The Preventive and Therapeutic Potential of the Flavonoids in Liver Cirrhosis: Current and Future Perspectives.

Non-alcoholic fatty liver disease (NAFLD) may vary from moderately mild non-alcohol fatty liver (NAFL) towards the malignant variant known as non-alcoholic steatohepatitis (NASH), which is marked by fatty liver inflammation and may progress to liver cirrhosis (LC), liver cancer, fibrosis, or liver failure. Flavonoids can protect the liver from toxins through their anti-inflammatory, antioxidant, anti-cancer, and antifibrogenic pharmacological activities. Furthermore, flavonoids protect against LC by regulation of hepatic stellate cells (HSCs) trans-differentiation, inhibiting growth factors like TGF-ß and platelets-derived growth factor (PDGF), vascular epithelial growth factor (VEGF), viral infections like hepatitis-B, C and D viruses (HBV, HCV & HDV), autoimmune-induced, alcohol-induced, metabolic disorder-induced, causing by apoptosis, and regulating MAPK pathways. These flavonoids may be explored in the future as a therapeutic solution for hepatic diseases.

How Patients of Oral Cancer Cope Up with Impact of the Disease? A Qualitative Study in Central India.

BACKGROUND: Oral cancer is an important cause of mortality and morbidity in India. The disease per se and side effects of different treatment modalities impart a negative physical and psychosocial impact on the patients. This study was designed to have a better understanding of patients concerns. MATERIALS AND METHODS: This is a qualitative study using in-depth interviews on 24 purposively selected oral cancer patients who have completed their treatment. The study was conducted from January 2016 to September 2017 in both urban and rural community development block in a district in Central India. Participants were selected irrespective of age, sex, occupation, education, stage of disease, and treatments received. The recorded interviews were transcribed for analysis, done using ATLAS ti. The study was conducted after ethical approval. RESULTS: Concerns regarding quality of life, social constraints, financial security, and eating problems were the four major themes, which evolved from the analysis. Emotional and physical distress, disfigurement, dependency, feeling blamed, and avoidance are the evolved subthemes that had a negative psychosocial impact. Spiritualism, acceptance of the disease and increased public attention and support are the factors that increase the confidence among the cancer patients. CONCLUSION: Quality of life of oral cancer patients should be given prime focus along with continuum of care starting from early means of diagnosis by screening to treatment completion. Nevertheless, it is the family support that seems to play the most vital role in helping cancer patients cope up with the problems.

Understanding the Psychosocial Impact of Oral Cancer on the Family Caregivers and Their Coping up Mechanism: A Qualitative Study in Rural Wardha, Central India.

BACKGROUND: A family caregiver is the one who provides care to their near and dear one who is suffering from some debilitating disease like oral cancer. Apart from providing physical care, they also provide emotional and financial support to their close relatives. They can be the patient's spouse, children, and siblings. This study was, hence, designed to understand the psychosocial impact of caregivers of oral cancer patients. METHODOLOGY: This was a qualitative study using in-depth interviews of 24 purposively chosen family caregivers irrespective of age, sex, and relationship with patients, who provided deep insight into the psychosocial impact of the disease on themselves during caregiving of their loved ones and how they coped with it. Interviews were taken in Hindi, in the houses of caregivers. Care was taken to maintain utmost privacy while taking the interviews, which were either audio recorded or noted down. Informed written consent was obtained from participants before the start of the study. Themes were evolved from the interviews and content analysis was performed using ATLAS.ti. RESULTS: Six themes emerged after data analysis. Those were the impact on physical health and lifestyle, emotional impact, impact on family and social relationship, impact on financial and work status, improvement of hospital services, spiritual concern, and acceptance of the disease. A concept map was made to provide a vivid explanation of how oral cancer caused these impacts on caregivers and their interrelationship. CONCLUSION: Caregiving is not an easy job. This study recommends extra care to be taken in preparing them for caregiving to the oral cancer patients with adequate knowledge of the disease process and its consequences along with counseling facilities in the hospital to address the different psychosocial needs of the patients.

How "Elderly Staying Alone" Cope Up with their Age and Deteriorating Health: A Qualitative Exploration from Rural Wardha, Central India.

