Exploring misclassification of injury intent: A burn register study.

INTRODUCTION: Burn registers are an important source of surveillance data on injury intent. These data are considered essential to inform prevention activities. In South Asia, intentional burn injuries are thought to disproportionately affect women. Assessment of injury intent is difficult because it is influenced by personal, family, social, and legal sensitivities. This can introduce misclassification into data, and bias analyses. We conducted a descriptive, hypothesis generating study to explore misclassification of injury intent using data from a newly digitised single centre burn register in south India. METHODS: Data from 1st February 2016 to 28th February 2022 were analysed. All patients in the data set were included in the study (n = 1930). Demographic and clinical characteristics for patients are described for each classification of injury intent. All data cleaning and analyses were completed using RStudio. RESULTS: Injury intent data were missing for 12.6% of cases. It was the most commonly missing variable in the data set. "Accidental" injuries had a similar distribution over time, age, and total body surface area (TBSA) for males and females. "Homicidal" injuries were more common in females. Injuries reported as "Suicidal" affected men and women equally. A decrease in reporting of "Suicidal" injuries in females corresponded to an increase in high TBSA injuries classified as 'Other' or with missing data. Overwriting of injury intent was present in 1.5% of cases. The overwritten group had a greater proportion of females (62.1% vs. 48.5%) and higher median TBSA (77.5% vs. 27.5%) compared to the group where intent was not overwritten. CONCLUSION: Our findings indicate that some subgroups, such as females with high TBSA burns, appear to be more likely to be misclassified and should be the focus of future research. They also highlight that quality of surveillance data could be improved by recording of clinical impression, change in patient reported intent, and use of a common data element for intent to standardise data collection. We also recommend that injury intent is recorded as a unique variable and should not be mixed with other elements of injury causation (e.g. mechanism). Although this is a single centre study, the methods will be of interest to those who utilise routinely collected data and wish to reduce misclassification of this important variable.

Validation of ToucHb, a non-invasive haemoglobin estimation: Effective for normal ranges, needs improvement for anaemia detection.

Non-invasive methods for haemoglobin estimation hold enormous potential for early detection and treatment of anaemia, especially in limited resource settings. We sought to validate the diagnostic accuracy of ToucHb, a non-invasive haemoglobin estimation device available in the Indian market. We prospectively evaluated the diagnostic performance of the ToucHb device using the Automated complete blood count (CBC) method as the gold standard. Persons referred for haemoglobin estimation to the central laboratory of the government medical college hospital in Mysore, southern India were included in the study. Out Of 140 people approached, 127 gave consent; 65% (n = 82) were female with median age of 37 (IQR 28-45). ToucHB reported median haemoglobin value of 14 g/dL compared to 13.3 g/dL for CBC. Within 1 g/dL and 2 g/dL of CBC, 55.2% (70/127) and 74% (94/127) of ToucHb haemoglobin observations fell, respectively. The Bland-Altman plot showed a mean difference of 3 g/dL in haemoglobin between ToucHb and CBC among those with anaemia. The ToucHb device showed 22.2% sensitivity and 94.5% specificity for anaemia detection. In rural resource-limited settings, point of care non-invasive devices such as ToucHb can improve access and acceptance for anaemia screening. However, ToucHb has showed low sensitivity for anaemia detection and low accuracy at lower haemoglobin values. The utility of the instrument is especially limited in detecting anaemia, while it can estimate haemoglobin accurately among those with haemoglobin is in the normal range. Based on these findings, ToucHb and devices that work on the core technology deployed in ToucHb may be better suited to monitor known haemoglobin level rather than in anaemia screening or detection in primary/ secondary care and community settings.

Development of an electronic burns register: Digitisation of routinely collected hospital data for global burns surveillance.

