COVID Vaccine Hesitancy among the Tribal Population and Its Determinants: A Community-Based Study at Berhampore Block of Murshidabad District, West Bengal

Background: On January 16, 2021, India rolled out the COVID vaccination drive. A successful and effective vaccination campaign requires much more than the availability of a safe and effective vaccine. This includes identifying vulnerable populations with lower vaccine confidence and identifying the drivers of vaccine hesitancy. Objective: This study aims to find out vaccine hesitancy among the tribal population regarding COVID‑19 vaccination. Methods: It was an observational descriptive cross‑sectional study, conducted at Manindranagar and Hatinagar gram panchayat of Berhampore Block of Murshidabad district, West Bengal, from June 2021–November 2021, among tribal people aged >18 years. A total of 198 tribal people were selected by applying the probability proportional to size sampling method. Participants were interviewed using predesigned, pretested, and semi‑structured schedules. Potential predictors of hesitancy were investigated using the multivariate logistic regression model. Results: Vaccine hesitancy was present among 36.9% of the study participants. Fear of side effects (78.1%) was the most common reason of vaccine hesitancy. Only 30.8% of them received at least one dose of vaccine. Vaccine hesitancy was associated with decreased family income in the last 1 year (adjusted odds ratio [AOR] = 8.23), knowledge regarding vaccine (AOR = 0.41), adherence to COVID‑appropriate behavior (AOR = 0.45), and trust on the local health‑care worker (AOR = 0.32). Conclusion: Vaccine hesitancy among the tribal population is driven by a lack of knowledge and awareness. Their economic status, attitudes toward the health system, and accessibility factors may also play a major role in vaccine hesitancy. Extensive information, education, and communication activity, more involvement of health‑care workers in the awareness campaign, and establishment of vaccination centers in tribal villages may be helpful.

Assessment of Acute Phase Protein Serum hs-CRP Levels and its Role in Severity of Disease in Vitiligo Patients – A Hospital Based Case Control Study in M.Y. Hospital, Indore M.P.

Introduction: Vitiligo an acquired pigmentary disorderof the skin and mucous membranes characterized by wellcircumscribed, depigmented macules and patches resultingfrom selective destruction of melanocytes. CRP is an acutephase protein secreted by the liver in response to severalinflammatory cytokines such as IL6. Since inflammatoryand immune factors plays a key role in the pathogenesis ofvitiligo, we aimed to assess the relationship between theserum level of hs-CRP and pathogenesis and severity ofvitiligo.Material and methods: The study was conducted in theDept. of Biochemistry and Dept. of Dermatology andVenereology in MGM Medical College & M Y HospitalIndore after approval from ethical committee on 70Confirmed & diagnosed cases of Vitiligo patients of agegroup 18 to 55 years attending Dermatology OPD in MYHospital Indore during a period of April 2018 to April 2019.Patients were divided into three groups according to thearea of skin affected. Healthy individual without vitiligowere taken as controls. Venous blood sample was analyzedfor serum hs-CRP levels and liver function. Appropriatestatistical tests were applied on Minitab Version 17.0 and pvalues < 0.01was considered significant.Results: In our study the mean serum hs-CRP in case groupwas higher 12.09 ± 11.64 than in control group it was 1.99 ±2.05 with negative but statistically significant correlation withage of onset of disease and positive statistically significantcorrelation with duration of disease thus, serum hs-CRPlevel might be useful for evaluating the disease activity ofvitiligo as Novel biomarker.Conclusion: As high-sensitive C-reactive protein (hs-CRP)is an important sensitive diagnostic and prognostic markerin many systemic inflammatory diseases and very lowconcentrations of hs-CRP can be analyzed in the serum, itsdetection and serial measurements helps to provide a novellink to evaluate the disease activity and severity and responseto treatment

Determination of individual type 2 diabetes risk profile in the North East Indian population & its association with anthropometric parameters

