Characteristics of Fatal Cases of Pandemic Influenza A (H1N1) from September 2009 to January 2010 in Saurashtra Region, India

Background: India reported first case of 2009 pandemic influenza A (H1N1) virus infection in May, 2009 and Saurashtra region in August, 2009. We describe the characteristics of fatal cases of 2009 influenza A (H1N1) infection reported in Saurashtra region. Methods: From September, 2009 to January, 2010, we observed 71 fatal cases that were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection; the clinico-epidemiological features were observed and documented. Results: Median age of the deceased (71) was 29 years, and 57.7% were females. Median time observed was 5 days from onset of illness to diagnosis of influenza A (H1N1), and 57.7% were referred from general practitioner (OR=0.42, CI=0.24-0.74). Median hospital stay reported was 3 days. All admitted patients received oseltamivir, but only 16.9% received it within 2 days of onset of illness. The most common symptoms were cough (97.2%), fever (93%), sore throat and shortness of breath. Co-morbid conditions were present in almost half of the patients who ultimately died, the most common of which was pregnancy (OR=0.15, CI=0.04-0.52). Radiological pneumonia was reported in 98% patients. Conclusion: Residing in urban area, delayed referral from general practitioner, presence of co-existing condition, especially pregnancy was responsible for mortality among influenza A (H1N1) infected positive

Biomedical Waste Management: A study of knowledge, attitude and practice among health care personnel at tertiary care hospital in Rajkot

Background: Bio medical waste (BMW) collection and proper disposal has become a significant concern for both the medical and general community. Effective management of biomedical waste is not only a legal necessity but also a social responsibility. Objective: To know the knowledge, attitude and practice among health care personnels working in tertiary care centre. Methods: The study was conducted from January 2013 to June 2013. It was a descriptive observational hospital based cross sectional study. Study participants included the resident doctors intern doctors, nursing staff, laboratory technicians, ward boys and sweepers working in the institute who are dealing with BMW. The study was conducted by using pretested, semi-structured proforma. The data was tabulated and interpretation was done by using percentages through Epi Info 3.5.1 software. Results: It included 123 resident doctors and interns, 92 nurses, 13 laboratory technicians, and 54 sanitary staff. Majority of study participants belongs to 21-30 years (61%) age group. More than two third of study participants working in hospital from 1 to 5 years. Only 44.3% study participants received training for bio medical waste management. HIV (74.47%) and Hepatitis B (56.03%) were the main infectious diseases transmitted by the bio medical waste. Conclusion: The importance of training regarding bio medical waste management cannnot be overemphasized, lack of proper and complete knowledge about bio medical waste management impacts practices of appropriate waste disposal

Characteristics of hospitalized patients with severe and non-severe pandemic influenza a (H1N1) in Saurashtra Region, India (two waves analysis)

Background: In India, the first case of 2009 pandemic influenza A (H1N1) virus infection was reported in May 2009 and the same in Saurashtra region in August 2009. We describe the epidemiology and factors associated with severe and non-severe cases of 2009 influenza A (H1N1) infection reported in the Saurashtra region. Materials and Methods: From September 2009 to January 2011, we reported 511 patients who were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals of Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing was used to confirm infection. Factors associated with severe cases were determined by comparing with non-severe cases. Results: Out of 511 patients, 140 had severe disease (requiring intensive care or died) and 371 non-severe diseases (admitted in wards and survived). Median age of 30 years; median time of 5 days from onset of illness to diagnosis, and 4 days median time was reported for hospital stay among severe disease patients. More than half (60.7%) were females. Out of the patients with severe disease, 52.1% patients residing in urban area (OR = 1.68, CI = 1.13-2.49). Significant association was reported among severe disease patients for delayed referral from general practitioner/physician after initial treatment. All patients received antiviral drug, however, only 27.1% received within 2 days of illness. Presence of coexisting condition (pregnancy (OR = 0.19, CI = 0.08-0.48) was strongly associated with severe disease. Conclusion: Delayed referral from general practitioner/physician, duration of antiviral treatment, presence of coexisting condition (i.e., pregnancy) were responsible for intensive care or mortality among severe influenza A (H1N1) illness

