Impact of COVID-19 pandemic on online medical education - An online survey of students' perspective.

Introduction: The year 2020 brings in a paradigm shift in medical education with the emergence of the COVID-19 pandemic. Since the government of India initiated the first countrywide lockdown, educational institutions, including medical colleges, have adopted online mode for undergraduate teaching. Medical education is virtually incomplete without appropriate practical exposure. This study was conducted to understand the opinion of the medical students towards online classes as an impact of this pandemic on medical education. Materials and Methods: A descriptive online survey was conducted using a google form among medical undergraduate students from across India. Snowball sampling was used to recruit study participants. The responses were analyzed using numbers and percentages. Continuous variables were expressed as the mean and standard deviation of the mean. Results: The mean age of the 1426 respondents was 20.46 years. The majority of the responses were from Karnataka (412), followed by Odisha (167). While fairly a good number of respondents agreed that online classes provided a conducive environment and independence in learning, a large proportion disagreed or remained neutral in terms of its usefulness. This could be attributed to several reasons, which may be categorized into three important groups: the technical competence of the students, the provision of an enabling environment and the ability of the teachers. Conclusion: Students had varying opinions on online classes, but most emphasized the need for redoing the lessons taught online.

Insight to the psychosocial factors of survivors of suicidal hanging.

Introduction: The incidence of hanging has increased over the last ten years and is the most common method of suicide. Because of its multifactorial causation, the reason behind hanging remains unfolded unless the victims leave a suicidal note. In the present study, the psychodynamic factors of hanging were assessed among the survivors of suicidal hanging. Materials and Methods: The cross-sectional study was conducted at S.C.B Medical College and Hospital, Cuttack, India, over a period of three years. Eighty-two individuals admitted in medicine ward of this tertiary care hospital to receive treatment for the complications as a sequel of hanging and willing to participate in study were included after obtaining informed consent. The information was recorded in a pre-designed pro forma. Results: Subjects from rural areas (87.8%) and low socio-economic backgrounds (67.1%) attempted suicide more often. Most of the victims were in the age group of 21-30 years, followed by less than 20 years. The most common cause of attempted suicide by hanging was family-related issues, and mainly by immediately available materials like dupattas, saree, lungi, and other fabrics. Females in rural areas and males from urban areas attempted suicide by hanging in significantly higher proportions (P = 0.041). Conclusion: Most people commit suicide at a younger age due to failure to cope with the different stressful situations. The most common reason for attempted suicide by hanging was family-related issues. Early intervention in family disputes in developing countries, especially in younger individuals, may help to curb suicide.

Prevalence and Risk Factors of Iron Deficiency Anemia among the Tribal Residential Adolescent School Students of Odisha: A Cross-Sectional Study.

Background: Globally, anemia is one of the biggest public health challenges. The highest prevalence of anemia is seen among adolescents. Tribal communities are especially at a disadvantage, with several studies documenting a high prevalence of anemia among tribal adolescents. We investigated the prevalence of anemia and its associated risk factors among the tribal residential adolescent school students in Odisha. Material and Methods: In a cross-sectional survey, the prevalence of anemia was estimated by spectrophotometry among adolescents of residential schools in three predominantly tribal districts of Odisha. The severity of anemia was defined as per the World Health Organization classification for adolescents. Results: The mean age of 953 subjects was 13.07 ± 1.48 years. The prevalence of anemia was found to be 37.3%. As per the World Health Organization classification, 19.9% had mild anemia, 16.3% had moderate, and 1% had severe anemia. Consumption of Iron Folic Acid (IFA) was associated with the level of hemoglobin at a statistically significant level. Conclusion: We found that the prevalence of anemia was lower than in similar studies conducted in other parts of the country. Despite poor coverage of beneficiaries with iron and folic acid at the national level, our study showed better compliance and was associated with a significantly higher level of hemoglobin among those who consumed IFA.

Survival of Gastric Cancer Patients at a Tertiary Care Hospital in Eastern India: A Retrospective Data Analysis.

