Determinants of severity among hospitalised COVID-19 patients: Hospital-based case-control study, India, 2020.

BACKGROUND: Risk factors for the development of severe COVID-19 disease and death have been widely reported across several studies. Knowledge about the determinants of severe disease and mortality in the Indian context can guide early clinical management. METHODS: We conducted a hospital-based case control study across nine sites in India to identify the determinants of severe and critical COVID-19 disease. FINDINGS: We identified age above 60 years, duration before admission >5 days, chronic kidney disease, leucocytosis, prothrombin time > 14 sec, serum ferritin >250 ng/mL, d-dimer >0.5 ng/mL, pro-calcitonin >0.15 µg/L, fibrin degradation products >5 µg/mL, C-reactive protein >5 mg/L, lactate dehydrogenase >150 U/L, interleukin-6 >25 pg/mL, NLR ≥3, and deranged liver function, renal function and serum electrolytes as significant factors associated with severe COVID-19 disease. INTERPRETATION: We have identified a set of parameters that can help in characterising severe COVID-19 cases in India. These parameters are part of routinely available investigations within Indian hospital settings, both public and private. Study findings have the potential to inform clinical management protocols and identify patients at high risk of severe outcomes at an early stage.

Smartphone, the New Learning Aid amongst Medical Students.

INTRODUCTION: The use of smartphone is increasing day by day for personal as well as professional purpose. They are becoming a more suitable tool for advancing education in developing countries. Mobile access to information and many applications are successfully harnessed in health care. Smartphones are also becoming popular as an effective educational tool. AIM: The present study was conducted to evaluate the use of smartphones as an educational tool amongst the medical students. The study also aimed at identifying the common medical application used by the students. MATERIALS AND METHODS: It was an observational cross-sectional study carried out amongst medical students of private medical institute in India. A validated 16 point, structured, open-ended, questionnaire regarding ownership and use of smart phones was self-administered to 446 medical students. Data were analysed using SPSS and open ended questions were analysed by summative content analysis. RESULTS: Among the study population, 96% owned a smartphone -Android based 72.4%, i phone 13.0%, Windows based Nokia phones 7% and Blackberry 3.6%. Common medical applications used by the students were Anatomy and Medical Dictionary in First MBBS; Medical Dictionary, Medscape and Google/Wikipedia in Second MBBS; and Medscape, Google/Wikipedia and Prognosis/Diagnosis in Third MBBS. More than 90% students, reported to have technological skills to use smartphones, for medical education, communication and instant access during bedside teaching. Advertently, 37.2% students felt if smartphones are used for clinical purposes, they will need to spend less time with patients. Almost 79.4% felt that smartphones should be introduced in MBBS course. CONCLUSION: Smartphone use amongst medical students as learning aid for various medical applications is rapidly advancing. But it will be worthwhile to study whether use of smartphones has any impact on the grades of the students before introducing them in medical schools.

Patient's Comprehension of Prescriptions at Municipal Urban Health Centre, Mumbai.

INTRODUCTION: Patient's often fail to follow the prescription given by the doctor. Patients understanding of the prescription play an important role in completion of treatment and quick recovery from the illness. The understanding of prescription is dependent on factors which could be both patient and doctor related. These factors need to be studied in order to improve the therapeutic outcome. AIM: Hence this study was undertaken to identify the various factors which affect patient's comprehension of prescription. MATERIALS AND METHODS: Observational, cross-sectional study based on exit interviews were carried out for 370 patients at Cheeta Camp Urban Health Centre, Mumbai over a period of 15 working days of OPD and 25 patients were selected randomly on each day. For data analysis, SPSS 15.0 with Chi-square test were used as test of significance. RESULTS: In the present study it was found that in the patients above 45 years, 19.4% have not understood the prescription completely compared to 5.8% below the age of 45 years. The difference was statistically significant. There is no difference between gender and understanding of prescription. Among the illiterate patients it was found that 16.3% have not completely understood the prescription compared to 5.6% of the literate patients. Also, socio-economic status was significantly associated with patients understanding of prescription. There was no significant difference associated with number of prescription and understanding of prescription. CONCLUSION: The patient related factors play an important role in understanding of prescription. It was found that patient's comprehension of prescription was significantly associated with age, socioeconomic status and Education.

