Clinico-biochemical profile and etiology of acute viral hepatitis in hospitalized children: A study from Eastern India

Background: Acute viral hepatitis (AVH) in children continues to be a major public health problem in India. Objective: To identify the etiology, and to assess the clinical and biochemical profile, complications and outcome of AVH in children. Materials and Methods: A total of 76 children with the clinical diagnosis of AVH were included in this record based retrospective study from January 2014 to August 2016. Data on clinical characteristics, laboratory parameters, immediate outcome, and treatment received were obtained, and analysis was performed. Results: Specific etiological agents were identified in 84.2% children. Out of these, 93.7% were due to a single virus, whereas 6.3% were due to mixed infection. Hepatitis A virus (HAV) was found to be the sole infecting agent in 75% children. Hepatitis B virus (HBV) and hepatitis E virus (HEV) were found in 12.5% and 6.2% children, respectively. Mixed infection was seen in the form of HAV and HEV in 3.1%, and HAV and HBV in 3.1%. The mean age of children with hepatitis A was 8.29±2.74 years, with 70.8% boys and 29.2% girls. Common clinical features were jaundice (95.8%), loss of appetite (95.8%), tender hepatomegaly (68.8%), fever (50%), vomiting (50%), pain abdomen (33.3%), splenomegaly (31.2%), itching (27.1%), bleeding (2.1%), and seizure (2.1%). Acute liver failure was seen in 4.1% and 2% of admitted children died. The mean age of presentation of AVH due to HBV and HEV were 10.7±2.6 years and 10±2.2 years, respectively. Clinical features were similar without any complications or mortality. Significant elevations in hepatic enzymes were seen in mixed infection due to HAV and HEV (p<0.05). Conclusion: HAV is the primary cause of morbidity and mortality due to AVH in this region. HBV and HEV infection may present with similar clinical features, and serological testing must be done to identify the cause

Mobile health application based intervention for improvement of quality of life among newly diagnosed type 2 diabetes patients

Background. Diabetes and its complications arebecominga major threat to public health. Quality of lifeamong diabetes patients is not optimum.Objective. To know the usefulness of the mobile healthapplication for improvement of QoL and diabetes selfmanagementactivities of the type 2 diabetes patients. Methods. The present study was conducted in a tertiarycare hospital for 2 years from October 2016 to October2018. In this study, 66 newly diagnosed type 2 diabetespatients, educated, techno-friendly smart phone users,aged between 18–60 years, were included. Theywere allocated to intervention and control group byblock randomization method. Intervention group wasallotted to use the android application and controlgroup was allotted to use the website. The data wereimported and analyzed by SPSS v 20. Results. Overall quality of life and general health was70.26 ± 16.51; for physical health it was 59.52 ± 7.15,for psychological it was 63.38 ± 9.2, for social relationsit was 74.87 ± 13.98 and for environment it was 71.87 ±± 8.38. The score of overall quality of life was increasedin both control and intervention group during follow-ups.It was found that there was significant improvement inglucose management, dietary control, physical activity,health care use and sum score. Wilk’s lambda was significantfor HbA1c both in control and intervention group. Conclusions. Mobile-based applications with focusingon diabetes self-management education may supportto reduce the complications of diabetes and improvethe QoL of diabetes patients

Mapping Concurrent Wasting and Stunting Among Children Under Five in India: A Multilevel Analysis

Objectives: The study aims to examine the coexisting forms, patterns, and predictors of concurrent wasting and stunting (WaSt) among children under five in India.Methods: We used data from the National Family Health Survey to understand the trend and association of WaSt among children under five-year-old in India. Univariate analysis and cross-tabulations were performed for WaSt cases. The association was determined using multilevel binary logistic regression and multilevel regression, and the results were provided as adjusted odds ratios (aOR) with 95% confidence intervals at the significance level of p < 0.05.Results: The prevalence of WaSt has decreased from 8.7% in 2005–06 to 5.2 percent in 2019–2020. The proportion of WaSt children grew rapidly from 6 to 18 months, peaked at 19 months (8%), then dropped after 24 months. The prevalence of concurrent wasting and stunting is higher among boys compared to girls. Compared to children of different birth orders, those in the higher birth order are 1.2 times more likely to be WaSt cases (aOR = 1.20, 95% CI = 1.09, 1.33). The education of the mother is strongly correlated with WaSt instances, and children of more educated mothers have a 47% lower chance of being WaSt cases (aOR = 0.63, 95% CI = 0.57, 0.71). Children from wealthy families are 52% less likely to be WaSt cases (aOR = 0.48, 95% CI = 0.43, 0.55).Conclusion: This study emphasizes the importance of concurrent wasting and stunting and its relationship with socioeconomic factors among children under five in India

