Risk correlates of acute respiratory infections in children under five years of age in slums of Bankura, West Bengal

Background: Acute respiratory infections (ARI) are the leading cause of mortality and morbidity globally inchildren under five years of age. Objective: To find out prevalence and risk factors of ARI among under fivechildren. Methods: A population based analytical cross-sectional study was conducted in the urban slums ofBankura, West Bengal on the prevalence of ARI and feeding practices, nutrition and immunization among 152children under five years of age. Results: Overall prevalence of ARI was 44.73 percent; 43.47 percent male and45.78 percent female were affected with ARI; half of the infants suffered from ARI (51.21%), it was 45.71percent in 13- 24 months age groups; with increasing age, prevalence of ARI gradually decreased. ARI was seenin 45.76 percent of exclusively breast fed children and 57.89 percent in children with breast feeding less than sixmonths; in bottle fed children ARI prevalence was 47.82 compared to 44.18 percent in breast-fed. Risk of ARIis almost equal in normal participants and undernourished children. ARI cases were seen among 38.73 percentof completely immunization in comparison to 80.00 percent of partially-immunized children (X2=4.97,p=0.026). Conclusion: The present study had identified a high prevalence of ARI in children less than fiveyears of age. In our study population, ARI was significantly associated with immunization status, but not withfeeding practices and nutritional status of the child

Work-related stressors and coping strategies during COVID-19 pandemic: A qualitative study on reflections of frontline health care workers from India

Background: Frontline healthcare workers, a vital workforce in developing countries is often out of mainstream vision and their challenges and coping behaviors under stressful conditions remain unclear to stakeholders. This study was undertaken with the objective to explore the challenges faced by community surveillance workers and their coping strategies during COVID-19 pandemic. Methods: A qualitative descriptive study with constructivism paradigm was undertaken for a period of one year by conducting eight focus group discussions and eight in-depth interviews among the health workers undertaking COVID-19 surveillance selected purposively from eight wards within three Boroughs of a Municipal Corporation using interview guide. Thematic analysis was used to compare and contrast the codes to generate themes inductively under two constructs. Results: The first construct, factors influencing work related stress was categorized into four themes related to- work environment, community’s response towards pandemic surveillance, organizational support and personal factors. Main predisposing factors of work place stress were risk of self-infection, concern for family safety, inadequate training, shortage of manpower and protective equipment etc. While a strong commitment towards work, assistance from local community influencers, administrative appreciation and supportive supervision were protective factors against stress. Second construct on coping strategies was categorized into managing stress by problem-focused strategies like adapting with experience, gathering information and sharing experiences, adopting self-care practices; while emotion-based coping strategies included denial, venting out, or turning to religion etc. Conclusion: Community surveillance workers faced considerable and variable stress during pandemics due to various underlying work stressors, managed innovatively, using self-coping strategies

Burden of traumatic brain injury in refugee population: unmet need of care and gaps in knowledge

Background and objectives. Due to marked increase in violence, the world is facing problem of refugee population either as a source of refugee population or shelter provider. These refugee population is exposed to prolonged physical and emotional distress over years, may result into spectrum of neuropsychiatric disease conditions including traumatic brain injury (TBI). Although trauma is one of the major events faced by refugee population, the exact details of the injuries still not documented and there is paucity of published literature; further these injuries may be recorded as unspecified. Methods. The present article is intended to provide a theoretical overview of existing knowledge and gaps on trauma and injuries in the refugee population. Authors analysed all relevant articles available on PubMed and Medline using the keywords: “Refugee”, “Traumatic Brian Injury”, “Head Injury”. Results. There is a gap in knowledge for this particular demographic population. They suffer a wide range of physical and emotional to social traumatic events. The most common cause of head injury was assault; however, motor vehicle accidents were less prevalent, and there is an ongoing struggle for resources to fulfil basic needs leading to health care taking a backseat. There is high prevalence of post-traumatic stress disorder. Many of the refugees are settled in relative economically poorer countries which further add to the burden of a nation already besotted with internal requirements. There is a need for international collaboration to tackle unique problem. Conclusion. Authors recommend urgent need to handle the root causes responsible for the generation of refugee population and at the same time it is necessary to identify the epidemiology, patterns, management challenges and consequences of injuries and barriers to seek and provide care in refugee population

