An Assessment of Knowledge and Practices Regarding Tuberculosis in the Context of RNTCP Among Non Allopathic Practitioners in Gwalior District

Introduction: India has the highest TB burden accounting for one-fifth of the global incidence with an estimated 1.98 million cases. Non- allopathic practitioners are the major service providers especially in rural and peri-urban areas, treating not just patients of diarrhea, respiratory infections and abdominal Pain but also of tuberculosis. Objectives: To assess the knowledge of sign and symptoms of TB and its management as per the RNTCP guidelines and to assess the practicing pattern regarding tuberculosis. Material & Methods: The present was carried out among the registered non allopathic practitioners providing their services in Gwalior District during the study period. A total of 150 non allopathic practitioners of various methods from both government and private sectors were interviewed using a pre-designed, pre-tested semi-structured questionnaire. The information was collected on the General profile of the participant, knowledge about signs and symptoms of TB and its management, practices commonly adopted in the management and their views on involvement of non allopathic practitioners in RNTCP programme. Result: The average score of government practitioners was 7.3 compared to 4.6 by private practitioners. There was a statistically significant difference between the two group on issue related to the management of TB patients as per the RNTCP guidelines. Government practitioners relied mostly on sputum examination for diagnosis and follow up compared to private practitioners who chose other modalities like X-ray, blood examination for this work. Conclusion: There is a gap in knowledge and practices of practitioners of both the sectors. Some serious efforts were required to upgrade the knowledge of non allopathic practitioners if the government is serious about controlling tuberculosis in India

