinical features and management of acute illness of COVID-19 among participants (n = 487).</p