INTRODUCTION: Burn registers provide important data that can track injury trends and evaluate services. Burn registers are concentrated in high-income countries, but most burn injuries occur in low- and middle-income countries where surveillance data are limited. Injury surveillance guidance recommends utilisation of existing routinely collected data where data quality is adequate, but there is a lack of guidance on how to achieve this. Our aim was to develop a rigorous and reproducible method to establish an electronic burn register from existing routinely collected data that can be implemented in low resource settings. METHODS: Data quality of handwritten routinely collected records (register books) from a tertiary government hospital burn unit in Mysore, India was assessed prior to digitisation. Process mapping was conducted for burn patient presentations. Register and casualty records were compared to assess the case ascertainment rate. Register books from February 2016 to February 2022 were scanned and anonymised. Scans were quality checked and stored securely. An online data entry form was developed. All data underwent double verification. RESULTS: Process mapping suggested data were reliable, and case ascertainment was 95%. 1930 presentations were recorded in the registers, representing 0.84% of hospital all-cause admissions. 388 pages were scanned with 4.4% requiring rescanning due to quality problems. Two-step verification estimated there to be errors remaining in 0.06% of fields following data entry. CONCLUSION: We have described, using the example of a newly established electronic register in India, methods to assess the suitability and reliability of existing routinely collected data for surveillance purposes, to digitise handwritten data, and to quantify error during the digitisation process. The methods are likely to be of particular interest to burn units in countries with no active national burns register. We strongly recommend mobilisation of resources for digitisation of existing high quality routinely collected data as an important step towards developing burn surveillance systems in low resource settings.

Effect of COVID-19 containment measures on access to snakebite care in India.

INTRODUCTION: The extensive spread of COVID-19 meant action to address the pandemic took precedence over routine service delivery, thus impacting access to care for many health conditions, including the effects of snakebite. METHOD: We prospectively collected facility-level data from several health facilities in India, including number of snakebite admissions and snakebite envenoming admissions on modality of transport to reach the health facility. To analyse the effect of a health facility being in cluster-containment zone, we used negative binomial regression analysis. RESULTS: Our findings suggest that that health facilities located within a COVID containment zone saw a significant decrease in total snakebite admissions (incidence rate ratio 0.64 (0.43-0.94), standard error 0.13, p≤0.02)) and envenoming snakebite admissions (incidence rate ratio 0.43 (0.23-0.81), standard error 0.14, p≤0.01) compared to when health facilities were not within a COVID containment zone. There was no statistically significant difference in non-envenoming admissions and modalities of transport used to reach health facilities. CONCLUSION: This article provides the first quantitative estimate of the impact of COVID-19 containment measures on access to snakebite care. More research is needed to understand how containment measures altered care-seeking pathways and the nature of snake-human-environment conflict. Primary healthcare systems need to be safeguarded for snakebite care to mitigate effects of cluster-containment measures.

Impact of Steam Inhalation, Saline Gargling, and Povidone-Iodine Gargling on Clinical Outcome of COVID-19 Patients in Bengaluru, Karnataka: A Randomized Control Trial.

Context: In the absence of any specific treatment available for COVID-19, people started practicing traditional nonpharmacological preventive home remedies such as salt water gargling and steam inhalation. The available research evidence on some of these measures opines that steam inhalation, saline gargling, and povidone-iodine gargling does have virucidal properties and do provide symptomatic relief. Aims: The aim is to test this hypothesis, and the present trial was undertaken with an objective to assess the effect of steam inhalation, saline gargling, and povidone-iodine gargling among the COVID-19-positive patients with respect to early test negativity and clinical recovery. Methodology: Open-labeled, parallel, randomized controlled trial was conducted among asymptomatic or mild COVID-19-positive patients in Bangalore from September 2020 to February 2021. In each group of steam inhalation, saline gargling, povidone-iodine gargling, and control, twenty participants were allocated. Daily follow-up was done for 21 days to assess early test negativity and clinical recovery. Trial Registry Number: Clinical Trial Registry India/2020/09/027687. Results: Among 80 participants recruited, 65 (81.3%) were symptomatic. Early test negativity was seen in povidone-iodine gargling group of 6 days (KaplanMeier survival curve, BreslowGeneralized Wilcoxon test P = 0.7 as per the intention-to-treat and as per-protocol P = 0.8). Significant clinical recovery was seen in saline gargling group (4 days, P = 0.01). Conclusion: Povidone-iodine gargling was effective in providing early test negativity, whereas saline gargling was effective in early clinical recovery.

Influence of Sociodemographic Factors in Measles-Rubella Campaign Compared with Routine Immunization at Mysore City.

