Compliance to the Tobacco-Free Educational Institution(ToFEI) guidelines at Madhyamik Vidhyalayas of Pimpri-Chinchwad, Pune, Maharashtra-A cross sectional study.

INTRODUCTION: Revised guidelines for Tobacco-Free Educational Institutes (ToEFI) were laid down in 2019 and they provide for tobacco free environment leading to a healthy life, implementation of legal provisions, and recognition about various approaches available for tobacco cessation. OBJECTIVE: To assess Madhyamik Vidyalays (MVs) for their compliance to the guidelines for ToFEI at the baseline using self-evaluation score card as part of operational research. MATERIAL AND METHOD: A cross sectional study was carried out during March 2021 among 19 MVs of Pimpri-Chinchwad block in Pune District, Maharashtra using census sampling. Trained data collectors scored for all 9 ToFEI criteria including the mandatory one's and their weightage points were calculated. RESULTS AND DISCUSSION: Eight {42%(0.21-0.64)} MVs had displays on tobacco-free area and awareness on the harms of tobacco displayed inside the premises and another three (16%(0.04-0.37)} had only the display of ToFEI signage at their boundary wall. No MV met with 4 or more criteria out of the total 9 criteria. The highest weightage of 29-30 out of 100 was achieved by only 2 {11%(0.01-0.30)} MVs and 5 {26%(0.10-0.49)} MVs achieved 0 points. No significance was given to tobacco free school probably because of untrained teachers and unawareness of the guidelines. CONCLUSION: This study demonstrates that minimal importance has been given to the revised ToEFI guidelines in making MVs tobacco-free. Hence, none of the them could attain the tobacco-free status.

Re-evaluation of umbilical cord coiling index in adverse pregnancy outcome - Does it have role in obstetric management?

Introduction: The placenta with the umbilical cord is a vital link between the mother and fetus. Umbilical cord supplies water, nutrients and oxygen from the mother to the fetus. The most unique character of the umbilical cord is its coiling, where the contents of the cord course in a coiled helical fashion. The umbilical coiling index(UCI) can be measured antenatally using ultrasonography. In the present study we have attempted to assess the UCI antenatally by ultrasound screening and correlate abnormal antenatal UCI with the adverse maternal and neonatal outcome of pregnancy. Aims: To study umbilical coiling index ultrasonographically and to correlate it with pregnancy outcome. Methodology: 150 antenatal cases in the second trimester of pregnancy between 22 and 28weeks of gestation attending the outpatient department were included for the study in a continuous manner and subjected to antenatal UCI measurement. The cases were followed up till delivery and various factors were noted. Results: We confirmed that maternal medical comorbidities ( gestational hypertension and anemia) have a significant correlation with abnormal umbilical cord coiling index, either hyper-coiling or hypo-coiling or both.Some studies have shown a particular adverse effect being manifested in both hypo and hypercoiling. In the present study significant correlation of abnormal coiling has been found with only anaemia and hypertension in pregnancy. The question, therefore, arises:"Does abnormal UCI have any significant role in prediction of adverse outcome in pregnancy or is it just a random association?" This study does not reflect any significant role of abnormal UCI in the prediction of adverse perinatal outcome. Hence efforts to monitor UCI in the antenatal period may not have any justification in the present scenario. The latest edition of William's Obstetrics also makes a similar comment. A population based larger study to generate cut offs for hypo and hyper coiling and finding any association between abnormal coiling and perinatal outcome may throw more light on the utility of UCI as a predictor of adverse outcome in pregnancy.

Predictors of disease severity in COVID-19 associated mucormycosis: impact of HbA1C levels, time lag to mucormycosis onset, and radiologic patterns of paranasal sinuses and spaces involvement.

