Quality of Life in Psoriasis: A Cross-Sectional Study from North India.

Background: Psoriasis is a chronic inflammatory papulo-squamous disease characterized by multiple remissions and relapses. This study aimed to assess the impact of psoriasis on the quality of life of patients. Materials and Methods: A hospital-based, cross-sectional study was conducted enrolling 198 adult patients of psoriasis. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies were followed. Clinical severity of psoriasis was measured using Psoriasis Area Severity Index (PASI), and quality of life was measured by EuroQoL 5D (EQ-5D-5L, EQ-VAS) and Psoriasis Quality-Of-Life-12 (PQOL-12) Questionniares. Results: Of the 198 patients, 71.7% (n = 142/198) were males with a mean age of 41.65 ± 13.19 years. The mean PASI score was 12.46 ± 11.51, and the mean PQOL-12 score was 50.18 ± 23.36. Up to 22.7% (n = 45) cases had 'severe' and 6.1% (n = 12) cases has 'very severe' PQOL-12 scores. Statistically significant correlation (P < 0.05) was observed between PASI scores and almost all domains of EQ-5D-5L and PQOL-12. Conclusion: Psoriasis affects most psycho-social domains of a patient's life. Coping with these QOL issues remains a challenge to the patients in everyday life. The goal of management of psoriasis therefore must include measures to improve quality of life along with long-lasting remittance of physical symptoms.

Determinants of substance use among young people attending primary health centers in India.

Background: Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India. Methods: A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10-24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use. Results: The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement. Conclusions: High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.

Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand.

Introduction: Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition. Material and Methods: A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD). Results: Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities. Conclusion: Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

Comparative Evaluation of Three Different Techniques of Radial Artery Cannulation: A Prospective Randomised Study.

OBJECTIVE: We planned this study to compare three approaches to arterial cannulation, i.e., catheter over the needle, catheter over the guidewire, and ultrasound-guided cannulation, in terms of overall success rate, first pass success rate, time for cannulation and incidence of complications. METHODS: After obtaining informed written consent from the patient, they were randomized into three groups, based on chits in the box technique, to undergo radial artery cannulation as follows: group N (using catheter over needle technique), group W (using catheter over guidewire technique), group U (radial artery cannulations under ultrasound guidance). We calculated a sample size of 50 patients in each group based on the primary endpoint of the overall success rate. The data was analyzed using one-way ANOVA and post hoc Tukey's test. RESULTS: There was a non-statistically significant trend towards a higher overall success rate in groups W and U compared to group N (47 and 46, respectively, compared to 43, p-value 0.35). Similarly, no significant differences were observed concerning any of the characteristics of radial artery cannulation, except the first pass success rate, where the success rate was highest in group W (33, 70.21%), followed by group U (34, 68%) with a p-value of 0.04. CONCLUSION: Though catheter over guidewire and ultrasound-based techniques offer advantages in terms of higher first-pass success rate, they do not significantly increase the overall success rate or reduce the total incidence of complications.

Health-related physical fitness, physical activity and its correlates among school going adolescents in hilly state in north India: a cross sectional survey.

INTRODUCTION: Health-related physical fitness, which includes body composition, cardiorespiratory fitness, muscular endurance, flexibility, power, and strength are associated with risks of chronic diseases and promote good health and wellness. There have been reports of increasing levels of physical inactivity among children and adolescents, leading to increasing rates of obesity and decreased physical fitness. The present study was conducted among school going adolescents to estimate the levels and correlates of PF for timely intervention. METHODOLOGY: School based cross-sectional study was done among students of class 8-11th in Government schools of Garhwal division of Uttarakhand. Multistage stratified random sampling was applied for recruitment of study participants. We recruited a final sample size of 634 students. Validated questionnaires and standard methods for assessment of physical fitness, physical activity levels and other variables such as waist circumference, hip circumference, BMI and hemoglobin estimation were done. RESULTS: Average and above average cardiorespiratory fitness score as per Harvard step test among boys (54.3%) was significantly higher as compared to girls (21.3%) (χ2 = 88.93, p < 0.001). There was a significant association between gender and dominant handgrip strength (χ2 = 8.02, p = 0.01) as well as between gender and Shoulder stretch test (SST) of dominant (χ2 = 17.5, p < 0.05) as well as nondominant arm (χ2 = 13.5, p < 0.05). Sit and reach test results also showed a significant association with gender (χ2 = 27.17, p < 0.001). Gender, hemoglobin level, BMI and PAL scores significantly predicted cardiorespiratory fitness scores (R2 = 0.188, F value of the model = 37.69, p =< 0.001)). CONCLUSION: Physical fitness of school going adolescents in Garhwal division of Uttarakhand was better than other parts of India, with significant gender differences. Physical activity levels (PAL) were poor and are also a significant predictor of physical fitness. More emphasis needs to be paid on the health and fitness of girl students. School based policies to increase PAL among students through innovation and rewards may go a long way in improving the long-term health of the students.

