Severe Necrotizing Pneumonia in Children: A Challenge to Intensive Care Specialist.

OBJECTIVE: Necrotizing pneumonia (NP) is recently recognized as a complication of pneumonia. The data on NP are scant from developing world and we aimed to describe the characteristic features of NP in our children. STUDY DESIGN: Single center retrospective cohort analysis. PATIENT SELECTION: Institutional database of children treated for pneumonia between September 2014 and May 2018 was searched to identify children with NP. METHODS: The demographic characteristics, laboratory results, and clinical information were recorded for patients selected as NP and analyzed. RESULTS: In total, 10 patients (3.7%) of NP were identified out of 272 patients with pneumonia. Median age was 3 years (range: 3 months to 12years). All cases had severe respiratory distress and 70% required mechanical ventilation and inotropic support. The causative pathogens were identified in 6/10 children (60%) with Staphylococcus aureus being most common (4/10). Pleural effusion and pneumothorax were seen in six cases. Four cases had bilateral pleural effusion and three had bilateral pneumothorax. Intercostal drainage (ICD) was placed in 70% and bilateral ICD was placed in 40% cases. Bronchopleural fistula (BPF) developed in two cases and one had bilateral BPF. Median [inter quartile range] ICD days and hospital stay were 9 (6-14) and 13.5 (7.5-18.5) days, respectively. Mean (±SD) total antibiotic (in hospital plus outpatient) days were 28.8 ± 9.6 days. Four cases had airway hemorrhage and in three cases this was massive and fatal. CONCLUSION: NP is a relatively rare but severe complication of pneumonia distinct from pediatric acute respiratory distress, pleural effusion and empyema. Airway hemorrhage is the most fatal complication.

N and O isotope (δ15 Nα , δ15 Nß , δ18 O, δ17 O) analyses of dissolved NO3- and NO2- by the Cd-azide reduction method and N2 O laser spectrometry.

RATIONALE: The nitrogen and oxygen (δ15 N, δ18 O, δ17 O) isotopic compositions of NO3- and NO2- are important tracers of nutrient dynamics in soil, rain, groundwater and oceans. The Cd-azide method was used to convert NO3- or NO2- to N2 O for N and triple-O isotopic analyses by N2 O laser spectrometry. A protocol for laser-based headspace isotope analyses was compared with isotope ratio mass spectrometry. Lasers provide the ability to directly measure 17 O anomalies which can help discern atmospheric N sources. METHODS: δ15 N, δ18 O and δ17 O values were measured on N/O stable isotopic reference materials (IAEA, USGS) by conversion to N2 O using the Cd-azide method and headspace N2 O laser spectrometry. A 15 N tracer test assessed the position-specific routing of N to the α or ß positions in the N2 O molecule. A data processing algorithm was used to correct for isotopic dependencies on N2 O concentration, cavity pressure and water content. RESULTS: NO3- /NO2- nitrogen is routed to the 15 Nα position of N2 O in the azide reaction; hence the δ15 Nα value should be used for N2 O laser spectrometry results. With corrections for cavity pressure, N2 O concentration and water content, the δ15 NαAIR , δ18 OVSMOW and δ17 OVSMOW values (‰) of international reference materials were +4.8 ± 0.1, +25.9 ± 0.3, +12.7 ± 0.2 (IAEA NO3 ), -1.7 ± 0.1, -26.8 ± 0.8, -14.4 ± 1.1 (USGS34) and +2.6 ± 0.1, +57.6 ± 1.2, +51.2 ± 2.0 (USGS35), in agreement with their values and with the isotope ratio mass spectrometry results. The 17 O excess for USGS35 was +21.2 ± 9‰, in good agreement with previous results. CONCLUSIONS: The Cd-azide method yielded excellent results for routine determination of δ15 N, δ18 O and δ17 O values (and the 17 O excess) of nitrate or nitrite by laser spectrometry. Disadvantages are the toxicity of Cd-azide chemicals and the lack of automated sampling devices for N2 O laser spectrometers. The 15 N-enriched tracer test revealed potential for position-specific experimentation of aqueous nutrient dynamics at high 15 N enrichments by laser spectrometry, but exposed the need for memory corrections and improved spectral deconvolution of 17 O.