Outcome analysis of upper and lower limb motor functions after anterior cervical discectomy and fusion for degenerative cervical disc disease

Background: Anterior cervical discectomy and fusion (ACDF) is the most commonly performed surgical procedure for symptomatic cervical disc disease. In this study, we analysed the upper and lower limb motor functions after ACDF for disc prolapse in patients with degenerative cervical disc disease. Methods: One hundred consecutive adult patients who underwent ACDF for single or two-level cervical disc prolapse during the study period (October 2015 to October 2017) were included in the study. Results: Preoperative motor deficits in limbs were noted in 73% (73/100) of the patients. Enhance recovery of motor deficits was noted in 72.6% (53/73) of these patients and persisting motor deficits in the remaining patients (20/73- 27.4%). Five patients (5/27- 18.5%) without any preoperative motor deficits developed motor deficits after ACDF. Detailed pre and postoperative (at the time of discharge) motor power (graded by MRC grade) in all 4 limbs (Shoulder abduction/adduction/flexion/extension, elbow flexion/extension, wrist flexion/extension, hip abduction/adduction/flexion/extension, knee flexion/extension, ankle flexion/extension) was recorded. Statistically significant improvement in motor power (as recorded at the time of discharge) was noted in all the tested muscle groups after ACDF. Conclusion: Early improvement in preoperative motor deficits can be expected in the majority of the patients with cervical PIVD following ACDF

Tinnitus after traumatic brain injury: An overview

Tinnitus is a frequent clinical feature encountered during follow up of Traumatic brain injury (TBI) that can be incapacitating in the long run. Literature suggests that post-TBI carries a higher psychological burden than tinnitus patients presenting with other non-traumatic or unknown etiologic. Posttraumatic tinnitus is of longer duration, frequently associated with hyperacousis and occurs in younger age group. If the symptoms are severe post-traumatic tinnitus can affect quality of life of the patients. The management of these patients needs detail evaluation and comprehensive rehabilitation plan

Venous thromboembolic sequel of head injury: A narrative review

In this systematic review, we detailed the current understanding and controversies on venous thromboembolism as the sequel following traumatic brain injury (TBI). The review was conducted on the literature survey to find the thromboembolic morbidities in TBI patients. This review presented the thromboembolic sequel of patients with TBI by a comprehensive focused assembly of research publications by searching various resources. A search strategy with specific inclusion criteria was performed in PubMed, Cochrane, Web of Science, and the WHO Global Health Library. TBI is related with the incremental presence of spectrum of thromboembolic disorders from primary and secondary injuries by the significant increases in the concentrations of the initiating factors of the coagulation cascade. The incidences of thromboembolism vary on factors like the severity of TBI, methods of prophylaxis used or the processes to diagnose embolic involvement. The most effective time for the initiation of antithrombotic therapy chemoprophylaxis should be initiated after 24 h or after 72 h in patients with brain trauma is still a controversial issue. Patients with brain injury are at increased risk for thromboembolism for which prophylaxis and timely management are highly recommended, and this should be available in all levels of care

Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients

Background: Acute Computerized Tomography (CT) characteristics are used widely and most accepted for prediction of outcome among Traumatic Brain Injury (TBI). The commonly available and simple combinations of existing and unexplored CT parameters may be more useful in prediction of outcome. The present study explores commonly available CT characteristics by possible combinations based on anatomical basics.Methods: Abnormal CT sign was considered with any cranial lesion. Based on anatomical locations of cortical lobes, nine possibilities were made that include individual and combinations of mentioned lobes. The laterality was either right or left or bilateral. The outcome was favourable or unfavourable based on discharge Glasgow Outcome Scale (GOS). Binary logistic regression was used to predict outcome.Results: 452 patients were recruited in the present study. There was significant risk of unfavourable outcome among patients with location of Sub Dural Haemorrhage (SDH) in Parietal + Temporal region (OR=10,p<0.001); Cerebral Contusion in Temporal region (OR=3,p=0.03), Frontal + Temporal region(OR=16,P=0.001), Frontal + Parietal + Temporal region (OR=18.7,p<0.001). Patients with four abnormal CT signs had worst outcome. Presence of SDH on right side (OR=4.5,p<0.001) and bilateral Cerebral Contusion (OR=4.5,p=0.003) was at the risk of unfavourable outcome.Conclusion: The present study based on anatomical classification has shown that location and laterality of lesion can significantly predict TBI outcome