Effect of adjuvant yoga therapy for asthma control: A randomized controlled trial.

BACKGROUND: Asthma is a chronic respiratory disease with symptoms of attacks of wheezing, shortness of breath, & tightness in the chest. Even with pre-existing treatment exacerbations go uncontrolled. OBJECTIVE: This study compared asthma control in yoga intervention versus non-yoga intervention group using Asthma Control Test. METHODS: In this randomized controlled trial, participants were allocated into two groups in 1:1 ratio - yoga intervention versus non-yoga intervention. Only outcome assessor was blinded. Sample size of 200 was calculated. Individuals between 18 and 60 years of age, diagnosed with mild to moderate asthma with no exacerbation in past one month were screened and enrolled. Per-protocol analysis was done to assess the outcomes of Asthma Control Test and expenditure.(CTRI/2020/02/023534) RESULTS: A total of 192 participants enrolled, 165 completed this study who were considered for final analysis. A significant difference (p < 0.001) was found between yoga and non-yoga exercise group at 13 weeks. Expenses were more in non-yoga exercise group. CONCLUSION: Our findings confirm that yoga exercise with routine medical care reduces exacerbations and improves asthma control.

Prevalence, Pattern, and Predictors of Ever Use of Complementary and Alternative Medicine in Diabetes and Hypertension: A Cross-Sectional Study.

Introduction: Noncommunicable diseases (NCDs) have emerged as a pandemic globally and the situation is worse for developing nations. The four major NCDs that are responsible for a major proportion of mortality across the globe are cardiovascular diseases, cancer, respiratory diseases, and diabetes. For a country with limited resources, an integrated approach toward the management of NCDs is of particular importance. Complementary and alternative medicines (CAMs) are those health-care and medical practices that are not currently an integral part of conventional medicine system. This study was undertaken to estimate the prevalence, pattern, and predictors of CAM use among patients with NCDs (diabetes, hypertension, or both). Materials and Methods: A health-facility-based cross-sectional study was conducted at different levels of government health-care facilities in Rishikesh, Uttarakhand. CAM categories included alternative medical systems, mind-body intervention, biologically based therapies, manipulative and body-based methods, and energy therapies. Additionally, jhaad phook/local healers were also included in our study. Results: The study showed that 41% of all the study participants were ever users of CAM. While most of the users were practicing more than one type of CAM, the most common type of CAM practiced was alternative medicine system (83.3%) followed by mind-body medicine (40.2%). Except religion and place of residence of the study participant, no other factor showed a significant association with ever usage of CAM. Conclusion: CAM use was popular among study participants as almost half of them were using/consuming it and alternative medicine system was the most common type of CAM practiced.

The Role of Yoga in Hospitalized COVID-19 Patients: An Exploratory Randomized Controlled Trial.