Approaches for achieving long-term accuracy and precision of δ18O and δ2H for waters analyzed using laser absorption spectrometers.

The measurement of δ(2)H and δ(18)O in water samples by laser absorption spectroscopy (LAS) are adopted increasingly in hydrologic and environmental studies. Although LAS instrumentation is easy to use, its incorporation into laboratory operations is not as easy, owing to extensive offline data manipulation required for outlier detection, derivation and application of algorithms to correct for between-sample memory, correcting for linear and nonlinear instrumental drift, VSMOW-SLAP scale normalization, and in maintaining long-term QA/QC audits. Here we propose a series of standardized water-isotope LAS performance tests and routine sample analysis templates, recommended procedural guidelines, and new data processing software (LIMS for Lasers) that altogether enables new and current LAS users to achieve and sustain long-term δ(2)H and δ(18)O accuracy and precision for these important isotopic assays.

The Extent of Delay in Diagnosis, Treatment and their Associated Factors among Tuberculosis Patients Attending Government Hospitals of Rishikesh, Uttarakhand: A Cross-Sectional Study.

BACKGROUND: "Tuberculosis (TB) remains a major public health problem" worldwide, affecting almost all age groups. "Early diagnosis and prompt treatment are essential to significantly reducing the TB burden." However, a significant proportion of cases remain undiagnosed and untreated, which plays a vital role in the transmission of the disease and severity of the illness in the community in most developing countries. AIMS & OBJECTIVES: This study aimed to assess "the extent of delay in diagnosis and treatment of TB patients" and to identify the major factors associated with such delays (whether patient or health system-related) among TB patients in Rishikesh. METHODS: This descriptive cross-sectional study was conducted in Rishikesh Town, Dehradun District, Uttara khand, India. Total of 130 newly diagnosed TB patients were recruited as study participants who attended the government hospitals of Rishikesh, All India Institute of Medical Sciences, Rishikesh and S P S Government Hospital, Rishikesh. A universal sampling technique was used in this study. RESULTS: The mean age of the study participant was 36.75 (Standard Deviation (SD), 17.6), and the median age was 34 years. Of the patients, 64.6% were men, and 35.4% were women. The extent of various delays, such as patient delay (median 16 days), diagnostic delay (median 78.5 days), treatment delay (median 4 days), health system delay (43 days), and total delay (median 81 days). CONCLUSION: The misconception of any chronic disease may lead to a false diagnosis or long treatment for symptomatic relief; the absence of proper diagnostic tests and doctor shopping could be the reasons for the prolonged diagnostic delay. Therefore, by strengthening the collaboration between private and public practitioners in order to meet the expectations of the Government of India to achieve the goals of the "National Strategic Plan for ending TB" in India by providing good quality care for all patients.

Psychometric Properties of the Hindi Version of the World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) Module in Dehradun, India.

BACKGROUND: The perception of quality of life (QOL) is a subjective concept; however, attempts have been made to discern the key points and to give a metric view of this concept. The World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) module is an international and cross-cultural tool that quantifies the QOL in older adults. OBJECTIVES: This study aimed to assess the psychometric properties of the Hindi version of the WHOQOL-OLD module by calculating its reliability and validity among the elderly residing in the Dehradun district of India. METHODOLOGY: This cross-sectional study was conducted among 440 elderlies from the rural and urban areas of Dehradun by using the Hindi version of the WHOQOL-OLD questionnaire. The mean and standard deviations were calculated for QOL scores. Reliability was checked by calculating Cronbach's alpha (α), and factor analysis was done for the validity of the questionnaire. RESULTS: Mean (±SD) for total QOL score was 54.3 (±9.3). The death and dying facet had the maximum mean score, whereas the minimum mean score was calculated in the autonomy facet. Cronbach's alpha reliability coefficient for the overall QOL score was calculated as 0.86 which shows good internal consistency of the items in the questionnaire. To measure the construct validity, exploratory factor analysis (EFA) by principal components analysis (PCA) was performed on the 24 items of the WHOQOL-OLD module, and a six-factor model was identified. Satisfactory goodness-of-fit statistics were found on the confirmatory factor analysis (CFA). CONCLUSION: QOL is a multidimensional concept. The Hindi version of the WHOQOL-OLD module is reliable and valid. QOL in the elderly population can be measured by using the WHOQOL-OLD module in India.

