Expression of programmed death ligand-1 (PD-L1) and tumor infiltrating lymphocytes (TILs) in breast carcinoma and their clinical significance.

Background and Aim: Carcinoma of the breast is the second most common cause of cancer death in women. Expression of programmed death ligand-1 (PD-L1) in cancer cells plays an important role in tailored therapy. This can be evaluated by immunohistochemistry using a monoclonal PD-L1 antibody in formalin-fixed and paraffin-embedded (FFPE) specimens. Our aim was to evaluate the expression of PD-L1 and tumor infiltrating lymphocytes (TILs) in invasive carcinoma of breast and their clinicopathological correlation. Materials and Methods: Immunohistochemical staining for PD-L1 and TILs was done in paraffin-embedded tissues of histologically diagnosed 50 cases of breast carcinoma. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 22 software. Results: Out of these 50 cases, PD-L1 and TIL expression were seen in 16 (32%) cases and 18 (36%) cases, respectively. PD-L1 positivity was seen in 33.33% cases of grade 1 breast carcinoma, 13.79% of cases of grade 2 breast carcinoma, and in 75% case of grade 3 breast carcinoma. TILs showed positivity in 6.9% cases of grade 1 breast carcinoma, 13.79% of cases of grade 2 breast carcinoma, and in 100% cases of grade 3 breast carcinoma. Proportion of patients having PD-L1 expression was higher in grade 3 carcinoma than in grade 1 or 2. The differences were statistically significant (Chi-square value = 13.417, degree of freedom = 1, P < 0.05). The Chi-square value for TILs was 28.07, degree of freedom was 1, and P value was <0.05, which was statistically significant. Conclusion: Both PD-L1 and TILs showed maximum positivity in grade 3 breast carcinoma.

Implementation of National Leprosy Eradication Programme during COVID-19 era: A qualitative research.

Introduction The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis.

Are household food security, nutrient adequacy, and childhood nutrition clustered together? A cross-sectional study in Bankura, West Bengal.

BACKGROUND: Research on different measures of food security and their interrelation in order to identify vulnerable households are scarce in India. OBJECTIVES: The objective was to assess household food security (HHFS), nutrient adequacy, dietary diversity, and nutritional status of under-five children along with their interrelation in the slums of Bankura Municipality, West Bengal. METHODS: A cross-sectional study was conducted during 2016-2017 among 240 households using two-stage 30-cluster random sampling. Information regarding socioeconomic characteristics, availability, and utilization of different poverty alleviation schemes was collected. HHFS was assessed by a validated HHFS scale-short form in Bengali and nutrient adequacy with 24-h recall method. The eldest under-five child in the family was measured for anthropometry using standard procedure and for dietary diversity with the Individual Dietary Diversity Score. RESULTS: Overall, 74 (29.1%) households had "food security," whereas 102 (44.3%) and 64 (26.6%) had, respectively, low and very low food security. Among 190 under-five children, 63 (35.3%) had single and 50 (25.5%) had multiple anthropometric failures. Overall, 89 (36.1%) households were deficient for both energy and protein and 111 (47.6%) had deficiency of either of these two. Indicators on the utilization of different poverty alleviation schemes were associated with low/very low food security. A "Composite Index of Food Scarcity" comprising of HHFS, nutrient adequacy, and dietary diversity was proposed which was found to have dose-response relationship with grades of anthropometric failure of under-five children. CONCLUSIONS: An index comprising of three indicators might help identify the vulnerable households in relation to food security more effectively than a single indicator.

Road Traffic Injuries: A Study on Severity and Outcome among Inpatients of a Tertiary Care Level Hospital of West Bengal, India.

BACKGROUND: Road traffic injuries (RTIs) are a complex phenomenon caused by nonlinear combination and interaction of man, vehicles, road, and environment. AIM: This study aims to find out the outcome and severity of RTI in a district of West Bengal, India. SETTINGS AND DESIGN: A cross-sectional study was conducted among inpatients of Departments of Surgery and Orthopedics of Bankura Sammilani Medical College and Hospital, West Bengal, India. MATERIALS AND METHODS: The study was conducted for 1 year interviewing 295 RTI selected through scheduled sampling. Information pertaining to demographic and correlates of RTI was collected by face to face and over telephone using semi-structured questionnaire. Nine-item Simplified Injury Severity Scale (SISS) was used to assess injury severity. Internal consistency of SISS scale was showed by Cronbach's alpha and association with the correlates was done by Mann-Whitney U-test. STATISTICAL ANALYSIS USED: With SPSS version 22.0, binary logistic regression, and Mann-Whitney U-test. RESULTS AND CONCLUSION: Fatal outcome in terms of death and permanent disability was 34.24% and they had higher marginally significant (P = 0.06), SISS score (45.17 ± 12.59). Participants with absence of protective devices, presence of comorbidities, drunkenness, with accidents over national highways, in-between 6 am and 6 pm, mechanized two-wheelers, and nonreceipt of first aid were found to have significantly high scores compared to their counterpart. SISS, as a proxy measure of severity assessment, could throw a light on it and awareness generation and legislative stringency might be need of the hour for the country.

