Structure and Process Evaluation of Cold Chain Management and Routine Immunization Services in Rural Western Gujarat

Maintenance of cold chain points are vital for preserving potency of vaccines for immunization of children and thereby averting vaccine preventable diseases in the community. Cold chain handlers should have sufficient knowledge and skills related to cold chain equipment handling and immunization practices.  The present study aims to evaluate maintenance of cold chain facilities at primary health care centers (PHCs), related logistics and observation of Mamta Day (Immunization Day). The observations include knowledge and practice of health workers about immunization activities, their communication skills, training status etc. Methods: There are total 31 Primary Health Centers in Jamnagar district, out of which, we decided to include 50% (15) of primary health centers and observed their cold chain, and Immunization day at a subcentre or Anganwadi centre of the selected PHC to assess the quality of immunization services. We included equal number of cold chain points from each block of the district to make it representative of entire district. Results:  Average population served by a cold chain point is 21985. Vaccine related logistics like cold boxes, vaccine carriers etc. were adequate in all facilities. All cold chain equipments were placed as per standard guidelines. The posts of medical officers and pharmacists were vacant in almost one fourth of cold chain points and they were run on deputation from other facilities. The knowledge and skills of health workers related to immunization practices were found to be satisfactory. Conclusion:  We observed that routine immunization program was implementing in the district satisfactorily. The posts of medical officers and pharmacists need to be filled up at the earliest for smooth functioning of immunization program in primary health centres

Problems faced by ASHA workers for malarial services under NVBDCP: a cross sectional study

Background: About 95% of the country’s population resides in malaria endemic areas. The NVBDCP is multi-faceted public health programme in the country. The NVBDCP became an integral part of the NRHM launched in 2005. In NRHM, ASHA worker should be placed at grass root level. So role of ASHA is critical at grass root level. Problems faced by ASHA, it will affect the performance. So, ASHA workers positioned at village, Population catered by them, education, work experience, problems related to incentive and any other problems should be considered. The primary objective was to know the problems faced by ASHA workers for malarial services under NVBDCP in Jamnagar district.Methods: A cross-sectional study was conducted in rural areas of the district by using multistage sampling.Results: There was vacant post of ASHA in one village of low performing sub-centre. ASHA having work experience of less than one year was concentrated in poor performing sub-centre villages. More than one third ASHA served > 2000 population and more than half of them belonged to low performing sub centres. Around one sixth ASHA workers had difficulty in getting incentive or any problems. Majority of them belonged to low performing sub centres-villages.Conclusions: Main identified problems were some areas were far to reach by them, getting incentive for work and populations catered by them were too high. Most of them belonged to low performing sub centre-villages. All of above findings had affected the performance of ASHA workers.

A Study on the Pattern of Self-reported Tobacco Addiction in Hypertensive Patients in Gujarat, India

Background: Both hypertension (HTN) and tobacco addiction pose a threat to the health, environment, and socioeconomic status (SES) of the people. When tobacco use disorder exists in people with HTN, it hastens the disease progress and causes early complications. The present study aimed to study the knowledge and practice of tobacco addiction in patients with HTN and find out the correlates of knowledge and practice of tobacco addiction. Methods: A cross-sectional study was conducted for a period of one year in the Jamnagar District of Western Gujarat, India. Out of total 400 samples, 50% were collected from the five selected Community Health Centers (CHCs) by random sampling and the rest from non-communicable disease (NCD) clinics at the tertiary care hospital of the district. Findings: Most of the patients were in their fifties or above (67.0%), women (57.0%), and married (86.5%). Only 12.0% had awareness about the hazards of tobacco addiction and the prevalence of tobacco addiction was 11%. It was found that use of smokeless tobacco (SLT) among samples was the highest (72.7%) followed by dual consumption, i.e., SLT and smoking (20.5%). The frequency of consumption was ≥ 5 times/day in 54.5%, 70.4% were addicted for > 10 years, and only 15.9% had ever tried to quit tobacco while only 11.4% had successfully quit it. It was seen that those who were aged < 50 years, men, literates, employed, and those belonging to higher SES and urban residence had better knowledge of the health hazards. This was found to have significant statistical association. Conclusion: The results provide valuable insight into the tobacco addiction in patients with HTN on which non-pharmacological treatment of HTN can be based

Assessment of ophthalmic morbidities in school children (6-14 years) in rural community