Impact of COVID-19 on the national tuberculosis elimination program in uttarakhand, india: a mixed-methods research study.

Background: The COVID-19 pandemic has had adverse effects on tuberculosis (TB) management in high-burden countries. We conducted a qualitative study to assess the impact of COVID-19 on Uttarakhand's TB elimination program. Methods: A mixed-methods study was conducted to assess the impact of COVID-19 on the National Tuberculosis Elimination Program (NTEP) in Uttarakhand, India. We collected secondary data through the NIKSHAY portal from April 1, 2019, to March 31, 2021, interviewed program managers for the qualitative part of the study, and documented changes in some of the program core indicators during the study period. Results: The study showed a decrease in TB case notification, an increase in the proportion of missing cases, and a fall in the treatment success rate of new cases during the ongoing COVID-19 pandemic by 17%, 54%, and 45%, respectively. Content analysis of in-depth interviews showed disruption in TB-care services because of COVID-19. Conclusion: TB care services in Uttarakhand have been impacted by measures taken to curb the spread of COVID-19. Both the quantitative and qualitative aspects of the study showed a serious impact on notification rates, diagnostic services, and treatment outcomes for TB patients. In addition, some negative changes have been observed when documenting program indicators (annual case notifications, success rate, treatment success rate) of the National Tuberculosis Elimination Program (NTEP). It is thus predicted that COVID-19 will undermine the Government of India's goal to eradicate TB by 2025 and will negatively affect the TB Program.

Assessment of Organ Dysfunction and Underlying Causes in Maternal Near-miss Cases at Health Care Facilities in Doiwala Block of District Dehradun - A Retrospective Study.

INTRODUCTION: The extent of maternal morbidity is a good gauge of a nation's maternal health care system. Maternal near-miss (MNM) cases need to be reviewed because they can indirectly contribute significantly to reducing the maternal mortality ratio in India. MNM cases can provide useful information in this context. Such women who survive these life-threatening conditions arising from complications during pregnancy, childbirth and post partum (42 days) share many commonalities with those who die because of such complications. AIM: To assess the organ dysfunction and the underlying causes, associated/contributory factors associated with "maternal near-miss" cases in pregnant, in labor, post-partum women (upto42 days) in the health care facilities of Doiwala block, district Dehradun. MATERIALS AND METHODS: The present study was conducted over a period of 6 months under the Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh. The cross-sectional study included the medical record files of all pregnant women attending the Department of Obstetrics and Gynecology, in the selected healthcare facilities of Doiwala block, district Dehradun. This study was conducted as per the WHO criteria for "near-miss" by using convenience sampling for the selection of healthcare facilities. The medical record files of all women who were pregnant, in labor, or who had delivered or aborted up to 42 days were included from a period of 01.06.2021 - 31.05.2022. RESULTS: It was found that Out of the women with maternal near-miss (n=91), the majority of women had coagulation /hematological dysfunction (n=45, 49.4%), followed by neurologic dysfunction (n=15, 16.4%), cardio-vascular dysfunction (n=11, 12%). Out of the total women with a maternal near-miss (n = 91), 10 women underwent multiple organ dysfunctions. Of the total 91 maternal near-miss cases, the underlying cause of near-miss was obstetric hemorrhage in almost half the participants (n=45, 49.5%) followed by hypertensive disorders (n=36, 39.5%). Eleven women had a pregnancy with abortive outcomes (12%) and 7 women had pregnancy-related infection. It was also seen that, out of 91 near-miss women, the leading contributory /associated cause was Anemia (n=89, 97.8%) followed by women having a history of previous cesarean section (n=63, 69.2%). Sixteen women had prolonged /obstructed labor (n = 16, 17.58%). CONCLUSION: Pregnancy should be a positive experience for every woman of childbearing age. A better understanding of pregnancy-related conditions enables early detection of complications and prevents the conversion of mild to moderate maternal morbidity outcomes to severe maternal outcomes with long-term health implications or death. There are already effective measures in place to reduce maternal and newborn mortality and morbidity.