Introduction The unpredictable course and sheer magnitude of coronavirus disease 2019 (COVID-19) have sparked a search for novel and repurposed pharmacological interventions. Non-pharmacological interventions may also play a role in the management of this multifaceted disease. This study aimed to evaluate the safety, feasibility, and effect of yoga in hospitalized patients with moderate COVID-19. Methods Twenty patients satisfying the inclusion criterion were randomized (1:1 ratio) into Intervention and Control groups. Patients in the intervention arm performed a one-hour yoga session that included pranayama and Gayatri mantra (GM) chant for up to 14 days. Sessions were fully supervised by a trained yoga trainer via an online platform. Patients in both groups received the normal treatment as per national guidelines. Outcome parameters were recorded on the 14th day/end of the hospital stay. Results Yoga is safe and feasible in hospitalized patients with COVID-19. The decline of high-sensitivity C-reactive protein (hs-CRP) levels was significantly greater in the Intervention Group. Quality of life (QOL), depression, anxiety, and fatigue severity scale (FSS) showed a decline in both groups with a significant decline observed in FSS scores of the Intervention Group. Median chest X-ray score values, duration of hospital stay, and reverse transcription-polymerase chain reaction (RT-PCR) conversion days were observed to be lower in the Intervention Group but were not significant (p>0.05). Conclusion The study found that incorporating pranayama and GM practices in hospitalized patients with moderate COVID-19 pneumonia was safe and feasible. It showed a notable reduction in hs-CRP levels and FSS scores in the Intervention Group, but the study was not powered to detect statistically significant results. Further research with larger sample sizes is needed for conclusive findings.

Community Perspective of Male Involvement in Maternal Health Care in Uttarakhand, India: A Qualitative Study.

Background: Due to the significant role of male in decision making in India, they may decide if, when and where a woman may access antenatal, delivery and postnatal care; and whether or not to provide financial resources to travel to these services. Men's involvement in maternity care is recognized as a key strategy in improving maternal health and accelerating the reduction of maternal mortality. This study explores key components and challenges to male involvement in maternal health care (MHC). Methods: Focus group discussions (FGDs) were conducted with a purposive sample of the community key stakeholders from the field practice area of All India Institute of Medical Sciences, (AIIMS) Rishikesh from October 2020 to January 2021. Manual thematic analysis with a semantic approach was used for the data analysis. Themes were prioritized using Participatory rural appraisal (PRA) technique. Results: Twenty-three participants represented the heterogeneous group of key stakeholders. Stakeholders identified the need for improved awareness regarding MHC services among men. Husband involvement is affected by availability (work stations at different places), literacy, gender-based work domain and social cultures, finances and health facility environment.Four major themes were identified: Male involvement in antenatal, intranatal; postnatal care; and barriers to male involvement in MHC. Sub-themes under male involvement in antenatal care; intranatal care; and postnatal care were further prioritized via PRA as 'very important'; 'important' and 'not so important' and scores were given as 3, 2 and 1 respectively. Conclusions: Male involvement is a key strategy to improve pregnancy outcome; however, different challenges exist in their involvement in the maternal health care. Current study helped to contextualize the perception regarding importance of male involvement in MHC; and the situation of study area in order to understand social and cultural factors that shape the behavior and practices of men in relation to their involvement.

The effect of yoga on pulmonary function in patients with asthma: A meta-analysis.

BACKGROUND: Asthma is one of the most common non-communicable diseases. Yoga with physical postures, breathing exercises, meditation, and relaxation may play an essential role in the complementary management of lower respiratory diseases. The study aimed to evaluate the impact of yoga (posture, breathing exercises, and meditation) on pulmonary function tests, asthma control tests, and health-related quality of adult asthmatic patients. METHODS: MEDLINE, PubMed, Embase, Cochrane, Scopus, Google Scholar, ResearchGate, Clinical Key, and Academia electronic search engines were explored to search the relevant literature. The present study included adult asthmatic patients (age -18 and 60 years) with mild to moderate asthma, per GINA (Global Initiative for Asthma) guidelines. The effect of yoga was assessed on the following outcomes; pulmonary function tests, including FeV1 (Forced expiratory volume 1 s), FVC (Forced vital capacity), FeV1/FVC, peak expiratory flow rate (PEFR), health-related quality of life, and asthma control test. A fixed-effect model was applied to compute significance for statistical heterogeneity. P-value <0.05 was considered for statistical significance. RESULTS: Finally, fifteen articles were included for meta-analysis. The forest plot for overall effect of yoga intervention and usual care favors the yoga intervention for improvement in pulmonary function as FeV1 (SMD = 0.96, CI = 0.77-1.14, I2 = 54%), FVC (SMD = 0.35, CI = 0.14-0.55, p = 0.11, I2 = 50%), Fev1/FVC (SMD = 0.18, CI = -0.38-0.02, p = 0.02, I2 = 50%), PEFR (SMD = 0.38, CI = 0.18-0.58, p = 0.0003, I2 = 0%), asthma control test (SMD = 0.16, CI = 0.15-0.48, p = 0.31, I2 = 86%) and health-related quality of life (SMD = 0.26, CI = 0.18-0.34, p = 0.02, I2 = 51%) of asthmatic patients. CONCLUSION: This meta-analysis provides a moderate level of evidence regarding yoga as a complementary therapy in managing mild to moderate asthmatic patients. It also adds to the current knowledge of the same.

