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

Viral Hepatitis in Dentistry – An overlooked contributor to disease burden and occupational hazard in India

Introduction: Dental professionals are considered to be at high-risk for contacting blood-borne pathogen transmissions. Thus, making it necessary for dentists to be aware on prevention, transmission and management of viral hepatitis. Objective: One day training programs for upskilling dental fraternity were conducted on 11th November 2019 and 11thFebruary 2020. Program also evaluated the Knowledge, Attitude, and Practices (KAP) of dentists regarding infection control practices and oral manifestations of viral hepatitis. Methods: One-day training program viz. “Viral hepatitis in Dentistry” under project Programmed Approach to Knowledge And Sensitization on Hepatitis (PRAKASH) was organized and a cross-sectional study using 20-item-self-reported questionnaire was conducted among participating professionals from six states of India. Identifying information was removed during statistical analysis. Results: Total of 625 dental professionals were trained; of which 470 participated in the KAP study i.e. response rate was calculated to be 75% (470 out of 625). Females represented about 73.2% of the sample(n=470). Sample comprised of experts from all the branches of dentistry. Almost 97% of responders were from private dental institutes or clinics. Mean knowledge score was found to be 4.71 ± 2.04, however when compared with age, knowledge in older professionals > 25 years was higher at 5.00 + 2.10 than participants’ aged<25, 4.57 ± 2.00 (p value = 0.03). Participating professionals seems to be following precautionary practices regarding viral hepatitis in dental clinics in a comparable manner irrespective of their age i.e. mean practice score of 6.81 ± 1.82 in professionals’< 25 years of age and mean practice score 6.81 ± 1.67 in trainees > 25 years. Conclusion: Study raised concerns regarding poor knowledge about infection prevention control and management of viral hepatitis in dental settings. Limited interventions in terms of capacity building programs for dentists on viral hepatitis, highlight the necessity of continued education through such training programs

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

Non-alcoholic Fatty Liver Disease in Children: An emerging Public health problem in India

NAFLD was earlier believed to be the disease of adults only however in 1983, the existence of this disease was seen in paediatric population. Nearly four decades have passed since the first description of the Paediatric NAFLD (P-NAFLD), yet it is one of the areas which is given least priority in the country. The P-NAFLD is reversible and can be prevented by lifestyle and behaviour modification and hence there is a need to this review highlights the importance of P-NAFLD in the country and need for formulating strategies for prevention and control of P-NAFLD in the country. All published articles in the MEDLINE database on P-NAFLD in India were included. The important findings were summarized and critically analysed. The existing review suggests, the prevalence of P-NAFLD is uncertain in the country. NAFLD is a phenotypic product of complex interaction of heredity (nature) and environment (nurture). This review summarizes the importance of P-NAFLD in India and discusses the predisposition of these risk factors in Indian children. Further population-based studies on prevalence and incidence are required on general paediatric population to quantify the magnitude of the disease in India for better management of the condition

A brief insight on knowledge about Viral Hepatitis in Pregnancy among clinicians

Viral Hepatitis (VH) is one of the most serious infections during pregnancy which not only creates complications for the mother but also transmits the infection to the newborn. Hence, clinicians should be aware about the diagnosis and management related to VH during pregnancy and modes to prevent it. Thus the present study aimed to assess the current knowledge about VH in pregnancy among clinicians. A cross-sectional study was conducted among physicians who attended National Seminar for Physicians on Viral Hepatitis in Pregnancy organized by PRAKASH. An online link to 25-item questionnaire was circulated with all the registered participants. The data was analysed using IBM-SPSS version-21. The statistical significance was considered to be &lt;0.05.A total of 64 physicians with mean age of 33.73±10.57 were included in the study. Mean knowledge score was found to be 15.41±3.47 out of 25 with 59% of the participants having poor-to-moderate knowledge about VH in pregnancy. The study raises serious concerns about initiating training related to diagnosis and management of VH in pregnancy among clinicians

A national level survey on knowledge, attitude and practices among Indian nurses on viral hepatitis

