Assessment of coping capacity of public health facilities with health emergency situations during an event of flood in Mumbai.

BACKGROUND: Floods had been a repeated phenomenon in India, causing considerable losses to properties, life and infrastructure, and public utilities. Floods are found to be a common natural disaster occurring not only in developing countries but also in developed nations. Hospital preparedness against disaster could help in the management of the surge of patients in an effective manner. This study aims to assess the capacity of public health facilities for coping up with health emergency situations during an event of flood in Mumbai. MATERIALS AND METHODS: A cross-sectional study was conducted among 38 public health facilities in Mumbai. A purposive sampling technique was used for the selection of the health facilities. Administrative staff, medical officers, and pharmacy in charges were included in the study. RESULTS: The study revealed that surge capacities in hospitals were adequate as they had additional beds for monsoon-related diseases for the preceding flood situation. There was a triage policy, and the staff were trained on the same. Procurement of drugs was easy because of a good networking system between hospitals. Due to this networking system, patients were also transferred to the nearest healthcare facility in a short span of time. CONCLUSION: The response during an event of a flood in the health facilities of Mumbai city was good as they have regular training sessions to be prepared for the emergency situations during monsoon as they have repeated exposure to floods.

Assessment of Knowledge and Biosecurity Practices Related to Avian Influenza Among Poultry Workers in a District of South India.

CONTEXT: Avian influenza, commonly known as bird flu, is a contagious disease that affects both animals and humans, posing a significant threat to public health, animal welfare, and the economy. This study aims to evaluate the knowledge of avian influenza among poultry farmworkers and evaluate the biosecurity practices implemented on their farms. OBJECTIVE: The study's primary objective was to assess the knowledge regarding avian influenza among poultry farmworkers and the biosecurity practices they follow at the farm. DESIGN: Cross-sectional study. SETTING: The study was conducted in a district of South India. PARTICIPANTS: This study included 105 poultry farmworkers across 70 poultry farms in the district. MAIN OUTCOME MEASURES: Assessment of the participants' knowledge related to avian influenza, and the association between knowledge levels, demographic, and farm-related factors such as working experience in the poultry farm, type of poultry farm, type of poultry reared, and biosecurity practices. RESULTS: In the study, 90% of participants were aware of avian influenza, with 36% correctly identifying the virus as its cause, whereas 5% wrongly cited it to be a bacteria. Although 90% knew avian influenza was infectious, only 18% recognized its potential transmission to humans; however, 82% understood prevention methods. Participants with an education level beyond high school displayed significantly higher awareness (P < .05), emphasizing importance of the education. CONCLUSIONS: The study showed diverse awareness levels among poultry farmworkers regarding avian influenza, emphasizing gaps in the knowledge, particularly about its transmission to humans. This underscores the need for targeted awareness campaigns focusing on zoonotic risks to improve the level of understanding and implement effective preventive measures against avian influenza.

Untangling the Complex Multidimensionality of the Social Determinants of Cardiovascular Health: A Systematic Review.

BACKGROUND: The cardiovascular literature is limited by the lack of consensus on what are the best metrics for reporting social determinants of health (SDH) or social deprivation, and if they should be reported as a single metric or separately by their domains. METHODS: A systematic review of the literature on cardiovascular surgeries and procedures was conducted, identifying articles from January 1, 2010, to December 31, 2023, that studied the relationship between health outcomes after cardiovascular procedures or surgeries and SDH/social deprivation. The cardiovascular procedures/surgeries of interest were coronary and valve surgeries and procedures including coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), valve replacement or repair, and transcatheter aortic valve intervention. RESULTS: After screening 638 articles, we identified 47 papers that met our inclusion and exclusion criteria. The most common procedure evaluated was CABG and PCI; 46 of the studies focused on these 2 procedures. Almost all of the articles reported a different metric for SDH/social deprivation (41 different metrics); despite this, all of the metrics showed a consistent relationship with worse outcomes associated with greater degrees of SDH/deprivation. Only 9 reported on the individual domains of SDH/social deprivation; 3 studies showed a discordant relationship. CONCLUSIONS: Although our systematic review identified numerous articles evaluating the relationship between SDH/social deprivation in cardiovascular disease, there was substantial heterogeneity in which metric was used and how it was reported. This reinforces the need for standards as to the best metrics for SDH/social deprivation as well as best practices for reporting.

Assessment of infant and young child feeding practices among mothers of Paniya tribal children aged 0-23 months in Gudalur Block, Nilgiris District.