BACKGROUND: Vaccines are mostly delivered through routine immunization and catch-up campaigns. Measles-rubella (MR) campaign, one of the largest vaccination campaigns, was launched on February 8, 2017, in five states of India including Karnataka. OBJECTIVES: The objective of this study was to compare the association of various sociodemographic factors influencing routine immunization and MR campaign and to identify the reasons for nonvaccination. MATERIALS AND METHODS: A cross-sectional study was done after the end of MR campaign, by interviewing parents of 147 children aged 9 months to 5 years in urban areas of Mysore. Sociodemographic factors and measles vaccination status by routine immunization and MR campaign were studied. RESULTS: The coverage of measles vaccination by routine immunization and the MR campaign was 93.9% (138/147) and 86.4% (127/147), respectively. While communication with field workers was significantly associated with both routine immunization and the MR campaign, religion and mother's educational status were associated with MR campaign (P < 0.05). The most common reason for not being vaccinated was lack of unawareness about the campaign and the location for vaccination which could have been curbed by health education. CONCLUSIONS: The study has shown that there are many factors which can be prevented by the health system that might help in improving immunization coverage.

Epidemiology of Handheld Cell Phone Use While Driving: A Study from a South Indian City.

BACKGROUND: Using cell phones while driving contribute to distractions which can potentially cause minor or major road traffic injuries and also stress among other drivers. With this background, the study was done to ascertain the proportion of handheld cell phone use while driving among road users in Mysore city and also patterns of the use by the day of week, type of road, and type of vehicle. METHODS: The study was conducted in Mysore, Karnataka, India. Four stretches of roads were observed thrice daily for 1 week. The total number of vehicles passing through the stretch and the number and characteristics of drivers using hand-held cell was noted. Pearson's Chi-square test was used to ascertain the significance of the difference in proportions. RESULTS: The overall proportion of cell phone users was calculated as 1.41/100 vehicles. The observed use of handheld cell phones was 1.78 times higher on nonbusy roads than busy roads (Χ2 = 25.79, P < 0.0001). More than 50% of the handheld phone users were driving a two wheeler, the proportion being 50.5% in busy roads, and 67% in nonbusy roads. There was no difference in the proportion of cell phone use by time of the day or across different days of the week. CONCLUSIONS: The proportion of drivers who use cell phones is found to be relatively lower, and use of cell phones was higher on nonbusy roads.

Need for Different Cutoff Values for Reading Mantoux Test with 2TU and 5TU PPD.

OBJECTIVE: To compare the tuberculin reaction of 2 tuberculin unit (TU) with 5TU purified protein derivative (PPD) (both calibrated against RT 23) in healthy children. METHODS: This was a cross sectional study done in the pediatric outpatient department of a tertiary care teaching hospital. Seventy healthy siblings of the children attending pediatric outpatient department in the age group of 1 to 12 y were enrolled. The exclusion criteria included previously diagnosed tuberculosis patients, malnutrition diagnosed according to the WHO classification, history of drug intake like steroids, recent history of measles, any skin lesions over forearm, history of fever, contact with tuberculosis and previous mantoux testing. The study was conducted wherein each child was subjected to simultaneous testing with 2TU and 5TU by standard technique. The reactions to both the tests was read at 48-72 h. Children with induration ≥10 mm were evaluated for tuberculosis by taking chest x-ray, gastric lavage or sputum smear examination for acid fast bacilli (AFB). RESULTS: Considering ≥10 mm induration as positive, subjects positive with 5TU were 7 (10%) and 2TU was 1(p value = 0.031); thus, there is no agreement between the two methods (McNemar's test). Comparing the mean diameter of induration of 2TU and 5TU (p < 0.001, Wilcoxon test), signified no agreement between the two strengths. Bland-Altman plot and kappa statistic showed no agreement between the two strengths. CONCLUSIONS: Cutaneous hypersensitivity to 2TU PPD is not comparable to that of 5TU PPD.

Attitudes of General Hospital Staff Toward Patients Who Self-harm in South India: A Cross-Sectional Study.

BACKGROUND: There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. METHODS: A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). RESULTS: Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. CONCLUSION: There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.

Psychiatric Morbidity and Correlates in Postpartum Women in a Tertiary Care Hospital.

BACKGROUND: A range of psychological disorders occur in women in the postpartum period apart from the traditional blues, postpartum depression and psychosis. These include obsession of infanticide, PTSD, morbid preoccupations regarding child birth and disorders of mother-infant relationships, though they are under emphasized. METHODS: it is a cross-sectional study conducted in the tertiary maternity care hospital. A total of 152 study subjects were interviewed on MINI (Mini International Neuropsychiatric Inventory) and GAF (Global Assessment of Functioning) within 2 weeks after delivery. RESULTS: The psychiatric morbidity was seen in 67 (44%) of the study subjects. About 26% of subjects had Depressive disorder NOS. Obsessive harm to the child, Panic disorder, Social phobia were the other disorders identified. There were no cases of Mania, Bipolar disorder, psychosis, post traumatic stress disorder or substance use disorder diagnosed across the sample. The Global Assessment of Functioning (GAF) score averaged 87.8. Statistically significant association was seen to be present between psychiatric illness and number of previous still births and dead children before this delivery (P = 0.045). CONCLUSIONS: The study reveals that psychiatric co-morbidity is very common in the postpartum period and can be detected as early as first week after delivery. Social phobia identified as a common association is a new finding and needs further replication. It needs a larger sample with a prospective assessment to generalize the findings of our study.