Gender differentials in prevalence and distribution of BMI categories among older adults in various strata of society in India

The study aims to estimate the prevalence of underweight, overweight and identified the gender differentials among various strata of 50 years and above older populations in India. A national representative cross-sectional data of n=7273 older adults from WHO’s Study on global AGEing and adult health (SAGE wave1) India, was used. Underweight was defined as body mass index (BMI) <18.5 Kg/M2 and >25 Kg/M2 as overweight. A wealth index was created by cumulating the inverse proportion rate of assets acquired by individuals. The various stratifying axes comprised age, caste, and wealth. Bi-variable cross-tabulation with Chi-squared tests was used to test the differences in the distribution of nutritional status across various strata. 35.5% were underweight, 49.7% were normal weight and 14.7% were overweight. Most women were overweight (10.9% men~18.6% women, p<0.001), and fewer women were underweight (36.5% men~34.5% women, p<0.001) reflecting a gendered difference in nutritional status. Further, there was a dose-response relationship in nutritional status. The distribution across the caste groups was significantly graded, privileged being more overweight and less privileged being underweight. A similar pattern of hierarchical difference was seen for the wealth index

End-of-life care and social security issues among geriatric people attending a tertiary care hospital of Eastern India

Context: The care of sick members is the hallmark of a civilized society. End-of-life care and social security for elderly are emerging issues nowadays. Aims: The aim of this study is to explore the desires of the elderly regarding the end-of-life care decisions along with to find out social security measures among the study population. Settings and Design: The cross-sectional study conducted in the geriatric outpatient department of a tertiary care hospital. Subjects and Methods: The study period was 4 months from August to November 2017. The geriatric patients attending geriatric outpatient department were interviewed using a predesigned and pretested questionnaire. Convenient sampling was used and a total of 138 participants were included in the study. Statistical Analysis Used: Proportions were used in the study. Results: A total of 63.77% participants expected to die at home surrounded by their family members during their time of death followed by hospital (31.88%). Majority (63.77%) stated their opinions to die a senile death. Organ donation after death was the willingness shown by as high as 70.3%, but registered organ donors were 6.5%. 94.2% participants expected to be cremated after their death while others buried in accord to their religious practices. Only 7.24% of participants had a legal will of their financial establishments. It was observed that even half of the population (47.8%) did not have any form of health or life insurance. Conclusion: Home-based care of the elderly is needed so that they can live their last days of life peacefully. Awareness about health and life insurance should be increased by urgent intervention

ASSOCIATION OF SELECTED RISK FACTORS OF CORONARY HEART DISEASE WITH LIPID PROFILE

 Objective: The objectives of this study is to assess the association of selected risk factors for coronary heart disease (CHD) with lipid profile.Methods: A cross-sectional study was conducted during May 2013–April 2014 among 350 subjects of 25–64 years selected by systematic random sampling. Data on sociodemographic and medical and personal history along with anthropometric measurements were collected through house-to-house visit. Blood sample was analyzed for fasting blood sugar and lipid profile.Results: In this study, 38.58% belong to the age group of 25–35 years and 58% were female. Majority (45.43%) of the participants belonged to lower socioeconomic status, followed by the middle (40.57%) and upper class (14%). It was observed that total cholesterol was significantly associated with blood sugar (p=0.0008), blood pressure (p=0.001), and body mass index (BMI) (p=0.018). There was no significant association among the risk factors of CHD such as smoking and alcohol with total cholesterol. Low-density lipoprotein level was significantly associated with BMI (p=0.0001) and blood sugar (p=0.003). There was a significant association among the risk factors for CHD such as smoking (p=0.002), alcohol, (p=0.017) blood sugar (p=0.004), and BMI (p=0.014) with triglyceride level.Conclusion: It was concluded from this study that various risk factors for CHD were associated with lipid abnormalities. Hence, a community-based education in this regard is of paramount importance