Optimal infant and young child feeding practices (IYCFPs), despite being emphasized since 2003, are yet to be met in India. This study assessed these practices and their association with various factors among mothers of children aged 0-23 months in Paniya tribes in Nilgiris, Tamil Nadu. About 89.1% of the infants below six months were timely breastfed and 77.9% of them were exclusively breastfed, respectively. Complementary food was introduced to 25% of infants aged six to eight months. About 27.8% of them received a diverse diet. About 91.7% of them were fed egg and/or flesh food and 37% of them were fed vegetables and fruits. Illiterate mothers and mothers who had a vaginal delivery fed the infant optimally. The adherence to these practices was found to decrease gradually with an increase in the infant's age. The prevalence of IYCFP is higher in the study population compared to the corresponding indicators for the district according to the National Family Health Survey-5.

A biogeographical description of the wild waterbird species associated with high-risk landscapes of Japanese encephalitis virus in India.

Wild reservoirs of Japanese encephalitis virus are under-studied globally, which presents critical knowledge gaps for JEV epidemiology and infection ecology despite decades of received wisdom regarding this high-impact mosquito-borne virus. As a result, ardeid birds, generally understood to be the primary reservoirs for JEV, as well as other waterbirds occupying landscapes at high risk for spillover to humans, are frequently ignored by current surveillance mechanisms and infrastructure. This is particularly true in India, which experiences a high annual burden of human outbreaks. Incorporating wild reservoirs into surveillance of human and livestock populations is therefore essential but will first require a data-driven approach to target individual host species. The current study sought to identify preliminary waterbird target species for JEV surveillance development based on species' distributions in high-risk landscapes. Twenty-one target species were identified after adjusting species presence and abundance for the biotic constraints of sympatry. Furthermore, ardeid bird species richness demonstrated a strong non-linear association with the distribution of human JEV outbreaks, which suggested areas with the highest ardeid species richness corresponded to low JEV outbreak risk. No association was identified between JEV outbreaks and anatid or rallid richness. The lack of association between Anatidae and Rallidae family-level diversity and JEV outbreak risk notwithstanding, this study did identify several individual species among these two bird families in high-risk landscapes. The findings from this work provide the first data-driven evidence base to inform wildlife sampling for the monitoring of JEV circulation in outbreak hotspots in India and thus identify good preliminary targets for the development of One Health JEV surveillance.

Vitamin D receptor gene polymorphism and vitamin D supplementation on clinical/ treatment outcome in tuberculosis: current and future perspectives.

INTRODUCTION: Tuberculosis (TB) is a transnational public health concern, which requires more precise treatment strategies than the existing approaches. Vitamin D modulates the inflammatory and immune response to the disease. Robust evidence shows that vitamin D deficiency and its receptor gene polymorphism influence the susceptibility to TB and the outcome of the anti-tubercular treatment (ATT). However, in the different populations, these findings were inconsistent and even contradictory. AREAS COVERED: The current review focuses on the association between vitamin D receptor (VDR) gene polymorphism with the risk of development of TB disease and response to the ATT. Additionally, it reviews various systematic reviews and meta-analyses on the impact of vitamin D supplements on both clinical and treatment outcomes in TB patients. EXPERT OPINION: Although the majority of the findings rule out the benefits of the supplementation, sufficient evidence is available to warrant larger epidemiological research that should be aimed to generate possible interaction among the VDR polymorphism, vitamin D status, and the outcome in TB. We conclude that establishing such an association in different ethnic populations will help design nutrigenomics- or pharmacogenomics-based vitamin D supplementation to develop a personalized medicine approach to flatten the curve of TB disease.

High-risk landscapes of Japanese encephalitis virus outbreaks in India converge on wetlands, rain-fed agriculture, wild Ardeidae, and domestic pigs and chickens.

BACKGROUND: Japanese encephalitis virus (JEV) is a zoonotic mosquito-borne virus that causes a significant burden of disease across Asia, particularly in India, with high mortality in children. JEV circulates in wild ardeid birds and domestic pig reservoirs, both of which generate sufficiently high viraemias to infect vector mosquitoes, which can then subsequently infect humans. The landscapes of these hosts, particularly in the context of anthropogenic ecotones and resulting wildlife-livestock interfaces, are poorly understood and thus significant knowledge gaps in the epidemiology of JEV persist. This study sought to investigate the landscape epidemiology of JEV outbreaks in India over the period 2010-2020 to determine the influence of shared wetland and rain-fed agricultural landscapes and animal hosts on outbreak risk. METHODS: Using surveillance data from India's National Centre for Disease Control Integrated Disease Surveillance Programme, JEV outbreaks were modelled as an inhomogeneous Poisson point process and externally validated against independently sourced data. RESULTS: Outbreak risk was strongly associated with the habitat suitability of ardeid birds, both pig and chicken density, and the shared landscapes between fragmented rain-fed agriculture and both river and freshwater marsh wetlands. CONCLUSION: The results from this work provide the most complete understanding of the landscape epidemiology of JEV in India to date and suggest important One Health priorities for control and prevention across fragmented terrain comprising a wildlife-livestock interface that favours spillover to humans.

