Empowering in-service nurses in management of viral hepatitis through Programmed Approach to Knowledge and Sensitization on Hepatitis (PRAKASH): An experience from a capacity building initiative.

BACKGROUND: Nursing fraternity are at an increased risk of acquiring hepatitis B and hepatitis C infections mainly attributable to occupational risk and close contact with the patients while treatment. However, unawareness and negligence about the severity, mode of transmission and preventive measures about the disease can further predispose the nursing fraternity to a higher risk of infection. To overcome these lacunae in knowledge, a training program named Project PRAKASH was initiated for in-service nurses across the country. The objective of the program was to impart up-to-date knowledge to the nursing professionals in the management of viral hepatitis and to assess the effectiveness of the training program through pre-post-knowledge assessment survey. METHODOLOGY: One-day training program titled 'Hepatitis Induction Program' was conducted for a period of 2 years (2018-2020) among nursing professionals. It was accompanied by administration of 54-item knowledge, attitude and practice (KAP) questionnaire with four sections: demographic details, knowledge (30 items), attitude (11 items) and practice (13 items), followed by post-knowledge assessment. An Impact Assessment Survey (IAS) was also administered to assess the change in attitude and practice among 10% of the attendees, at least 6 months post training. RESULT: A total of 32 one-day training programmes were organised which witnessed the training of 5,253 nursing professionals from 292 institutions across 12 states. A data of 4,474 participants were included in the final analysis: improvement in the knowledge score was significant (P-value < 0.001) with mean knowledge score of 19.3 ± 4.4 in pre-test and 25.7 ± 3.9 in the post-test. CONCLUSION: The one-day training resulted in improvement of knowledge and significant changes in the attitude and practices of the nursing professionals.

Capacity building of healthcare workers: Key step towards elimination of viral hepatitis in developing countries.

BACKGROUND: Lack of awareness about viral hepatitis (VH) potentially predisposes the healthcare workers (HCWs) to a higher risk of infection and may in turn increase the risk of transmission of the infection to their families and in the community. Thus, combating VH, requires adequate and updated training to the HCWs. With this objective, Project PRAKASH designed a meticulously planned training program, aimed to assess the effect of a one-day training on VH among in-service nurses. METHODS AND MATERIAL: The content and schedule of scientific sessions of the training program were decided by subject experts to improve knowledge, attitude and practice(KAP) related to VH among in-service nurses. A 54-item questionnaire divided into four domains: Transmission and Risk Factors; Prevention; Treatment; Pathophysiology and Disease Progression were used to assess the KAP related to VH. The questionnaire consisted of four sections: demographic details, knowledge(30-items), attitude(12-items) and practice(12-itmes) with a total score of 30, 60 and 24 respectively in each section. The pre-post knowledge assessment was done and impact assessment survey was undertaken among the participants who completed six months post-training period. Paired-t-test was used to assess the effect of training on knowledge using SPSSv-22. RESULTS: A total of 5253 HCWs were trained through 32 one-day trainings, however data for 4474 HCWs was included in final pre-post knowledge analysis after removing the missing/incomplete data. Mean age of participants was 33.7±8.4 with median experience of 8(IQR: 3-13). Mean improvement in knowledge score was found to be significant (p<0.001) with mean knowledge score of 19.3±4.4 in pre-test and 25.7±3.9 in the post-test out of 30. Impact assessment survey suggested change in attitude and practice of HCWs. CONCLUSION: The one-day training programs helped the in-service nurses to enhance their knowledge related to viral hepatitis. The study provided a roadmap to combating viral hepatitis through health education among HCWs about viral hepatitis.

Dioctophymiasis: A Rare Case Report.

Dioctophyma renale commonly known as "giant kidney worm' is found in the kidney of carnivorous mammals. Human infestation is rare, but results in destruction of the kidneys. Very few cases have been reported worldwide. We are here reporting a case of Dioctophymiasis in a 35-year-old male patient who presented with retention of urine and subsequent passage of worm and blood in urine. The worm was confirmed as Dioctophyma renale based on its morphology and clinical presentation. This is a very rare case report and to best of our knowledge only two cases have been reported from India.

Accidental injection of 2% chlorhexidine gluconate instead of an anesthetic agent: A case report.

We report a case where 2% chlorhexidine (CHX) gluconate was mistaken for an anesthetic solution and infiltrated into the buccal vestibule during routine root canal treatment. Accidentally, 2% CHX gluconate solution was injected in the right upper buccal vestibule (16) of a 23-year-old male during routine root canal treatment. The patient experienced pain and a burning sensation over the injected area shortly after injection. Swelling with mild extraoral redness over the right cheek area was observed clinically. The patient was immediately administered dexamethasone intramuscularly, and was prescribed antibiotics, analgesics, and antihistamines. The patient complained of a loss of sensation over the right cheek by the 15(th) day. The swelling reduced gradually over a period of 15 days. Reversal of sensation was attained after 35 days.

Pulmonary Infection by Blastoschizomyces capitatus in An old Tuberculosis Patient.

Blastoschizomyces capitatus is an arthrospore filamentous fungus. Lung infection by Blastoschizomyces can develop as an opportunistic infection in patients with underlying conditions especially when there is immunosuppression including neutropenia. However, it can occur in non-neutropenic patients with solid organ transplant and patients whose local pulmonary defenses are altered by chronic underlying lung pathology. We report here a case of pulmonary infection by B. capitatus in an old tuberculosis patient.

Balantidiosis: a rare accidental finding in the urine of a patient with acute renal failure.

Balantidium coli is the only ciliated protozoan which is known to infect human and nonhuman primates. Route of infection is faecal-oral route. It is actively motile and causes mostly asymptomatic infections, or it may develop dysentery which is similar to that which is caused by Entamoeba histolytica. Here, we are describing a case of an accidental finding of B.coli in the urine of a patient who presented with acute renal failure, based on its characteristic morphology and motility which were seen on light microscopy. This is the third case of Urinary Balantidiosis which has been reported from India.