External ventricular drainage for intraventricular hemorrhage

Background: Intervention to reduce intracranial pressure using External Ventricular Drain (EVD) is a common life saving measure in a neurosurgery intensive care unit(ICU). Objective: The present study was undertaken to assess the outcome of patients who underwent external ventricular drainage for intraventricular hemorrhage(IVH). Methods: The available data of the patients who underwent placement of external ventricular drain from February 2012 to May 2016 for intraventricular hemorrhage (IVH) at Narayana Medical College and Hospital, Nellore, was retrieved from the hospital case records and analyzed. Results: Total of 69 patients were included in this study. Mean age was 53.7 ±11.6 years. Clinical presentation included altered sensorium in 66 patients (96%), hemiparesis in 62 patients (90%) , vomiting in 40 patients (58%) and seizures in 9 patients (13%). Fifty two patients (75%) were known hypertensives and 10 patients (15%) were diabetic. Past history of smoking was recorded in 16(23%) patients and alcohol intake in 17 patients (25%). GCS at the time of admission was 3-8 (low) in 39 patients (57%), 9-12 in 23 patients(33%) and 13-15 in 7 patients (10%). At the time of admission, 60 patients ( 87%) had diastolic blood pressure more than 90 mmHg, 63 patients (91%) had systolic blood pressure more than 140 mmHg. Major site of hemorrhage was basal ganglia in 24 (35%), thalamus in 13 (19%), cerebellum in 5 (7%), brain stem in 3, frontal/temporal in 2 patients. SAH with IVH was noted in 12 patients (17%) and only IVH was noted in 10 patients (14%). Mean duration of external ventricular drainage was 4.6+1.7 days (Range 1-9 days). Mean hospital stay was 11.3±7.5 days and mean ICU stay was 8+5.4 days. Thirty eight patients (55%) died during hospital stay. At the time of discharge, poor out come (Glagow out come score 1-3) was noted in 52 patients (75%) and good out come (Glagow out come score-4,5) was noted in 17 patients. Among various parameters analyzed , poor GCS (3-8) at admission, history of smoking and alcohol intake were found to correlate significantly with poor outcome. None of the other factors like old age, site of bleed, pupillary asymmetry at admission, high blood pressure at admission, past history of hypertension and diabetes were found to correlate with poor outcome. Conclusions: Majority of the patients with intracranial hematomas with intraventricular extension presented in poor neurological condition (GCS= 3-8). Poor neurological condition at the time of admission, past history of smoking and alcohol intake were associated with poor outcome

Referral Pattern to Neurosurgeons in a tertiary care teaching Hospital

Background: Due to lack of pre-hospital care, direct admission of traumatic brain injury (TBI) patients to dedicated neurosurgical department remains difficult in many parts of world. Objective: The present pilot study was conducted to understand the referral pattern of patients to the neurosurgery department and to develop an algorithm to stratify the spectrum of cases as per the severity of condition and possibility of direct neurosurgical care. Materials and Methods: Details of referral patterns, demographic and clinical profile, management and outcome of consecutive TBI cases admitted in the Department of Neurosurgery were collected with pre-designed proforma. Results: Of total 55 cases, 40 (73%) were males; 26 (47%) between 36-55 years age; 26 (47%) referred directly to the center; 24 (44%) self-referred; 34 (62%) referred from Emergency department; mostly (32, 58%) admitted after 12PM; 22 (40%) admitted for 16-30 days. In the analysis of investigations, 37(67%) cases had CT, 15 (27%) had MRI, 4 (7%) had X-ray, 1 (2%) undergone all three investigations, while 8 (15%) didn’t have any; mostly (42, 76%) cases were referred for the management of TBI and 38 (69%) required operative interventions. Conclusion: Our findings strongly suggest that referral of TBI cases need improvement in this part of country where hindrances delay TBI cases to reach dedicated neurological intensive care leading to delay of committed care and optimization of strategy for reduction of case fatality