BACKGROUND: Despite being preventable and treatable, viral hepatitis remains a major public health problem in India. In the line of their duties, nursing professionals are constantly at risk of infection. To combat viral hepatitis, it is essential to ascertain the level of knowledge, attitude, and practices among nursing professionals. MATERIALS AND METHODS: A descriptive cross-section study was conducted at a tertiary public hospital, as a nation-wide online survey after ethical clearance and participants' consent. A convenience sampling, from November 2021 to September 2022, yielded a total of 4532 nurses, nursing students and educators. A self-administered 62-item questionnaire on viral hepatitis with four sections: demographic details, knowledge (33-items), attitude (5-items), and practice (24-itmes) was prepared by expert panel and had a content validity and reliability >0.8. The scale was compiled onto the SurveyMonkey app, field tested before administration and widely circulated on email. RESULT: The response rate of the survey was 77%. Frequency, percentage, and the odds ratio (at 95% confidence interval) were analyzed on SPSS v22.0. Majority were females (87.1%) aged <30 years (60%) with <5 years' experience (57.8%). Almost equal number worked in public or private sector and was holders of diploma (44.5%) or degree (43.8%). Overall poor knowledge (85.3%), unfavorable attitude (86.2%), and unsafe practices (55.6%) were exhibited by nurses; 42.2% encountered needle stick injury last year and 49.8% had never checked Anti-HBs titer. In the event of needle stick injury, 74.78% cleansed with soap and water; used antiseptics or washes (33.5%), placed finger in mouth (5.10%), forced wound bleed (17.3%), scrub wound (17.54%), or apply bandage (12.58%). Multivariate analysis of factors influencing knowledge of viral hepatitis was educational qualification, designation, and type of health facility. CONCLUSION: As nursing professionals are constantly at risk, there is an urgent need to raise awareness about hepatitis, the post-exposure prophylaxis and vaccination status. Every healthcare facility should include training and capacity building for nurses about risk, prevention, transmission, and management of viral hepatitis, as an integral part of orientation and continuing education on-the-job; follow stringent policies; and set-up mechanisms for monitoring and follow up. Further, policymakers and statutory bodies need to ensure the standards of nursing practice and improve the health of nurses and their patients

Effect of one-day training on Knowledge related to Biosafety and waste management among life-science Students

Context: Laboratory workers are at increased risk of occupational hazards especially microbial infections. These occupational hazards can be reduced by merely creating awareness related to Biosafety. Thus biosafety and waste management training is important and needs to be inculcated at novice stage. Aims: The present study aimed to assess the effect of one-day training program on knowledge related to biosafety and biohazard among life-science students. Settings and Design: The study was conducted through online medium, organized by Department of Microbiology, Institute of Home Economics, University of Delhi using a Quasi Experimental design. Methods and Material: A one-day training on Biosafety and Waste Management was organized by Department of Microbiology for life-science students. A pre-test with 15 questions was administered to the participants before commencement of the training. One mark was allotted for each correct response and zero marks for incorrect marks. At the end of training, post knowledge was assessed using the same questions as pre-test. Statistical analysis used: The data on pre-post knowledge assessment was analyzed using SPSS Version 21. Paired t-test was used to assess the mean difference in pre and post knowledge assessment amongst the participants. The level of significance was taken as &lt;0.05. Results: A total of 81 participants was analyzed for pre-post analysis. The mean age was 19.98 ± 1.06 years with 59(72.8%) being females. The mean pre-knowledge and post-knowledge score was found to be 10.20 ± 2.09 and 14.02 ± 1.63 respectively. The mean difference of 3.83 ± 2.23 in pre and post knowledge was found to be significant (p&lt;0.001). Conclusions: Life-science students have poor-to-moderate knowledge about biosafety and waste management. Training on biosafety helps in improving knowledge

Performance Evaluation of an Improved HBsAg Assay (HBsAg NEXT) for the Detection of HBsAg Levels