BACKGROUND: This study is done to explore the various changes and problems faced by the "elderly people staying alone" and how they cope up to maintain their life amidst the physical, familial, social, and financial crisis in their lives. MATERIALS AND METHODS: This qualitative study was carried out in the villages surrounding Bhidi Rural Health and Training Center, located in the Vidarbha region of Maharashtra. A triangulation of free listing and pile sorting exercise was used. Elderly >65 years of age of either sex, living alone in their own houses, for at least 2 years were included in the study. Twenty-four such individuals were selected purposively who could figure out the different words and concepts regarding the three domains of our study for the purpose of line listing, namely, change of life since staying alone, problems faced while staying alone, and how they cope up with the problem of living alone. The data were analyzed using Anthropac software. The study findings were presented to the participants, who later pointed out few recommendations to be made. RESULTS: The "elderly staying alone" face the problems of lack of family, social, and financial support in their day-to-day life. They cope with these problems by a number of ways. Although there are a number of government schemes to protect the elderly, none of these policies are dedicated to this special group of elderlies. CONCLUSION: There is no social structure that can take care of this vulnerable group of elderlies in rural India. It is high time for the government to step in to bring some societal and familial reforms that will safeguard the elderly staying alone from the ongoing familial, social, and financial hardship.

Financial impact of oral cancer treatment on the households in rural India.

Background: Oral cancer ranks second and accounts for over 20% of all cancers reported in India. Like management of all other cancers, oral cancers bring a heavy financial burden to their families. This study analyzes the financial burden on families during the management of oral cancer at Kasturba Hospital, Sewagram, a government-aided tertiary health care facility in central India. Methods: The hospital-based cross-sectional study was conducted in the cancer unit of a government-aided tertiary hospital of central India. A total of 100 patients with oral cancer being treated in the hospital were included in the study. Information regarding cost incurred on management of oral cancer was inquired from a close family member or a caregiver of the study subjects. Results: The out-of-pocket expenditure on treatment of oral cancer was approximately INR 100,000 (USD 1363). It has been found that 96% of families experienced catastrophic health expenditure as a result of treatment. Conclusion: Although India aims for universal health coverage, it is important to protect cancer patients from catastrophic health expenditure.

Perceived burden, causes and consequences of adolescent pregnancy in the rural Maharashtra: a cultural domain analysis.

OBJECTIVES: The existing level of the early age pregnancy necessitates in-depth discussions and study. The objective of this study is to explore the perception of rural population regarding adolescent pregnancy with reference to the perceived burden, causes and consequences. METHODS: A cross-sectional study through cultural domain analysis using free listing and participatory learning and action (PLA) tool of ten seed analysis was used for exploring the perceptions of the community. Cognitive salience was estimated using the Sutrop (Su) index. RESULTS: The perceived burden of adolescent pregnancy was around 18%. Early marriage (Su index = 0.274), love/relationship (Su index = 0.246), pre-marital sex (Su index = 0.215), rape/incest (Su index = 0.162), and poor educational status (Su index = 0.152) were the salient causes of adolescent pregnancy. The salient consequences identified were weak baby (Su index = 0.170), social stigma (Su index = 0.124), excessive bleeding during delivery (Su index = 0.114), mother may die (Su index = 0.112) and abortion (Su index = 0.109). CONCLUSIONS: Teenage pregnancy is perceived as a problem by the community. The causes of teenage pregnancy in this setting are multi-dimensional and are deeply embedded in the system of local values, beliefs and practices.

The prevalence of depression among the elderly people living in rural Wardha.

BACKGROUND: Depression is the most common psychiatric disorder among elderly population in India, which generally remains undiagnosed and undertreated. Exact burden of depression among the elderly population in rural India was not known. AIM: This study was conducted to determine the prevalence of depression among the elderly population in rural population of Wardha, Maharashtra. MATERIALS AND METHODS: This is a cross-sectional study carried out among the elderly (≥60 years) population of both sexes residing in the field practice area of the department of community medicine. Geriatric depression scale was used for screening depression among the study population. Data collection was completed within 2 months using convenience sampling. Ethical approval was taken before beginning the study. Magnitude was expressed in percentage along with its 95% confidence interval (CI). Univariate and multivariate logistic regressions were done. Odds ratio and 95% CI were used to express association. RESULTS: Magnitude of depression among the elderly population was found to be 41.7% (95% CI: 36.1-47.4). In this study, we found the following factors to have positively contributed towards depression among elderly population in rural Wardha: female sex, widowed, separated, divorced, decreased decision-making capability, abused, or being suffering from chronic illnesses. CONCLUSION: Our study showed the prevalence of mild depression to be 26.72% and that of severe depression to be 15.17% among the elderly study participants.