Background: School children are affected by various eye disorders like refractive errors, squint, Vitamin A deficiency and eye infections. Most of the ophthalmic morbidities originate in childhood and if they are not diagnosed early they may result in severe disabilities and affects children’s performance in the school. Objectives: To find out prevalence of various ophthalmic morbidities in the school children (6 – 14 years) and to study the socio demographic profile of school children (6 – 14 years) related to ophthalmic morbidities. Materials and Methods: A cross-sectional study was carried out on 500 school children in schools of Aliabada village, Jamnagar district. A Pretested semi-structured proforma was used to collect the information related to study and students were screened for eye disorders by visual acuity testing using snellen’s chart and colour blindness was checked by using Ishihara’s chart and torch light examination. Visual acuity was assessed. Data entry and analysis was done using Microsoft excel 2007 and Epi info. Results: The prevalence of ophthalmic morbidity was found to be 33%. Among the various ophthalmic morbidities, major were refractive errors i.e. 25.6% followed by Vit A deficiency in 8.6% cases and followed by squint 2.4% and various others. The study also found that social class and age were associated with ophthalmic morbidity. It is found statistically significant. Conclusions: Refractive error was the most common ophthalmic morbidity in the school children followed by Vit A deficiency, squint and various others. In the study we found that social class and age were significantly associated with ophthalmic morbidity

Synthetic and mass spectral fragmentation studies on trisubstituted 2H-pyran- 2-ones and comparative EIMS behaviour of biologically active 3,5- disubstituted pyrazoles and isoxazoles

872-87

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

47, XYY Syndrome and its Association with Male Infertility: Case Report

47, XYY syndrome is one of the most common sex chromosomal anomaly found in humans after Klinfelter syndrome (47, XXY). It is frequently associated with infertility in males. This syndrome has an extra Y chromosome (XYY) due to non-disjunction of the Y chromosome in paternal meiotic II. The presence of an extra Y chromosome causes hormonal disbalance in the gonads that responsible for abnormal function of human chorionic gonadotropin. In the present study two cases of infertile men with severe oligozoospermia and azoospermia that also confirm by conventional cytogenetic analysis of the peripheral blood lymphocytes revealed the constitutional karyotype of 47, XYY. This report is likely to be helpful for counselling and early management of such infertile males

A lay epidemiological study on coexistent stress in hypertension: Its prevalence, risk factors, and implications in patients' lives

Introduction: Hypertension poses a global challenge in terms of morbidity and mortality. Worldwide prevalence of hypertension is over 40%. Management of hypertension targets blood pressure control to prevent disease complications. Though stress and hypertension are closely related, stress management is often overlooked in the treatment of hypertension. Aims: (1) To estimate the prevalence of stress in hypertensive patients and (2) to study the associated risk factors of stress and its implications in disease management. Materials and Methods: It was a hospital-based, cross-sectional study done in Western India for 1 year. Data were collected from 400 hypertensive patients attending the selected health institutions using a pretested questionnaire. Chi-square tests were done using Medcalc 10.4.8.0. Results: The prevalence of stress in hypertensive patients was found to be 84.3%. Only 2.4% of these patients sought help from any health professional for stress. The most common stressors found in the patients were financial dependence on others, living in rented house, having a daughter of marriageable age because of associated dowry, death of a loved one, sleep-related problem, and owing a debt among others. Significant statistical association (P < 0.05) of stress was observed with the type of family and socioeconomic status. A highly significant association (P < 0.001) of stress with religion and residential area (whether urban non-slum, slum, or rural) was observed. Stress in individuals leads to poorer compliance with treatment and blood pressure control. Conclusion: Coexistent stress should be diagnosed and managed in patients of hypertension for proper disease management and control

REal-world treatment outcomes after delayed intRavitreal therapy in center-involving diabetic macular edema – RETORT study

Abstract Purpose To compare real-life data on delayed intravitreal treatment of diabetic macular edema (DME) patients to early treatment. Methods In this single-centre, retrospective, interventional, comparative study, DME patients were divided into two groups based on when they received treatment: Group 1 - received treatment within 24 weeks and Group 2 - at or after 24 weeks from the time of treatment advice. Visual acuity and central subfield thickness (CSFT) changes were compared at various time points. Reasons for delaying treatment were noted. Results The study included 109 (Group 1–94; Group 2–15) eyes. When treatment was advised, demographic profile, diabetes duration, glucose control and VA between two groups were comparable. At this point, CSFT was higher in Group 1 than in Group 2 (p = 0.036). At injection time, Group 2 had better VA and lower CSFT than Group 1 (p < 0.05). Group 2’s VA (53.4 ± 12.67) was significantly lower than Group 1’s (57.38 ± 20.01) after 1-year treatment. At 1-year, CSFT decreased in Group 1 and increased in Group 2. Group 1 had mean improvement of + 7.6 letters and Group 2 had a decline of -6.9 letters. Group 2 required more intravitreal anti-VEGF (median – 3; IQR: 2–4), steroid injections (median – 4; IQR: 2–4) and focal laser sessions (median – 4; IQR: 2–4). Conclusion Late-treated DME eyes needed more injections and focal laser sessions than early treated eyes. Adherence to early treatment of DME in real-life will help prevent long-term vision loss