Non-Alcoholic Fatty Liver Disease and other Non-Communicable Diseases: Time for an Integrated Approach

Non-Alcoholic fatty liver disease (NAFLD) is a broad term covering a spectrum of conditions ranging from hepatic steatosis, steatohepatitis and cirrhosis. NAFLD is highly prevalent across all regions of the world with its global prevalence of 25.2%(95%CI:22.1-28.7). It is commonly referred as the ‘hepatic manifestation’ of metabolic syndrome (MetS). Moreover, it is strongly associated with the individual components as well as MetS as a whole. NAFLD has been independently associated with other non-communicable diseases (NCDs) like chronic kidney disease (CKD), Polycystic ovary Syndrome (PCOS), Stroke and Cancers. This strong association of NCDs with NAFLD not only affects the prevalence but also the progression and management of the disease. Thus, this review aims at highlighting the association of NAFLD with other NCDs. A literature search was undertaken in the MEDLINE database using the necessary MeSH terms. The review concludes NAFLD is a systemic disease, not just confined to liver-specific morbidity and mortality, but also associated with numerous extra-hepatic manifestations, such as metabolic syndrome, cardiovascular diseases, chronic renal diseases, and malignancy. With co-existence of NAFLD with various NCDs it is expected to become the most overwhelming liver disease in the world in coming years. Hence, to reduce medical and economic impact associated with these comorbidities, it is recommended that all countries should estimate and predict the burden on comorbidities associated with NAFLD and galvanize its health resources in providing integrated therapeutic approaches for management of NAFLD and related comorbidities at an early stage

Hepatitis update program: need of the situation to co-manage viral hepatitis and COVID-19

Background: Government of India has taken several initiatives towards combating viral hepatitis but due to sudden surge in COVID-19 cases resulted in suspension of viral hepatitis program related activities. Moreover, COVID-19 has several liver related complications hence more special precautions are required to manage patients with known liver diseases. Nurses play an important role in management of any disease. However, there is limited knowledge among nurses on co-management of COVID-19 and viral hepatitis. With this background, two-day training program for nursing professionals was conceptualized under the project PRAKASH to educate and train the nurses about co-management of COVID-19 and viral hepatitis.        Methods: A pre-post study was undertaken among nurses who have registered for hepatitis update program. The online link to 25-knowledge related questions along with demographic variables was shared with the registered participants. Paired t test and other statistical analyses were done using SPSS v-21. Level of significance was taken at p<0.05Results: A total of 1151 responses were received out of 1477 trained participants. The mean age of the nursing participants was 32.5±6.95 years. The overall mean knowledge score in the pre-assessment was found to be 15.47±4.13 out of 25, which further increased to 20.72±3.81 in the post-assessment. Gender, type of facility, education, willingness to get trained and prior training related to viral hepatitis were found to be independently associated with pre-knowledge score.Conclusions: Training programs should be encouraged for diseases which are of public health importance and can’t be ignored with respect to increasing burden of COVID-19 cases

Time trend and predictors of lab positivity among suspected cases in the post pandemic phase of H1N1

BackgroundWHO declared Influenza A H1N1  to have entered the post pandemic phase on August 10, 2010. Continued surveillance activities are recommended in the post pandemic phase to watch over the trend, severity and impact of Influenza like illnesses (ILI).AimsThis study aimed to document the epidemiological profile of lab positive H1N1 cases in post pandemic period from August 2010-December 2014 in nodal H1N1 surveillance centre of Puducherry.MethodsThe study analysed secondary data collected during the period August 10, 2010 to Dec 2014 from ILI suspects attending a tertiary care hospital, for the Integrated Disease Surveillance Project (IDSP).  Demographic details, lab positivity based on Real time –PCR technique for H1N1, clinical symptoms and outcomes were extracted. Data were analysed using STATA version 11.0. Independent predictors of lab positivity rate were identified using logistic regression analysis.  Time trend of frequency of suspected cases and lab positivity rate were performed using time series plots.ResultsA total of 2065 suspected cases were reported, of whom 197 cases were positive for H1N1 (lab positivity rate 9.5%).  Being an adult (OR: 1.6; 95% CI:1.1 - 2.3; p=0.02), management in in-patient settings (OR: 2.5; 95% CI:1.3-4.7; p=0.001), history of contact (OR: 2.7; 95% CI1.5 - 4.5; p=0.0001) and history of travel (OR: 2.3; 95% CI: 1.2 to 4.3; p=0.01) were the independent predictors for lab positivity. Death rate among lab confirmed cases was found to be 9.6 %. After 2012, the trend of laboratory confirmed H1N1 cases became a plateau. One needs to screen 35 suspected cases to capture one lab confirmed case of H1N1 in 2014.ConclusionLab positivity was seen among 9.5% of cases and the independent predictors were severe cases, adult patients, positive history of contact and travel. The number needed to screen to get one lab positive H1N1 case is 35 suspected cases

IS 30 THE MAGIC NUMBER? ISSUES IN SAMPLE SIZE ESTIMATION

ABSTRACT Research has become mandatory for career advancement of medical graduates. Researchers are often confounded by issues related to calculation of the required sample size. Various factors like level of significance, power of the study, effect size, precision and variability affect sample size. Also design issues like sampling technique and loss to follow up need to be considered before calculating sample size. Once these are understood, the researcher can estimate the required sample size using softwares like Open Epi. Correct estimation of sample size is important for the internal validity of the study and also prevents unnecessary wastage of resources

Prevalence of self-medication practices and its associated factors in Urban Puducherry, India

Background and Objectives: Self medication is an important concern for health authorities at global level. This study was aimed to find the prevalence of self medication for allopathic drugs and associated factors among households of urban community. This study was also aimed at assessing the attitude of respondents who had experienced self-medication. Materials and Methods: This cross-sectional study was done in field practice area attached to a medical institution in urban Puducherry. A total of 352 subjects from 124 households were selected by random sampling. With pretested interview schedule, information regarding self-medication use in the past three months and associated sociodemographic factors, purpose, source of drug procurement, attitude toward self-medication use were collected. Results: Prevalence of self-medication was found to be 11.9%. Males, age >40 years and involving in moderate level activity of occupation, were found to be significantly associated with higher self-medication usage (P < 0.05). Fever (31%), headache (19%), and abdominal pain (16.7%) are most common illnesses where self-medication is being used. Telling the symptoms to pharmacist (38.1%) was the commonest method adopted to procure drugs by the users. Majority of the self-medication users expressed that self-medication is harmless (66.6%) and they are going to use (90%) and advice others also (73.8%) to use self-medication drugs. Conclusion: Self-medication is an important health issue in this area. Health education of the public and regulation of pharmacies may help in limiting the self-medication practices