BACKGROUND: Identifying early predictors of severe Covid-19 associated mucormycosis (CAM) can help improve management and treatment outcomes. OBJECTIVES: Primary: To identify clinical and radiological predictors of disease severity in CAM. Secondary: To describe patterns of central nervous system (CNS) involvement in CAM. METHODS: A total of 71 patients with CAM were included in the study. Based on the anatomical extent of involvement on MRI, patients were divided into three groups: Sinus (paranasal sinuses), Orbit (orbital spread), and CNS (CNS spread). Clinical parameters and radiological patterns of involvement of sinuses and extra sinus spaces were studied between the three groups. Patterns of CNS involvement were also described. RESULTS: A shorter time lag between COVID-19 infection and CAM, as well as high HbA1C levels, were found to be associated with severe disease. Involvement of the sphenoid, ethmoid and frontal sinuses, T1 hyperintense signal in the sphenoid, as well as bony involvement of the sphenoid sinus, were significantly associated with severe disease. Extra-sinus spread into pre/retroantral space, pterygopalatine fossa, and masticator spaces were also significantly associated with a severe disease course. The most common pattern of CNS spread was cavernous sinus involvement, followed by pachymeningeal spread and cranial nerve involvement. CONCLUSION: Early identification of the above-described predictors in patients presenting with CAM can help detect those at risk for developing severe disease. A longer duration of amphotericin, combined with a more aggressive surgical approach in selected cases, may lead to better long-term outcomes.

Urinary Albumin Excretion, Estimated Glomerular Filtration Rate, and Prevalence of Microalbuminuria in Obese Nondiabetic and Nonhypertensive Adults: A Cross-Sectional Study.

CONTEXT: Obesity even in absence of diabetes and hypertension increases the risk for microalbuminuria (MAU), glomerular hyperfiltration, and therefore nephropathy. AIMS: This study aims to assess the urinary albumin excretion (UAE), prevalence of MAU, and values of estimated glomerular filtration rate (eGFR) in obese nondiabetic and nonhypertensive patients, vis a vis thin healthy subjects, and attempts to correlate anthropometric measurements with UAE and eGFR. SETTING AND DESIGN: Cross-sectional analytical study on 60 cases who were obese according to Asia Pacific guidelines and 60 nonobese controls. Patients with diabetes, hypertension, ischemic heart disease, and established renal disease were excluded. METHODS AND MATERIAL: Albuminuria was assessed in each patient by quantitative immunoturbidimetry method on a spot urine sample. eGFR was calculated by Cockcroft-Gault formula. STATISTICAL ANALYSIS: Data was analyzed using SPSS (2015 version). Mann-Whitney U-test, Fisher Exact test, and Spearman's correlation coefficient was used for various variables. RESULTS: The mean age of cases was 31.90 ± 6.32 years. About 78.33% were in class 1 and 21.66% in class 2 obese groups. The mean UAE at 21.20 ± 26.82 mg/g creatinine was higher in the case group. The prevalence of MAU was 11.66% and 3.33% in case and control groups, respectively. The cases had a significantly higher mean eGFR of 123.29 ± 20.49 mL/min/kg as compared with controls who had a mean eGFR of 106.59 ± 10.15 mL/min/kg. There was moderate correlation between anthropometric measurements and eGFR. CONCLUSION: Younger, class 1 obese patients had a higher UAE, eGFR, and three times higher MAU prevalence, even in absence of diabetes and hypertension, with a correlation between anthropometry and eGFR as compared with nonobese individuals.

Profile of non-fatal injuries due to road traffic accidents from a industrial town in India.

BACKGROUND: India has one of the highest road traffic accident rates in the world. To lessen this burden, information on the contributing factors is necessary. MATERIALS AND METHODS: We studied a series of cases of non-fatal road traffic accidents in two tertiary care hospitals in Pimpri, Pune, India. A total of 212 non-fatal road traffic accidents admitted over a period of one year in these two hospitals constituted the study sample. The study variables were, the gender of the accident victims, mode of accident, days of week on which the accident took place, time of day when the injury was sustained, part of the body injured, nature of injury, and self-reported reasons for the accident. STATISTICAL ANALYSIS: data were summarized using percentages. The Chi-square test for goodness of fit was applied, to see whether there was any association between the different weekdays or time of day and the accidents. RESULTS: MALE : female ratio was almost 5 : 1, which was statistically significant (Chi-Square for goodness of fit = 95.11, df = 1, P < 0.0001). The maximum accidents occurred on Sundays and Mondays and the least around midweek (Wednesday). This pattern was also statistically significant (Chi-square for goodness of fit = 30.09, df = 6, P < 0.001). Pedestrians were the most vulnerable group, followed by drivers and pillions of two wheelers. These categories of road users contributed to almost 80% of the cases of Road Traffic Injuries (RTIs). Accidents were more likely in the time zone of 8 pm to midnight, followed by 4 pm to 8 pm (Chi-square for goodness of fit = 89.58, df = 5, P < 0.0001). A majority of the patients sustained multiple injuries followed by injuries to the lower limbs. A majority reported impaired visibility and fatigue as the cause of accident. Almost half (46.22%) of the injured admitted to drinking alcohol on a regular basis. CONCLUSION: Wide pavements and safe zebra crossings should be provided for pedestrians, as the highest casualty in this study were pedestrians. More accidents occurred on Sundays and Mondays and in the late evenings. Extra supervision by traffic police may be considered on Sundays / Holidays and the day following. Roads should be well lit to improve visibility after sunset.

