Assessment of risk factors in pyogenic liver abscesses in children.

Background: Pyogenic liver abscess (LA) is a significant contributor to morbidity and mortality in developing countries like India. The risk factors predisposing to the LA specifically in children are not known. Studies done in the past largely remain inconclusive and have identified only probable causes. The cause of LA in children with no coexisting illness remains unknown. Methodology: This prospective observational study was conducted at a tertiary teaching hospital located in New Delhi, India. All children between 2 months and 12 years of age with sonographically confirmed LA presenting to the hospital were included and managed with appropriate intravenous antibiotics and relevant investigations. Results: A total of 52 children were included. The mean age was 6 years and 4 months, and the male: female ratio was 1.4:1. Around 50% of the patients were malnourished. Fever, abdominal pain and loss of appetite were the most common symptoms. Nine patients (17%) were managed conservatively, 13 (25%) needed percutaneous needle aspiration and 30 (57.69%) required drainage using a pigtail catheter. Poor socioeconomic status and anaemia were found to be the most commonly associated risk factors. Selective immunoglobulin A (IgA) deficiency was the most common primary immunodeficiency disorder followed by T-cell defect. On multivariate analysis, it was seen that in those with clinical icterus, gamma-glutamyl transferases >350 IU/m, and those with impending rupture, the time to defervescence was significantly different (P = 0.05). Conclusion: Poor socioeconomic status causing malnutrition emerged as a significant risk factor for LA in children. Selective IgA deficiency was the most common immunodeficiency seen in a few children. Adopting a conservative approach like aspiration and percutaneous drainage led to lower mortality and good recovery rates.

Characterization of MSW incineration bottom ash for use as structural fill in reinforced soil structures: Geoenvironmental, geotechnical and economical assessment.

The study presents the geoenvironmental and geotechnical characterization of MSW incineration bottom ash (IBA) and examines its reuse as structural fill in reinforced soil structures (RSS).The suitability of reuse has been assessed with regard to international regulatory standards. The prime focus of the work remains on evaluating the pullout response of geosynthetic reinforcements through IBA fill to determine the interaction coefficient, which has never been addressed in the literature. The economic viability of using IBA instead of locally available river sand for a 12 m high MSE wall is also established. The column leaching test results confirm that IBA can be utilized in RSS with suitable design measures. The geotechnical investigation shows that IBA is a well-graded, non-plastic lightweight material with adequate drainage and high shear strength. The pullout test results demonstrate that the interaction coefficient of polymeric strips and geogrid in IBA (0.73-1.53 and 0.79-1.91, respectively) is comparable or higher to materials conventionally used as structural fill in RSS, indicating adequate bondage between IBA and geosynthetic reinforcement. Further, it is estimated that using IBA as a substitute for available river sand in the vicinity can potentially reduce the overall RSS project cost by 15-20%, even if IBA has to be transported 50 km away from the project site.

Knowledge, attitude and practice of physical activity promotion among physiotherapists in India during COVID 19.

INTRODUCTION: Coronavirus disease (COVID-19) pandemic and the nationwide lockdown has increased sedentary time and physical inactivity. Physiotherapists are one of the essential health professionals who are actively involved in promoting physical activities. The study objectives included assessing knowledge of physical activity guidelines, physiotherapist attitude towards involvement in physical activities and practice of routine physical activity assessment, and its promotion among physiotherapists in India during COVID-19. METHOD: In this cross-sectional survey study, the study tool was prepared using Google Forms. It consisted of sixteen questions on knowledge, attitude, and practice of physical activities among physiotherapists. Study participants were physiotherapists with a minimum of a bachelor's degree qualification and practicing in India. RESULTS: One hundred and eighty responses were received from sixteen states of India. The average age of respondents was 28 years, and the average work experience of five years. This study found that only 19% of physiotherapists could give the correct answer in all three domains of WHO PA guidelines. 70% of physiotherapists found with an appropriate attitude as they met the 150 min of moderate PA per week. 68% reported that they promote physical activities in routine practice. CONCLUSION: This study suggested the majority of physiotherapists perform physical activity assessment and promotion in routine practice in India. Most of them have an appropriate attitude towards physical activity, but very few physiotherapists have adequate knowledge of WHO physical activity guidelines. Physiotherapists should actively promote physical activities in routine practice to reduce the impairment due to physical inactivity especially during the Corona virus disease pandemic in India. Efforts should be made to increase the physical activity awareness in terms of knowledge of WHO physical activity guidelines, different assessment, and promotion strategies.

India's health and wellness centres: realizing universal health coverage through comprehensive primary health care.

In common with other countries in the World Health Organization South-East Asia Region, disease patterns in India have rapidly transitioned towards an increased burden of noncommunicable diseases. This epidemiological transition has been a major driver impelling a radical rethink of the structure of health care, especially with respect to the role, quality and capacity of primary health care. In addition to the Pradhan Mantri Jan Arogya Yojana insurance scheme, covering 40% of the poorest and most vulnerable individuals in the country for secondary and tertiary care, Ayushman Bharat is based on an ambitious programme of transforming India's 150 000 public peripheral health centres into health and wellness centres (HWCs) delivering universal, free comprehensive primary health care by the end of 2022. This transformation to facilities delivering high-quality, efficient, equitable and comprehensive care will involve paradigm shifts, not least in human resources to include a new cadre of mid-level health providers. The design of HWCs and the delivery of services build on the experiences and lessons learnt from the National Health Mission, India's flagship programme for strengthening health systems. Expanding the scope of these components to address the expanded service delivery package will require reorganization of work processes, including addressing the continuum of care across facility levels; moving from episodic pregnancy and delivery, newborn and immunization services to chronic care services; instituting screening and early treatment programmes; ensuring high-quality clinical services; and using information and communications technology for better reporting, focusing on health promotion and addressing health literacy in communities. Although there are major challenges ahead to meet these ambitious goals, it is important to capitalize on the current high level of political commitment accorded to comprehensive primary health care.