Background & objectives: Diabetes genomics research has illuminated single nucleotide polymorphism (SNP) in several genes including, fat mass and obesity associated (FTO) (rs9939609 and rs9926289), potassium voltage-gated channel subfamily J member 11 (rs5219), SLC30A 8 (rs13266634) and peroxisome proliferator-activated receptor gamma 2 (rs1805192). The present study was conducted to investigate the involvement of these polymorphisms in conferring susceptibility to type 2 diabetes (T2D) in the North East Indian population, and also to establish their association with anthropometric parameters. Methods: DNA was extracted from blood samples of 155 patients with T2D and 100 controls. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing. To confirm the association between the inheritance of SNP and T2D development, logistic regression analysis was performed. Results: For the rs9939609 variant (FTO), the dominant model AA/(AT+TT) revealed significant association with T2D [odds ratio (OR)=2.03, P=0.021], but was non-significant post correction for multiple testing (P=0.002). For the rs13266634 variant (SLC30A 8), there was considerable but non-significant difference in the distribution pattern of genotypic polymorphisms between the patients and the controls (P=0.004). Significant association was observed in case of the recessive model (CC+CT)/TT (OR=4.56 P=0.001), after adjusting for age, gender and body mass index. In addition, a significant association (P=0.001) of low-density lipoprotein (mg/dl) could be established with the FTO (rs9926289) polymorphism assuming dominant model. Interpretation & conclusions: The current study demonstrated a modest but significant effect of SLC30A8 (rs13266634) polymorphisms on T2D predisposition. Considering the burgeoning prevalence of T2D in the Indian population, the contribution of these genetic variants studied, to the ever-increasing number of T2D cases, appears to be relatively low. This study may serve as a foundation for performing future genome-wide association studies (GWAS) involving larger populations.

Diagnostic value of serum adenosine deaminase in Type 2 diabetic patients

Background: Adenosine deaminase (ADA) is suggested to modulate the bioactivity of insulin, but its clinical significance in Type 2 diabetes mellitus (DM) is not yet established. The present study was undertaken to evaluate serum ADA activity and serum uric acid levels in patients of Type 2 DM. Aim: To evaluate the serum ADA level and to correlate ADA levels with Blood Glucose, Glycated Hemoglobin (HbA1c) levels in Type-2 DM patients. Material and Method: It is a case control study. The subjects in this study were divided into 3 groups. Group I consisted of 50 normal healthy individuals who served as controls with no history of DM. Group II consisted of 50 patients of Type 2 DM both males & females in the age group of 40-65 years on oral hypoglycemic drugs with HbA1c <7%. Group III consisted of 50 patients of Type 2 DM both males & females in the age group of 40-65 years on oral hypoglycemic drugs with HbA1c >7 %. Serum levels of fasting blood sugar, HbA1c, ADA and uric acid were estimated in all the subjects. Results: FBS, HbA1c, ADA and serum uric acid levels were found to be increased in the patients of Type 2 DM as compared with controls. Conclusion: It is concluded that there is an increase in serum ADA levels with increase in HbA1c levels. Serum uric acid levels increased with moderately increasing levels of HbA1c <7% and then decreased with further increasing levels of HbA1c >7% (a bell-shaped relation).

A roadmap for achieving health equity in India: A proposed framework and assessment of the determinants of health equity

With the upcoming technical interventions in the health sector of India, India has been able to create a great scope for Medical Tourism in the country. People from different nations are coming to India to avail many critical treatments at an affordable price. Even after such great development, Health Equity has always been a great challenge for our country. Through Health Equity, we mean availing the standard health services by the under-privileged, marginalized group of people compared to the privileged segment of the community. The present study will help us to highlight on the prioritization of the allocation of the resources to the most eminent tier of the Health care structure. Also, this study will focus on the effectiveness of this component of the Health care structure of India and how this can help in throwing light on the disparity of the health care services through a proposed model.

Primary Tubercular ulcer in Glans Penis mimicking neoplastic lesion.

Tuberculosis is a very common disease especially in developing countries but primary tuberculosis of penis is extremely rare. Here we are presenting a case of Primary tuberculosis of glans penis of 82 years male.

Lycopene - tomato's secret weapon against oxidative stress.