Correlation among perceived stress, emotional intelligence, and burnout of resident doctors in a medical college of West Bengal: A mediation analysis.

BACKGROUND: Perceived stress and burnout are by-products of powerless responsibility imposed on resident doctors. Emotional intelligence (EI) works as an adapting and coping tool. OBJECTIVE: The objective of this study is to find out the role of work-related perceived stress on burnout and influence of EI on it. METHODS:: A descriptive cross-sectional study was conducted from February to April 2016 among 63 resident doctors of different departments of Bankura Sammilani Medical College and Hospital. Data were collected through a self-administered questionnaire for background characteristics and work-related variables. Cohen perceived stress scale, Trait EI, and Shirom-Melamed burnout questionnaire were applied for measuring perceived stress, EI, and burnout, respectively. Statistical analysis was done with of SPSS version 22.0, and for mediation analysis, Andrew F. Hyne's SPSS macro was adopted. Nonparametric bootstrapping was done assuming small sample. RESULTS: Out of complete responses, 67%, 22.9%, and 9.8% were from clinical, paraclinical, and preclinical specialties, respectively. Burnout had a significant positive correlation with perceived stress and in negative correlation with EI-well-being and positive correlation with EI-self-control and sociability. Physical fatigue factor of burnout had a significant positive correlation with EI-emotionality. Perceived stress had a negative correlation with EI-well-being. On mediation analysis, assuming EI as a mediator, total, direct, and indirect effects of perceived stress on burnout were significant (<0.05). Mediation was proved to act with percent mediation of 0.07. CONCLUSION: There was definite mitigating effect of EI on burnout by perceived stress among resident doctors. This necessitates more attention by decision-makers toward this burning problem for the sake of care of caregivers.

Status of early childhood education under integrated child development services scheme in Bankura Municipality, West Bengal.

BACKGROUND: Early childhood education (ECE) is an important service provided by Integrated Child Development Services (ICDS). It is largely responsible for developing school readiness in children. OBJECTIVE: The objective of this study is to assess ECE component of ICDS services through measurement of school readiness and find out other correlates. METHODS: A cross-sectional evaluation study was carried out among Anganwadi centers (AWCs) under Bankura Municipality, West Bengal, India from July to November 2015. AWCs were selected by 30 cluster sampling. From each selected center Anganwadi worker (AWW), 7 randomly selected children of 5 years of age and their caregivers were included in the study. Data were collected by assessment of children, interview of AWWs and caregivers of children, observation of ECE activity and record review using ECE Program Evaluation Package developed by World Bank and predesigned schedule. Mean, standard deviation, proportions were estimated for description and correlation, unpaired t-test, analysis of one-way variance, multivariable linear regression were performed to find out correlates of school readiness using SPSS 22.0 version. RESULTS: Average duration of ECE activity was 66.0 min/day which was far less than the norm. Overall average score of school readiness of 210 children was 14.0 out of 40. Inadequate physical facility, poor classroom performance acted as deterrents for school readiness. Help in the study at home was revealed to be a determinant of school readiness. CONCLUSION: For the preparation of formal schooling of children most important needs of the hour are physical facility of AWCs, supportive supervision of AWWs, and creation of congenial environment at home.

Taking stocks of antimalarial activities: A study on knowledge and skill of health personnel at primary care setting in the state of West Bengal, India.

BACKGROUND: Early diagnosis and effective treatment are the key areas in malaria control in India. OBJECTIVE: The present study was carried out to assess the knowledge and skill of health personnel at primary care level and the logistic support related to the program at subcenter (SC) level. METHODS: A cross-sectional, descriptive study was conducted among medical and paramedical personnel working at primary health-care institutions in two districts of West Bengal. Knowledge was assessed using a structured questionnaire while diagnostic skill and logistic support were assessed with structured checklists. Clinical skill was assessed with case vignettes. RESULTS: Requisite knowledge on diagnostic procedure was found in two-third to three-fourth of health personnel while only 26.7% and 12.4%, respectively, knew the correct treatment of Plasmodium vivax and Plasmodium falciparum malaria. Median standardized score for knowledge was 50.0 while the scores for skill of preparing blood slide and for rapid diagnostic test were 70.0 and 57.1, respectively. Education and work experience were related to diagnostic skill but had little effect on knowledge. In clinical skill, medical personnel scored 50% or more in investigation and treatment aspects only. In another case vignette, health workers excelled over medical officers and other staff in all axes other than history taking and clinical examination although their performance was also suboptimal. Formal training on malaria did not show any bearing on median knowledge and skill score. Supply of diagnostics and drugs was insufficient in majority of SCs. CONCLUSION: Renewed efforts are needed to create competent workforce and ensure adequate logistic supply.

