Evaluation of risk factors for non-alcoholic fatty liver disease in India: A systematic review and meta-analysis.

INTRODUCTION: NAFLD is emerging as an important cause of liver disease in India. It is estimated that 16-32% of general population in India (nearly 120 million) has NAFLD. OBJECTIVE: This study aimed to identify the risk factors of NAFLD and to identify the association of lifestyle (dietary and physical activity), genetic, and environmental factors with NAFLD in India. MATERIALS AND METHODS: A systematic literature search was conducted using an international electronic database: PubMed (MEDLINE) and Google Scholar from the date of inception 31st March 2021 to 28th September 2021. We included studies examining patients with NAFLD: Adults above 18 years of age. Studies with or without a control population were both eligible. The studies with a diagnosis of NAFLD based solely on abnormal liver tests were excluded. We tried to get unpublished data but they were not of the quality of inclusion. Meta-analysis was performed using the software STATA 14.2 (StataCorp, College Station, TX, USA). For each of the studies, the standard error was calculated using the reported number of outcomes and the sample size. A forest plot was used to graphically represent the study-specific and pooled prevalence estimates for overall and subgroup analysis. RESULTS: In a systematic review and meta-analysis of 8 studies including data from over 1800 individuals, we found that among components of lipid profile, LDL and HDL had a negative effects on NAFLD while triglycerides had a positive effect on NAFLD. CONCLUSION: Type 2 Diabetes Mellitus, Hypertension, and Obesity were the potential risk factors for NAFLD but the evidence generated was only from single studies.

An economic evaluation of diabetes mellitus in India: A systematic review.

BACKGROUND: Approximately 88 million people throughout Southeast Asia have diabetes, of which 77 million reside in India. India had an annual estimated diabetes treatment cost of Rs.10,000 to 12,000 crore in 2003, which is likely to rise to as high as Rs. 1,26,000 crores by 2025. AIM: To assess the annual mean expenditure for an individual with diabetes mellitus. METHODS: We used search terms and Boolean operators to identify studies on the economic burden of diabetes mellitus patients in India between 2015 and 2020. Thereafter, we used the checklists of STROBE, as well as the PRISMA, Drummonds and down, and Black criteria, to assess the quality of included studies. Then, Meta xl was used to calculate the weighted means and weighted proportion based on the quality assessment findings. RESULTS: Mean expenditure with a maximum weightage of 100% was found in a community-based study, whereas the lowest weightage obtained was 20%. The mean expenditure on diabetes and its complications was calculated as INR 15,535/-(USD 209.3) per year, with a pooled mean of INR 17, 080(USD 230.1)per year. On average, the OPD charges were 3%-5% of the total annual income of the individual. However, when there were complications and hospitalization, the average expenditure was higher (21%) which averages to around 11,000 INR. CONCLUSIONS: While patients spent 3% of their annual income on only OPD charges on average, complications substantially increased the total cost by more than 10%, which amounts to catastrophic health expenditure.

Provision of Care Following Road Traffic Injuries in a District in South India: A Qualitative Analysis of Stakeholder Perspective.

INTRODUCTION: It is essential to explore ways to prevent and reduce the severity of injuries in road crashes. This study attempts at getting a ground-level understanding of perspectives surrounding road traffic injury among various stakeholders. MATERIALS AND METHODS: In-depth interviews and focused group discussions were conducted over a period of 6 months among traffic police, toll booth operators, road transport officers, nurses, and intensive care specialists. The transcribed data were coded and analyzed, and a percentage of final themes as well as codes were drawn. RESULTS: The common reasons cited for delay in transport of accident victims were fear regarding medicolegal issues among the first responders (36.9%) and delay in ambulance (41.5%). 26.1% agreed that time delay in transport can be reduced by generating awareness. Teaching first aid to the general public is essential as opined by 75% of nursing staff and 66.7% of emergency physicians. Documentation procedures (15.4%), long waiting hours (10.2%), and out-of-pocket expenditure and financial constraints (10.2%) were the commonly cited reasons for problems faced by patient bystanders. CONCLUSIONS: Creating awareness and improving access to ambulance were the two essential recommendations to prevent delay in prehospital care. Majority of the care providers and patient bystanders agreed that improving insurance coverage is essential to reduce financial constraints.

Knowledge and Attitude Toward Corneal Donation Among High School Children in Northern India.

PURPOSE: To assess the knowledge and attitude of school-going adolescents regarding corneal donation in government and private schools in an urban area of Northern India. METHODS: A school-based cross-sectional study was conducted in an urban field practice area of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. A total of 365 participants of the seventh to 10th grade were enrolled from a government school and a private school. A pretested, semistructured, self-administered, bilingual (English and Hindi) questionnaire was used to assess the sociodemographic profile and knowledge and attitude related to corneal donation. RESULTS: Most (87%) (confidence interval, 83.1%-90.0%) participants had heard about corneal donation. Only 2% of students answered all the knowledge-related questions correctly. None knew about the national toll-free number for corneal donation. Three-fourth (72%) supported the idea of corneal donation. Of them, only 44% (confidence interval, 41.0-47.1) were willing to pledge to donate their own eyes. Fears and myths were the persistent barriers. The government and private schools differed in both knowledge and attitude, with the latter performing better. CONCLUSIONS: Knowledge among the selected high school children was poor. Although many supported the idea, only a few were willing to donate. We suggest that program components be evaluated from time to time. Future studies should explore the role of strengthening Information Education and Communication (IEC) activities among high school students for motivating community members to pledge to donate for corneal donation.