Background Gastric cancer is one of the most common cancers and a leading cause of death worldwide. Most cases of gastric cancer are diagnosed at an advanced stage when no definitive treatment is available leading to an overall declined survival rate. In this study, we aimed to investigate the survival rate of gastric cancer patients admitted to our tertiary care center and determined the relationship between sociodemographic and clinicopathological characteristics with mortality. Methodology Gastric cancer patients treated between January 2019 and December 2020 were included in this retrospective study. The clinicopathological and demographic data of 275 gastric cancer patients were analyzed. The Kaplan-Meier method was used to calculate the overall survival of gastric cancer patients. The Kaplan-Meier log-rank test was used to calculate the difference. Results The mean survival of gastric cancer patients was 20.10 months (95% confidence interval = 19.20-21.03). Deaths were higher among stage III (42.6%) and stage IV (36.1%) patients compared to stage I (1.6%) and stage II (19.7%) patients. Mortality was significantly higher (70.5%) in patients without surgery. Conclusions The mean survival in our study setting is lower and is associated with the pathological stage of the disease, surgical intervention, and patients presenting with other gastrointestinal symptoms. A lower survival rate can be attributed to late diagnosis.

Point-of-care versus central laboratory measurements of electrolytes and hemoglobin: A prospective observational study in critically ill patients in a tertiary care hospital.

Background: A blood gas analyzer is a point-of-care (POC) testing device used in the Emergency Department (ED) to manage critically ill patients. However, there were differences in results found from blood gas analyzers for hemoglobin (Hgb) and electrolytes parameters. We conducted a comparative validity study in ED in patients who had requirements of venous gas analysis, complete blood count, and electrolytes. The objective was to find the correlation of Hgb, sodium (Na+), and potassium (K+) values between the blood gas analyzer and laboratory autoanalyzer. Methods: A total of 206 paired samples were tested for Hgb, Na+, and K+. Total 4.6 ml of venous blood was collected from each participant, 0.6 ml was used for blood gas analysis as POC testing and 4 ml was sent to the central laboratory for electrolyte and Hgb estimation. Results: The mean difference between POC and laboratory method was 0.608 ± 1.41 (95% confidence interval [CI], 0.41-0.80; P < 0.001) for Hgb, 0.92 ± 3.5 (95% CI, 0.44-1.40) for Na+, and 0.238 ± 0.62 (95% CI, -0.32-0.15; P < 0.001) for K+. POC testing and laboratory method showed a strong positive correlation with Pearson correlation coefficient (r) of 0.873, 0.928, and 0.793 for Hgb, Na+, and K+, respectively (P < 0.001). Conclusion: Although there was a statistical difference found between the two methods, it was under the United States Clinical Laboratory Improvement Amendment range. Hence, starting the therapy according to the blood gas analyzer results may be beneficial to the patient and improve the outcome.

Prevalence, Patterns, and Predictors of Physical Inactivity in an Urban Population of India.

Physical inactivity (PI) is a risk factor for mortality and morbidity. PI and its predictors among the urban population in Bhubaneswar, India, were unknown. Finding out the contribution of PI as a cause of existing noncommunicable diseases (NCD) is difficult without following up with a cohort. The study was hence done to find out the prevalence, patterns, and predictors of physical inactivity in an urban population, and simultaneously investigate its causal relationship with NCD from this cross-sectional study. Cluster random sampling was used with a sample size of 1203 with a design effect of three. Socio-demographic, health profile, physical activity levels, and stage of change for physical activity behavior were collected. Logistic regression and marginal structural model analysis (by inverse probability of treatment weighting {IPTW} using a generalized estimating equation {GEE} to investigate the relationship between physical activity and prevalence of NCDs) were done using IBM SPSS v20 software (Armonk, NY: IBM Corp.). Statistical significance was tested at p=0.05. A total of 1221 subjects participated. The mean age was 35.25 years and 71.9% were physically inactive. General caste, presence of NCD, and being in a static stage of change influenced physical activity positively. PI was found to be a risk factor for NCD with 1.54 times higher odds in this population. The study concluded that the prevalence of physical activity was low and PI was a causative factor for NCD.