VITAMIN D; AN EVIDENCE BASED MEDICINE

Vitamin D [25OHD] is both a nutrient and hormone which provides wide variety of health benefits to human health; hence makes it unique. Vitamin D deficiency prevails all over Indian subcontinent including both urban and rural population with a prevalence rate 70%–100% in general Indian population [1]. Vitamin D deficiency leads to rickets, osteomalacia and osteoporosis.  Vitamin D also plays an important role in cardiovascular diseases, diabetes, cancer and infectious disease such as tuberculosis.  The health benefits of vitamin D are beyond bone metabolism confirmed from various studies. vitamin D not only regulate calcium metabolism but also regulates insulin production, reduces the risk of diabetes and cancer, rennin production, helps in destruction of infectious agents, regulates cell growth, enhances immunity, maintenance of vascular tone of the body, myocardial function and helps in many more complex diseases [2]. Recently, Vitamin D has received enormous attention worldwide and referred as drug of the decade. The advocacy for vitamin D supplementation would not have been done only for populations who are at risk for developing vitamin D deficiency; sensible sun exposure is an inexpensive and enjoyable way to maintain vitamin D stores. Unfortunately, it seems a paradox where majority of population is vitamin D deficient living in sunny country. Reasons to this problem are many including higher melanin content, environmental (latitude & altitude), clothing pattern, food habits and genetic factors [3].  Although, Randomized controlled trials provide some low-quality evidence to support vitamin D supplementation for the reduction of asthma exacerbations in children is either limited or inconclusive with limitations such as high degree of clinical diversity (interventions and outcomes) and methodological heterogeneity (sample size and risk of bias) in included trials are challenges  [4]. Results of recent trials assessing the effect of vitamin D supplementation on the prevention of childhood acute respiratory infections (ARI) have been also inconsistent [5] and have no beneficial effect of vitamin D in improving insulin resistance was identified as well [6].  In addition vitamin D supplementation (1400 IU/ week) to low birth weight infants did not decrease the incidence of severe morbidity and mortality. (7)   On the other hand results of various studies supports the vitamin D supplementation including improvement in handgrip strength [8] increased newborn's length [9] reduces risk of maternal co-morbidities and helps improve neonatal outcomes [10]. Vitamin D requirements are probably greater in pregnancy, as evidenced by physiologically higher 1,25-dihydroxy vitamin D levels seen in the second and third trimesters. Studies recommended that vitamin D should continue to supplement in all pregnant women from the 12th week of gestation onwards [11]. Whether Vitamin D supplementation in prediabetes subjects prevents the development of diabetes is a matter of debate, and the results are inconsistent from available studies. Short-term vitamin D supplementation was found helpful in the decline of residual beta cell function (RBCF) in children with type 1 diabetes [12]. A study in subjects with pre-diabetes evaluated the effect of 12 months of Vitamin D supplementation on glycemic parameters and progression of pre-diabetes to diabetes in an ethnically homogeneous Kashmiri population, found that vitamin D supplementation helps significantly in  lowering FPG, 2-h plasma glucose and A1C levels [13]. On the other hand vitamin D supplementation (200 IU/day) did not affect plasma CRP and whole blood cytokine production of low birth weight infants (14). Study on healthy subjects also shown beneficial effect that were supplemented with cholecalciferol at a dose of 60,000 IU/week for 12 weeks resulted in improvement in the skeletal muscle energy metabolism[15].  Oral dose of vitamin D can be easily distributed among populations. However, 1000 IU of vitamin D/day has shown better results than 60, 000 IU/week in populations but it will be difficult to feed 1000 IU/Day to populations due to logistics issues. So, 60,000 IU/ week up to 8 weeks then once a month may be chosen as a dose schedule in populations [16]. Moreover, the usual calcium pill contains 200 IU of vitamin D and 2 pills a day equals 400 IU/day which is grossly inadequate. To achieve optimal serum 25 (OH) D levels i.e. 30 ng/ml in population; 2000 IU of vitamin D/day is required [17] thus at present it may be safest to adhere to 2000 IU/day as a standard practice in India. Indian studies regarding vitamin D supplementation including pregnant women [18], Young women [19] and asian Indians [20] already shown beneficial effect. Studies in animal models show plausible evidence in favour of vitamin D as an anti-inflammatory agent and a viable option for treatment of anti- inflammatory disease i.e crohn's disease (CD). Epidemiological and cross sectional studies indicate that vitamin D may have a potential of treating CD in humans [21]. Recent findings from various studies provide evidence of a possible beneficial effect of vitamin D supplementation in patients with early Parkinson's disease [22], respiratory tract infections [23] chronic heart disease (CHD) [24] and also helps in strengthening femoral neck (FN) in a dose-dependent manner, especially in women [25]. In a recent study we have shown improvement in bone health after vitamin D supplementation in patients with hyperthyroidism [26].  Hence, we propose that vitamin D may be used as evidence based medicine in clinical practice. This will also helpful in mitigating the growing burden of communicable and non-communicable diseases in India. The health benefits of vitamin D are beyond bone metabolism confirmed from various studies. vitamin D not only regulate calcium metabolism but also regulates insulin production, reduces the risk of diabetes and cancer, rennin production, helps in destruction of infectious agents, regulates cell growth, enhances immunity, maintenance of vascular tone of the body, myocardial function and helps in many more complex diseases [2]. Recently, Vitamin D has received enormous attention worldwide and referred as drug of the decade. The advocacy for vitamin D supplementation would not have been done only for populations who are at risk for developing vitamin D deficiency; sensible sun exposure is an inexpensive and enjoyable way to maintain vitamin D stores. Unfortunately, it seems a paradox where majority of population is vitamin D deficient living in sunny country. Reasons to this problem are many including higher melanin content, environmental (latitude & altitude), clothing pattern, food habits and genetic factors [3].  Although, Randomized controlled trials provide some low-quality evidence to support vitamin D supplementation for the reduction of asthma exacerbations in children is either limited or inconclusive with limitations such as high degree of clinical diversity (interventions and outcomes) and methodological heterogeneity (sample size and risk of bias) in included trials are challenges  [4]. Results of recent trials assessing the effect of vitamin D supplementation on the prevention of childhood acute respiratory infections (ARI) have been also inconsistent [5] and have no beneficial effect of vitamin D in improving insulin resistance was identified as well [6].  In addition vitamin D supplementation (1400 IU/ week) to low birth weight infants did not decrease the incidence of severe morbidity and mortality. (7)   On the other hand results of various studies supports the vitamin D supplementation including improvement in handgrip strength [8] increased newborn's length [9] reduces risk of maternal co-morbidities and helps improve neonatal outcomes [10]. Vitamin D requirements are probably greater in pregnancy, as evidenced by physiologically higher 1,25-dihydroxy vitamin D levels seen in the second and third trimesters. Studies recommended that vitamin D should continue to supplement in all pregnant women from the 12th week of gestation onwards [11]. Whether Vitamin D supplementation in prediabetes subjects prevents the development of diabetes is a matter of debate, and the results are inconsistent from available studies. Short-term vitamin D supplementation was found helpful in the decline of residual beta cell function (RBCF) in children with type 1 diabetes [12]. A study in subjects with pre-diabetes evaluated the effect of 12 months of Vitamin D supplementation on glycemic parameters and progression of pre-diabetes to diabetes in an ethnically homogeneous Kashmiri population, found that vitamin D supplementation helps significantly in  lowering FPG, 2-h plasma glucose and A1C levels [13]. On the other hand vitamin D supplementation (200 IU/day) did not affect plasma CRP and whole blood cytokine production of low birth weight infants (14). Study on healthy subjects also shown beneficial effect that were supplemented with cholecalciferol at a dose of 60,000 IU/week for 12 weeks resulted in improvement in the skeletal muscle energy metabolism[15].  Oral dose of vitamin D can be easily distributed among populations. However, 1000 IU of vitamin D/day has shown better results than 60, 000 IU/week in populations but it will be difficult to feed 1000 IU/Day to populations due to logistics issues. So, 60,000 IU/ week up to 8 weeks then once a month may be chosen as a dose schedule in populations [16]. Moreover, the usual calcium pill contains 200 IU of vitamin D and 2 pills a day equals 400 IU/day which is grossly inadequate. To achieve optimal serum 25 (OH) D levels i.e. 30 ng/ml in population; 2000 IU of vitamin D/day is required [17] thus at present it may be safest to adhere to 2000 IU/day as a standard practice in India. Indian studies regarding vitamin D supplementation including pregnant women [18], Young women [19] and asian Indians [20] already shown beneficial effect. Studies in animal models show plausible evidence in favour of vitamin D as an anti-inflammatory agent and a viable option for treatment of anti- inflammatory disease i.e crohn's disease (CD). Epidemiological and cross sectional studies indicate that vitamin D may have a potential of treating CD in humans [21]. Recent findings from various studies provide evidence of a possible beneficial effect of vitamin D supplementation in patients with early Parkinson's disease [22], respiratory tract infections [23] chronic heart disease (CHD) [24] and also helps in strengthening femoral neck (FN) in a dose-dependent manner, especially in women [25]. In a recent study we have shown improvement in bone health after vitamin D supplementation in patients with hyperthyroidism [26]. Hence, we propose that vitamin D may be used as evidence based medicine in clinical practice. This will also helpful in mitigating the growing burden of communicable and non-communicable diseases in India