Repurposing of Metformin for the prevention and treatment of Tuberculosis

Abstract The bidirectional relationship between tuberculosis (TB) and diabetes mellitus (DM) is a major concern for medical professionals and epidemiologists as DM affects the severity, progress and outcome of TB and vice versa. Patients affected with TB have a higher rate of morbidity, treatment failure and mortality. Likewise, DM triples the risk of contracting TB and therefore poses a threat to the progress made in the reduction of TB incidence. Hence, it is pivotal to address both the diseases keeping in mind the each other. It is known that adjunct therapy with immunomodulatory drugs can enhance TB immunity among diabetic patients. Metformin, a commonly used anti-diabetic drug with adenosine monophosphate-activated protein kinase (AMPK) activation property, has shown the capacity to reduce the growth of Mycobacterium tuberculosis within the cell. This drug inhibits the mitochondrial complex and possesses anti-inflammatory action. Therefore, Metformin can be considered as an ideal molecule for host-directed or host-targeted therapy for TB.

Low mammalian species richness is associated with Kyasanur Forest disease outbreak risk in deforested landscapes in the Western Ghats, India.

Kyasanur forest disease virus (KFDV) is a rapidly expanding tick-borne zoonotic virus with natural foci in the forested region of the Western Ghats of South India. The Western Ghats is one of the world's most important biodiversity hotspots and, like many such areas of high biodiversity, is under significant pressure from anthropogenic landscape change. The current study sought to quantify mammalian species richness using ensemble models of the distributions of a sample of species extant in the Western Ghats and to explore its association with KFDV outbreaks, as well as the modifying effects of deforestation on this association. Species richness was quantified as a composite of individual species' distributions, as derived from ensembles of boosted regression tree, random forest, and generalised additive models. Species richness was further adjusted for the potential biotic constraints of sympatric species. Both species richness and forest loss demonstrated strong positive associations with KFDV outbreaks, however forest loss substantially modified the association between species richness and outbreaks. High species richness was associated with increased KFDV risk but only in areas of low forest loss. In contrast, lower species richness was associated with increased KFDV risk in areas of greater forest loss. This relationship persisted when species richness was adjusted for biotic constraints at the taluk-level. In addition, the taluk-level species abundances of three monkey species (Macaca radiata, Semnopithecus hypoleucus, and Semnopithecus priam) were also associated with outbreaks. These results suggest that increased monitoring of wildlife in areas of significant habitat fragmentation may add considerably to critical knowledge gaps in KFDV epidemiology and infection ecology and should be incorporated into novel One Health surveillance development for the region. In addition, the inclusion of some primate species as sentinels of KFDV circulation into general wildlife surveillance architecture may add further value.

Vitamin D in Prevention and Treatment of COVID-19: Current Perspective and Future Prospects.

Vitamin D deficiency (VDD) partly explains geographical differences in COVID-19 susceptibility, severity, and mortality. VDD among African-Americans, diabetics, hypertensive, and aged populations possibly explain the higher death rate, aggravated by cocooning. Vitamin D is pleiotropic, mediating bone metabolism, calcium homeostasis, and immune functions, whereas VDD is associated with inflammatory reactions and immune dysfunction, predisposing individuals to severe infections. Vitamin D modulates innate and adaptive immunity via the expression of genes that code antimicrobial peptides (AMPs). And the expression of cluster of differentiation (CD)14, the co-receptor for epidermal toll-like receptor (TLR)4. AMPs stimulate TLR2 in macrophages, increasing the conversion of vitamin D into its active form by cytochrome P450 27B1. Antiviral properties of vitamin D-induced AMPs can shift the polarization of the adaptive immune response from helper T cells (Th)1 to the more regulatory Th2 responses that suppress immune over-reactivity by preventing cytokine storm, which is already demonstrated during the Spanish flu episode. Vitamin D induces antiviral effects by both direct and indirect mechanisms via AMPs, immunomodulation, the interplay between major cellular and viral elements, induction of autophagy and apoptosis, variation of genetic and epigenetic factors. The crosstalk between vitamin D and intracellular signaling pathways may operate as a primary regulatory action on viral gene transcription. VDD may increase the likelihood of infection with enveloped viruses, including retrovirus, hepatitis, and dengue. Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, suggesting benefits from supplementation.Key teaching pointsVitamin D induces antiviral effects by direct and indirect mechanisms via AMPs, immunomodulation, induction of autophagy, etc.Epidemiology of VDD partly explains geographical differences in COVID-19 susceptibility, severity, and mortality.Global data correlates severe VDD with COVID-19 associated coagulopathy, disrupted immune response and mortality, reduced platelet count, and prolonged prothrombin time, together suggesting benefits from supplementation.Many clinical trials are underway globally to delineate the role of vitamin D in both prevention and treatment of COVID-19.