Prevalence of diabetic retinopathy in urban and rural India: A systematic review and meta-analysis.

A systematic review and meta-analysis were conducted to estimate the prevalence of diabetic retinopathy (DR) in India's urban and rural areas. Medline, Scopus, and ScienceDirect databases were searched for population-based studies published in English between January 1990 and April 2021, wherein the prevalence of DR among Indian residents with type 2 diabetes mellitus (DM) was reported. A random-effects model was used to estimate the overall, rural, and urban prevalence. Data from 10 eligible studies were aggregated for meta-analysis. The prevalence of DR was 17.44% (95% confidence interval [CI], 14.33-20.55) in urban and 14.00% (95% CI: 9.13-18.86) in rural population (P = 0.24). The overall DR prevalence was 16.10% (95% CI: 13.16-24.32), and the population prevalence was 1.63% [95% CI: 0.94-2.32]. Prevalence of DR in people with diabetes was lower in the age group of 40-49 years [13.57% (95% CI: 7.16-19.98)] than in the age group of 50-59 years [16.72% (95% CI: 12.80-20.64)] and the age group of 60 years and above [16.55% (95% CI: 12.09-21.00)]. Variability in studies was high: urban (I2 = 88.90%); rural (I2 = 92.14%). Pooled estimates indicate a narrow difference in DR prevalence among people with diabetes in rural and urban India. The fast urbanization and increasing diabetes prevalence in rural areas underscore the need for providing equitable eye care at the bottom of the health pyramid.

Medication Adherence Among Patients of Type II Diabetes Mellitus and Its Associated Risk Factors: A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India.

BACKGROUND: Type 2 diabetes mellitus is a major public health problem. Adherence to anti-diabetic medications improves glycaemic control, which in turn prevents complications as well as reduces out-of-pocket expenditure. The World Health Organization highlights that the impact of interventions directed to improve adherence has far greater implications than specific medical interventions. There are several factors that contribute to poor adherence. Not many studies have been conducted to explore adherence to diabetes medications in eastern India. OBJECTIVES: To measure medication adherence among patients suffering from diabetes. To determine the various risk factors influencing adherence to medication. To find out the association of health-related quality of life with adherence to medication. METHODOLOGY: A hospital-based cross-sectional study was conducted in the outpatient Department of General Medicine and Endocrinology of a tertiary care hospital in eastern India from January to March 2020. Adult subjects, who were diagnosed with type 2 diabetes mellitus for at least six months, were interviewed using a pretested, structured questionnaire containing 8-item Morisky Medication Adherence Scale (MMAS-8) to determine adherence to diabetic medications. Data were analysed in SPSS version 27 (IBM Corp., Armonk, NY, USA). RESULTS: The mean age of the 331 participants interviewed was 53.40 (SD 11.0) years and the majority were males (57.1%). Medication adherence of 34.14% (n=113) was found among the subjects. Having any comorbidity, positive family history of diabetes and the habit of current alcohol intake increased the odds of poor adherence by 3.26 times, 1.88 times, and 2.35 times respectively in binary logistic regression analysis. Those following a diabetic diet had a protective effect, decreasing poor medication adherence by 79.6%. Poor medication adherence increased by 1.077 times with every one-day increase in unhealthy days. CONCLUSION: The medication adherence was 34.14% and as compared to other similar studies medication adherence in the study population was poor and was associated with unhealthy days.

Macintosh laryngoscope versus AMBU King Vision video laryngoscope for endotracheal intubation using a COVID-19 barrier box: A randomized controlled trial.