Usage of Plastic Bags and Health Hazards: A Study to Assess Awareness Level and Perception about Legislation Among a Small Population of Mangalore City.

INTRODUCTION: Plastic bag users are at risk of number of health hazards. There is paucity of data with regard to awareness of health hazards among general population in India. AIM: This study was done to find out the status of awareness of the health hazards associated with the usage of plastic bags among people and their perception towards the legislation prohibiting the usage of plastic bags. MATERIALS AND METHODS: This cross-sectional study conducted in Mangalore city in August 2013. Data was collected by interviewing any adult member (aged above 18 years) in each of the selected households using an interview schedule. RESULTS: Mean age of the 250 participants was 32.8±10.8 years. Majority 160(64%) were females educated up to undergraduate level or above 187(74.8%). Among the participants 216(86.4%) were aware of the health hazards associated with the use of plastic bags. Awareness was significantly more amongst females (p=0.027), well-educated participants (p=0.004) and among professionals and semi-professionals (p<0.001). There were 50(20%) participants reusing plastic bags for shopping after initial usage. The cloth bags were used for shopping in place of plastic bags by 13(5.2%) participants. Among the participants 213(85.2%) were aware of the legislation banning the use of plastic bags and out of which 166(77.9%) were in its favour. Semi-professionals and students favoured the ban on plastic bags whereas unskilled and semiskilled workers were against the ban (p=0.01). CONCLUSION: Most of the participants in the settings had the awareness of hazards of plastic bag usage. However, there is a need for spreading the awareness of using alternative strategies and effective implementation of legislation in order to minimize the usage of plastics in the community.

Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India.

BACKGROUND: World Health Organization/International Society of Hypertension (WHO/ISH) charts have been employed to predict the risk of cardiovascular outcome in heterogeneous settings. The aim of this research is to assess the prevalence of Cardiovascular Disease (CVD) risk factors and to estimate the cardiovascular risk among adults aged >40 years, utilizing the risk charts alone, and by the addition of other parameters. METHODS: A cross-sectional study was performed in two of the villages availing health services of a medical college. Overall 570 subjects completed the assessment. The desired information was obtained using a pre-tested questionnaire and participants were also subjected to anthropometric measurements and laboratory investigations. The WHO/ISH risk prediction charts for the South-East Asian region was used to assess the cardiovascular risk among the study participants. RESULTS: The study covered 570 adults aged above 40 years. The mean age of the subjects was 54.2 (±11.1) years and 53.3% subjects were women. Seventeen percent of the participants had moderate to high risk for the occurrence of cardiovascular events by using WHO/ISH risk prediction charts. In addition, CVD risk factors like smoking, alcohol, low High-Density Lipoprotein (HDL) cholesterol were found in 32%, 53%, 56.3%, and 61.5% study participants, respectively. CONCLUSION: Categorizing people as low (<10%)/moderate (10%-20%)/high (>20%) risk is one of the crucial steps to mitigate the magnitude of cardiovascular fatal/non-fatal outcome. This cross-sectional study indicates that there is a high burden of CVD risk in the rural Pondicherry as assessed by WHO/ISH risk prediction charts. Use of WHO/ISH charts is easy and inexpensive screening tool in predicting the cardiovascular event.

Clinical Assessment of Weight Gain with Atypical Antipsychotics - Blonanserin vs Amisulpride.