Effects of sanitation and hygiene perceptions on international travelers' health, travel plans and trip experiences in India.

Background: International travelers often experience travelers' diarrhea. However, there is paucity of data on whether self-reported gastrointestinal symptoms influence travelers' perceptions of adequacy of sanitation and hygiene services encountered during travel, and to what degree their travel plans, and overall trip experience are impacted. Methods: A cross-sectional face-to-face survey was conducted amongst international travelers in India. Data collected included socio-demographics, travel characteristics, self-reported occurrence and frequency/severity of gastrointestinal symptoms, perceptions of sanitation and hygiene encountered, and adverse effects of symptoms on travel plans and trip experiences. Chi-square tests and logistic regression were performed to describe differences and associations between categorical variables. Results: Of the 300 international travelers surveyed, 46.3% experienced diarrhea. At least two thirds of travelers perceived the quality of sanitation (67.0%) and hygiene (70.0%) encountered to be inadequate. Perceptions of inadequate sanitation (adjusted OR = 3.0; 95% CI 1.7-5.5) and poor hygiene (adjusted OR = 7.7; 95% CI 4.1-15.5) were higher among travelers who experienced diarrhea. Additionally, both higher likelihood of travel plans being affected (adjusted OR = 10.7; 95% CI 5.1-23.6) and adverse impacts on overall trip experience (adjusted OR = 2.8; 95% CI 1.4-5.8) were reported among those who experienced diarrhea. Conclusions: More than two thirds of travelers surveyed in India experienced inadequate sanitation and hygiene services, with perceptions influenced by occurrence and frequency of diarrhea. Self-reported diarrhea was also associated with adverse effects on travel plans and overall trip experience. While these results may seem intuitive, they have important implications and suggest that improving sanitation and hygiene standards in India could potentially enhance tourism.

Psychological and other Correlates of Academic Performance in Medical Students at a Tertiary Care Hospital: A Cross-Sectional Study.

Background: High percentage of medical students showed multiple psychological factors that may interfere with their academic performance and identifying the problems in early stage and providing them advice is very important for their mental health. Methodology: The study targeted undergraduate medical students studying at All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. Selected students completed the self-administered questionnaire comprising the psychological correlates such as perceived stress scale, Pittsburgh sleep quality index, ten-item personality inventory, and other correlates such as sociodemographic and scholastic characteristics. The association of these psychological and other correlates with academic performance was analyzed using the Chi-square test at P >0.05. Results: Students with poor sleep quality 60.2% and 57.1% of students had high-stress levels perform well in academics. 70.2% of girls and 64.5% of general category students performed well in academics. Student's family head having a professional degree was associated with good performance in academics 64.3%. Moreover, students belonging to the upper class (69.2%) performed better. No significant association was observed between psychological correlates with academic performance but observed between sociodemographic and scholastic variables with academic performance. Conclusion: Among undergraduate medical students, there was no significant association of psychological correlates such as stress level, sleep quality, and anxiety trait with academic performance.

Evaluation of an Interventional Health Education Project: Screening of Breast Cancer and Health Education (SHE).