A two wave comparison of characteristics of hospitalized patients with severe and non-severe pandemic influenza A (H1N1) 2009 (H1N1pdm09) in Saurashtra Region, India

Objective: The primary objective of the following study was to determine and secondarily to compare the clinical and epidemiological characteristics of hospitalized patients with severe and non-severe pandemic influenza A (H1N1) during two waves from September 2009 to January 2011. Materials and Methods: A total of 274 cases were hospitalized during the first wave from September 2009 to March 2010 and from June 2010 to February 2011, 237 cases hospitalized in different hospitals of Rajkot during the second wave. Real-time reverse-transcriptase-polymerase-chain-reaction testing was used to confirm infection. Two wave′s comparison was made for factors associated with disease severity. Results: During the first wave 87 (31.8%) patients had severe disease with mortality of 81.6% while during the second wave there were 53 (22.36%) patients having severe disease with higher mortality (94.3%) than the first wave. There were more children up to 15 years of age that required intensive care during the second wave (30.2%) compared to the first wave (20.7%). First wave reported more females and cases from an urban area. Presence of co-existing condition, especially pregnancy was a significant risk factor during the first wave, but not during the second wave. All patients have received antiviral drug oseltamivir during both waves. During the second wave, 39.6% of patients with severe cases received it within 2 days of onset of illness. This was higher than the first wave (19.5%). Conclusion: Higher mortality was reported during the second wave of pandemic influenza A (H1N1) 2009 (H1N1pdm09). There were more cases among the younger age group than adults during the second wave

Evaluation of integrated Child Development Services program in Gujarat, India for the years 2012 to 2015

Background: The Integrated Child Development Services (ICDS) scheme has been operational for more than three decades in India. Objective: To evaluate the various aspects of the ICDS program in terms of inputs, process and outcome (coverage), utilization, and issues related to the ICDS program. Methods: A total of 130 Anganwadi centers (AWCs) were selected including 95 AWCs from rural areas and 35 AWCs from urban areas from April 2012 to March 2015, from 12 districts of Gujarat and the union territory of Diu. Information was collected for infrastructure, baseline characteristics of AWWs, provision, coverage and utilization of various ICDS services, and various issues related to program operation. Results: A majority of pregnant (94.7%) and lactating (74.4%) mothers, and adolescent girls (86.6%) were availing ICDS services. In 96.9% of the AWCs, a growth chart was available and 92.3% AWWs were using it accurately. A total of 14.9% children were underweight including 13.5% moderately and 1.4% severely malnourished children. Two-third (66.2%) children were covered by supplementary nutrition (SN). Only 14.6% of the AWCs reported 100% preschool education (PSE) coverage among children. More than half (55.4%) of the AWCs reported an interruption in supply during the last 6 months. Various issues were reported by AWWs related to the ICDS. Conclusion: The study has reported gaps in terms of infrastructure facility, different trainings, coverage, supply, and provision of SN, status of PSE activities in AWCs, and provision of different services to the beneficiaries

A preliminary analysis of repetitive sequence organisation in <i>Bubalus bubalis</i> genome

62-66The most prevalent feature of eukaryotic genomes is their repetitive DNA sequences, which plays a critical role in genome evolution. Hence, identification and analysis of repetitive DNA regions are vital to understand genome structure and function completely. The investigation of repeats in preliminary draft sample of buffalo genome with 60,999 contigs was carried out through comparison of sequences with those in curated repeat libraries using WU-Blast. It was found that around 80% of the genome can be currently recognized as repetitive elements including simple repeats, satellite, long terminal repeats (LTR) retrotransposons, long interspersed nuclear elements (LINE) and short interspersed nuclear elements (SINE), which together cover the total repetitive fraction. Repeat analysis revealed the presence of ribosomal RNA (rRNA) and transfer RNA (tRNA) repeats along with other repeats like DNA/hAT, DNA/TCMAR and a small amount of unknown repeats. A comparative analysis of repeats of the buffalo, cow, mouse and human genomes was also discussed