BACKGROUND: Coronavirus disease 2019 (COVID-19) barrier box is being used by health-care workers for protection against aerosol-transmitted infection. Usually, a Macintosh laryngoscope (MC) or a video laryngoscope (VL) is used for endotracheal intubation (ETI). We aimed to determine the most suitable laryngoscope blade in terms of time to ETI, ease of ETI, and the first-pass success rate. METHODS: American Society of Anesthesiologists Grade I and II patients undergoing surgery under general anesthesia were randomized into the MC and the King Vision VL groups in a 1:1 ratio. ETI was performed using either the MC (the MC group) or the King Vision VL (the VL group) with a COVID-19 barrier box. The first-pass intubation success rate, intubation time, and ease of ETI were analyzed. RESULTS: The first-pass success rate was higher in the MC group (P = 0.43). The mean duration of ETI was 33 s and 47 s in the MC group and VL group, respectively. The difference was statistically significant between the groups (P = 0.002). The ease of ETI was comparable between the groups (P = 0.57), and the Cormack-Lehane grade was significantly different between the groups (P = 0.0025). CONCLUSION: ETI duration was shorter in the MC group than in the VL group. Hence, a MC can be used along with a COVID-19 barrier box by experienced operators for the prevention of aerosol spread.

Prevalence, Patterns, and Predictors of Yoga Practice Among Adults in an Urban Population in Eastern India.

The objective of this study was to determine the prevalence and predictors of yoga practice. This cross-sectional study was conducted as a part of a larger study that included yoga as a form of physical activity. Data were collected during April and August 2019 from the adult urban population of Bhubaneswar, India. This study was conducted using a cluster random sampling method. A representative sample (n = 1,203) of adults aged 18-59 years, irrespective of gender, was interviewed using a questionnaire adapted from the 2012 U.S. National Health Interview Survey, with the Epicollect5 handheld data-collection tool. Predictors of yoga practice were explored using multivariable logistic regression. The mean age of the participants was 35.19 ± 10.67 years, with 55.3% males. The majority were Hindu (93.62%) and belonged to the unre s e rved category (65.60%), people generally of higher relative socioeconomic status. The lifetime prevalence of yoga was 16.9%. Prevalence of any form of yoga (yoga, pranayama, or meditation), all forms of yoga (yoga, pranayama, and meditation), pranayama, and meditation was 17.0%, 10.7%, 14.3%, and 11.4%, respectively. After adjusting for confounders, female gender, Hindu religion, minimum of higher-secondary or graduate-level education, and having received advice from professionals for yoga practice had significantly higher odds of practicing yoga, and those of higher socioeconomic status had significantly lower odds of practicing yoga. We found a low prevalence of yoga. Sociodemographic characteristics like gender, religion, education, socioeconomic status, and other factors like learning yoga from professionals may be important predictors of continued yoga practice.

Challenges in Detection of Adolescent Anaemia: Validation of Point-of-Care Device (Mission® plus) for Haemoglobin Measurement among Tribal Residential School Children of Selected Districts of Odisha, India.

BACKGROUND: Screening for anemia among tribal school children has been a challenge. OBJECTIVES: To validate a point-of-care (POC) device (mission® plus hemoglobinometer) to the gold standard method, spectrophotometry. STUDY DESIGN: Cross-sectional study. PARTICIPANTS: The representative sample of 953 tribal adolescents from the residential schools of Odisha. METHODS: Hemoglobin was measured simultaneously by the POC and gold standard method during January to July 2019. The validity of the POC device was measured by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The area under the curve was calculated using receiver operating characteristic (ROC) analysis. Concordance of the POC device with the gold standard method was determined by the Bland-Altman plot. The intraclass correlation coefficient (ICC), precision (⍴), a bias correction factor (Cb), and the concordance correlation coefficient were also calculated. Deming regression analysis was performed, and a linear equation was established. RESULTS: The mean age of the study participants was 13.07 (±1.48) years. The prevalence of anemia was 45.54% by the gold standard method. The sensitivity and specificity of the POC device were 94.9% and 56.1%, respectively. PPV and NPVs were 64.4% and 93.0%, respectively. The area under the ROC curve was found to be 0.856. The ICC was 0.887 (95% confidence interval: 0.872-0.901). CONCLUSIONS: Very good reliability/absolute agreement for hemoglobin measurements existed between the POC device and the gold standard method making it suitable as a screening device.

