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.

Capacity building among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs): Findings of an implementation study from Bihar, India.

Background: Community-based screening is one of the key preventive strategies to tackle the ever-rising burden of non-communicable diseases (NCDs) under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Objective: The current study was aimed to build capacity among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs) under NPCDCS in the selected districts of Bihar state. Methodology: This was an implementation study with follow-up components, conducted among 75 FHWs [14 auxiliary nurse midwives (ANMs) and 61 accredited social health activists (ASHAs)] from 15 primary healthcare facilities across four districts of Bihar state from October 2019 to September 2021. The selected FHWs were initially trained on NPCDCS for a day, including pre- and post-training knowledge assessment. Then, supportive supervision (SS) visits using a predesigned questionnaire were done. Results: The pre- and post-training mean knowledge scores of the FHWs were 12.9 and 22.1, respectively, with an overall effect size of 2.5. During SS visits, only 20.0% of the visited primary healthcare facilities had all the required logistics to conduct weekly NCD screening clinics for CVDs. Considering different measurements and operative skill proficiencies of FHWs, waist circumference skills (41.7% for ANMs and 50.8% for ASHAs), followed by blood pressure (BP) (41.7%) and random blood sugar (RBS) measurement (25.0%), were found to be the most deficient skills (among ANMs). Moreover, the quality of initial and follow-up home visits was found to be satisfactory for only 54.1% of the ASHAs. The reported barriers of NCD screening were reported to be non-cooperation, unawareness among community dwellers, lack of knowledge and skill of FHWs, logistic constraints and delayed honorarium credit. Conclusion: One-day training on NCDs for FHWs was quite effective. However, for translating all the desired skills for CVD screening into action, periodic training needs assessment, and SS of FHWs might be fruitful.

Impact of Lockdown due to COVID-19 on lifestyle and diet pattern of college students of Eastern India: A cross-sectional survey.

Background: The emergence of the COVID-19 pandemic and lockdown measures to confine it has disrupted the routine of the public. The impact of such long-term confinements on the lifestyle and diet of students are not known and hence this study was designed to assess the impact of lockdown due to the COVID-19 pandemic on the lifestyle and diet of university students. Methods: An online cross-sectional survey among 622 university students across various educational institutes of east India using a pre-designed questionnaire about lifestyle-diet before and during the lockdown. Results were tabulated and statistical tests like Paired t-test, Wilcoxon Rank sign test, and Mc-Nemar tests were applied and overall significance was attributed to P<0.05. Results: During the lockdown a total of 2.4% (95% CI: 1.4-3.8%) decrease in prevalence of tobacco use, 8.7% (95% CI: 6.6-11%) decrease in physical activity and a 0.8 hour (95% CI: 0.6-0.9 hour) increase in the mean sleep duration was observed. There was a significant increase in use of fresh fruits consumption [Median(IQR)-before:2(1-5);during:3(1-5) days] and a decrease in meat-poultry[Median(IQR)-before: 2(0-3);during: 1(0-3)days] and junk food[Median(IQR)-before:1(0-2);during:0(0-2)days] consumption during the lockdown. Conclusion: A significant proportion of changes in lifestyle and frequency of consumption of certain food items in the dietary pattern during the lockdown.

Prevalence and knowledge of hepatitis B infection in pregnant women in a primary health center of Patna district, Bihar.