Access to health services among slum dwellers in an industrial township and surrounding rural areas: a rapid epidemiological assessment.

CONTEXT: The biggest challenge in implementing the primary health care principles is of equitable distribution of health care to all. The rural masses and urban slum dwellers are most vulnerable to lack of access to health care. AIM: To study access to health services among slum dwellers and rural population. SETTING AND DESIGN: A cross-sectional survey in an urban slum and surrounding rural areas in field practice area of a medical college. MATERIALS AND METHODS: Structured instrument along with qualitative techniques such as focus group discussions, were used to collect information on access and utilization of health services from 865 individuals of both sexes and all ages selected from urban slums, villages, and indoor and outdoor patients. Access to basic determinants of good health such as housing, water, and sanitation was also elicited. Besides, health needs based on self-reported disease conditions were compiled. RESULTS: More than 50% of respondents were living in poor housing and insanitary conditions. Besides the burden of communicable diseases and malnutrition (especially in children), risk of lifestyle diseases as evidenced by high Body mass index in 25% of adults surveyed was found. Private medical practitioners were more accessible than government facilities. More than 60% sought treatment from private medical facilities for their own ailments (for sickness in children this proportion was 74%). People who visited government facilities were more dissatisfied with the services (30.88%) than those who visited private facilities (18.31%). This difference was significant (OR=1.99, 95% confidence interval 1.40 to 2.88; χ(2) =15.95, df=1, P=0.007). The main barriers to health care identified were waiting time long, affordability, poor quality of care, distance, and attitude of health workers. CONCLUSION: The underprivileged in India continue to have poor access to basic determinants of good health as well as to curative services from government sources during illness.

Behavioral surveillance survey regarding human immunodeficiency virus/acquired immunodeficiency syndrome among high school and junior college students.

BACKGROUND AND AIMS: It is necessary to know the baseline knowledge, attitude, and practices about human immunodeficiency virus/acquired immunodeficiency syndrome among young people and the changes in these with intervention to guide prevention efforts. METHODS: A cross-sectional pre- and post-survey with health education as a method of intervention was carried out in four different randomly selected schools and junior colleges among the Class IX-XII students of both sex. Instrument developed by the World Health Organization (WHO)/UNAIDS in their best practice recommendations was used for data collection. RESULTS: Knowledge about all correct methods was present in 61.23% of the respondents. Knowledge of at least two methods of prevention was present in 70.31% of the respondents. Misconceptions about prevention were that good diet (33.42%), avoiding mosquito bite (49.71%) and avoiding public toilets (65.14%) could help in the prevention. With intervention, there was an improvement in the knowledge. However, the proportion of students with misconceptions did not come down. Correct knowledge about two methods of prevention also did not reach the WHO recommendation of 90%. CONCLUSION: It is very difficult to change the attitude and practices by a single health educational intervention and an ongoing behavior change communication is recommended.

Aceclofenac organogels: in vitro and in vivo characterization.

PURPOSE: To develop and evaluate the suitability of lecithin organogels containing aceclofenac for topical application and compare its In vitro and In vivo effects with conventionally used hydrogels. METHODS: The components and their concentration necessary for organogels formation were evaluated using phase diagram. Solubility of aceclofenac was determined. The In vitro skin permeation ability of aceclofenac from ethyl oleate based lecithin organogels [EO/lecithin organogel] and hydrogel was investigated. The In vivo characterization of ethyl oleate based organogel study was compared with that of hydrogel.The alterations in microstructure of organogels during diffusion study were elucidated. Viscosity and micellar size of the organogel sample were estimated. The safety of optimized organogel was determined using histopathological investigation. RESULTS: The flux calculated for skin permeation ability of aceclofenac was in the order EO/lecithin organogel > hydrogel. The In vivo results also demonstrated that organogels are more effective in faster drug release as compared to hydrogels. It was observed that viscosity of gels decreased with increasing stress .The size of micellar aggregation increased with water added and has been revealed in dynamic light scattering (DLS) study. The histopathological data showed that EO/lecithin organogel were safe enough for topical purpose.

