Study the association between spirometry based functional grading and six minute walk distance in chronic respiratory disease patients at a rural tertiary care centre of India.

Introduction: Six-min walk test (6MWT) is easy to use, the least expensive, and a quick measure of physical function and it reflects the capacity to perform our day-to-day activities hence quality of life can be assessed with 6MWT. This study was planned to assess the role of 6MWT in chronic respiratory disease patients and its association with spirometry-based functional grading at a rural tertiary care center of northern India. Materials and Methods: This was a hospital-based cross-sectional study done between December 2019 and July 2021. In this study, 110 patients were included as per inclusion and exclusion criteria. 6MWT and spirometry were conducted as per the American Thoracic Society/European Research Society recommendation using Spiropalm 6MWT and the association between 6MWT and spirometry was assessed. Results: A total of 110 chronic respiratory disease patients were included in the study. There were 69 (63%) males while 41 (37%) were females. Among study participants, chronic obstructive pulmonary disease patients were the most common 48 (43.6%) patients, followed by asthma 28 (25.5%), posttuberculosis sequelae patients 22 (20%), interstitial lung disease 9 (8.2%), and bronchiectasis 3 (2.7%) patients were found. There was a significant positive correlation of 6-min walk distance (6MWD) and % predicted 6MWD with spirometric parameters, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and there was a significant positive correlation of 6MWD with FEV1% (predicted) also. 6MWD and % predicted 6MWD negatively correlated with FEV1/FVC and association between 6MWD and FEV1/FVC was not statistically significant and between % predicted 6MWD and FEV1/FVC, it was found statistically significant. Conclusion: The 6MWD traveled by chronic respiratory disease patients was significantly lower than the predicted 6MWD and 6MWD correlated with spirometric variables well. Therefore, it can conclude that 6MWT is a useful alternative of spirometry in the management of chronic respiratory disease patients in resource-limited settings.

Résumé Introduction: Le test de marche de six minutes (6MWT) est facile à utiliser, le moins coûteux et constitue une mesure rapide de la fonction physique. Il reflète la capacité à effectuer nos activités quotidiennes et la qualité de vie peut donc être évaluée à l'aide du test de marche de six minutes. Cette étude avait pour but d'évaluer le rôle du6MWT chez les patients atteints de maladies respiratoires chroniques et son association avec le classement fonctionnel basé sur la spirométrie dans un centre de soins tertiaires rural du nord de l'Inde. Matériels et méthodes: Il s'agit d'une étude transversale en milieu hospitalier réalisée entre décembre 2019 et juillet 2021. Dans cette étude, 110 patients ont été inclus selon les critères d'inclusion et d'exclusion. Le 6MWT et la spirométrie ont été effectués conformément aux recommandations de l'American Thoracic Society et de l'European Research Society. Thoracic Society/European Research Society en utilisant le Spiropalm 6MWT et l'association entre le 6MWT et la spirométrie a été évaluée. Résultats: Au total, 110 patients atteints de maladies respiratoires chroniques ont été inclus dans l'étude. Il y avait 69 hommes (63 %) et 41 femmes (37 %).41 (37 %) étaient des femmes. Parmi les participants à l'étude, les patients atteints de bronchopneumopathie chronique obstructive étaient les plus nombreux (48 (43,6 %)), suivis de l'asthme (28 (25,5 %)) suivis par l'asthme 28 (25,5%), les séquelles de la tuberculose 22 (20%), la pneumopathie interstitielle 9 (8,2%) et la bronchectasie 3 (2,7%).3 (2,7 %). Il existe une corrélation positive significative entre la distance de marche de 6 minutes (6MWD) et le % prédit de la 6MWD avec les paramètres spirométriques, l'expiration forcée et le taux de mortalité.avec les paramètres spirométriques, le volume expiratoire forcé en 1 s (VEMS), la capacité vitale forcée (CVF) et le volume de l'air expiré.) et la capacité vitale forcée (CVF), et il existe une corrélation positive significative entre le 6MWD et le VEMS.entre le 6MWD et le VEMS(prédit). Le 6MWD et le % prédit du 6MWD étaient négativement corrélés avec le VEMS / CVF et l'association entre le 6MWD et le % prédit du VEMS./CVF et l'association entre le6MWD et le VEMS/n'était pas statistiquement significative et entre le % prédit du 6MWD et le VEMS/CVF, elle s'est avérée statistiquement significative. Conclusion: Le 6MWD parcouru par les patients atteints de maladies respiratoires chroniques était significativement plus bas que le 6MWD prédit et le 6MWDétait bien corrélé avec les variables spirométriques. On peut donc conclure que le 6MWT est une alternative utile à la spirométrie dans la prise en charge des patients atteints de maladies respiratoires chroniques dans les pays à ressources limitées.des patients souffrant de maladies respiratoires chroniques dans des contextes où les ressources sont limitées. Mots-clés: distance de marche de 6 minutes, test de marche de 6 minutes, maladies respiratoires chroniques, spirométrie.

