Recent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from ...non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India.
NCD risk factors survey was conducted among 5078 residents, aged 18-69 years during 2016-17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples.
Males were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.3-42.4) and 18.8% (95% CI: 15.8-21.8). One- tenth (11%) (95% CI: 8.6-13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6-37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6-27.8) and 15.5% (95% CI: 11.0-20.0). 91.3% (95% CI: 89.3-93.3) of the population had higher salt intake than recommended 5gms per day.
The documentation of strikingly high and uniform distribution of different NCDs and their risk factors in state warrants urgent need for evidence based interventions and advocacy of policy measures.
Introduction: Veno-arterial extracorporeal membrane oxygenation (ECMO) is well-recognized treatment modality for patients with refractory cardiogenic shock. Uncomplicated cannulation is a ...prerequisite and basis for achieving a successful outcome in ECMO. Vascular access is obtained either by surgical cut-down. Common vascular access complications are bleeding and limb ischemia.
Objective: To evaluate cannulation technique, the incidence of vascular complications, and their impact on the outcome.
Methods: A retrospective data analysis conducted on 95 patients receiving ECMO from 2013 to 2020 was done. The patients were divided into two groups: no vascular access complications (non-VAC group) and vascular access complications (VAC group). The groups were compared related to the hospital and ICU stays and blood transfusion.
Results: The patients in both groups were demographically and clinically comparable. The Non-VAC group had 75 patients, whereas the VAC group had a total of 20 patients. The main complication observed in the VAC group was bleeding from the cannulation site which required more blood transfusion than the non-VAC group (6.8 ± 1.02 vs 4.2 ± 1.26). Limb ischemia was another complication seen in the VAC group (4.2%, n = 4). Two patients had delayed bleeding after decannulation. The overall average length of stay in the hospital was statistically similar in both the groups (22 days in the VAC group vs 18 days in the non-VAC group), but the average ICU stay was more in the VAC group compared to the non-VAC group (18 days vs 12.06 days).
Conclusion: Bleeding and limb ischemia are the important vascular access site complications, which increase blood transfusion requirements, ICU stay, and overall hospital stay.
Background: An acute respiratory disease (COVID-19), caused by a novel coronavirus (SARS-CoV-2,), has been declared a pandemic by WHO. A surgery on COVID-19 patients not only involves a risk of ...spread of the disease but also there is a serious concern for the patient's surgical outcomes and resources requirement. Aim: The retrospective study is aimed to provide a protocol for pre-operative testing of SARS CoV-2 using RT-PCR in the patient undergoing cardio-thoracic surgeries. Material and Methods: To analyze the impact of pre-operative testing of SARS- CoV-2 using RT-PCR in the patient undergoing elective cardio-thoracic surgeries. The patient who underwent surgical interventions during the COVID-19 lockdown period was divided into two phases. Phase I (without COVID-19 RT-PCR testing) and Phase II (with pre-operative COVID-19 RT-PCR testing). The retrospective comparison between the two study groups was done using Student t-test, Mann-Whitney U, and Chi square (χ2) test depending upon the clinical variable to be analyzed. Results: During the early phase (phase I), 26 patients underwent cardio-thoracic surgery without COVID-19 RT-PCR test. Whereas, during phase II, all patients were tested for COVID-19 using RT-PCR, preoperatively and a total of 64 surgeries were performed during this phase. One patient planned for CABG was positive on RT-PCR for COVID-19 and was sent to the quarantine ward. The difference in the pre-operative hospital stay between two groups was found to be statistically significant and a significant decrease in the number of PPE kits used, during the phase I. Conclusion: All asymptomatic patients should be tested for COVID-19 using RT-PCR prior to cardio-thoracic surgeries not only to contain the disease but to avoid potential implications of COVID-19 on the perioperative course, without added financial implications.
•This study assesses climate change vulnerability of Himalayan communities and their potential to adapt to these changes.•The assessment is based on the five capitals of sustainable livelihood ...framework.•The study results that the households reside away to district head quarter are in disadvantageous position and more vulnerable than those households, who reside near to district head quarter in mountainous settings.