Suspected anthrax outbreak: Investigation in a rural block of west Bengal and public health response.

Anthrax is one of the top 10 diseases reported in India and also one of the major causes of death in livestock. This study was conducted to confirm the outbreak of suspected anthrax, determine the transmission mechanism, and implement control measures in Bhatar block of Burdwan district, West Bengal, India. A cross-sectional descriptive study was conducted through house-to-house visits in Oregram and Kathaldanga villages during the period from May 30, 2013 to June 8, 2013. Out of the 93 persons exposed to anthrax, 11 persons had history of slaughtering, while 82 consumed the meat. All of the 7 cases of suspected anthrax were male (mean age 41.14 ± 10.04 years) and involved in slaughtering the animal. Most cases presented with papule and vesicle over the upper extremity and the trunk. One patient among the suspected cases died. The outbreak was labeled as a suspected anthrax outbreak. A health awareness camp was organized to improve awareness of anthrax among villagers.

Adherence to highly active antiretroviral therapy in a tertiary care hospital in West Bengal, India.

INTRODUCTION: The introduction of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has led to the reduction of mortality and the improvement of the quality of life of people living with HIV/AIDS (PLWHA). The present study was conducted to determine the pattern of adherence to HAART among PLWHA, and to assess the factor(s) affecting nonadherence, if any. METHODS: This study was a hospital-based analytical, cross-sectional epidemiological study conducted between July and October 2011. A total of 370 adult HIV-positive patients registered in the Antiretroviral Therapy Centre of Burdwan Medical College and Hospital, West Bengal, India, were included. Nonadherence was defined as missing at least a single dose of medicine within the last four days. Data was analysed using the Statistical Package for the Social Sciences version 19.0 (IBM Corp, Armonk, NY, USA). RESULTS: A total of 87.6% of patients were found to be adherent to HAART. Principal causes of nonadherence were forgetting to take medicine (70.2%), being away from home (65.2%), and busyness with other things (64.7%). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with a positive family history of HIV/AIDS (odds ratio [OR] 16; 95% confidence interval [CI] 2.2-114.3; p = 0.01), occurrence of side effects with HAART (OR 9.81; 95% CI 1.9-51.7; p = 0.01) and employment (OR 5.93; 95% CI 1.5-23.2; p = 0.01). CONCLUSION: Although overall adherence was high, the factors that affect nonadherence can be addressed with proper counselling and motivation of patients and their family members. Adherence to HAART could delay the progression of this lethal disease and minimise the risk of developing drug resistance.

Coverage and awareness of and compliance with mass drug administration for elimination of lymphatic filariasis in Burdwan District, West Bengal, India.

India adopted WHO's strategy of repeated rounds of mass drug administration (MDA) with diethylcarbamazine to eliminate lymphatic filariasis. The present study attempted to assess the coverage and awareness of and compliance with MDA for elimination of lymphatic filariasis in Burdwan district of India, following MDA round in July 2010. A cross-sectional study was conducted among the four randomly-selected clusters in the district of Burdwan, West Bengal, India, covering 603 individuals from 154 households, using a predesigned pretested schedule. The drug distribution coverage, compliance, and effective coverage were 48.76%, 70.07%, and 34.16% respectively. Only 41.4% of the study population was aware of the MDA activity. This evaluation study noted that MDA is restricted to tablet distribution only. There is an urgent need to improve compliance with drug intake through strengthening of the awareness programme involving both government health workers and community volunteers.

A study on socio-demographic characteristics of alcoholics attending the de-addiction center at Burdwan medical college and hospital in West Bengal.

Prevalence of alcohol use in India is reported to be 21.4% and there is increasing alcohol intake among the young people. The present study was undertaken to study the socio-demographic characteristics of patients having alcohol-related disorders attending the de-addiction center at Burdwan Medical College in West Bengal and to find out some factors responsible for that. A clinic-based descriptive cross-sectional study was conducted among 187 patients with the help of pre-tested pre-designed schedule after obtaining informed consent. Data analysis was carried out with the help of Epi info software version 6. Majority of the patients were male, in productive age group and married. Age of initiation and amount of alcohol intake were significantly associated with positive family history of alcoholism. Children having family history of alcoholism should be counseled to prevent development of alcoholism.