How cancer of oral cavity affects the family caregivers? - A cross-sectional study in Wardha, India, using the Caregiver Quality of Life Index - Cancer questionnaire.

INTRODUCTION: Oral cancer is now a major public health problem in India. It does not only affect the patient, but also has a deep psychosocial impact on the family caregivers who are deeply involved with the cancer patient for nursing, timely medication, and consulting the doctor. Studies have found that the caregivers often suffer from depression, anxiety, and fear of losing their near and dear ones. This study aims to capture the psychosocial impact of oral cancer on the family caregivers. MATERIALS AND METHODS: This was a cross-sectional study carried out in a tertiary care hospital with the primary caregivers of those oral cancer patients who completed their treatment and came for follow-up after 2-3 months of treatment completion. The study participants were recruited till a sample size of 100 was reached. This was adequate to report proportions with an error of 10%. We have used "The Caregiver Quality of Life Index - Cancer" scale to capture the psychosocial impact of oral cancer on primary caregiver of the patient. The study was initiated after obtaining approval from the Institutional Ethics Committee. Informed written consents were obtained from all the study participants before beginning the interviews. RESULTS: Caregivers played an important role in the recovery of the patients. However, the strain of caregiving resulted in increased emotional stress among them. We found 56% of the family caregivers were female and 41% were male. Majority of the caregivers who accompanied the patients to hospital were the spouses. For the caregivers, the mean score for burden of the disease was found to be 60.0 (±20.2), that for disruption was 50.4 (±21.7), and for positive adaptation was 61.4 (±20.7). CONCLUSION: Caregivers, who are usually invisible to the health-care team, should be recognized and their mental and physical well-being should also be given attention.

Outbreak investigation of cholera outbreak in a slum area of urban Wardha, India: An interventional epidemiological study.

INTRODUCTION: Cholera, though a preventable and treatable disease, is still regarded as an important public health problem in developing countries including India. Migration, unhygienic living conditions, overcrowding, open field defecation, and ignorance about the spread of disease are the major reasons for the occurrence of cholera in the slum areas. Cholera was detected in the stool sample of a 3-year-old child from a slum area of urban Wardha, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic. MATERIALS AND METHODS: This was a cross-sectional epidemiological study, where we have used pretested, predesigned epidemiological case sheets obtained from IDSP. A case definition was proposed before beginning the investigation. Linelisting, collection of stool and water samples, immediate referral, and treatment of the patients suffering from loose stool and/or vomiting were performed. A detailed epidemiological report was made with recommendations and plan of action that was forwarded to the district health system. RESULTS: In all, 28 suspected cases of cholera were line listed. Among the affected population, more than half of the suspected cases were from the age group of 0-10 years of age. Males were more affected when compared with females. The overall attack rate was 27% and case fatality rate was 0%. There was positive history of travel in the index case. Two of the water samples were found to be unsatisfactory for drinking. CONCLUSION: The investigation report was soon developed and shared with the district health authorities, and recommendations were given to prevent such outbreaks in future.

Magnitude of depression and its correlates among elderly population in a rural area of Maharashtra: A cross-sectional study.

BACKGROUND: Depression is the most common psychiatric disorder among elderly population in India, yet, it is commonly misdiagnosed and undertreated. The exact burden of depression among the elderly population in rural India was not known. OBJECTIVES: To study the magnitude of depression among the elderly masses in rural Maharashtra and to find its correlates. MATERIAL AND METHODS: This is a cross sectional study, carried out among the elderly (≥60 years) population of both sexes residing in the field practice area of the department of community medicine. Geriatric depression scale was used for screening depression among the study population. Data collection was completed within 2 months using convenience sampling. Ethical approval was taken before beginning the study. Magnitude was expressed in percentage along with its 95% confidence interval (CI). Univariate and multivariate logistic regression was carried out to study associated correlates. Odds ratio and 95% CI was used to express association. RESULTS: The magnitude of depression among the elderly population was found to be 41.7% (95% CI 36.1-47.4). We got the significant positive association of female sex, living without spouse, lacking in decision making capability, a victim of abuse or neglect, or suffering from chronic illnesses with depression among elderly population in univariate analysis that did not hold good in the multivariate logistic regression. Our study showed the prevalence of mild depression among elderly to be 26.72% and that of severe depression to be 15.17%. CONCLUSION: To deal with this huge social problem of depression among the elderly population, more enthusiastic steps should be undertaken.