There is an increasing incidence of breast cancer in India, especially among younger women. The study's main objective was to create awareness related to breast cancer and breast self-examination by community health workers and assess the effectiveness of improving knowledge and practice. Secondary objective was to conduct clinical breast examination (CBE) of women and prompt referral. METHODS: An outcome evaluation of the Educational Interventional project was conducted in a hilly district of Uttarakhand. Twenty Accredited Social Health Activists (ASHA) were identified and trained in breast cancer awareness, the procedure of breast self-examination, and screening methods. These ASHA's further created awareness among study participants (women above 30 years). A structured questionnaire on knowledge and practice was administered before and after educational intervention by ASHA workers. Clinical Breast Examination (CBE) camps were held for women at high risk for breast cancer who were referred to the Division of Breast Surgery, AIIMS Rishikesh, for further management. RESULT: One thousand sixty-one females participated in health education sessions by ASHAs. There was an improvement in knowledge and practice regarding Breast Self-examination after health education intervention. A low prevalence of risk factors for breast cancer was found among attendees of the CBE camp. 3.2% of participants had abnormalities on breast examination needing further workup. CONCLUSION: In the pre-test assessment, we found a low awareness and practice regarding breast cancer which increased significantly among women after behavioral change intervention. The prevalence of risk factors for breast cancer was very low. Trained community health workers were found to be effective in raising awareness, selective screening, and prompt referral.

Obstetric and perinatal outcomes in pregnant women with COVID-19: an interim analysis.

The coronavirus disease (COVID-19) has affected the health-care system worldwide. The effect of COVID-19 on obstetric and perinatal outcomes is yet to be completely ascertained. A hospital-based prospective observational study was conducted at the Department of Obstetrics & Gynecology, AIIMS Rishikesh from July to December 2020. A total of 60 COVID-positive pregnant women were included. Obstetric and perinatal outcomes were compared with 60 COVID-negative pregnant women. A subgroup comparison was also performed between symptomatic and asymptomatic pregnant women with COVID-19. Majority of COVID-positive pregnant women were asymptomatic (81.7%). Eleven patients were symptomatic, out of which 9 (15%) had mild disease and only 2 (3.3%) had severe pneumonia. There was an increased likelihood of early pregnancy loss (5%), oligohydramnios (21.7%), preterm birth (31.7%), and cesarean section (53.3%). The occurrence of preterm birth was significantly higher in symptomatic women than asymptomatic women (p = .01). Oligohydramnios was significantly more frequent in COVID-positive than COVID-negative pregnant women (p = .048). Preterm birth and cesarean rate were slightly higher in COVID-positive group but the difference was not statistically significant. Other obstetric outcomes were comparable in both groups. The majority of women with COVID-19 infection in pregnancy remain asymptomatic or have mild symptoms. Still, it may lead to maternal death and poor fetal outcomes in form of early pregnancy loss, prematurity, oligohydramnios, intrapartum fetal distress, and increased cesarean rate. Therefore, COVID-19 preventive measures should be strictly implemented and followed.

Cardiovascular Morbidity, Quality of Life, and Cost of Care among Diabetic Patients: A Comparative Study from a Tertiary Care Hospital of Uttarakhand, India.

OBJECTIVES: Diabetes is commonly observed to be associated with several comorbidities, out of which cardiovascular comorbidities are most frequently observed. The present study has been done to estimate the proportion of cardiovascular comorbidities among patients of diabetes and to compare it with that of matched nondiabetics. It also aimed to compare the quality of life (QOL) scores and the cost of treatment between diabetics and nondiabetics with cardiovascular comorbidities. METHODOLOGY: A hospital-based comparative analytical study was conducted in a tertiary care hospital of Uttarakhand, India. One hundred and ninety-five diabetic were compared with an equal number of age- and gender-matched nondiabetics. We compared the two groups for the presence of comorbidities by Chi-square test and for QOL and cost of care by independent t-test. Regression was done to study factors associated with direct cost incurred for treatment among diabetics with cardiovascular comorbidity. RESULTS: The present study reported about four-time higher risk (odds ratio: 3.9; confidence interval: 2.5-6.1) of comorbidities of cardiovascular system (CVS) among diabetics as compared to nondiabetics. QOL scores were reported to be significantly lower among diabetics with comorbidities of CVS in comparison to nondiabetics. Significant predictors of direct cost among diabetics were religion, marital status, income, and use of alcohol. CONCLUSION: Cardiovascular comorbidities have been reported to be four times higher among diabetics in comparison to nondiabetics, leading to an adverse effect on QOL and increased expenditure on treatment.

Evaluation of equiosmolar 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate on intraoperative brain relaxation and hemodynamic parameters in patients undergoing craniotomy for supratentorial tumors: a prospective randomized study.