Hypothesis testing, type I and type II errors.

Hypothesis testing is an important activity of empirical research and evidence-based medicine. A well worked up hypothesis is half the answer to the research question. For this, both knowledge of the subject derived from extensive review of the literature and working knowledge of basic statistical concepts are desirable. The present paper discusses the methods of working up a good hypothesis and statistical concepts of hypothesis testing.

Probability, clinical decision making and hypothesis testing.

Few clinicians grasp the true concept of probability expressed in the 'P value.' For most, a statistically significant P value is the end of the search for truth. In fact, the opposite is the case. The present paper attempts to put the P value in proper perspective by explaining different types of probabilities, their role in clinical decision making, medical research and hypothesis testing.

Formulation and evaluation of flurbiprofen microemulsion.

The purpose of the present study was to investigate the microemulsion formulations for topical delivery of Flurbiprofen (FP) in order to by pass its gastrointestinal adverse effects. The pseudoternary phase diagrams were developed and various microemulsion formulations were prepared using Isopropyl Myristate (IPM), Ethyl Oleate (EO) as oils, Aerosol OT as surfactant and Sorbitan Monooleate as cosurfactant. The transdermal permeability of flurbiprofen from microemulsions containing IPM and EO as two different oil phases was analyzed using Keshary-Chien diffusion cell through excised rat skin. Flurbiprofen showed higher in vitro permeation from IPM as compared to that of from EO microemulsion. Thus microemulsion containing IPM as oil phase were selected for optimization. The optimization was carried out using 2(3) factorial design. The optimized formula was then subjected to in vivo anti-inflammatory study and the performance of flurbiprofen from optimized formulation was compared with that of gel cream. Flurbiprofen from optimized microemulsion formulation was found to be more effective as compared to gel cream in inhibiting the carrageenan induced rat paw edema at all time intervals. Histopathological investigation of rat skin revealed the safety of microemulsion formulation for topical use. Thus the present study indicates that, microemulsion can be a promising vehicle for the topical delivery of flurbiprofen.

An Outbreak of Food Poisoning in a Military Establishment.

BACKGROUND: An outbreak of food poisoning in a military establishment mess was investigated and remedial measures suggested. METHODS: A total of 391 persons had consumed meals in the mess on the day of the outbreak. A detailed food history was taken from available persons and the attack rates of each specific food items were calculated with the relative risks. RESULTS: Of the 391 persons who had consumed meals at the mess, 123 were affected giving an overall attack rate of 31.5%. Majority of the cases had loose motions, fever, pain abdomen and vomiting. The maximum attack rate (65.1%) was for those who had eaten chicken preparation. The relative risk was also highest for those who had eaten chicken at lunch on the day of the outbreak (RR - 33.21, 95% CI 8.39 to 131.53). The mean incubation period was 19.73 hours (range 6 - 57 hours). The median incubation period was 18 hours. Bacteriological confirmation was not successful. CONCLUSION: The chicken dish was the epidemiologically incriminating food item responsible for the outbreak. Clinical and epidemiological features were suggestive of salmonella food poisoning. However, same could not be confirmed bacteriologically.

Behavioural Surveillance Survey Among Troops in a Large Military Station.

A cross sectional survey was carried out among the troops located in a large cantonment using the UNAIDS standard survey questionnaire (UN Best Practice Collection) for Behavioural Surveillance Survey (BSS). A total of 556 randomly selected recruits and soldiers were administered the questionnaire. The median age at first sexual encounter was 25 years for service personnel and 18 years for recruits. 5.5% of the recruits and 1.7% of regular soldiers reported having regular sexual partners other than spouse. Among those who had casual sex 46.3% reported using condoms. 52.3% were aware about the two main preventive indicators. Some incorrect beliefs regarding transmission of HIV/AIDS were also present among some of the respondents. The findings have been discussed in relation to previous studies.