Assessment of preparedness against emerging infectious disease among private hospitals in a district of South India.

BACKGROUND: The emergence of many infectious diseases has been of serious public health implication in the 21st century. Hospital preparedness is a key step in strengthening a country's ability to address any public health emergency of international concern caused by these diseases. In India, because 80% of the health-care utilization happens in the private hospitals, it is of at most importance to assess the preparedness level of these hospitals against emerging infectious diseases. METHODS: The study was a cross-sectional study, and hospitals which provided consent were included. The estimated participants for the study were 54. RESULTS: The results were expressed in a descriptive manner. For the purpose of analysis, the questionnaire was redistributed based on the monitoring and evaluation framework of International Health Regulations and its core capacities. It was found that there was a need to enhance the preparedness of the hospitals in the response against emerging infectious diseases. There were gaps in the implementation of various plans and protocols for staff training, risk communication, surge capacity, laboratory capacity, and infection control in the hospitals. CONCLUSION: The findings were suggestive of a need for preparedness of the hospitals against the upsurge of emerging infectious diseases.

Nutritional Status of Adolescent Girls Belonging to the Tea Garden Estates of Sivasagar District, Assam, India.

BACKGROUND: Any deficiency or inadequate dietary pattern can lead to poor nutrition which can further influence both growth and development throughout from infancy to adolescence. Since adolescents represent the next generation of parents, it is important to monitor their nutritional status at this crucial stage. Thus, this study aimed to explore the factors associated with nutritional status among adolescent girls belonging to these tea gardens. OBJECTIVE: The objective of this community-based cross-sectional study was to assess the nutritional status of adolescent girls belonging to the tea garden community and the association of the sociodemographic factors with it. MATERIALS AND METHODS: Anthropometric measurement was taken among adolescent girls in the tea estates of Nazira subdivision of Sivasagar district, Assam. The pattern of dietary intake among adolescents was also studied. The statistical analysis was done using SPSS version 15. RESULTS: The prevalence of thinness and stunting across 265 adolescent girls was 49.4% and 50.6%, respectively. Calorie and protein deficits were found to be 76.60% and 65%, respectively. Majority of the respondents, i.e., 66.80% of the participants, had a poor intake of essential food constituents. Moreover, 76.21% of the respondents were anemic. The association of different sociodemographic factors with thinness, inadequate protein intake, and anemia were found during the study. CONCLUSION: Thinness and stunting along with protein-energy malnutrition and inadequate intake of important food groups were prevalent in adolescent tea community girls. Overall, the public health burden of malnutrition is still a persisting health problem in the tea gardens of Assam.

Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital.

PURPOSE: Diabetic foot infections (DFIs) are major public health concerns. In the view of the ever increasing burden of multidrug-resistant (MDR) organisms, improving the use of antimicrobial agents (AMAs) is a national priority. Objective of the study was to determine antimicrobial susceptibility (AMS) pattern of aerobes in DFIs. METHODS: A cross-sectional study was conducted for a period of 3 years at Department of Surgery, Kasturba hospital, Manipal, India during which, 260 diabetic foot ulcer (DFU) patients admitted in the general surgery wards were enrolled for the study. These patients' culture specimens were observed as Gram-stained smears and cultured aerobically on blood agar and MacConkey agar plates. AMS test was performed by disc diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: A total of 354 microbes were isolated from the ulcer wounds of 213 diabetic foot patients, with an average of 1.7 organisms per lesion. Monomicrobial infections were less common (n=81; 31.2%) than polymicrobial infections (n=132; 50.7%). Gram-negative bacteria were the most common among the isolates (n=192; 54.2%). Aerobic Gram-positive Cocci accounted for 162 (45.8%) of all isolates. On the other hand, Staphylococcus aureus was the most frequently isolated aerobe (n=106; 29.9%) followed by Pseudomonas aeruginosa (n=91; 25.7%). CONCLUSION: AMS data from our study recommends that doxycycline would be the appropriate choice as single drug for empirical coverage for Gram-positive organisms. The most appropriate antibiotic for Gram-negative organisms is meropenem. One of the critical observations is the presence of Acinetobacter, an MDR isolated from DFIs, which is either relatively or totally resistant to all the AMAs tested.