BACKGROUND: Atypical antipsychotics appear to have the greatest potential to induce weight gain. Antipsychotic-induced weight gain is the one of main cause of non-compliance and discontinuation of treatment, often resulting in the relapse of psychosis. OBJECTIVE: To compare the weight gain between amisulpride and blonanserin treatment, in persons with psychosis. MATERIALS AND METHODS: Fifty six subjects with psychosis attending psychiatry department at KR Hospital, Mysore were randomized into two equal groups. After obtaining informed consent, subjects of group I received amisulpride tablets 200 mg BD, and group II received blonanserin tablets 4 mg BD, for eight weeks. Body weight, Body Mass Index (BMI) and Waist Hip Ratio (WHR) were measured at baseline, 4 weeks and 8 weeks. RESULTS: The mean weight gain with amisulpride at 4 weeks was 2.73 kg (5.21%) and at 8 weeks was 4.34 kg (8.28%) from the baseline. The mean weight gain with blonanserin at 4 weeks was 1.77 kg (3.46%) and at 8 weeks was 3.46 kg (6.75%) from the baseline. The mean BMI increase at 8 weeks with amisulpride was 1.66 ± 0.56 and with blonanserin was 1.34 ± 0.77. The mean WHR increase at 8 weeks with amisulpride was 0.036 ± 0.026 and with blonanserin was 0.029 ± 0.020. There was statistically significant increase in weight, BMI and WHR associated with both blonanserin and amisulpride at 8 weeks. But there was no statistically significant difference in those parameters between blonanserin and amisulpride, at eight weeks. CONCLUSION: Even though there was no significant difference in the weight gain caused by blonanserin, in comparison with amisulpride, both these drugs individually caused significant weight gain at 8 weeks, which is in contrast with the earlier studies, which needs to be further evaluated.

High prevalence of cardiovascular risk factors among policemen in Puducherry, South India.

BACKGROUND: Diabetes mellitus and hypertension (HT) are common diseases in adulthood, pre-disposing to many cardiovascular complications, posing a major public health challenge. Few studies have reported increased prevalence of cardiovascular disease risk factors and type 2 diabetes in policemen. Hence, this study aims to assess the prevalence of cardiovascular risk factors such as diabetes, HT, smoking, alcohol intake, and obesity among policemen. MATERIALS AND METHODS: A cross-sectional study was carried out in 2008-2009 among 256 policemen in Puducherry, South India. Policemen were selected by simple random sampling. Socio-demographic details and some of the risk factors such as alcohol intake and smoking history were obtained using a pre-tested, structured questionnaire. Presence of stress was measured using the professional life stress score questionnaire. Blood pressure, waist circumference, and hip circumference were measured by standard methods. Fasting blood sugar was estimated using a glucometer. Serum cholesterol was also measured. Lipid profile was measured for a randomly chosen subgroup of 50 participants. RESULTS: Mean age of study participants was 40.9 years (SD ± 10.9). Out of the study subjects, 23% (n = 60) were known diabetic and 16.8% (n = 43) were known hypertensive. Prevalence of diabetes among study participants was 33.6% (CI: 27.8%-39.6%). Prevalence of HT among study participants was 30.5% (CI: 24.9%-36.5%). Seventy percent (n = 178) had at least moderate range of stress in their life related to their profession and 4% (n = 11) had stress as a "problem" in their life. CONCLUSIONS: Burden of cardiovascular risk factors such as diabetes and HT was high among police personnel of Puducherry.

Comparison of haemodynamic responses to intubation: Flexible fibreoptic bronchoscope versus bonfils rigid intubation endoscope.

BACKGROUND: The flexible fibreoptic bronchoscope and bonfils rigid intubation endoscope are being widely used for difficult intubations. METHODS: The haemodynamic response to intubation under general anaesthesia was studied in 60 adult female patients who were intubated using either flexible fibreoptic bronchoscope or bonfils rigid intubation endoscope (30 in each group). Non-invasive blood pressure and heart rate (HR) was recorded before induction of anaesthesia, immediately after induction, at the time of intubation and, thereafter, every minute for the next 5 min. The product of HR and systolic blood pressure (rate pressure product) at every point of time was also calculated. STATISTICAL ANALYSES: Graph pad prism, 5.0 statistical software, independent t test and repeated measure ANOVA test were used. RESULTS: Both bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope required a similar time (less than 1 min) for orotracheal intubation. After intubation, there was a significant increase in HR, blood pressure and rate pressure product (P<0.001) in both the groups compared with the baseline and post-induction values. There was no significant difference in HR, blood pressure and rate pressure product at any of the measuring points or in their maximum values during observation between the two groups. The time required for recovery of systolic blood pressure and HR to post-induction value (±10%) was not significantly different between the two groups (more than 2 min). CONCLUSION: In female adults under general anaesthesia, bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope require a similar time for successful orotracheal intubation and cause a similar magnitude of haemodynamic response.