Objectives Detection of hepatitis B surface antigen (HBsAg) plays an important role in the screening and diagnosis of hepatitis B virus (HBV) infections. There is a need of highly sensitive assays with an improved lower limit of detection (LoD). Here, we evaluate the performance characteristics of the HBsAg NEXT (HBsAg new) assay in the detection of HBsAg in clinical samples. Material and Methods This was a cross-sectional study conducted at a tertiary care liver center in North India. The study included 439 clinical samples. The HBsAg new assay was compared to the conventional chemiluminescence-based assay (HBsAg old assay, Architect, Abbott Diagnostics, United States). The analytical sensitivity of the HBsAg new assay was evaluated by checking its performance with the second World Health Organization (WHO) international standards for HBsAg. Results Out of 439 blood samples that were retrieved from the departmental repository stored at –80°C, 100 samples were positive and 339 samples were negative for HBsAg as per the HBsAg old assay. The HBsAg new assay showed incremental detection of HBsAg in 11 additional samples. Out of these, 5 samples were confirmed as occult HBV infection and the remaining 6 were classified as “exposed-to-virus” samples (HBV core total antibody-positive). The HBsAg new assay demonstrated a high positive significant correlation with the HBsAg old assay (r = 0.881, p-value < 0.001). The HBsAg new assay could effectively detect the second WHO international standards to the level of 0.0033 IU/mL. Conclusion The HBsAg NEXT assay is a highly sensitive assay with an improved lower LoD

Knowledge, attitude, and practice toward prevention and management of COVID-19 among indian nurses: A cross-sectional study

Background: To plan suitable policy against COVID-19 pandemic, it is important that the nurses have updated knowledge related to prevention, diagnosis, treatment, and management of COVID-19 and have an optimistic attitude and good practices in managing the patients during the pandemic crisis. Thus, we conducted a study on the knowledge, attitude, and practices (KAP) related to COVID-19 among Indian nursing professionals. Methodology: A cross-sectional study was conducted from April 22 to May 22, 2020 using a pretested 37-item-self-reported e-questionnaire among nursing professionals above 18 years of age, working in health-care setting across 25 states. The questionnaire consisted of four sections: demographic details, knowledge (26 items), attitude (6 items), and practice (5-itmes). KAP questionnaire was shared through e-mail, SMS, and WhatsApp groups. Results: A total of 1182 participants responded to the online survey with 94% completion rate. The study analyzed the data for 1110 nurses with a mean age of 30 ± 6.7 years and 68% being females. The mean KAP score was 16.82 ± 3.3, 9.77 ± 2.03, and 18.37 ± 3.29, respectively. Knowledge was significantly correlated with attitude (r = 0.1316) and practice (r = 0.1526). Practice and attitude were also found to be positively correlated (r = 0.4398). Good knowledge related to COVID-19 was significantly affected by age, gender, location, and type of facility (<0.01). Conclusion: The study raised concerns regarding poor knowledge, anxiety, and fear from COVID-19 duty affects the health-care workers (HCWs) performance and provides resistance in working. A comprehensive training program for HCWs focuses more in terms of infection, prevention, control, and management and maintaining good mental health is required

Measurement of the double-differential inclusive jet cross section in proton-proton collisions at s\sqrt{s} = 5.02 TeV

International audienceThe inclusive jet cross section is measured as a function of jet transverse momentum $p_\mathrm{T}$ and rapidity $y$. The measurement is performed using proton-proton collision data at $\sqrt{s}$ = 5.02 TeV, recorded by the CMS experiment at the LHC, corresponding to an integrated luminosity of 27.4 pb$^{-1}$. The jets are reconstructed with the anti-$k_\mathrm{T}$ algorithm using a distance parameter of $R$ = 0.4, within the rapidity interval $\lvert y\rvert$$\lt$ 2, and across the kinematic range 0.06 $\lt$$p_\mathrm{T}$$\lt$ 1 TeV. The jet cross section is unfolded from detector to particle level using the determined jet response and resolution. The results are compared to predictions of perturbative quantum chromodynamics, calculated at both next-to-leading order and next-to-next-to-leading order. The predictions are corrected for nonperturbative effects, and presented for a variety of parton distribution functions and choices of the renormalization/factorization scales and the strong coupling $\alpha_\mathrm{S}$