Factors influencing utilization of reproductive health services among mothers in Meghalaya, India.

BACKGROUND: Antenatal care (ANC) is one of the basic components where it can provide pregnant women with an expansive scope of well-being, health promotion, and preventive health services. However, still 830 women die every day from preventable pregnancy-related causes, and 99% of these deaths occur in developing countries, out of which 20% of these deaths were from India. OBJECTIVES: The objective of this study is to explore the factors influencing the utilization of reproductive health services among mothers and to find the association between various factors and utilization of reproductive health services. METHODS: A community-based cross-sectional study was conducted during January-June 2017 among 160 mothers who had an infant aged <6 months in Mawkyrwat Block, South West Khasi Hills District in Meghalaya. Respondents were selected through simple random sampling, and semi-structured questionnaire was used for data collection. Data were analyzed using SPSS 16. RESULTS: Mothers attending four or more antenatal checkups were 10.6%, where 53.5% of the mothers registered their first ANC checkups only by the second trimester and 57.5% preferred home delivery. Nearly 52.9% of the mothers were staying more than 5 km away from the health-care facilities. The usage of family planning methods was very low, i. e., 96.9% of the mothers are not using any of the family planning methods. CONCLUSION: Study finding reveals that the utilization of health-care services was low. Area-specific approaches such as health camps and mobile clinics might result in improved utilization of reproductive health services.

Development and Evaluation of Patient Information Leaflet for Diabetic Foot Ulcer Patients.

BACKGROUND: Patient education (PE) is as important as medical and surgical interventions in the management of diabetic foot ulcer (DFU). Patient information leaflets (PILs) are globally accepted patient counseling aids. OBJECTIVES: This study aimed at developing PILs for DFU patients and investigating its validation. METHODS: The PILs were prepared based on different model leaflets available from various online resources, including "Patient UK". The PILs readability was evaluated by Flesch/ Flesch-Kincaid readability (FRE/FK-GL) method before user-testing (n = 34 DFU patients) by quasi-experimental methods in patients with DFU. Additionally, user-opinion on legibility and content of the PIL was also determined. Baker Able Leaflet Design (BALD) method was employed to assess the layout and design characteristics of the PIL. RESULTS: The best FRE score achieved was 73.9 and the FK-GL score was 6.1. The mean BALD assessment score for English and Kannada versions of PIL were 27 and 26, respectively. The ICC of the test-retest reliability of user-testing and user-opinion questionnaires in both English and Kannada ranged from 0.91 to 0.96. The overall user-testing knowledge-based mean score significantly improved from 43.4 to 69.7 (P < 0.05). Overall, 82.4% of patients reported overall user-opinion on legibility and content of the PIL as good. CONCLUSIONS: The developed PILs met the criteria of fairly easy readability and good layout design. The user-opinion of the majority of patients reported the PIL content, legibility, and design as good. The Pictogram-based PILs (P-PILs) was found to be an effective PE tool in DFU patients.

Postpartum related morbidities among women visiting government health facilities in Udupi Taluk, Karnataka, India.

BACKGROUND: Maternal morbidities are considered a leading contributor to the burden of disease among women. Especially, if postpartum morbidities are left untreated, this can cause a negative impact on the quality of life. The study was conducted to determine the proportion and types of postpartum morbidities among women visiting government health facilities in Udupi Taluk, Karnataka and to find out the association between the morbidities and various factors. SUBJECTS AND METHODS: A cross-sectional study was conducted in various government hospitals in Udupi Taluk, consisted of 229 postpartum women. These subjects were selected from mothers who accompanied their children for immunization from February 2013 to July 2013 using purposive sampling technique. Multiple logistic regression analysis was used to find out the association between the morbidities and various factors using SPSS version 15. RESULTS: Among 112 (48.9%) women who experienced postpartum morbidities, back pain (23.6%), and perineal pain (15.7%) were most commonly reported physical morbidities. Similarly, anxiety (10%) and irritability (7.9%) were the most common psychological problems. Demographic factors such as religion 2.4 (95% confidence interval [CI] 1.1, 5.4) and occupation 2.5 (95% CI 1.1, 5.9) were associated with the morbidities. Likewise, obstetric factors such as place of delivery 1.5 (95% CI 0.8, 2.9) and type of delivery 1.9 (95% CI 1.0, 3.6) were also associated with various morbidities. CONCLUSIONS: The findings showed a high proportion of postpartum morbidities being reported in our study settings. These observation priorities a need of health program for early recognition, treatment and improving awareness of postpartum morbidities among near mothers.