Investigating Mumps Outbreak in Odisha, India: An Opportunity to Assess the Health System by Utilizing the Essential Public Health Services Framework.

AbstractMumps, a highly contagious, viral disease continues to spread in India, despite the availability of an effective vaccine. On November 24, 2014, we came across a suspected case of mumps in a 6-year-old boy in a village of Bhusandapur sector in Odisha. We initiated an outbreak investigation using standard techniques outlined by the Centers for Disease Control and Prevention, Atlanta, GA. This uncovered a silent epidemic of 94 case patients (10% of the population) over a period of 16 weeks between August and December 2014, in a single village, which had gone completely unnoticed by the existing health-care system. Since the index case was one of the last case patients of the outbreak, investigation for immediate control was not a priority. Hence, we have used this exercise to describe the outbreak and identify causes that led to its nondetection. Age range of the case patients was between 2 and 40 years; 85 (90.4%) case patients were ≤ 15 years of age and 54 (57.4%) were females. Average duration of illness was 9 days. No child had received the mumps vaccine. The outbreak had led to a community expenditure of 538 USD. The exercise uncovered a number of weak links in the essential public health services within the health-care delivery system in the area.

Operational Assessment of ICDS Scheme at Grass Root Level in a Rural Area of Eastern India: Time to Introspect.

INTRODUCTION: Integrated Child Development Service (ICDS), a flagship program of Government of India (GoI) for early childhood development hasn't delivered the desired results since its inception four decades ago. This could be due to infrastructural problems, lack of awareness and proper utilization by the local people, inadequate program monitoring and corruption in food supplies, etc. This study is an audit of 36 Anganwadi centres at Khordha district, Odisha, to evaluate the implementation of the ICDS. AIM: To assess operational aspects of ICDS program in a rural area of Odisha, in Eastern India. MATERIALS AND METHODS: A total of 36 out of 50 Anganwadi Centres (AWCs) were included in the study. We interviewed the Anganwadi Workers (AWW) and carried out observations on the AWCs using a checklist. We gathered information under three domains manpower resource, material resource and functional aspects of the AWC. RESULTS: Most of the AWCs were adequately staffed. Most of the AWWs were well educated. However, more than 85% of the AWCs did not have designated building for daily functioning which resulted in issues related to implementation of program. Water, toilet and electricity facilities were almost non-existent. Indoor air pollution posed a serious threat to the health of the children. Lack of play materials; lack of health assessment tools for promoting, monitoring physical and mental development; and multiple de-motivating factors within the work environment, eventually translated into lack of faith among the beneficiaries in the rural community. CONCLUSION: Inadequate infrastructure and logistic supply were the most prominent issues found, which resulted in poor implementation of ICDS program. Strengthening of grass root level facilities based on need assessment, effective monitoring and supervision will definitely help in revamping the ICDS program in rural areas.

Estimation of post-mortem interval: A comparison between cerebrospinal fluid and vitreous humour chemistry.

Accurate estimation of post-mortem interval is of great importance in medico-legal autopsy cases. The present study is intended to compare the accuracy of estimating post-mortem interval from biochemical parameters of vitreous humour and cerebrospinal fluid (CSF). Both the fluids were collected from 100 medico-legal autopsies with known time of death and analysed for potassium, glucose, sodium, calcium, urea and creatinine. The current study found that vitreous humour is a better fluid in comparison to CSF for estimation of post-mortem interval. It is also observed that among the statistically significant parameters in both the fluids, level of potassium and sodium in vitreous humour are giving more accurate results in comparison to their corresponding parameters in CSF while accuracy of glucose is more or less same in both the fluid. Nevertheless potassium concentration in vitreous humour is a single best time honoured parameter to estimate post-mortem interval.

Do socio-demographic factors still predict the choice of place of delivery: A cross-sectional study in rural North India.