Prognostic Role of Catecholamine in Moderate-to-Severe Traumatic Brain Injury: A Prospective Observational Cohort Study.

Objective Traumatic brain injury leads to the activation of sympathetic nervous system and elevation in serum catecholamine levels. The aim of this study was to determine whether catecholamine level obtained within 24 hours of traumatic brain injury provides a reliable prognostic marker for outcome. Materials and Methods This study was a prospective observational cohort study on 36 moderate-to-severe traumatic brain injury. Plasma epinephrine (E), norepinephrine (NE), and dopamine (DA) levels were measured by using computed tomography enzyme-linked immunosorbent assay test and compared with Glasgow coma scale (GCS) that was obtained concurrently. Neurological outcome was determined by GCS at day 7 of treatment and by Glasgow outcome scale at mean follow-up of 9.73 ± 2.26 months. Results Patients with GCS 3 to 4 had markedly increase in baseline mean E (771.5 ± 126.0), NE (2,225.0 ± 215.4), and DA (590.2 ± 38.8) levels as compared with control, while patients with better GCS (11-12) had mildly elevated levels. Patients with GCS 5 to 10 had intermediate values. Cases with markedly elevated baseline E, NE, and DA level were either died or remained in poor GCS (3 or 4) at day 7 of treatment and remained in persistent vegetative state at mean follow-up of 9.73 ± 2.26 months. Cases with only mildly elevated E, NE, and DA level were improved to better GCS on treatment and had good recovery on follow-up. Conclusion These data indicate that a markedly elevated catecholamine level was an excellent endogenous and readily quantifiable marker that appears to reflect the extent of brain injury and predict the likelihood of recovery.

Hospital-Based Retrospective Cross-sectional Study to Analyse the Causes of Maternal Deaths at a Tertiary Health Care Facility.

Context: Maternal mortality is considered a key health indicator of Maternal and Child Health. Considering the fact that complications are preventable and most of them are modifiable, the study has been planned to analyse maternal deaths in order to suggest recommendations for preventing it. There are various delays according to the three-delay model at primary and secondary level; therefore, interventions are needed at those levels to prevent maternal deaths. Aims: To determine the various direct and indirect causes of maternal deaths, analyse the association of medical and social factors with maternal deaths and ^to determine the predictors of maternal deaths. Settings and Design: Hospital-based retrospective cross-sectional study of all the maternal deaths occurring in the last 4 years at a tertiary health care facility. Methods and Material: Data were collected from the Facility Based Maternal Death Review forms. Statistical Analysis Used: Data were entered and analysed by IBM SPSS version 25.0 software. Results: For maternal deaths, direct obstetric causes were responsible in 128 (74.4%) and indirect causes in 45 (26.2%) cases followed by unspecified causes in 78 (45.3%) and 1 (0.6%) coincidental cause. Statistically significant associations were observed between maternal death and period of gestation, mode of delivery and outcome of delivery (P = 0.12, P = 0.04 and P < 0.001, respectively). Conclusions: The health professionals of primary and secondary level should be well equipped to diagnose the complications and to manage it as early as possible. Thus, maternal mortality rates can be decreased to significant level.

Prevalence of high-risk pregnancy among pregnant women enrolled under Pradhan Mantri Surakshit Matritva Abhiyan in government health facilities of district Etawah, Uttar Pradesh: A cross-sectional study.

Background: According to the Sample Registration System report, India has reduced the maternal mortality rate from 130 per 100,000 live births in 2014-2016 to 113 per 100,000 live births in 2016-2018. The main purpose of antenatal care is to identify "high-risk" cases as early as possible from a large group of antenatal mothers and provide them skilled and appropriate care. Objective: To determine the prevalence of high-risk pregnancy (HRP) in pregnant females availing services under pradhan mantri surakshit matritva abhiyan (PMSMA) and to assess awareness of pregnant mothers about services provided under PMSMA in district Etawah of Uttar Pradesh. Material and Methods: Community-based cross-sectional study was carried out among 400 female beneficiaries who were registered under the PMSMA scheme and delivered their baby at any government health facility during one year of study period. Results: It was observed that from all the antenatal women visiting the community health center for HRP day under the PMSMA scheme, 162 (40.5%) were categorized as HRPs and 238 (59.6%) of them were nonhigh-risk pregnancies. A statistically significant association was observed (P-value = 0.005 at 95% CI) between the difference in the proportion of HRPs and the educational status of the pregnant mothers. Out of 400 beneficiaries, 167 (41.75%) were aware of the PMSMA scheme. Conclusion: Regular antenatal care (ANC) check-ups, early identification of HRP, health education, and timely screening are needed to reduce maternal mortality.