Burden of hospitalized pediatric morbidity and utilization of beds in a tertiary care hospital of kolkata, India.

BACKGROUND: Childhood morbidity consumes a substantial portion of health care resources in terms of hospital bed utilization, and overload in hospital ward remains a major concern in many countries, including India. A possible way to minimize the problem of scarcities of bed is to analyze the pattern of bed utilization by causes and plan services accordingly. OBJECTIVES: To determine the burden of pediatric morbidity and utilization pattern of pediatric beds in a tertiary care hospital. MATERIALS AND METHODS: A retrospective analysis of pediatric inpatient's records was conducted over a period of 1 year from 1 January 2007 to 31 December 2007. RESULTS: Of 3983 total admitted cases, about one-third were infants, of which neonatal and post-neonatal age group constituted 45% and 55% of the cases, respectively. In terms of bed-day utilization, infants, 1-4 years and 5-11 years age group accounted for 35.10%, 32.58% and 32.32% of total days of admission, respectively. Utilization of pediatric beds by major causes of morbidity was respiratory tract infection (22.23%), convulsive disorder (12.68%), accident and poisoning (6.07%), diarrheal disease (4.97%) and chronic hemolytic anemia (4.42%). CONCLUSION: A minor change in admission policy through provision of day care unit for management of certain cases would allow efficient use of hospital beds.

Comparative Analysis of RNTCP Indicators in a Rural and an Urban Tuberculosis Unit of Burdwan District in West Bengal.

BACKGROUND: Data pertaining to managerial indicators of RNTCP are rare. The present study was done to analyze the RNTCP indicators in one rural and one urban tuberculosis unit in Burdwan, West Bengal, and find out any influencing factor. MATERIALS AND METHODS: A comparative record analysis for the year 2007 was undertaken RESULTS: The study revealed significantly more urban adolescents (P<0.001) were treated. In both areas, the proportion of NSN cases and smear positive retreatment cases among total smear positives were less than expected, while more NSP cases were registered. Significantly lesser retreatment cases (13.33%) were registered in the rural area. Smear negative and EP cases of all the patients in Cat I were significantly less in the rural area. Outcomes like cured, treatment completed, default, and death were similar approaching the RNTCP norm. But sputum conversion (78.02%) and failure rate (4.93%) were worse than the RNTCP norm in the urban area and varied significantly between two areas. The outcomes like cured, treatment completed, and default differed significantly with age in the areas. The outcome of TAD cases was different, but the outcomes of NSN, EP, and other retreatment cases were similar in two areas. Age at treatment onset was found to be the only factor associated with default. CONCLUSION: Managerial indicators may reveal something different despite common indicators showing acceptable results.

A study on the role of parental involvement in control of nutritional anemia among children of free primary schools in a rural area of West Bengal.

An intervention study was conducted among students of three randomly selected free primary schools in rural West Bengal to assess the effect of health-nutrition education for behavior modification of parents on nutritional anemia of children. Clinically anemic students were school-wise randomized into 'groups of two' and intervened with anthelminthic, iron-folic acid (IFA) pediatric tablet and health-nutrition education by reoriented teachers. Parents of study group were involved in behavior change processes. Baseline overall prevalence of anemia was 64.4%. After IFA therapy, prevalence of anemia was not found to differ between two groups (χ² = 2.68, P > 0.05, RR= 0.48, 95% C.I 0.2 < RR < 1.19) while reducing 52.2% of relative risk. Reassessment after six months showed significantly lower prevalence in study group (χ² = 18.14, P < 0.05, RR = 0.20, 95% C.I. 0.08 < RR < 0.49). Parental involvement for life style and dietary modification may curb childhood anemia.

A study on factors influencing treatment outcome of failure patients receiving DOTS in a district of West Bengal.

Failure to primary treatment under RNTCP can be an enormous setback for the society. A record based retrospective cohort analysis of 212 patients failing primary treatment under Cat I or Cat III was done in Burdwan district of West Bengal to find the treatment outcome after re-registration under Cat II and its possible influencing factors. Retreatment of failed patients resulted in 24.06% chronicity. Important factors influencing the outcome of being failure were found to be Adolescence (AOR = 2.350; C.I. 0.660-8.281), Urban residence (AOR = 1.878; C.I. 0.705-5.002), primary categorization in Cat I versus Cat III (AOR = 5.036; C.I. 0.897-28.281), higher bacillary load at the beginning of retreatment regimen (AOR = 5.437; C.I. 0.787-37.562) and more than three weeks delay in instituting Cat II treatment (AOR = 3.550; C.I. 0.941- 13.393). 17.35% of such failed patients were still defaulters. Hence such factors may be looked into for more efficient control of Tuberculosis in our country.