INTRODUCTION: There is a risk of chronic hepatitis B virus (HBV)infection to the newborn through perinatal transmission from a hepatitis B surface antigen (HBsAg) positive mother that can later cause liver cirrhosis or hepatocellular carcinoma. This study was undertaken in a primary health center (PHC)in the Patna district to determine the prevalence of HBV among pregnant women and assess their knowledge across different characteristics. METHODOLOGY: A cross-sectional study was done among 275 pregnant women attending the PHC for the first time, using consecutive sampling. The study duration was 12 months. Socioeconomic, obstetric, risk history, and levels of knowledge about hepatitis B were collected followed by rapid diagnostic test (RDT)for serum HBsAg. Univariate analysis was used to compare the knowledge levels across different background characteristics. The significance was set at P < 0.05. RESULTS: Hepatitis B-positive pregnant women were 0.4%. Out of the 275 participants, only 43 had heard about hepatitis B. The mean knowledge score was 0.65 (±1.73) with 1.45% having adequate knowledge. The knowledge score was significant across education (P 0.040), category (P 0.022), hepatitis B immunization status (P 0.003), and risk factor (P 0.039). CONCLUSION: Knowledge was higher in the literate women belonging to the general category and higher social class, who received hepatitis B vaccination. However, the overall level of knowledge among the pregnant women was very poor, so they should be targeted for quality health education. Additionally, identifying the afflicted pregnant women through point-of-contact diagnosis will aid in community prevention of chronic hepatitis B.

Dopamine modulates acute responses to cocaine, nicotine and ethanol in Drosophila.

BACKGROUND: Drugs of abuse have a common property in mammals, which is their ability to facilitate the release of the neurotransmitter and neuromodulator dopamine in specific brain regions involved in reward and motivation. This increase in synaptic dopamine levels is believed to act as a positive reinforcer and to mediate some of the acute responses to drugs. The mechanisms by which dopamine regulates acute drug responses and addiction remain unknown. RESULTS: We present evidence that dopamine plays a role in the responses of Drosophila to cocaine, nicotine or ethanol. We used a startle-induced negative geotaxis assay and a locomotor tracking system to measure the effect of psychostimulants on fly behavior. Using these assays, we show that acute responses to cocaine and nicotine are blunted by pharmacologically induced reductions in dopamine levels. Cocaine and nicotine showed a high degree of synergy in their effects, which is consistent with an action through convergent pathways. In addition, we found that dopamine is involved in the acute locomotor-activating effect, but not the sedating effect, of ethanol. CONCLUSIONS: We show that in Drosophila, as in mammals, dopaminergic pathways play a role in modulating specific behavioral responses to cocaine, nicotine or ethanol. We therefore suggest that Drosophila can be used as a genetically tractable model system in which to study the mechanisms underlying behavioral responses to multiple drugs of abuse.

Ethanol intoxication in Drosophila: Genetic and pharmacological evidence for regulation by the cAMP signaling pathway.

Upon exposure to ethanol, Drosophila display behaviors that are similar to ethanol intoxication in rodents and humans. Using an inebriometer to measure ethanol-induced loss of postural control, we identified cheapdate, a mutant with enhanced sensitivity to ethanol. Genetic and molecular analyses revealed that cheapdate is an allele of the memory mutant amnesiac. amnesiac has been postulated to encode a neuropeptide that activates the cAMP pathway. Consistent with this, we find that enhanced ethanol sensitivity of cheapdate can be reversed by treatment with agents that increase cAMP levels or PKA activity. Conversely, genetic or pharmacological reduction in PKA activity results in increased sensitivity to ethanol. Taken together, our results provide functional evidence for the involvement of the cAMP signal transduction pathway in the behavioral response to intoxicating levels of ethanol.

Management of thoracic amebiasis.

The thoracic complications of amebiasis frequently necessitate surgical intervention. Experience with 28 patients is presented. Involvement included the pleura in 19 patients, the lungs in 10, and the pericardium in five. In 25%, more than one site was involved. Treatment consisted of measures designed to obliterate the pleural space or widely drain the pericardial sac, as indicated. Concurrent drainage of the associated amebic liver abscess was done in half the cases. The mortality rate was 36%, generally related to the poor general condition of the patients and their delay in seeking hospitalization.

Typhoid perforation of the bowel. Experiences in 78 cases.