Morbidity pattern and personal hygiene in children among private primary school in urban area: are the trends changing?

INTRODUCTION: School health is an important intervention as a great deal of research tells us that schools can have a major effect on children's health, by teaching them about health and promoting healthy behaviors. AIMS: The aim of this study is to determine common health problems and assess personal hygiene status among primary school children. SETTINGS AND DESIGN: A cross-sectional study was conducted in academic years 2009-2010 and 2010-2011, with three health check-up camps organized in private primary school of Pune city. MATERIALS AND METHODS: A total of 450 students were assessed for health problems and composite score of personal hygiene status was calculated ranging from 0 to 5 by examination of hairs, nails, skin and clothes. STATISTICAL ANALYSIS USED: Proportions calculated with application of Chi-square test and Pearson co-efficient applied to observe the relation between two quantitative variables. RESULTS: Out of 450 students examined, 56.2% were boys and 43.8% were girls with age ranging from 5 to 10 years. The major morbidities observed were dental caries (65.1%), upper respiratory tract infections (38.2%), ear wax (29.9%) and myopia (10.0%). Mean hygiene score was significantly higher in girls (4.32) than boys (3.95) and poor hygiene observed in older boys. CONCLUSION: Increasing myopia and poor dental hygiene denotes a changing morbidity pattern in private primary school of the urban area. The hygiene status of the girls is significantly better than boys.

Male health clinic strategy in control of STI/HIV: a program review.

A community-based, longitudinal interventional study was conducted in a slum in north-east (NE) Mumbai, using a pretested, semi-structured proforma and a pre- and follow-up interview schedule to assess the male health clinic (MHC) strategy as an approach for the control of sexually transmitted infections (STIs) in males. The focus groups that emerged for behavior change communication (BCC) activities were clients in second and third decades of life, unmarried and married but not staying with wife, clients with no permanent place of occupation, clients with habit of alcohol, and illiterate clients. Postintervention, there was an overall increase in STI knowledge score, alcohol habit score, and high-risk sexual activity score. Less than 50% of the clients received advice on substance abuse and information on consequences of STI/human immunodeficiency virus (HIV). The study concluded that MHC strategy is an effective approach for control of STIs in males and recommended strengthening of the weaker components of the strategy with focus on the important client groups.

Assessment of awareness regarding climate change in an urban community.

BACKGROUND: Climate change has emerged as one of the most devastating environmental threats. It is essential to assess the awareness regarding climate change in the general population for framing the mitigation activities. AIM: To assess the awareness regarding climate change in an urban community. SETTINGS AND DESIGN: Urban field practice area of a medical college in the Pune city. Observational study. MATERIALS AND METHODS: The cross-sectional survey was conducted in the urban adult population who had given the written consent. A pre-tested questionnaire was used for a face to face interview. Responses were evaluated. STATISTICAL ANALYSIS USED: Proportions, percentage. RESULTS: Total 733 respondents above 18 years of age were included in the present survey. 672 (91.68%) respondents commented that global climate is changing. 547 (81.40%) respondents opined that human activities are contributing to climate change. 576 (85.71%) respondents commented that climate changing based on their personal experiences. Commonest source of information about climate change was television (59.78%). Poor awareness about UNFCC, Kyoto Protocol and IPCC was found. 549 (74.90%) respondents commented that deforestation contribute most significantly towards climate change. As per 530 (72.31%) respondents water related issues are due to changing climate change. According to 529 (72.17%) respondents, direct physical hazards of extreme climatic events are most important health related impact of climate change. According to 478 (65.21%) respondents, life style changes (63.3%) would be most effective in tackling climate change and for preventing further climate change. CONCLUSION: The urban general population is aware about changing global climate. Personal efforts are more important in mitigating climate change as per the urban general population. The awareness campaigns regarding mitigation activities are recommended.