This study evaluated the climate change vulnerability of Himalayan communities, and their potential to adapt to these changes, through assessing their perceived reactions and counter-actions to climate change. The evaluation was conducted through proposing and testing indices for vulnerability (Climate Vulnerability Index – CVI) and adaptation (Current Adaptive Capacity Index – CACI) based on the assumption that a community is an active dynamic entity and has tremendous capability to address the impacts of climate change through an ability to make adjustments based on perceived experiences. Both CVI and CACI include the five forms of capital leading to sustainable livelihood, i.e. human, natural, financial, social and physical capital, and were assessed for each of these forms of capital based on the IPCC framework of vulnerability assessment and its three dimensions (exposure, sensitivity, adaptive capacity). Data for the analysis were collected from randomly selected households located away from district headquarters (ADH) and near district headquarters (NDH). Each dimension was measured based on associated socio-environment-specific indicators for assessing vulnerability and sustainability at community level. The results showed that ADH households had higher human capital and natural capital vulnerability than NDH households. In contrast, NDH households had higher social capital and financial capital vulnerability than ADH households. Overall, ADH households had greater vulnerability than NDH households.
These results improve understanding of the environmental and socio-economic changes affecting rural livelihoods and the measures needed to address their specific vulnerabilities by addressing bottlenecks in education and training facilities for skill up-grading, increasing interaction opportunities through local functions and creating opportunities for income generation and effective market and farm linkages. An attempt was made to reduce the gap between bottom-up understanding and top-down policies by suggesting precautionary and ongoing adaptation practices for the communities studied, leading to effective and efficient addressal of vulnerabilities. Vulnerability in the study context was taken to mean externally driven change leading to disturbance in the human environment that could alter internal and external livelihood settings.
Peripheral vascular disease of the lower extremities comprises a clinical spectrum that extends from no symptoms to presentation with critical limb ischemia (CLI). Bone marrow derived Mesenchymal ...Stem Cells (BM- MSCs) may ameliorate the consequences of CLI due to their combinatorial potential for inducing angiogenesis and immunomodulatory environment in situ. The primary objective was to determine the safety of BM- MSCs in patients with CLI.
Prospective, double blind randomized placebo controlled multi-center study was conducted in patients with established CLI as per Rutherford classification in category II-4, III-5, or III-6 with infra-inguinal arterial occlusive disease and were not suitable for or had failed revascularization treatment. The primary end point was incidence of treatment - related adverse events (AE). Exploratory efficacy end points were improvement in rest pain, increase in Ankle Brachial Pressure Index (ABPI), ankle pressure, healing of ulcers, and amputation rates. Twenty patients (BM-MSC: Placebo = 1:1) were administered with allogeneic BM-MSCs at a dose of 2 million cells/kg or placebo (PlasmaLyte A) at the gastrocnemius muscle of the ischemic limb.
Improvement was observed in the rest pain scores in both the arms. Significant increase in ABPI and ankle pressure was seen in BM-MSC arm compared to the placebo group. Incidence of AEs in the BM-MSC arm was 13 vs. 45 in the placebo arm where as serious adverse events (SAE) were similar in both the arms (5 in BM-MSC and 4 in the placebo group). SAEs resulted in death, infected gangrene, amputations in these patients. It was observed that the SAEs were related to disease progression and not related to stem cells.
BM-MSCs are safe when injected IM at a dose of 2 million cells/kg body weight. Few efficacy parameters such as ABPI and ankle pressure showed positive trend warranting further studies.
NIH website (http://www.clinicaltrials.gov/ct2/show/NCT00883870).
Background: With ever-increasing digitization, the internet has intertwined into the daily lives of users to a large extent. It holds tremendous educational benefits to college students; however, its ...excessive usage can lead to addiction and even psychological morbidities. Objectives: To determine the prevalence of internet addiction and its association with various factors including depression, anxiety, and stress. Materials and Methods: A cross-sectional study was conducted among undergraduate students of two professional colleges, i.e., medical and engineering colleges in the Jammu region. A pre-tested, semi-structured questionnaire was used to elicit the information regarding socio-demographic and personal details of students. Young's internet addiction scale was used to assess internet addiction, whereas the DASS 42 scale was used to measure depression, anxiety, and stress. Data thus collected were analyzed using the PSPP software. Results: A total of 480 students constituted the study population. The prevalence of internet addiction was found to be 78.7%, with a significantly higher prevalence seen among the male students in comparison to females (P < 0.005). A significantly positive correlation of internet addiction was found with depression, anxiety, and stress. Conclusions: Internet addiction is significantly associated with psychopathology among the respondents. In this context, there is an urgent need to develop effective strategies for the prevention of internet addiction by promoting awareness among the students.