Seventy-eight patients ranging from four to 65 years of age were treated for typhoid perforation of the bowel. Sixty-one patients (78%) were males. The average time from perforation to admission was 56 hours. The mortality rate was 32% and was adversely influenced by the duration of illness, duration of perforation, shock, uremia, encephalopathy and fecal peritonitis. Forty-nine patients were treated by closure of the perforation, resection or miscellaneous procedures; the other 29 by closure of the perforation combined with an end-to-end ileotransverse colostomy. Although mortality was the same in both groups, those undergoing bypass had a significantly smoother postoperative course.

Cricotracheal disruption owing to strangulation. A report of two cases with successful surgical repair.

Two patients with cricotracheal disruption resulting from accidental strangulation of the neck were treated. The first patient had severe respiratory obstruction. In the second patient, a fascial tube maintained airway continuity between the separated larynx and trachea, and she had no difficulty breathing. A preoperative diagnosis of tracheal injury was based on the findings of respiratory obstruction, bloody secretions in the endotracheal tube, and subcutaneous emphysema in the neck. In both cases, an endotracheal tube was easily passed and entered the distal tracheal lumen. This relieved the respiratory obstruction in the first case and allowed administration of general anesthesia and control of ventilation during the operation. Prompt repair with cricotracheal anastomosis was followed by excellent results in both cases.

Serum hormone levels in women undergoing abortion with intra-amniotic, extra-amniotic or intra-muscular administration of 15(S) 15-methyl-prostaglandin F2alpha.

The serum levels of estradiol-17beta, progesterone and HPL have been estimated by specific radioimmunoassay in thirty women undergoing abortion with 15-methyl-PGF2alpha given by intra-amniotic, extra-amniotic or intra-muscular route. A significant decline in the levels of these hormones was observed in 27 cases in which the pregnancy was terminated. However, in the remaining three cases, 15-methyl-PGF2alpha was found to be unsuccessful, and no significant change in the hormone levels was evident. The decline in these hormones was more marked by intra-muscular route, than that observed by the other routes. The pattern of estradiol-17beta decline was more consistent when compared with progesterone and HPL. The levels of progesterone and HPL, in a few cases, rather showed an increase in the initial hours of 15-methyl-PGF2alpha administration before the decline began and this pattern was more prominent on extra-amniotic administration. In general, the decline in the hormone levels was slower in cases which took longer time for abortion than cases with shorter induction-abortion time (IAT). The decline in estradiol-17beta levels was about 65% at six hour of intra-muscular administration of 15-methyl-PGF2alpha, whereas the corresponding fall with intra-amniotic and extra-amniotic routes was 29 and 22%, respectively. However, the net drop in its levels during IAT was not significantly different (range 70 to 80%) by the three routes. About 38% fall in progesterone levels was observed at six hour of intra-muscular administration whereas, by intra-amniotic the fall was 19%. The net decline in progesterone levels, during IAT, was in the range of 46 to 60% by the three routes. Similarly, intra-muscular 15-methyl-PGF2alpha evoked a sharper decline in HPL levels as compared with other routes. The total decline during IAT was 58 to 66%. The results, thus indicated that the abortion with 15-methyl-PGF2alpha was associated with a fall in the serum hormone levels, which could be resultant effect of alterations in the hormone production by the foeto-placental unit. This along with the uterine contractions may play a significant role in the abortifacient action of 15-methyl-PGF2alpha.

End-to-side splenorenal shunt for treatment of portal hypertension.

Twenty-eight patients with portal hypertension were treated with splenectomy and end-to-side splenorenal shunt. Nineteen had cirrhosis and nine had portal vein thrombosis. Among the patients with cirrhosis, there was one hospital death due to recurrent bleeding in a patient in whom shunt could not be constructed and only splenectomy was done. During the follow-up period, one patient developed encephalopathy and later died of liver failure. There were three additional deaths, one due to an unrelated causes and two due to liver failure. All the remaining patients are well and none has had recurrent bleeding. All the patients with portal vein thrombosis survived the operation and are well. None has had recurrent bleeding. Encouraged by these results, we continue to use end-to-side splenorenal shunt in all patients except small children.