Effect of Electromagnetic Radiation from Mobile Phones on Auditory Brainstem Response.

Mobile phones are being used by around 70% of the global population. A simple non-invasive procedure to detect early impairment of the acoustic nerve and auditory pathway is by auditory brainstem response (ABR). It's a response to the sound stimulus generated from the brainstem in the form of electrical impulses. To determine the effect of long-term usage of mobile phones on auditory brainstem responses (ABRs). This Epidemiological, cross-sectional study was undertaken at a tertiary care hospital and includes 865 individuals aged between 18 to 45 years using mobile phone for > 2 years. Users were categorized into various groups according to the minutes of mobile usage per day, years of mobile usage and total duration of mobile phone use in dominant (mobile using) and non-Dominant (non-mobile using) ears. The changes in ABR were studied in each ear to ascertain the effect of EMF exposure due to chronic mobile phone use. Mean age of subjects was 27.01 years. (M: F = 1.57:1.0). Range of mobile phone usage was from 4 to 900 min/day, with mean as 85.94 min/day. No significant differences were seen between dominant and non-dominant ears in regard to amplitudes of wave I, III and V, latencies of wave I and V and Inter peak latency (IPL) of wave I-III, III-V and I-V. No statistically significant difference for I-III, III-V and I-V IPL were found b/w two groups/ears except for usage of mobile phone for > 180 min/day in wave I-V, usage for 0-4 years in wave I-III and I-V and net hours usage for > 1500 h in wave I-V. The mean IPL in all the waves increases with the increase in years of mobile usage and is maximum in all waves in > 12 years mobile users. The long-term exposure to EMF does induce measurable changes in ABRs. Amplitude and IPLs of ABR were found comparable between the dominant and non-dominant ears using mobile phones, except for those using mobile usage for > 180 min/day and with increasing years of usage of mobile phone. Therefore, prudent use of mobile phone should be encouraged for a shorter period of time and for essential purpose only.

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case-control study.

Introduction: Exposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities. Methodology: Multicentric case-control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA). Results: A total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29-4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43-3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home. Discussion: The results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Second hand smoke exposure in pregnant women in Dehradun, Uttarakhand: A cross sectional study.

Aim: The aim of this study was to estimate the percentage and sources of secondhand smoke (SHS) exposure among non-smoking pregnant women. It was a cross-sectional study conducted among the non-smoking pregnant women registered at the primary health center (PHC) under the All India Institute of Medical Science (AIIMS), Rishikesh. Materials and Methods: All registered pregnant women at sub-center in the field practice area (Raiwala) of the Department of Community and Family Medicine, AIIMS Rishikesh were recruited in the study. In this study, a questionnaire was used for measuring the exposure of SHS. Mean and standard deviation (SD), median, minimum, and maximum were used for continuous variables. A Chi-square test was used to compare the association of categorical variables. Results: Out of the total participants, 62% were exposed to SHS. 33% of participants were exposed to SHS at home only, 24% at public places only, and 5% were the ones exposed both at home and public places. More than half (69%) of the participants were having inadequate knowledge about the harms caused by SHS. Conclusions: More than half of the participants were exposed to SHS. Inadequate knowledge among the participants about adverse effects of SHS exposure and insufficient practices and action were observed.

Study of Diagnostic Delay among Symptomatic Breast Cancer Patients in Northern India: A Mixed-Methods Analysis from a Dedicated Breast Cancer Centre.

OBJECTIVE: We conducted this study to understand the factors that contribute to the delay in diagnosis of symptomatic breast cancer patients. METHODOLOGY: We did a prospective analytical study with both quantitative and qualitative components over 14 months. The total delay in diagnosis of breast cancer from first symptom onset was defined as diagnostic delay. Presentation delay was defined as the time duration between the first symptom and the first visit to a health care provider. Provider delay was defined as the time duration between the presentation to a health care provider and the final diagnosis. Three hundred female breast cancer patients with a diagnostic delay of at least 3 months were interviewed using a pre-tested semi-structured questionnaire. RESULTS: We found that more than 50% of patients with delayed presentation were between 30-50 years of age. Painless breast lump was the most common initial symptom. More than 70% of patients presented with locally advanced and metastatic disease. The patient-related delay was more common than provider delay. Breast cancer awareness (p = 0.040) and reasons for delay (p = 0.014) were found to significantly influence the delay. More than 70% of patients reported their symptoms to male members of their families. CONCLUSION: Breast cancer awareness is the single most important determinant influencing diagnostic delay among symptomatic patients.