Back ground: Lycopene, 40 carbon acyclic carotenoid containing 11 conjugated double bonds, is a phytochemical found in tomatoes and other red fruits. Oxygen derived free radicals are the most reactive species and as an antioxidant lycopene has a singlet oxygen quenching ability twice as high as that of ?-carotene and 10 times higher that of ?-tocoferol, lycopene participate in a host of chemical reactions to protect critical cellular biomolecules including lipid, proteins and DNA. Materials and Methods: The present study include 30 subjects having oxidative stress, age between 40-60 years, nonsmoker, with no history of chronic systemic illness and no medication were taken as patients.30 patients matched healthy subjects were taken as control. All subjects were selected from outpatient department of NSCB Medical College Jabalpur M.P. After estimation of base line antioxidant enzyme and vitamins, we supplement 180 gm of tomato (products like soup, paste. ketchup) contain 12 mg of lycopene to the patient group. After 60 days of lycopene supplementation oxidative stress biomarkers like SOD, GPX, GR, GSH, lipid peroxidation product MDA and other antioxidant vitamins A, vitamin C, vitamin E were estimated in patient's blood sample. Results: The main result of the study revealed that lipid per oxidation product MDA was found to be decreased significantly but after lycopene supplementation levels were improved. The results of SOD , GPX, GR, GSH,Vitamin A ,Vitamin E and Vitamin C were significantly increased after lycopene supplementation, it indicates the improved antioxidant profile after the supplementation of lycopene. Conclusion: There was a significant decrease in oxidative stress after the supplementation of lycopene therefore the study suggest that body's internal production of antioxidant is not enough to neutralize all free radicals, so increased dietary intake of antioxidant lycopene in the form of tomato products is beneficial, which is easily available in developing country like India.

Hepatopulmonory syndrome--an uncommon and severe complication of certain liver diseases.

Hepatopulmonary syndrome (HPS) is charaterised by arterial hypoxaemia found mainly in association with chronic liver disease (most commonly cirrhosis of liver) but also rarely with acute liver diseases like fulminant hepatic failure or Budd-Chiari syndrome. The purpose of this article is to present an uncommon but grave complication mostly associated with cirrhosis of liver and to differentiate this entry from cyanotic heart diseases or certain lung conditions. Investigations include history and physical examination, certain biochemical tests, upper gastro-intestinal (GI) endoscopy, abdominal ultrasonography, liver biopsy and venacavography in appropriate cases. Finally, the suspected cases underwent arterial blood gas (ABG) analysis and contrast enhanced echocardiography (CEE) for confirmation of the diagnosis of HPS. Of the 123 cases of cirrhosis of liver, three cases of HPS (2.4%) were found-all of them being males. Also one male patient with inferior vena cava (IVC) obstruction amongst other causes presenting with HPS was encountered. As of now, no medical treatment has been proved to be useful and liver transplant remains the only hope for this disorder.

A study of bone mineral density in diabetes mellitus in eastern India.

To measure bone mineral density in diabetic patients at the time of clinical diagnosis of diabetes mellitus and to find out correlation, if any, with microvascular complication of diabetes mellitus and glycosylated haemoglobin, a study was conducted at Medical College and Hospital, Kolkata among 138 cases of diabetes and 212 controls. All patients were screened for ophthalmoscopy, routine blood and urine examinations. Bone ultrasound attenuation study of the calcaneus was performed in all cases. The bone ultrasound attenuation result was compared to a mean normal population result and expressed as Z score and T score. The age of diabetic patients varied from 11 years to 70 years. Of 138 diabetics, 32 (23.18%) had type 1 diabetes and rest type 2 diabetes. Forty-two diabetic patients had retinopathy, 42 nephropathy and 48 had neuropathy. Glycosylated haemoglobin was above 7% in 124 patients. The broadband ultrasound attenuation of type 1 diabetics ranged from 38 to 95 dB/MHz and in type 2 it was 35 to 104 dB/MHz. There was no statistically significant correlation between neuropathy, nephropathy, retinopathy and bone mineral density status. It was also found no correlation between glycosylated haemoglobin values and ultrasound attenuation.

Leptospirosis and Weil's disease in eastern India.