Communication and management of public risks (with specific reference to the COVID-19 global pandemic)

We are in the midst of a global pandemic, the COVID-19. With no vaccine against the infection or medicines to treat the infected, the world is struggling to cope up with the increasing infections and casualties. It is recognized by everyone that the only option available to reduce the spread of the infection is to bring in lifestyle changes. Active participation by everyone is mandatory for success of this strategy. It is emphasized that the scientific community can play a very effective role in conveying this message across the entire population

A Multidimensional Approach to Sustainable Rural Development

A little more than seven decades after independence, India has undoubtedly emerged as a global player- politically, economically, and strategically. However, Indian villages seem to be missing out on the overall progress of the country even though they form the backbone of India’s selfsufficiency in food. Indian villages are rich in natural resources of one kind or another. We argue that there exist considerable economic opportunities for the marginal farmers outside standard agriculture such as in animal husbandry, poultry farming, apiculture, pisciculture, mushroom farming, organic agriculture, etc. Increasing the use of local renewable energy resources can, not only address the energy needs of the villages but also trigger innovation and entrepreneurship in the villages creating jobs and wealth. The villages can also benefit by exporting the surplus electricity to the grid or by producing storable and transportable fuels like hydrogen and ammonia for several transport and industrial applications in the future. The need for country-wide mapping of resources at the village level, widespread dissemination of success stories that can be replicated, incentives for entrepreneurship, and investments in villages are also highlighted

Managing production-demand mismatch in thermal power plants

The present policy of the Government asking regional electricity grids to absorb all the power generated by renewable power installations, and the thermal power stations to run at lower capacities than their installed values would not only force many thermal power plants to run at power levels much lower than their design values, but also constantly ramp up and down their outputs every day causing more wear and tear of the system. We suggest that the problem can be avoided by running the thermal power plants at their installed capacities, and use the surplus electricity to produce and store onsite hydrogen and oxygen. The stored hydrogen can be subsequently used not only to supplement coal in their own furnaces, but also for a variety of applications such as production of ammonia for fertilizers, as automobile fuel or for any other industrial applications. The ultrapure oxygen may be marketed for medical and other industrial applications

Perception, attitude, and practice of labor analgesia among obstetric care providers in Eastern Uttar Pradesh

Background: Labor pain is among the foremost severe pain that ladies experience in their lifespan, if inadequately treated can lead to certain complications in labor. Relieving this pain with medical interventions is also full of misconceptions and disagreement among people. Different traditional and pharmacological methods for labor pain relief are utilized by obstetric care providers. Aims and Objectives: The aim of the study was to obtain perception, attitude, and practice of labor analgesia among obstetric care providers in Eastern Uttar Pradesh. Materials and Methods: A cross-sectional online survey was conducted among obstetric care providers practicing in eastern Uttar Pradesh to access the perception, attitude, and practice of labor analgesia. Results: A total of 152 valid responses were obtained from the 250 participants contacted (response rate of 60.8%). The majority (98%) of them were in favor of utilizing some or the other technique of labor pain relief, and 80.3% of the participants were utilizing some of the available methods solely or in combination. Non-pharmacological methods were the most frequently used technique (77.9%). Epidural analgesia was used by only 9.8% of participants. Less awareness among pregnant women, fear of harm to the baby, lack of dedicated supporting staff, and non-availability of anesthesiologists were among the most commonly pointed out as barriers to utilizing labor epidural analgesia. Conclusion: The majority of obstetric care providers were in favor of using some or the other technique of labor analgesia, but there was a large gap between the practice and attitude among health-care service providers regarding labor analgesia. Epidural analgesia was practiced very less due to some myths and scarcity of workforce