A BSTRACT Background: Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric ...morbidities usually manifests as impaired quality of life and poor treatment adherence. Objectives: The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables. Methodology: The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects. Results: The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities ( P < 0.05). Conclusions: The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.
Background: Attention-deficit hyperactive disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and has the potential for continuity into adolescence and adulthood. Its ...presence increases difficulties in academic performance and social interactions besides leading to low self-esteem. The present study aimed to determine the prevalence of ADHD among children of age 6-12 years in Government schools of a rural area in Jammu district of J and K. Methods: The present study was conducted in R.S. Pura block of Jammu district. Miran Sahib zone of R.S Pura block was chosen randomly and all the government primary schools in this zone were included in the survey. The presence of ADHD was assessed using Vanderbilt ADHD diagnostic teacher rating scale. The children positive for ADHD were visited at their residential places and a personal information questionnaire (PIQ) was administered to their parents-preferably the mother. The data thus collected was presented as proportions. Results: ADHD prevalence was found to be 6.34% (13/205). Majority (69.3%) of the ADHD-positive children were living in a joint family and belonged to lower/lower middle class. Family history of ADHD was absent in all the ADHD-positive children. Conclusion: The current study conducted in a rural area among 6- to 12-year-old children of Government schools has shown a reasonably high ADHD prevalence of 6.34%.
Purpose: The aim of this study is to analyze anticoagulation-related complications in patients following mechanical valve replacement and factors influencing the outcome.
Materials and Methods: A ...total of 250 patients were analyzed during OPD follow-up for anticoagulation-related complications and various factors influencing outcome. Patients received prosthetic valve at mitral and/or aortic or both.
Results: Out of 250 patients, 48% were male and 52% were female. The mean age was 41.9 ± 14.4. A total of 139 had mitral valve replacement (MVR), 70 had aortic valve replacement (AVR), 40 had double valve replacement (DVR), and 1 patient had triple valve replacement. Valves implanted were mechanical bileaflet valve. The mean international normalization ratio (INR) in the study was 2.4 ± 0.56. A total of 49 events occurred during follow-up, of which 4.5% per patient years were anticoagulation-related hemorrhagic events and 4.8% per patient years were thromboembolic events. Among thromboembolic events, valve thrombosis occurred in 10 patients and cerebrovascular accidents occurred in 11 patients. Mean INR for thromboembolic events was 1.46 ± 0.25 and anticoagulation-related hemorrhagic events was 4.4 ± 1.03. Mortality rate was 1.6% in AVR, 4% in MVR, and 0.4% in DVR groups; about 34% of patients needed dose modification of Acenocoumarol and reason for derangement of INR was associated with infectious process and poor compliance; 85% of cases showed good compliance for daily anticoagulation therapy.
Conclusion: Anticoagulation for mechanical valve replacement can be managed with INR range of 2.0 to 2.5 in MVR and 1.5 to 2.0 in AVR with acceptable hemorrhagic and thromboembolic events. We must educate and counsel the patients during follow-up for better compliance to optimal anticoagulation.
The present study proposes an index to assess the potential for adaptation to climate change for households in the mountainous regions. The index provides a realistic approach to recognize social and ...natural factors which contribute to successful adaptation and addresses several household functions, such as social networking, livelihood strategy, adjustment strategies, resource availability and accessibility. The proposed Adaptation Capability Index （ACI） is analytically defined, mathematically formulated and field tested on mountainous households in urban and semi-urban regions of the Uttarakhand Himalaya in India. To gather data on the topic relevant to the ACI, a household scale questionnaire was developed and administered to 12o heads of households through face-to-face interviews. The results highlight higher adaptive capability of urban households and low adaptation capacity of rural households due to poor farm productivity, low accessibility and availability of resources and technological input. Future programs and policies must include and implement regulations to remedy attributive factors responsible for higher adaptation. This paper may be applicable to other mountainous regions and may provide insights for effective adaptation strategies to climate change.
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