Effect of 0.5% povidone-iodine on the nasopharyngeal and oropharyngeal viral loads in patients with COVID-19: A double-blind placebo-controlled randomized clinical trial.

Background and Objective: The povidone-iodine (PvP-I) nasal antiseptic has been shown to completely inactivate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro at variable concentrations. This study was performed to investigate the effect of 0.5% PvP-I nasal drops and oral gargles on the nasopharyngeal and oropharyngeal viral loads in SARS-CoV-2-positive patients. Methods: This was a double-blind, placebo-controlled, randomized clinical trial among patients aged ≥18 years with reverse-transcriptase polymerase chain reaction confirmed in the mild to moderate category of SARS-CoV-2 infection. A total of 32 patients were randomly assigned to receive either freshly prepared 0.5% PvP-I solution or distilled water in the form of supervised self-administered 4-5 nasal drops, followed by 20 ml for gargling for at least 30 seconds. The main outcome measure was the mean change in viral titer and Ct values in the nasopharyngeal and oropharyngeal samples at baseline, 5 minutes, and 3 hours post intervention. Results: The mean change in viral titers across the time duration for the test group when compared with the control group was not statistically significant (P = 0.109). However, the mean change in Ct value was found to be borderline statistically significant (P = 0.042). Noticeable differences were noted among the mean viral titers and Ct values in the intervention group when plotted against the time of testing as compared to the control group. PvP-I solution at 0.5% dilution was well tolerated, and no evident side effects were reported. Conclusions: This study shows that 0.5% PvP-I has an effect on reducing nasopharyngeal and oropharyngeal viral loads in COVID-19 patients. This can be of substantial aid for the primary care physicians, especially for the practitioners in remote and resource poor areas.

Evaluation of Cognitive Functions in Traumatic Brain Injury Patients Using Mini Mental State Examination and Clock Drawing Test.

BACKGROUND: Traumatic brain injuries (TBIs) are the leading cause of morbidity, mortality, disability, and socioeconomic losses globally, but of more concern, in India and other developing countries. The Mini mental state examination (MMSE) and clock drawing test (CDT) are the two mostly adapted methods for cognitive impairment screening. Therefore, it is necessary to establish a robust evaluation system exclusively for post-TBI cognitive impairment. MATERIALS AND METHODS: One hundred and thirty-four cases treated previously at the health facility for TBIs were evaluated for cognitive functions during the follow-up period ranging from 3 weeks to 6 months in the out-patient department. All cases underwent mini-mental score examination (MMSE) and CDT to assess their cognitive performances. The data were analyzed statistically using Chi-square and ANOVA tests of significance. RESULTS: Statistically significant association (P < 0.001) between the cognitive status of patients on the basis of overall MMSE score and the site of brain injury was observed. It was noted that 76 (56.7%) of the cases had cognitive impairment (MMSE score <24) with majority 44 (32.8%) patients having frontal lobe injuries, followed by 14 (10.1%) having brain injuries in the temporal lobe. On the other hand, using CDT score, it was observed that 102 (76.1%) of the cases had cognitive impairment (CDT score <5) with the majority 49 (36.6%) cases having frontal lobe injury followed by 19 (14.2%) having brain injury in the parietal lobe. CONCLUSION: The CDT was able to access cognitive function disruption in those patients, in whom the mini-mental score examination was not able to assess the same, and this difference in detection capabilities of both the tests was statistically found significant.

A deep learning-based COVID-19 automatic diagnostic framework using chest X-ray images.

The lethal novel coronavirus disease 2019 (COVID-19) pandemic is affecting the health of the global population severely, and a huge number of people may have to be screened in the future. There is a need for effective and reliable systems that perform automatic detection and mass screening of COVID-19 as a quick alternative diagnostic option to control its spread. A robust deep learning-based system is proposed to detect the COVID-19 using chest X-ray images. Infected patient's chest X-ray images reveal numerous opacities (denser, confluent, and more profuse) in comparison to healthy lungs images which are used by a deep learning algorithm to generate a model to facilitate an accurate diagnostics for multi-class classification (COVID vs. normal vs. bacterial pneumonia vs. viral pneumonia) and binary classification (COVID-19 vs. non-COVID). COVID-19 positive images have been used for training and model performance assessment from several hospitals of India and also from countries like Australia, Belgium, Canada, China, Egypt, Germany, Iran, Israel, Italy, Korea, Spain, Taiwan, USA, and Vietnam. The data were divided into training, validation and test sets. The average test accuracy of 97.11 ± 2.71% was achieved for multi-class (COVID vs. normal vs. pneumonia) and 99.81% for binary classification (COVID-19 vs. non-COVID). The proposed model performs rapid disease detection in 0.137 s per image in a system equipped with a GPU and can reduce the workload of radiologists by classifying thousands of images on a single click to generate a probabilistic report in real-time.