Health budget in light of pandemic: Health reforms from mirage to reality.

The outbreak of coronavirus disease (COVID-19) has triggered changes and reforms in the health sector in India. As the pandemic points to a gap in the industry, it has led to the creation of new opportunities to solve problems. To help the country repair the damage caused by the virus pandemic, the Government of India announced that in the health budget 2021, promotion of health and well-being will be one of the six pillars. Investment in health infrastructure in the 2021 budget has increased significantly to welcome the much-needed increase in budget allocations of Rs. 2.3 lakh crore. Three areas will also be strengthened, including preventive health care and therapeutic health care. Special emphasis is placed on prevention, treatment, and health care. To promote primary health care, the country will establish 17,000 rural and 11,000 urban health care centers. Provision of affordable quality medical insurance will be provided by the government. The integrated and collaborative model of the public and private sectors in the provision of health services has led to a rapid expansion of work. This is an attempt to demonstrate the planned reforms in the health budget, especially during the COVID-19 pandemic. The budget of 2022-23 is about to be announced soon. It is to be seen how the financial allocation for the health sector impacts the health of the Indian people.

The epidemiology and dynamics of COVID-19 disease transmission among healthcare workers of a tertiary healthcare setting in India.

Context: The novel coronavirus disease 2019 (COVID-19) that has emerged as a pandemic now has put health care workers (HCWs) at great risk as they are the warriors in frontlines screening and treating the infected patients. When a COVID-19-positive HCW is identified, its contacts need to be traced to check the spread of the infection among patients and other HCWs. Aims: This study was aimed to study epidemiology and risk factors associated with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection among HCWs and to quantify the risk of infection among HCWs in a tertiary level health care setting. Settings and Design: This cross-sectional study enrolled all the HCWs who were exposed to a patient with COVID-19 in a tertiary level health care center, Rishikesh, Uttarakhand from 1st May to 30th July, 2020. Methods and Material: All the exposed HCWs were followed up for 14 days after the last exposure to a patient with confirmed COVID-19 infection. Epidemiological data were obtained using structured interviews. Statistical Analysis Used: The data were analyzed using SPSS 23.0. Frequencies and proportions were calculated for descriptive variables, and risk ratios were calculated for risk factors affecting the transmission of disease. Results: We observed that 1,141 HCWs of the tertiary level health care hospital were exposed to COVID-19 patients during the study period. A total of 22 HCWs were tested COVID-19 positive among these exposed HCWs. Univariate analysis revealed a high risk of exposure to be significantly associated with a higher secondary attack rate of SARS CoV-2. Conclusions: The study demonstrates the risk of COVID-19 transmission through asymptomatic carriers. Therefore, periodic testing of all health care workers is necessary to ensure early mitigation of the shortage of health care providers.

COVID-19 Infection After Vaccination Among Healthcare Workers at a Tertiary Level Health Care Center in Northern India: A Cross-Sectional Study.

BACKGROUND AND AIMS: COVID-19 vaccines are now accessible to all Indian citizens. Infection with COVID-19, on the other hand, continues to spread constantly. Our study aimed to determine the number of persons who had COVID-19 infections despite receiving the recommended number of doses of the COVID-19 vaccination at AIIMS Rishikesh, a tertiary care facility in Uttarakhand, India. METHODS: We analysed meticulously preserved data regarding COVID-19 vaccination, COVID-19 infection, clinical symptoms, and RT-PCR testing among all HCWs in our healthcare institution from 16 January 2021 to 30th June 2021. RESULTS: During this period, 5273 (90.3%) HCWs received two doses of the COVID-19 vaccine, while 566 (9.7%) received only one dose. 628 HCWs (10.8%) were BBV152 recipients and 5211 (89.2%) were AZD1222 (ChAdOx1-S) recipients. 423 HCWs (7.2%, confidence interval of 95% - 13.8, 22.0) reported COVID-19 infections. 274 (5.19% of total vaccinated HCWs) breakthrough infections and 149 non-breakthrough COVID-19 infections were reported in HCWs who had previously received a single dose of the COVID-19 vaccination. CONCLUSION: Viral infections, especially breakthrough infections, following adequate vaccination, are a cause for concern, but there is a lack of data on these infections in the actual world. Therefore, the primary focus of research should be on the emergence of illness in India following the completion of a full vaccine course.