Assessment of mineral phosphate-solubilizing properties and molecular characterization of zinc-tolerant bacteria.

Plant growth-promoting bacteria with the ability to tolerate heavy metals have importance both in sustainable agriculture and phytoremediation. The present study reports on the isolation and characterization of mineral phosphate-solubilizing (MPS) bacteria associated with the Achyranthes aspera L. plant (prickly chaff, flower plant). Out of 35 bacterial isolates, 6 isolates, namely RS7, RP23, EPR1, RS5, RP11 and RP19, with high MPS activity were selected and subjected to the assessment of MPS activity under various stress conditions, viz. ZnSO(4) (0.30-1.5 M), NaCl and temperature. MPS activity by the selected isolates was observed at concentrations of as high as >1.2 M ZnSO(4). Significant improvement in plant growth was observed on bacterization of seeds (pearl millet) with all of the six selected isolates. Plant growth was measured in terms of root length, shoot length, fresh weight and % increase in root biomass. The molecular diversity among the phosphate-solubilizing bacteria was studied employing enterobacterial repetitive intergenic sequence-PCR (ERIC-PCR). Representative strains from each ERIC type were identified, on the basis of a partial sequence of the 16S rRNA gene, as members of the genera Pseudomonas, Citrobacter, Acinetobacter, Serratia, and Enterobacter. Among all the isolates, RP19 was the best in terms of phosphate-solubizing activity and its response to various stresses. The ability of RP19 and other isolates to exhibit MPS activity at high ZnSO(4) concentrations suggests their potential as efficient biofertilizer for growing plants in metal (ZnSO(4))-contaminated soil.

Indian approaches to retaining skilled health workers in rural areas.

PROBLEM: The lack of skilled service providers in rural areas of India has emerged as the most important constraint in achieving universal health care. India has about 1.4 million medical practitioners, 74% of whom live in urban areas where they serve only 28% of the population, while the rural population remains largely underserved. APPROACH: The National Rural Health Mission, launched by the Government of India in 2005, promoted various state and national initiatives to address this issue. Under India's federal constitution, the states are responsible for implementing the health system with financial support from the national government. LOCAL SETTING: The availability of doctors and nurses is limited by a lack of training colleges in states with the greatest need as well as the reluctance of professionals from urban areas to work in rural areas. Before 2005, the most common strategy was compulsory rural service bonds and mandatory rural service for preferential admission into post-graduate programmes. RELEVANT CHANGES: Initiatives under the National Rural Health Mission include an increase in sanctioned posts for public health facilities, incentives, workforce management policies, locality-specific recruitment and the creation of a new service cadre specifically for public sector employment. As a result, the National Rural Health Mission has added more than 82,343 skilled health workers to the public health workforce. LESSONS LEARNT: The problem of uneven distribution of skilled health workers can be solved. Educational strategies and community health worker programmes have shown promising results. Most of these strategies are too recent for outcome evaluation, although this would help optimize and develop an ideal mix of strategies for different contexts.

Assessment of hemispheric asymmetry: Development and psychometric evaluation of a chimeric face test.

BACKGROUND: Anomaly in hemispheric functioning has been linked with various psychiatric conditions. However, most of the procedures used to assess hemispheric asymmetry in clinical population require special training and/or complex procedures and some of the measures suffer from such methodological problems that undermine their utility for clinical use. Further, the available economical procedures such as chimeric face test (CFT) utilize facial expression of emotions posed by western expressers and are therefore less valid measures in Indian context. AIM: Taking these limitations into account, the present study makes an attempt to develop a CFT (using facial affect photographs of Indian expressers) as an alternative and economical procedure for the assessment of hemispheric asymmetry. MATERIALS AND METHODS: Using the happy and neutral expressions of eight Indian expressers, 32 chimeric faces were developed by combining the half happy and half neutral expressions. These 32 chimeric faces were presented in pairs (arranged in top-bottom fashion) in booklet form to 225 right-handed participants. Using the contemporary item analytic procedure, finally 22 pairs of chimeric faces that showed satisfactory psychometric properties were retained. These 22 pairs of chimeric faces formed the final CFT. The psychometric properties of the various items as well as that of the whole CFT were found satisfactory. RESULTS: All the items were found reliable and valid as indicated by item-total correlation and alpha-if-item deleted. The internal consistency of the CFT was also found to be highly satisfactory (Cronbach's alpha =.80). Further, the participants on the average showed a right hemispheric advantage on the CFT that provide support to its validity. The findings of intermediate analysis of the data of an ongoing project also provide preliminary evidence for the validity of the CFT. CONCLUSION: The CFT is a reliable and valid measure to assess hemispheric asymmetry in the processing of facial emotions and may prove to be an economical and useful tool in clinical setting.