RV in COPD - The complicated matters of the heart - Correlation of ECHO and biomarker with COPD severity and outcome.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular involvement, which is among the leading causes of morbidity and mortality worldwide. Echocardiography (ECHO) could be a reliable, non-invasive tool for predicting the risk of cardiovascular modalities in patients with COPD. Combining the ECHO parameters with highly selective cardiac troponin could predict the severity and outcome of patients with COPD. METHODS: This prospective observational study was conducted at a tertiary care hospital in South India. All patients who met the criteria were included. Patients with other concomitant chronic lung diseases were excluded. An echocardiographic examination was performed, and blood samples for hs-Tnt were taken on admission for patients admitted with COPD. Categorical variables were analyzed using Pearson's Chi-square test, and the T-test was used to compare the means. One-way analysis of variance (ANOVA) followed by the Bonferroni multiple comparison tests was done to compare different echo parameters concerning COPD severity. RESULTS: The mean tricuspid annulus plane systolic excursion (TAPSE) and right ventricle (RV) fraction area change (FAC) values were lower with the increase in the disease severity (P < 0.001). There was a significant increase in the mean systolic pressures in the right atrium and ventricle in patients with severe COPD (P < 0.001). The mean hs-TnT values were significantly higher in patients with severe COPD (18.86 ± 18.12) and correlated well with the increase in the severity of the disease (P < 0.001). Changes in the echo parameters, such as mean TAPSE and RV FAC values, negatively correlated with COPD severity. There was an increase in systolic pressure in both atria and ventricles with the progression of COPD. Troponin helped predict mortality during hospitalization. CONCLUSION: Comprehensive echocardiographic parameters, such as TAPSE and RV FAC, help assess the disease's severity, predict mortality, and evaluate whether the proper ventricular function is reliable. Troponin is a valuable adjunct that is an independent and strong predictor of overall mortality in patients with COPD.

Effectiveness of multi-component modular intervention on screen-based and non-screen-based sedentary time among adolescents in an urban area of Mangalore: a school-based cluster randomised controlled trial-protocol.

Background: Behavioural risk factors may often present during adolescence and account for 70% of premature deaths during adulthood. Excessive sedentary behaviour and screen time have become significant concerns, especially among adolescents, due to their potential negative impact on physical and mental health. Adolescents with a high screen-based sedentary time are more likely to be physically inactive, have unhealthy body structure and poor academic performance. The objective of our study is to assess the effect of multi-component modular educational intervention on screen-based sedentary time (SST) and non-screen-based Sedentary time (NSST) among adolescents. Methods: Ethical approval for the study has been obtained from the institutional Ethics Committee of Kasturba Medical College in Mangalore, India. This cluster randomized control trial will be carried out in schools located in the urban area of Mangalore. Using simple randomization, the eligible schools will be randomized into intervention and control arms, each consisting of 10 clusters. A multi-component modular educational intervention will be administered to participants in the intervention group at baseline, second and fourth month. The control group will receive the standard curriculum. Both the groups will be assessed at baseline and at second month, fourth month and sixth month of follow up for SST, NSST and level of physical activity. Anthropometric measurements like height, weight, waist circumference and hip circumference will be taken at baseline and sixth month of follow up. Results: A comprehensive school-based modular educational intervention can have cumulative advantages by reducing screen- and non-screen-based sedentary time, and encouraging physical activity. Similar modular teaching can be incorporated into the curriculum, which will promote healthy life-style among the adolescents.

Cardiovascular risk factors and carotid intima-media thickness with neurocognitive dysfunction in people living with HIV on stable combination anti-retroviral therapy.

The goal of this clinical research was to determine the relationship between carotid intima-media thickness (cIMT), cardiovascular risk factors, and neuro-cognitive function in people living with HIV (PLHIV) and were on stable combination anti-retroviral therapy (cART). This is a cross-sectional study performed at a single center, including 149 patients who visited the anti-retroviral therapy center of our tertiary care hospital. Among the PLHIV of our research, 62.4% had at least one associated cardiovascular risk factor, and 61.1% of them had abnormally high cIMT (≥ 0.9 mm on any one side, p = 0.035). These factors and being the male gender (p = 0.028) were associated with a greater Framingham 10-year risk percentage. Hypercholesterolemia was observed in 30.9% of the PLHIV and a higher body mass index (≥ 25 kg/m2) was found in 26.8% of them. The cognitive impairment was milder in 71.8% of cases and moderate in 9.4% of PLHIV. The Chi-square test revealed that a higher proportion of participants who had lower HDL-C levels (p = 0.045), smokers (p = 0.029), systolic blood pressure ≥ 140 mmHg (p = 0.012), and lower educational status (p = 0.017) had a poorer cognitive performance. In our sample population, a higher prevalence of elevated cIMT, cardiovascular risk factors, and mild and moderate cognitive deficiency was observed in PLHIV, who were on stable cART. However, routine assessment of the neuropsychological functions and management of modifiable risk factors are not performed in our patients. Further exploration of the relationship between cardiovascular risks, cIMT, and cognitive impairment in PLHIV is essential to formulate the guidelines and delay the onset of neurocognitive disorders in these patients.

Impact of COVID-19 Pandemic on the Exacerbation Rates in COPD Patients in Southern India - A Potential Role for Community Mitigations Measures.

Introduction: The impact of the coronavirus 2 (SARS-CoV-2) pandemic and the effect of preventive health strategies on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are largely unknown. The public health model imposed during the pandemic and the lessons learnt have implications on recommending future preventive strategies for COPD care in general and exacerbations in particular. Aim: This study endeavors to assess the role of preventive strategies of COVID-19 on exacerbation rates of COPD during the lockdown period compared to similar periods the previous year and assess the compliance to preventive strategies for COVID-19 among COPD patients. Methods: This is a hospital-based descriptive cross-sectional study at a tertiary care center. AECOPD in patients during a period spanning five months in the pre-lockdown days was compared with exacerbation rates for a similar period during the national lockdown. Results: Sixty-eight patients were recruited (mean age: 67.38) among whom 47 were males and 21 were females. There were only 7 (10.3%) reported admissions during the lockdown period of 5 months compared to 50 (73.5%) during the corresponding period pre-lockdown. Mild exacerbations reported during the lockdown period were also significantly less with only 17 (25%) against 58 (85.3%) during the pre-lockdown period. Adherence to measures such as donning of masks, hand hygiene, and social distancing was observed among COPD patients with good compliance to the health practices promulgated in the pandemic. Discussion: A significant reduction in exacerbation rates among AECOPD patients during the period of lockdown was observed compared to a similar period the year prior. Noticeable were the findings that both community-based milder exacerbations and severe exacerbations necessitating hospitalizations showed a reduction during the period of lockdown. Adaptability, compliance and acceptance to usage of masks, hand hygiene measures, and norms such as physical distancing were observed in the majority of COPD patients.

Mental health and quality of life among patients with chronic respiratory failure on domiciliary oxygen: a prospective cohort study from a tertiary care centre in India.

OBJECTIVES: The study aims to assess the prevalence of anxiety, depression and the quality of life among patients with chronic respiratory failure and the changes in anxiety and depression scores after initiating domiciliary oxygen. DESIGN AND SETTING: Prospective, single-centre cohort study conducted in a tertiary care hospital in India. PARTICIPANTS: Patients of Indian origin with chronic respiratory failure who visited the hospital where domiciliary oxygen is indicated were included in the study. Patients with acute respiratory failure on a mechanical ventilator, haemodynamic instability and already-diagnosed psychiatric conditions were excluded from the study. INTERVENTIONS: Patients who met the inclusion criteria were assessed at baseline, at 3 and 6 months, for anxiety and depression using the 7-item Generalised Anxiety Disorder questionnaire (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9). Quality of life was evaluated using the WHO Quality of Life-BREF questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the proportion of patients with chronic respiratory failure having depression and anxiety and assessing the changes in anxiety and depression scores after initiating domiciliary oxygen. The secondary outcome is the change in health-related quality of life (HRQOL) of patients on domiciliary oxygen. RESULTS: 121 patients who met the inclusion criteria were included in the study. Of 102 patients who completed the study, 36.2% (n=37) had anxiety and 44.1% (n=45) had depression at baseline. There is a worsening trend in the mean GAD-7 (p=0.003) and PHQ-9 score (p=0.015) in patients over 6 months while on domiciliary oxygen. HRQOL is poor in all the domains at baseline, and there is a progressive worsening during follow-up while on oxygen. CONCLUSIONS: The worsening trend in anxiety and depression in patients after initiating domiciliary oxygen may be related to social isolation, restricted mobility, economic issues, addictions and frequency of exacerbations. Screening for psychological problems in these patients at baseline and on follow-ups helps early detection, and prompt intervention could improve the quality of life and survival.

Paternal perspectives towards infant and young child feeding (IYCF): a qualitative analysis from Coastal South India.

BACKGROUND: The infant and young child feeding practices (IYCF) decide child growth and well-being. Paternal perspectives and involvement in IYCF are of paramount importance and are grossly under-studied. AIMS: To study the experiences and opinions of fathers of infants and young children towards feeding practices. SETTINGS AND DESIGN: Two focus group discussions (FGD) were carried out in the community settings in Dakshina Kannada District, Karnataka State. METHODS AND MATERIAL: FGDs were carried out in the areas of two selected primary health centres. FGD guide was used and the discussions were audio recorded. Themes were derived from the transcript. RESULTS: Four main themes were generated from the transcripts of two FGDs. Lack of time to involve in child feeding, lack of felt need for increased involvement, sense of being complete in providing paternal care and readiness to learn were the generated themes. All participating fathers had favourable attitudes towards learning more about IYCF. CONCLUSIONS: Lack of time felt need for higher paternal involvement in IYCF and sense of being complete in providing paternal care were the themes extracted, along with favourable attitude towards increasing their involvement in IYCF.

Clinical and seasonal pattern of dengue in a tertiary care hospital of South West India.

Background: Dengue is an emerging global viral disease with an increase 30-fold in incidence in the past fifty years. In the past decade it was restricted to only few a states of South and Northern India but in the recent past it has affected almost all the states in India. The objective of this study was to assess the clinical profile, trends and outcome of dengue cases. Methods: This retrospective record based cross-sectional study was conducted in tertiary hospital, Mangaluru in Southern India. The study population included all dengue positive cases diagnosed either by IgM Capture ELISA or Dengue Non-structural Protein NS1 antigen over a period of five years. Information from pre-recorded case sheets were used for data collection. The data was analyzed using SPSS Version 20. Results from the analysis have been expressed in percentages, means and graphs. Results: The study included 401 dengue cases. Most cases were in the age range of 20-40 years with a male to female ratio of 3:2. Overall seropositivity rate was 23.94% with High IgM prevalence. Monthly distribution showed a maximum cases were in the months of June and July and minimum were in January and February. Among the study participants, 91.5% of patients recovered completely and 1.7% of patients had died. 6.8% of patients were discharged against medical advice. Conclusions: Dengue continues to be major public health problem in this part of the globe affecting mainly the working age group. Low seropositivity with High IgM prevelance makes dengue an important differential for febrile illness of vague nature and invokes the need for robust public health response to curb the hyper-endemicity.

Effectiveness of multi-component modular intervention among adults with prehypertension in a village of Dakshina Kannada district - a community-based interventional study - protocol.

INTRODUCTION: The Joint National Committee (JNC 7) report on Prevention, Detection, Evaluation, and Treatment of Hypertension, defined "prehypertension," as individuals with a Systolic Blood Pressure (SBP) in the range of 120-139 mmHg and a (diastolic blood pressure) DBP of 80-89 mmHg. Prehypertension is directly linked with hypertension which is a precursor of CVDs. Owing to its high conversion rate to hypertension, it is important to identify individuals with blood pressures in this category and bring about lifestyle modifications in them that can prevent them from being hypertensive and from developing cardiovascular diseases later in life. METHODS: This randomized controlled trial will be done among the selected pre-hypertensive adults of all genders residing in Kateel Gram panchayat, Dakshina Kannada district, Karnataka. A baseline survey will be done initially to assess the level of prehypertension among the study population. To study the effectiveness of the intervention, 142 individuals will be randomly allocated using block randomization technique to intervention and control groups. A multi-component module (educational intervention) will be developed, validated, and administered to participants in the intervention group, while the control group receives standard care. Each participant will then be followed up once in four months till the end of the study period of one year to assess for changes in SBP, DBP, WHR, BMI, stress levels, and usage of tobacco and alcohol. ETHICS AND DISSEMINATION: Institutional Ethics Committee approval was obtained from Kasturba Medical College in Mangalore, India. The plans for dissemination of findings include presenting at scientific conferences and publishing in scholarly journals.

Immunohistochemical expression of androgen receptors in urothelial carcinoma of urinary bladder. Is it significant? Experience from coastal India.

BACKGROUND: Bladder carcinoma (BC) ranks second among the genitourinary cancers worldwide. Influence of androgens and expression of androgen receptors in neoplasms are recent findings which were implicated in the development of BC. We aimed to study androgen receptor (AR) expression in bladder urothelial neoplasms and correlate its expression with grade and stage of the tumor. METHODS: Immunohistochemistry (IHC) was done on samples collected in a tertiary care hospital over one year consisting of 71 urothelial BC and 20 non-neoplastic urothelial conditions. Two pathologists graded the IHC and nuclear staining was considered as positive expression. RESULTS: AR was expressed in 23.9% (17/71) of bladder urothelial neoplasms. AR was expressed in 25.7% and 22.3% of high and low-grade tumors and 25% and 22.3% of non muscle-invasive and muscle-invasive BC. AR expression had no significant correlation with gender, age (> 50 years), muscle invasion or grade. AR expression was significantly absent in non-neoplastic conditions (p = 0.018). CONCLUSIONS: AR has varied expression in BC and it is relatively lower in this study population.

Early diagnostic markers in predicting the severity of dengue disease.

The aim of the present study was to determine whether the serum ferritin, the biomarker of an acute phase reactant and the gall bladder wall edema, an early indicator of capillary leakage can predict the severity of dengue fever. This study included 131 patients, who were between the age group of 18-80 years. The patients presented to our department with an acute illness, within the first four days of high temperature. The statistical analysis of this study was performed by using the Chi-square and independent Student's t tests. The diagnostic markers are considered statistically significant, if the serum ferritin level is higher than 500 ng/ml and the gall bladder wall thickness is more than 3 mm. The present study observed that, 39 patients (89%) who had severe dengue (n = 44) revealed a significant gall bladder wall thickening, and this correlation was significant statistically (p < 0.000). It was also observed that, the ferritin levels have a highly significant positive correlation with the severity of dengue. The severe dengue patients had a mean ferritin level of 9125.34 µg/l, whereas the non-severe group had 4271 µg/l. This comparison was also statistically significant, as the p value was 0.003. We report that the serum ferritin levels have a highly significant positive correlation with the severity of dengue. The gall bladder wall edema during the third and fourth day of the illness was also associated with severe dengue. However, diffuse gall bladder wall thickening and high serum ferritin levels are also reported in various other conditions and their exact cause have to be determined by the correlation of associated clinical findings and imaging features.

Module intervention to improve involvement and practices of fathers towards infant and young child feeding (IYCF) in Coastal South India - a randomized controlled trial.

Background: Overall child health depends on nutrition and its related practices. At the family level, responsibility of child feeding lies with both parents. There is no uniform and systematic way to determine and assess the practices of fathers in infant and young child feeding (IYCF). Also, there is a paucity of evidence related to interventions for fathers in improving their practices and involvement in the feeding of their infant or young child (aged less than two years). Methods: This was a community-based randomized control trial, conducted among 120 fathers with infants and/or young children in Dakshina Kannada District of Karnataka. Fathers with poor level of involvement and practices towards IYCF, during the initial assessment, were included as the study participants. For the intervention, a module in the flipchart format was developed. Simple randomization technique was used to allot the participants into two groups - intervention and control. Participants in the intervention group received module intervention, in addition to the care which they received routinely, and the control group received only routine care. The participants in the intervention group were paid a monthly visit to implement the module, for six months. The post-intervention assessment was done at the end of 6 months. Results: A total of 117 participants provided post-intervention data. The mean age was 34.7 (+/- 5.48) years in the intervention group and 34.36 years (+/- 5.26) in the control group. The intervention group had a significant improvement in knowledge, attitude, and practice components at 6 months. We noted higher change scores for the intervention group (p<0.05). Conclusions: The extent of increase in practice and involvement in child feeding was clearly higher among the intervention group. The module developed was successful in improving the practices of fathers in feeding their infants and young children. Clinical Trials Registry India: CTRI/2017/06/008936 (29/06/2017).

Kikuchi-Fujimoto disease in a tertiary care teaching hospital in Coastal South India: A 8-year retrospective study.

Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation. METHODS: A retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed. RESULTS: A total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients ( n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months. CONCLUSIONS: KFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.

Incentives for pregnant mothers during antenatal care for better maternal and neonatal health outcomes in low and middle income countries: A systematic review protocol.

Background: Universal access to maternal new-born and child healthcare services (MNCH) is detrimental for attainment of Sustainable Development Goal (SDG) three pertaining to promotion of health at all ages. Incentivization in the form of cash, vouchers, and goods have been used as part of strategies to improve maternal and neonatal health outcomes around the world. However, there exists uncertainties regarding the effectiveness of various incentive-based programmes targeted for pregnant mothers in low- and middle-income countries during their antenatal period. Methods: We will search six electronic databases, namely the Medical Literature Analysis and Retrieval System Online (Medline), Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, and Embase in addition to Google Scholar. Manual searching of the reference lists of included studies will also be done. The reporting of this protocol will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 statement [29]. Only interventional studies that follow randomized, quasi randomized, and cluster randomized controlled study designs will be included. A three-stage screening process will be adopted to select articles. Risk of bias for the included studies will be assessed using the tools and criteria specified in the Cochrane handbook. In addition, the GRADE approach will be used to assess the quality of evidence for the maternal and neonatal health outcomes. Conclusion: This review of trials is essential to inform the effectiveness of incentive-based programmes targeted for pregnant women in low- and middle-income countries. It will help the policy makers to utilise the resources more effectively and to integrate the evidence based public health initiatives into the health system. This can also help build the continuum of care financial packages for all pregnant women.

Risk Assessment for Diabetes Mellitus by Using Indian Diabetes Risk Score Among Office Workers of Health Institutions of South India.

BACKGROUND: Diabetes mellitus (DM) is one of the non-communicable diseases plaguing the world and contributes a major part to the total disease burden. Diabetes has been prevalent in all countries throughout the years, with the majority of diabetics living in low- and middle-income countries. Madras Diabetes Research Foundation developed the Indian Diabetes Risk Score (IDRS), a simple and cost-effective method to assess the chances of developing diabetes. OBJECTIVES: To assess the diabetes risk profile of office workers using IDRS and to determine the proportion of individual risk factors of diabetes among the participants. METHODS: This cross sectional study included 94 non-diabetic office workers working in two health care institutions situated in coastal South India. Data was collected by a study questionnaire consisting of three sections. Section A included details related to participant characteristics, Section B included anthropometric measurements, and Section C consisted of the Indian Diabetes Risk Score. The collected data were coded and entered into Statistical Package for Social Sciences. RESULTS: The mean age of the study participants was 40.88 (±9.761) years, and the mean BMI was 23.8 (±3.6) kg/m2. Majority (n=65, 67%) of the study participants did not have a family history of diabetes. One-third of the study participants had IDRS ≥ 60, which allocated them in the high risk category for type 2 diabetes (n=34, 35.1%). CONCLUSION: It has been conclusively shown from the study that most of the office workers have moderate to high risk of developing diabetes and are also overweight or obese.

Integrating Research into Undergraduate Medical Education Curriculum: A 20-year Experience from a Medical School in Coastal South India.

Research is the key to advancement in medical science. Medical school can nurture the skill of research right from the under graduation. Research forms an integral part of the medical curriculum in western countries. We attempted the same in our medical school in India. We developed a structured research methodology program, which was implemented in the undergraduate (UG) curriculum in two phases. Phase I focuses on research methodology and Phase II on manuscript writing. With the implementation of a competency-based medical education curriculum (CBME), we have extended the research methodology program with manuscript writing and introduction to systematic reviews, which is being offered as electives to UG medical students in the third professional year. Our experience in training students at an UG level has been immensely satisfying. We hope that this article will help other medical schools to adopt a similar method of training UG medical students in research methodology and scientific medical writing.

The COVID-19 pandemic and mental health outcomes - A cross-sectional study among health care workers in Coastal South India.

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care. Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1 st March -30 th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported. Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05) Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.

Vaccine hesitancy among mothers of under-five children in Coastal South India: a facility-based cross-sectional study.

Background: Vaccine hesitancy (VH) has been identified by the World Health Organization as one among the top ten threats to global public health. There is limited literature regarding VH from developing countries like India. Methods: In this facility based cross-sectional study, 172 mothers of under-five children were assessed regarding VH using the parental attitude towards childhood vaccination questionnaire (PACV). Results: The prevalence of VH was 3.4% (n=6). Only 7.6% (n=13) of the study participants had ever refused vaccination for their child and the most common reason cited for their refusal was that they thought it was not safe (n=6). Government health facilities was the place of routine immunization for 60.5% (n=104) participants. Health care providers (n =79, 46%) were the major source of information regarding vaccines. Conclusions: Our study highlights the presence of very low prevalence of VH in Mangalore compared to similar studies from India and other parts of the world. The limited number of participants had refused vaccination due to concerns related to vaccine safety.

Association between Veterans Aging Cohort Study (VACS) index and neurocognitive function among people living with HIV-a cross sectional study in coastal South India.

BACKGROUND: HIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients. METHODS: In our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment. RESULTS: We found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p < 0.01), specifically in the domains of attention (p < 0.01) and fine motor skills (p = 0.01). Our study also showed that among all the VACS components, older age (p = 0.02) and lower hemoglobin (p < 0.01) values were associated with global NCI. After plotting an ROC curve, a VACS cut-off score of 11.00 was identified as it had good sensitivity (87.0%) and specificity (71.4%) in identifying Global NCI. CONCLUSION: Our findings extend prior research on the use of VACS Index to predict global and domain-wise NCI in HIV-positive patients. However, further research with more comprehensive neurocognitive testing is required in our setting before VACS Index can be used as a tool to screen for neurocognitive dysfunction among PLHIV.

Paternal Involvement in and Sociodemographic Correlates of Infant and Young Child Feeding in a District in Coastal South India: A Cross-Sectional Study.

Context: The feeding practices during first 2 years of life determine the overall health and survival during childhood and beyond. Child nutrition is responsibility of both parents and so far emphasis has been laid mostly on mothers. Fathers' involvement toward Infant and Young child feeding (IYCF) has been proved to be of paramount importance and yet it is given limited importance. Objectives: This study aims to study the level of paternal involvement toward IYCF and its associated factors and to assess the knowledge, attitude, and practices toward IYCF in Dakshina Kannada District in South Indian State of Karnataka. Settings and Design: This community-based cross-sectional study was conducted in the coastal District of Dakshina Kannada; Karnataka State in India. Methods: The study included 450 fathers of infant and young children (aged <2 years) in five taluks of Dakshina Kannada district. They were assessed for knowledge, attitude, and practices related to IYCF. Median score for the practice component was considered cut off to classify involvement in IYCF. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Chi-square-test and Binary Logistic Regression with Hosmer-Lemeshow goodness-of-fit model were used. Unadjusted and adjusted odds ratios were generated. A p-value of <0.05 was considered statistically significant. Results: Mean age of the study population was 34.6 years (SD, 5.4). The practice scores median (IQR) was 34.0 (IQR, 31.0-39.0), and 40.9% of the participants had poor involvement in IYCF. This was significantly higher among fathers from predominantly urban area. Those who had education above graduation and younger fathers had better involvement in IYCF. Conclusions: Less than half of fathers had poor involvement in IYCF, and it was lower among fathers from urban areas, higher age, and lower educational levels.