Double coin in esophagus at same location and same alignment - a rare occurrence: a case report

Coin is the most common foreign body swallowed by pediatric age group. The multiple coin swallowing is extremely rare and very few cases had been reported in English literature. Most of them were present at different site and had different alignment in the esophagus. The location of the coin (trachea vs. esophagus) is commonly determined by the alignment of the coin on radiographic studies. A 4-year-girl was presented to us with history of coin ingestions one day back without any respiratory distress. On radiological study there was suspicion of two coins on same location and alignment. The diagnosis was confirmed after removal. The both coin was removed successfully by esophagoscopy. Unexpected second foreign bodies in pediatric esophageal coin ingestions are rare and it is mandatory to do post operative radiography after removal to exclude duplex coin or tracheal coin. We are presenting this case because of its rarity, difficulty in diagnosis especially when proper history is not available

A Novel Approach for Development and Evaluation of LiDAR Navigated Electronic Maize Seeding System Using Check Row Quality Index.

Crop geometry plays a vital role in ensuring proper plant growth and yield. Check row planting allows adequate space for weeding in both direction and allowing sunlight down to the bottom of the crop. Therefore, a light detection and ranging (LiDAR) navigated electronic seed metering system for check row planting of maize seeds was developed. The system is comprised of a LiDAR-based distance measurement unit, electronic seed metering mechanism and a wireless communication system. The electronic seed metering mechanism was evaluated in the laboratory for five different cell sizes (8.80, 9.73, 10.82, 11.90 and 12.83 mm) and linear cell speed (89.15, 99.46, 111.44, 123.41 and 133.72 mm·s-1). The research shows the optimised values for the cell size and linear speed of cell were found to be 11.90 mm and 99.46 mm·s-1 respectively. A light dependent resistor (LDR) and light emitting diode (LED)-based seed flow sensing system was developed to measure the lag time of seed flow from seed metering box to bottom of seed tube. The average lag time of seed fall was observed as 251.2 ± 5.39 ms at an optimised linear speed of cell of 99.46 mm·s-1 and forward speed of 2 km·h-1. This lag time was minimized by advancing the seed drop on the basis of forward speed of tractor, lag time and targeted position. A check row quality index (ICRQ) was developed to evaluate check row planter. While evaluating the developed system at different forward speeds (i.e., 2, 3 and 5 km·h-1), higher standard deviation (14.14%) of check row quality index was observed at forward speed of 5 km·h-1

Single-Stage Repair versus Traditional Repair of High Anorectal Malformations, Functional Results’ Correlation with Kelly’s Score and Postoperative Magnetic Resonance Imaging Findings

Introduction: Posterior sagittal anorectoplasty (PSARP) is the standard treatment for anorectal malformations. In the present study, the clinical evaluation of anal continence was carried out using Kelly’s scoring system and the results of primary PSARP or abdomino-PSARP were compared with the traditional three-stage procedure and the functional outcome was correlated with the findings of MRI, which was used as an objective method of evaluation.Patients and methods: A total of 40 patients with intermediate and high anorectal malformations were studied and were divided into two groups on the basis of a random number table. The patients in group A were treated with a single-stage operation, whereas the patients in group B were treated with a standard staged operation (either PSARP or abdominoperineal pull-through). After clinical evaluation using the Kelly score, patients were divided into three clinical groups irrespective of whether they were operated in one stage or in three stages. All patients were subjected to MRI at the age of 3 years and the findings were correlated with the clinical scoring system.Result: Patients were categorized according to their Kelly’s scores as follows: group 1: clinically good (score 5–6); group 2: clinically fair (score 3–4); and group 3: clinically poor (score 0–2). The proportions of good development of the muscles (puborectalis, external sphincter muscle, and levator muscle hammock) were 78.9% in group 1, 40% in group 2, and none in group 3. Development of muscles was found to be a significant factor for anal continence. Other significant factors for anal continence are rectal diameter and anorectal angle.Conclusion: Clinical assessment using the Kelly score was similar for the single-stage operation and the staged procedure, and this was supported by MRI findings. Therefore, we recommend the single-stage procedure to achieve a better outcome in intermediate and high anorectal malformation.Keywords: Anorectal Malformations, MRI, Posterior Sagittal Anorectoplast