BACKGROUND: Research comparing 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate for intraoperative hyperosmolar therapy during supratentorial tumor excision is sparse. With the hypothesis that equiosmolar concentration of these agents will produce equivalent effects, this study was conducted to compare the effects on intraoperative brain relaxation and hemodynamics. METHODS: The prospective study was conducted over a period of one year. Ninety patients, aged 18-60 years, American Society of Anesthesiologists class Ι and ΙΙ with supratentorial tumor and scheduled for surgery were randomized into three groups to receive equiosmolar 20% mannitol (group 1), 3% hypertonic saline (group 2) and 8.4% sodium bicarbonate (group 3). Primary outcome assessed was the effect on intraoperative brain relaxation score while hemodynamic parameters, changes in arterial blood gas parameters, serum electrolytes, serum osmolarity, urine output, fluid intake, post-operative course, hospital stay were the secondary outcomes. RESULTS: Demographic characteristics, surgical and anesthetic variables, were comparable between the three groups. Brain relaxation scores were significantly better in group 3 compared to group 2 and group 1 respectively. Patients in group 1 had lower mean blood pressure and central venous pressure values, higher urine output, fluid intake compared to other groups. Patients of group 3 had significantly higher pH, bicarbonate, partial pressure of carbon dioxide, serum sodium and serum osmolarity values compared to groups 1 and 2. CONCLUSIONS: Eight point four percent sodium bicarbonate solution infusion is associated with superior intraoperative brain relaxation scores and improved haemodynamic stability compared to equiosmolar 3% hypertonic saline solution and 20% mannitol.

Initial experience with use of infrared assistance for intravenous injection of radiopharmaceuticals.

Radiopharmaceutical injection is challenging as it poses radiation exposure to staff as well as patient. Infrared light-assisted devices have been available since many years and have garnered mixed reviews in the pediatric age group. However, there are no data on outcome of infrared assistance for radiopharmaceutical injection. We compared results of first-attempt intravenous access (in cubital veins) with and without infrared assistance device for injection of radiopharmaceuticals. All adult patients who underwent nuclear scan in the initial weeks of infrared device installation were injected utilizing infrared device assistance. These were compared with those who underwent injection without infrared assistance. Three hundred consecutive patients were studied for success of intravenous injection with and without infrared assistance. Of these, 150 were injected with and 150 without infrared assistance. A success rate of 72%/51.3% was noted with and without infrared assistance, respectively, on the first attempt which was statistically significant. In our initial experience, assistance with infrared device was found to improve the outcome of first-attempt intravenous access for injection of radiopharmaceuticals. This method has potential of improving outcome for radiopharmaceutical injection.

Out-of-Pocket, Catastrophic Health Expenditure and Distress Financing on Non-Communicable Diseases in India: A Systematic Review with Meta-Analysis.

OBJECTIVE: The aim of this systematic review is to determine pooled estimates of out-of-pocket (OOPE) and catastrophic health expenditure (CHE), correlates of CHE, and most common modes of distress financing on the treatment of selected non-communicable disease (cancer) among adults in India. METHODS: PubMed, Scopus and Embase were searched for eligible studies using strict inclusion and exclusion criteria. Data was extracted and pooled estimates using random effects model of meta-analysis were determined for different types of costs. Forest plots were created and heterogeneity among studies was checked. RESULTS: The pooled estimate of direct OOPE on inpatient and outpatient cancer care were 83396.07 INR (4405.96 USD) (95% CI = 44591.05-122202.0) and 2653.12 (140.17 USD) INR (95% CI = -251.28-5557.53), respectively, total direct OOPE was 47138.95 INR (2490.43 USD) (95% CI = 37589.43-56690.74), indirect OOPE was 11908.50 INR (629.15 USD) (95% CI=-5909.33-29726.31) and proportion of individuals facing CHE was 62.7%. However, high heterogeneity was observed among the studies. Savings, income, borrowing money and sale of assets were the most common modes of distress financing for cancer treatment. CONCLUSION: Income- and treatment-related cancer policies are needed to address the evidently high and unaffordable cancer treatment cost. Economic studies are needed for estimating all types of costs using standardised definitions and tools for precise estimates. Robust cancer database/registries and programs focusing on affordable cancer care can reduce the economic burden and prevent impoverishment.