Improving maternal health is one of the goals to be achieved under the Millennium Development Goal (MDG), especially MDG-5. One of the predictors of maternal health is place of child birth. This study was carried out to determine the prevalence of home delivery and different socio-demographic factors associated with them. This study was a community-based cross-sectional study. Women who delivered a baby in the past 1 year were included in this study. A total of 300 women responded (93.2%) and gave consent to participate in the study. Prevalence of home delivery was 37.7%. Bivariate analysis showed that religion, caste, education of women and their partners, occupation of the spouse, monthly family income and socioeconomic status had a significant association with the choice of place of delivery. But multivariate regression analysis showed only religion, caste, education of spouse and monthly income to be significant factors in determining place of delivery. The findings of this study suggest that individual countries have to formulate interventions which will target marginalized or vulnerable populations with reference to caste, religion and wealth. A significant improvement in reaching the 5th MDG can be achieved if the first three MDG goals are focused on, i.e., eradication of poverty, achieving universal education and women empowerment.

Four new vaccines for routine immunization in India: what about hemophilus influenza B and pneumococcal vaccine?

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. The Expanded Program on Immunization (EPI) was flagged off in India in 1978. According to the recommendation of National technical advisory group of India (NATGI), Government of India is going to include four new vaccines in the UIP for whole India. The four new vaccines are Inactivated Poliomyelitis Vaccine (IPV) for polio, rota viral vaccine, vaccine against rubella, and Japanese encephalitis vaccine (179 districts in India). Here, authors have tried to show a comparative descriptive analysis of the hemophilus influenza and pneumococcal pneumonia with rota virus, so that in near future Government of India can also consider their inclusion in the national UIP. In India, 39.2% of all diarrheal death are due to rota virus, whereas 0.72 million deaths are due to hemophilus influenza B and 1.3 million are due to pneumococcal pneumonia in <5 years age-group. India's indigenous developed rota viral vaccine's (Rotavac) efficacy is 56% in 1(st) year compared to H influenza B (Hib) efficacy 95% and PCV13 vaccine "3 + 1" dose efficacy 100% (South Africa). Rotarix incremental cost-effectiveness ratio is US $21.4 to US $34 per disability-adjusted life years (DALYs) compared to Hib US $ 819 per DALYs in India. In case of pneumococcal vaccine, India needs more trails on the serotype specificity, efficacy, and cost-effectiveness but there is enough evidence that hemophilus influenza burden is high in India and the present Hib vaccine is safe and highly effective. In future with the help of donor agencies, India should include the hemophilus influenza B and pneumococcal pneumonia vaccine in national UIP which will save millions of poor children's life.

Usage and Perceived Side Effects of Personal Protective Measures against Mosquitoes among Current Users in Delhi.

Background. Mosquito-borne diseases constitute an important cause of morbidity and mortality. The use of personal protective measures (PPM) like mats, bednets, screening, repellents, liquid vaporizers, mosquito coils, and so forth has been advocated as an effective tool in control of mosquito-borne diseases, but data about the safety profile of personal protective measures is still scarce. Objective. To study the usage and side effects of personal protective measures against mosquitoes among current users in Delhi. Materials and Methods. A community-based cross-sectional study among 350 adult individuals selected by systematic sampling method. Data was collected using pretested semistructured questionnaire after taking written informed consent. Data was analysed using SPSS version 17. Chi-square/Fisher's Exact test was used for qualitative variables to find association and P value <0.05 was considered significant. Results. Out of 350 families selected, 210 belonged to rural area and 140 to urban area. Personal protective measures were used by 219 (62.5%) subjects. Liquid vaporizer was the most preferred method (41.4%). Most common perceived side effect of personal protective measures was headache (7.7%). Other perceived side effects were cough (3.2%), sore throat (2.7%), allergy (1.3%), and eye irritation (0.9%) predominantly among coil users. Conclusion. There is a need to have a close watch for side effects of personal protective measures among users. Further research is also needed to develop safe and effective personal protective measures against mosquitoes.