Leptospirosis is characterised by a broad spectrum of clinical manifestations varying from inapparent infection to fulminant fatal disease. Severe leptospirosis characterised by profound jaundice is referred to as Weil's disease. In the present study 20 patients of leptospirosis, of which 7 belonged to Weil's disease, were diagnosed based on the demonstration of IgM antileptospira antibody and supported by clinical correlation and appropriate biochemical markers. Overall, the male and female ratio was 17:3 and the same ratio for the Weil's disease was 6:1. The most common presentation involved fever, malaise and myalgia. Conjunctival congestion was found in 75% of the cases and jaundice was encountered in 90% of the cases. The prognosis of all these patients, including that of Weil's disease was excellent. Early recognition and initiation of antibiotic therapy were found to be important.

Assessment of the need for a training course in rational use of drugs: a cross-sectional pilot study.

Rational use of drugs means need-based use of them keeping in mind the pathological status, therapeutic indices, drugs interactions and adverse drug reactions. Lacunae in the existing undergraduate curriculum cause irrational use of drugs. The present study was undertaken among 2,200 fresh medical graduates from all over the country with a list of questionnaire distributed among them and analysing the answers. The aim was to ascertain the adequacy of present undergraduate curriculum on pharmacology in equipping the doctors on rational use of drugs and to assess the need and feasibility of Refresher's course. More than half (55%) replied prescriptions were not truly rational. Ninety-eight per cent opened Refresher's course is beneficial in rational prescribing. This cross-sectional survey could provide a glimpse of existing undergraduate pharmacology curriculum and its impact on rational prescribing practice. The Refresher's course in the early internship period involving the clinical departments and department of pharmacology is suggested.

Surrogate endpoints: do they really contribute in therapeutic decision making?

Surrogate endpoints are substitutes for the true endpoints and measured in any clinical research to relate in some way to the outcome of primary interest. Inappropriate selection of surrogate markers may lead to controversies during clinical trials or therapeutic interventions. Use of surrogate markers depends upon thorough understanding of the pathophysiology of the disease and pharmacology of drugs. Results obtained with surrogates should be regarded as preliminary and necessitates definitive studies.

Correlation of clinical profile of myotonic dystrophy with CTG repeats in the myotonin protein kinase gene.

The molecular genetic analyses (PCR and Southern hybridization) of Indian patients with myotonic dystrophy (DM) were carried out to determine the degree of repeat expansion and an attempt was made to correlate the repeat number with disease severity. A scoring system based on the salient clinical features was devised to objectively assess the disease severity. The repeat expansion was seen in 11 of 12 patients examined and showed an inverse correlation with the age of onset confirming the phenomenon of anticipation. This was further established in the two pedigrees studied, clearly demonstrating both clinical and genetic anticipation. The clinical severity score, however, did not correlate well with the repeat number. Nonetheless, such molecular genetic analyses may have immense value as a screening procedure to identify premutations as well as in prenatal diagnoses.

Role of Anopheles culicifacies during an outbreak of malaria in Gorubandha P.H.C., Assam.

Entomological investigation during an outbreak of malaria in Gorubandha PHC in Sonitpur district revealed unusually high density of Anopheles culicifacies followed by An.minimus. Parity rates of both the species were very high, 65% and 62.2% respectively. An. culicifacies was incriminated as malaria vector. Sporozoite rate recorded was 0.63%. Both the species were found susceptible to DDT. This substantiates the epidemiological observation which yielded 98% Plasmodium falciparum malaria out of 35.2% malaria positive cases. Incrimination of An. culicifacies means adding one more malaria vector to this region.

Detection of rabies virus in different tissues of experimentally infected mice at preclinical and postclinical stages of the disease.

Rabies fixed virus (CVS) was passaged 10 times in mice by intramuscular (im) route followed by experimental inoculation of the titrated virus in 4 groups of mice with the dose of 0.1 ml of 1000 mouse (LD50 0.03 ml) using intracerebral (ic), intravenous (iv), intramuscular (im), intraocular (io), and intranasal (in) routes respectively. No marked variation in clinical signs due to variation of routes could be detected. Involvement of brain with io route could be detected even in preclinical stage. Although the virus could be detected in the postclinical stage in all the tissues under study (brain, skin, salivary gland and corneal impression), with io and ic routes spread of the virus was observed in comparatively higher concentrations.