Socioeconomic Inequalities in the Prevalence of Non-Communicable Diseases among Older Adults in India

Understanding socioeconomic inequalities in non-communicable disease prevalence and preventive care usage can help design effective action plans for health equality programs among India’s aging population. Hypertension (HTN) and diabetes mellitus (DM) are frequently used as model non-communicable diseases for research and policy purposes as these two are the most prevalent NCDs in India and are the leading causes of mortality. For this investigation, data on 31,464 older persons (aged 60 years and above) who took part in the Longitudinal Ageing Survey of India (LASI: 2017–2018) were analyzed. The concentration index was used to assess socioeconomic inequality whereas relative inequalities indices were used to compare HTN, DM, and preventive care usage between the different groups of individuals based on socioeconomic status. The study reveals that wealthy older adults in India had a higher frequency of HTN and DM than the poor elderly. Significant differences in the usage of preventive care, such as blood pressure/blood glucose monitoring, were found among people with HTN or DM. Furthermore, economic position, education, type of work, and residential status were identified as important factors for monitoring inequalities in access to preventive care for HTN and DM. Disparities in non-communicable diseases can be both a cause and an effect of inequality across social strata in India

Interwencja oparta na mobilnej aplikacji zdrowotnej w celu poprawy jakości życia u nowo zdiagnozowanych chorych na cukrzycę typu 2

WSTĘP: Cukrzyca i jej powikłania stają się poważnym zagrożeniem dla zdrowia publicznego. Jakość życia chorych na cukrzycę nie jest optymalna. Celem pracy była ocena przydatności mobilnej aplikacji zdrowotnej do poprawy jakości życia i samoopieki u pacjentów z cukrzycą typu 2. METODY: Niniejsze badanie przeprowadzono w szpitalu specjalistycznym przez okres 2 lata, od października 2016 roku do października 2018 roku. Do badania włączono 66 pacjentów z nowo rozpoznaną cukrzycą typu 2, wykształconych, znających nowoczesne technologie użytkowników smartfonów, w wieku od 18 do 60 lat. Uczestników badania przydzielono do grupy eksperymentalnej lub do grupy kontrolnej, stosując metodę randomizacji blokowej. Osoby w grupie eksperymentalnej korzystały z aplikacji na urządzenia z systemem operacyjnym Android, a grupie kontrolnej ze strony internetowej. Dane zostały zaimportowane i przeanalizowane przez SPSS v 20. WYNIKI: Ocena ogólnej jakość życia i ogólnego stanu zdrowia wynosiła 70,26 ± 16,51; ocena zdrowia fizycznego 59,52 ± 7,15, psychicznego 63,38 ± 9,2, relacji społecznych 74,87 ± 13,98, środowiska 71,87 ± 8,38. W okresie obserwacji ocena ogólnej jakości życia wzrosła zarówno w grupie kontrolnej, jak i eksperymentalnej. Stwierdzono, że nastąpiła znaczna poprawa w zakresie kontroli glikemii, diety, aktywności fizycznej, korzystaniu z opieki zdrowotnej i wyniku sumarycznego. Współczynnik lambda Wilka był istotny w odniesieniu do HbA1c zarówno w grupie kontrolnej, jak i eksperymentalnej. WNIOSKI: Aplikacje mobilne służące edukacji w zakresie samoopieki w cukrzycy mogą się przyczynić się do zmniejszenia częstości powikłań cukrzycy i poprawy jakości życia pacjentów z cukrzycą

Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

Introduction The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.Methods Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020–October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.Results Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30–60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6–7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).Conclusion Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality