Toxicity of targeted anticancer treatments on the liver in myeloproliferative neoplasms.

The liver has a central role in metabolism, therefore, it is susceptible to harmful effects of ingested medications (drugs, herbs, and nutritional supplements). Drug-induced liver injury (DILI) comprises a range of unexpected reactions that occur after exposure to various classes of medication. Even though most cases consist of mild, temporary elevations in liver enzyme markers, DILI can also manifest as acute liver failure in some patients and can be associated with mortality. Herein, we briefly review available data on DILI induced by targeted anticancer agents in managing classical myeloproliferative neoplasms: Chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, and myelofibrosis.

A mixed method study to assess notification of tuberculosis patients by private practitioners in New Delhi, India.

Background: A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low. Objectives: The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private-sector treatment providers. Methods: This cross-sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done. Results: Out of 375 private practitioners, over two-third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was "don't know how to" and major barrier considered was "lack of training." Conclusion: Strategies such as training and retraining, and one-to-one sensitization of private practitioners to address barriers may enhance TB notification.

Burden of iodine deficiency disorders and its association with various sociodemographic variables in a district of North East India.

Introduction: Iodine is one such micronutrient, the deficiency of which can impair the mental growth and development of young children and is the leading cause of preventable mental impairment. The present study has been conducted to study the prevalence of iodine deficiency disorders (IDDs) and its association with various sociodemographic variables among children (6-12 years) residing in the East Khasi Hills district of Meghalaya. Methods: The sample size was 2700 with a multistage 30 cluster sampling method. A questionnaire was used to collect data on the various sociodemographic variables. The weight and height of each child were recorded as per the standard procedure. In order to assess goitre, children were examined as per standard procedures prescribed by the National Iodine Deficiency Disorder Control Programme (NIDDCP). Results: A total of 2700 children were interviewed in total. Out of these, 1365 (50.5%) were males. The total goitre rate was found to be 195 (7.22%), indicating that IDDs are a mild public health problem in the study area. The median (interquartile range) urinary iodine excretion levels were 150 (108.05-189.37) mg/L. With respect to weight-for-age, it was observed that 93 (3.9%) children were severely underweight and 389 (16.8%) had severe stunting. A significant association was observed between goitre with the age group of children (p <.00001), maternal education (p <.00001), prevalence of stunting (p <.00001), and underweight (p <.05).

Psychological impact of Covid-19 pandemic among the Healthcare workers in a North-Eastern state of India.

Background: Previous studies done during SARS 2003 outbreak and early reports related to COVID-19 show that healthcare workers experience considerable anxiety, stress and fear. Although similar studies were done in other parts of India, there is dearth of data on this topic in the Northeastern region. Aim: This study aimed to assess the mental health status of Healthcare Workers during Covid-19 pandemic in the region. Methods: The study was conducted among the doctors and nurses of a Northeastern state of India through an online survey. PHQ-9, GAD-7 and ISI scales were used to assess depression, anxiety and insomnia among the participants. Results: The prevalence of depression, anxiety and insomnia among the HCWs was 74.5%, 42% and 32%, respectively. Moderate to Severe form of depression, anxiety and insomnia was experienced by 15.5%, 20.5% and 8.5%, respectively. Females and those who directly cared for Covid-19 patients were more prone to suffer from depression. Participants who reported having previous history of any psychological problems reported eight-fold, seven-fold and three-fold increased odds of developing depression, anxiety and insomnia, respectively, during the pandemic. Conclusions: A large proportion of HCWs reported symptoms of depression, anxiety and insomnia among the healthcare workers. Protecting the mental health of these health workers is paramount to ensure psychological wellbeing, which in turn will ensure a healthy and robust workforce. Relevance for Patients: Improves the productivity of Healthcare workers in terms of Patient care and Management.

A Community-Based Study on Functional Disability and Its Associated Factors Among Elderly Individuals in a Rural Setting in Northeastern India.

Background Functional disability in older adults is common and adversely impacts the quality of life. Given the paucity of population-based data, the present analysis attempted to determine the prevalence and factors associated with functional disability in basic activities of daily living (ADLs) among the elderly population in a rural setting of Northeastern state of India Methods A total of 430 elderly were recruited in a population-based cross-sectional study among elderly individuals (≥60 years) during the period 2013-2016 in rural areas of the Dibrugarh district of Northeastern India. The Barthel index was used to measure ADL. Anyone with a Barthel index score <100 (or having limitations in one or more ADL items) were considered as having a functional disability. The analysis of variance (ANOVA) test and the binary logistic regression analysis were used to examine the factors associated with functional disability. Results Overall, 43.7% % (Male 42.9%, Female 44.5%) of the participants had a functional disability. Increasing age, being widowed, having no formal education, being underweight (body mass index (BMI)<18.5 kg/m2), and increasing numbers of morbidities were significantly associated with functional disability among the elderly in this study in age and gender-adjusted logistic regression analysis. Being ≥80 years was associated with a three-fold greater risk (OR=31.72, 95% CI=1.3-6.91) of functional disability than the youngest age group (60-69 years). On the other hand, the presence of more than five morbidities was associated with a nearly 20 times increased risk (OR=19.61, 95% CI=9.01-42.68) than those with zero to two morbidities. Conclusion A high proportion of the rural elderly residents of Dibrugarh had a functional disability. The study provides epidemiological evidence of the risk factors of functional disability in this setting. This epidemiological information may be useful for developing prevention strategies to reduce the burden of functional disability.

Introduction of Class-room quality circles among 1st year MBBS students and its effect on students learning.

AIM: The aim of this interventional study was to introduce classroom quality circles (QCs) among first-year MBBS students, to assess the effectiveness of QCs on learning experience of the students, and to evaluate the students' satisfaction level during the process of learning. MATERIALS AND METHODS: A problem pool was created through a questionnaire. The study was carried out in the department of biochemistry, for a period of 6 months. Student's quality circle (SQC) group of five students was created. Then, feedbacks were collected from students by SQC after every class/topic delivered, and fortnightly meeting was held between the SQC group and faculty members of the department, and issues were brought to focus depending on these feedbacks collected by them. Possible initiatives and improvements were done on teaching-learning strategies depending on the outcome of these discussions. RESULTS: The effectiveness of SQC group was assessed by a pre-post questionnaire (Questionnaire-3) feedback from the students and scoring was done based on 5-point Likert scale. There was a statistically significant difference (P = 0.009) between the mean of pre-post questionnaire. To analyze the students' satisfaction level, a set of questionnaires were given to them and scoring was done. Thirty-four students agreed, 11 students were neutral, and 6 students were disagreed, that introduction of SQC was effective in solving their problems related to teaching and learning of biochemistry. CONCLUSION: SQC creates an environment of student centric, fairness, student empowerment, improving solving skills. Implementation of student-generated feedback through introduction of SQC has improved the quality of the course as well as its delivery. It complements and supplements in achieving students intended learning outcome and hence may contribute to overall learning quality in the long run.

Introduction of structured feedback for MBBS students: Perception of students and faculty.

INTRODUCTION: Feedback is an important part of the assessment process. However, one-to-one structured and constructive feedback to the students is not practiced mostly due to lack of practice and feasibility issues. The present study was conducted to understand the perception of students and faculty toward one-to-one structured feedback. METHODOLOGY: All the 3rd MBBS professional students were included in the study. An orientation was given to the faculty regarding the importance of feedback and how to give structured feedback. A standardized format was provided to the faculty for providing the feedback to the students. After completion of the assessments, a one-to-one structured verbal feedback was given to all the students. Thereafter, faculty and student's perception on the feedback process was obtained through questionnaires. A focused group discussion was also conducted among the students. RESULTS: A total of 42 students participated in the study out of 50. A positive response was received from all the students regarding the feedback. Nearly84.34% of the students acknowledged that feedback is important for understanding their mistakes, 92.84% of the students responded positively that feedback helps to build a good rapport with the teacher, and 92.85% of the students reported that they were satisfied with the overall experience of receiving feedback. Most of the faculty (80%) perceived that giving feedback after the assessment was a good idea. The faculty felt motivated to give feedback to the students after the hands-on experience. However, only 20% of the faculty agreed that the process of feedback was easy to carry out (mean score: 2.2 ± 1.09). CONCLUSION: The positive responses received from both the students and the faculty highlight that the students are receptive toward feedback provided it is structured, constructive, and helps them to achieve their learning goals.

Iodine Deficiency Disorders in Children in East Khasi Hills District of Meghalaya, India.

OBJECTIVE: To assess the prevalence of iodine deficiency disorders among school-going children in Meghalaya. METHODS: Multi-stage 30 cluster sampling with probability proportionate to size (PPS) method was used. Children (age 6-12years) were examined clinically for goiter. Urinary iodine excretion (UIE) was performed by spectrophotometric method. Iodine content in the salt was analyzed using iodized salt test kits. RESULTS: A total of 195 (7.22%) out of 2700 children had goiter on examination. Goitre prevalence was significantly associated with wasting (P<0.05) and stunting (P <0.001). The median (IQR) UIE level was 150 (108.05 - 189.37) µg/dL. Nineteen (9.74%) children had severe iodine deficiency (UIE<20µg/L). Iodine content was above the recommended level of 15 ppm in 95.9% salt samples. A positive correlation was observed between household salt consumption and UIE levels (r=0.25; P<0.001). CONCLUSIONS: Iodine deficiency disorder is a public health problem in Meghalaya, which needs to be addressed.

Nutritional status and personal hygiene practices of primary school children: A cross-sectional study from Meghalaya, India.

BACKGROUND: Poor nutritional status in primary school children can lead to several health problems such as easy susceptibility to common childhood diseases. Personal hygiene status is an important predictor of nutritional status and morbidity in children as water- and sanitation-related diseases are the leading causes of early morbidity and mortality in children. The present study was conducted to assess the nutritional status as well as personal hygiene practices of primary school going children. METHOD: The present study was a cross-sectional study conducted in selected urban and rural areas of Shillong in children 6-12 years of age. Two schools each from the rural and urban area were selected using simple random sampling. The total sample size calculated was 510. Height, weight, and BMI were taken for all the children following the standard procedures. WHO growth standards were used for grading of nutritional status. A questionnaire with scores was used for grading of personal hygiene status. RESULTS: The overall prevalence of underweight in the children of 6-9 years was 74 (18.7%) and that of stunting was 68 (17.2%). The overall prevalence of thinness and stunting in children aged 10-12 was 38 (19.1%) and 46 (23.2%). The prevalence of nutritional deficiency syndromes was 192 (32.4%). Regarding the personal hygiene status, it was observed that 65 (11%) had very good personal hygiene, 292 (49.3%) were labeled as good, 200 (33.8%) were average, and 35 (5.9%) had poor personal hygiene. CONCLUSION: The primary school going children in Shillong had poor nutritional status but the majority of them had good personal hygiene practices. Mother's educational status played an important role in determining the nutritional and personal hygiene status of the children.

Sociodemographic variations in health-related quality of life (HRQOL) among elderly individuals in an urban locality in India.

BACKGROUND: Elderly population is growing rapidly in India. To direct public health actions to improve quality of life among elderly, it is important to understand the sociodemographic factors associated with quality of life. The aim of study was to assess health-related quality of life (HRQOL) among urban elderly in a setting of Assam, India, and to examine how HRQOL varied across different sociodemographic groups among the elderly populations. MATERIALS AND METHODS: A cross-sectional study was carried among elderly aged ≥60 involving 300 participants. Eight domains of HRQOL of participants were measured using RAND SF-36. Analysis of variance test was used to examine sociodemographic differences in HRQOL. RESULTS: The BP domain had highest (71.78 ± 22.25) and GH had lowest mean HRQOL score (48 ± 16.93). Males had significantly higher HRQOL score than females only in BP domain. Age gradients were observed with respect to HRQOl scores in five domains, with youngest age group having the best and oldest age group having the poorest HRQOL. Financially dependent subjects had lower HRQOL in five domains than those who were financially independent. Significant associations between education and HRQOL were found only in physical components of HRQOL, with lowest educated group being the most disadvantaged in terms of HRQOL. Marital status was found to be significantly associated with lower HRQOL scores. CONCLUSION: The study highlights sociodemographic inequalities in HRQOL among urban elderly in an Indian setting. The results may help reducing sociodemographic health inequalities among elderly in this region initiating public health actions paying more attention toward more vulnerable sections of populations.

Pattern of ocular morbidities: A cross-sectional study on school-going children in Shillong city.

INTRODUCTION: India is plagued by ocular morbidities in school-children. However, there exists paucity of studies, school health check-ups, and health education in the north-eastern region. This study aimed at estimating the prevalence and pattern of various ocular morbidities in school-going children of Shillong. METHODOLOGY: It was a school-based cross-sectional study done in Shillong, Meghalaya among 540 school-going children from class VI to X. Data were analyzed using SPSS version 23. RESULTS: The most common ocular morbidity was refractive error (57.4%) followed by vitamin A deficiency (38.1%), color blindness (3.1%), nevus (3%), manifest squint (2.2%), ptosis (2.2%), conjunctivitis (0.9%), stye (0.4%), etc., There was statistically significant association (P = 0.0192) among the variations of presence of ocular morbidities in the various age groups, among students attending Government or Private schools (P = 0.0430), and socio-economic status (P = 0.012). The prevalence of ocular morbidities was found to have highly significant association with the educational status of both the father (P = 0.0001) and mother (P = 0.001). In addition, the occupational status of the father (P = 0.0472) and the mother (P = 0.0251) were significantly associated with the prevalence too. CONCLUSION: The prevalence of ocular morbidities was found to be much higher than in other places of the country, which may be because of environmental factors and lifestyle combined with a lack of awareness and timely diagnosis and an absence of robust school health program. A regular screening along with specific health education campaigns can go a long way in decreasing the same.

Evaluation of thyroid function in type 2 diabetes in north-eastern part of India: A hospital-based study.

BACKGROUND: Diabetes mellitus (DM) and thyroid dysfunctions are the two most common endocrine disorders to come across in any clinical practice. Both thyroid hormones and insulin act antagonistically in metabolic pathways or cycles of cells. The aim of our study is to look for thyroid dysfunction in patients with type 2 DM and its correlation with insulin resistance (IR). METHODS: A cross-sectional study was carried out among 80 newly diagnosed type 2 diabetic patients. Thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, and insulin were measured in fasting serum sample. Homeostasis model assessment for IR was calculated as per formula. RESULTS: Among 80 diabetic patients, 20 were hypothyroid, 4 were hyperthyroid, and 56 were found to be euthyroid. IR was found to be significantly higher in hypothyroid as compared to euthyroid patients. A positive association was found between TSH and IR (r = 0.230) among hypothyroid patients though association was not significant. In hyperthyroid patients, a strong negative correlation (r = -0.94933) was found between TSH and IR, but no association was found among euthyroid patients. CONCLUSION: The inability to recognize the presence of thyroid hormone dysfunction may be one of the important causes of poor management of type 2 DM. Therefore, there is a need for routine assay of thyroid hormones in type 2 diabetic patients to improve the medical management as well as to reduce the morbidity in them.

Tobacco: Consumption pattern and risk factors in selected areas of Shillong, Meghalaya.

BACKGROUND: The percentage of adults above 15 years who consume tobacco in Meghalaya as per the Global Adult Tobacco survey is 55.2%. AIM: In the context of the high burden of tobacco use in Meghalaya, this study aims to study the consumption pattern and the sociodemographic correlates of tobacco use in the urban slums of Shillong, Meghalaya. MATERIALS AND METHODS: This study is a cross-sectional study conducted in adults over 15 years of age. Data collection was done by personal interview using a pretested questionnaire during house-to-house visit after taking informed verbal consent. RESULTS: A total of 400 people were included in this study. Most of the study population belonged to the age group 15-24 years (120, 30%). The majority of the study population (322, 80.5%) were aware of the health hazards of tobacco consumption. Most of the population (287, 71.75%) were tobacco consumers with 265 (76.4%) of them having co-addictions. In the study, 35% consumed smokeless forms, 30% were into smoking, and 35% consumed both forms. A significant association was observed between the status of tobacco consumption and knowledge of second-hand smoke harm (P = 0.019) as well as knowledge of any law regulating tobacco consumption (P = 0.026). CONCLUSION: It was observed that despite having a basic knowledge of the ill effects of tobacco, its consumption is still widely prevalent in the region. There is a need for stringent laws regarding tobacco consumption and proper measures should be taken to enforce these laws.

Association of secondary hyperparathyroidism with hemoglobin level in patients with chronic kidney disease.

PURPOSE: Secondary hyperparathyroidism (SHPT) is one of the less recognized reasons of anemia in chronic kidney disease (CKD). In this study, we evaluated the role of SHPT as a cause of anemia and correlation of intact parathyroid hormone (iPTH) and hemoglobin (Hb) level in hemodialysis (HD) patients. METHODS: This cross-sectional study was carried out in 63 individuals admitted in HD unit of the institute. Serum samples were collected and urea, creatinine, Hb, ferritin and iPTH levels were measured. Statistical analysis was carried out using the SPSS software (IBM, NY, USA). RESULTS: Mean ± standard deviation for serum urea, creatinine, Hb, ferritin and intact PTH were 177 ± 15.52, 15.16 ± 2.28 mg/dl, 7.03 ± 2.26 g/dl, 654.7 ± 563.4 ng/ml, 539.18 ± 493.59 pg/ml respectively. A reverse correlation was found between intact PTH and Hb level. CONCLUSIONS: A variety of postulated pathophysiological mechanisms linking SHPT and anemia in CKD are discussed. An efficient control of parathyroid hormone hypersecretion may be required to achieve a better management of anemia in HD patients.