Assessment of child health services under Reproductive, Maternal, Neonatal, Child and Adolescent (RMNCH+A) strategy at primary health care level in Doiwala block of Dehradun District, Uttarakhand, India - A cross - sectional study.

Background: The reproductive, maternal, newborn, child + adolescent health (RMNCH+A) strategy was launched by the Indian government in the year 2013 to remain in the lead of the global war against child and maternal mortality and morbidity. Under RMNCH+A program in Uttarakhand state, according to the State public health policy, various provisions are needed to be done for maintenance of downtrend in infant mortality rate (IMR). There are various thrust areas under the child health program. The purpose of our study is to monitor the program implementation in terms of Input and Process indicators and to identify if there are any gaps in the child health services provided by RMNCH+A in the PHCs and subcentres of Doiwala block of Dehradun district, Uttarakhand. Aim: To evaluate Input and the process indicators of child health services under RMNCH+A strategy at Primary health care level in Doiwala block of Dehradun district, Uttarakhand. Methods: This Cross-sectional study was carried out in Doiwala Block of Dehradun district, Uttarakhand in 3 randomly selected Primary health centres (PHCs) and their 6 subcentres using a validated standard checklist for PHCs and subcentres. Results: In PHCs, mean obtained score for Input indicators was 56% and for Process indicators was 35%. The mean obtained score in subcentres for Input indicators and Process indicators was 53% and 51%, respectively. Conclusions: Both the input and the process indicators for child health services in PHCs and subcentres of Dehradun district were inadequate. Most indicators scored less than 50% at both the PHCs and subcentres.

Village health, sanitation, and nutrition committee: Do the village level functionaries aware of their roles?

Background: National Health Mission intended to achieve decentralization and community participation through creating and supporting Village Health Sanitation and Nutrition Committees (VHSNCs). The services offered through VHSNC include maternal and child health, family planning, sanitation, communicable diseases and health promotion, and nutrition. The study was carried out to assess awareness on the implementation of the functioning of VHSNC implementation among village-level functionaries in the Dehradun district. Methods: A community-based cross-sectional study was conducted in the Doiwala and Raipur blocks of Dehradun district from June 2019 to July 2019. Members of VHSNC with at least 3 months of membership were included in the study. A pretested semi-structured questionnaire was used to collect sociodemographic variables and questions about their awareness and responsibilities in implementing VHSNC. Data were collected by personal interviews using Epi-Collect and analyzed by SPSS 23. Result: Out of 69 members, 64 (92.4%) had formal education until high school. Only around 50% of members knew about the essential documents related to the VHSNC. Sixty-five members (98.48%) believed that the committee had the primary role in health-related services in the village, 54 (81.82%) members also marked providing safe drinking water as a function, 48 (72.73%) were in favor of access to clean public toilet and sanitation facilities while some others added role in Public Distribution System. Conclusion: Around half of the members were partially or completely aware of the functioning of VHSNCs. Providing them with further awareness is required.

Digital Warfare Against COVID-19: Global Use of Contact-Tracing Apps.

The current COVID-19 (coronavirus disease 2019) pandemic has perpetuated a worldwide tussle to control this infection and minimizing death toll and economic damages. The year 2020 would always be remembered as a year of war against a virus, but it would also be marked as a year showing upsurge of technology evolution to deal with infections. Contact tracing has emerged as a new buzzword. Contact tracing digital tools have been introduced worldwide to prevent transmission. In this article, we have outlined various contact tracing apps being used globally, which are rated according to their safety, privacy, and efficacy.