Abdominal and Chest Ultrasonography: A predictor for disease progression in nonsevere dengue.

Background: Dengue is one of the most rapidly spreading arboviral infections in the world. Ultrasound is well established in abdomino-thoracic evaluation of patients with dengue infection. The aim of this study was to explore the role of ultrasound in predicting occurrence of severe infection in dengue patients and in predicting deterioration in patients with nonsevere dengue. Methods: The serologically proven dengue patients who reported to hospital during the study period were divided into three categories based on the dengue infection severity score. Ultrasound findings of abdomen and chest in these patients were noted in the initial, as well as follow-up scans and inferences drawn. Results: 61% belonged to the category of Dengue Fever, 35% were in Dengue Hemorrhagic Fever category, and 4% had Dengue Shock Syndrome. Positive ultrasound findings were seen to be significantly higher in patients with severe dengue. Logistic regression analysis revealed the presence of pericholecystic fluid to be significantly associated with the severe disease, while the presence of gall bladder wall edema, ascites, and any ultrasound finding were significantly associated with the disease progression. The odds of a patient with severe dengue having gall bladder wall edema, ascites, or any ultrasound finding were 2.74, 2.04, and 2.619 times, respectively. Conclusion: Our study indicates that positive findings on ultrasound are significantly higher in severe dengue and also that ultrasound can be reliably used to identify the patients with nonsevere dengue who are likely to progress to severe dengue.

To Study the Role of Serum Homocysteine Levels and Ocular Involvement in Retinal Vasculitis.

Idiopathic retinal vasculitis is a chronic disease of unknown aetiology which results in ocular morbidity in patients of productive age group. Homocysteine has been implicated in various ocular conditions like age-related macular degeneration, retinal vein occlusions, diabetic retinopathy, and optic nerve diseases. We conducted a study to investigate the relation between serum homocysteine levels and retinal vasculitis at a tertiary care centre in North India. In this case-control study, 32 cases and 64 controls were included and the duration was from June 2017 to March 2019. Serum homocysteine of cases and controls was detected by reflectance photometry using VITROS Chemistry Products HCY 2 (Homocysteine) and the normal range of serum homocysteine as per this method was 6.60 to 14.80 micro mol per litre. Our study found that of the total 32 retinal vasculitis patients, serum homocysteine was raised in 65.62% (21 cases out of 32) and in 70.31% of control group (45 out of 64). Chi square test results showed that there was no significant association found between S. homocysteine levels and Reticular vasculitis (P: 0.64). The two groups were comparable in terms of the age with mean ± SD in cases being 33.47 ± 8.336 years and controls being 35.16 ± 8.568 years with a P value of 0.37 being statistically insignificant. The data collected was analysed using SSPS-16 (Statistical Package for Social Sciences Version 16) software and test of association was Odd's ratio. Power of study was 80% and P < 0.05 is considered statistically significant. We found that there is no significant association between raised serum homocysteine and retinal vasculitis (with P < 0.64). Odds ratio was 0.80(0.33-1.99) implying that the cases and controls were statistically significantly different with respect to homocysteine levels.

Scoring system for activation of critical care air transport team for aeromedical evacuation.

BACKGROUND: Our hospital began work on formulating its own critical care air transport team (CCATT) and patient transfer unit (PTU) in 2007. A total of 293 patients have been evacuated by air using the various models of the PTU from April 2008 to February 2017. This study has been undertaken to formulate a protocol for activation of CCATT for aeromedical evacuation that best suits our setup keeping in view the availability of electromedical equipment, manpower and aircrafts. METHODS: The study is a cross-sectional study involving patients who were air evacuated between January 2010 to February 2017. Statistical analysis tests were performed to compare and analyze the two scoring systems to find out the sensitivity and specificity of the two scoring systems and to find out the degree of agreement. RESULTS: The data using each scoring system were compared with actual requirement of CCATT based on recommendation of team leader of each CCATT mission and available data of each patient. It was observed that the old scoring system showed poor agreement with kappa coefficient of 0.162. The new scoring system based on modified early warning physiological score showed good agreement with kappa coefficient of 0.895. CONCLUSION: CCATT can be activated by peripheral medical echelons based on objective criteria rather than subjective ones so that optimal use of resources can be carried out not only in peace time but also during mass casualty scenarios such as natural calamities or war.

Impact of individualized nutritional counseling on infant and young child feeding practices.

BACKGROUND: Improper complementary feeding practices are common in India, thus leading to malnutrition. The objective was to compare complementary feeding practices of mothers with children aged between 6 months and 2 years before and after individualized nutritional counseling. METHODS: This before-and-after interventional study was carried out in a tertiary care teaching hospital between June 2018 and August 2018 on 30 mothers attending an immunization clinic. Feeding practices were assessed using interview techniques with the Breastfeeding Promotion Network of India Maharashtra checklist for Complementary Food Counseling (Diet Audit), and scoring was carried out. Baseline data included history of inclusion of items from food groups such as cereals; pulses; vitamins A, C, and D; vegetables/fruits; milk/dairy products; non-vegetarian items; and iron-rich foods; and consumption of baby feeds and junk foods. Individualized counseling was given to all study subjects, which lasted for 30-40 min. Models of various food items were shown to mothers. Feeding practices were reassessed after 4 weeks of one-to-one counseling. RESULTS: Feeding by mothers improved significantly in the form of items from the total number of groups from 4.3 (1.4) to 5.6 (1.3) after nutritional counseling (p: 0.001). Consumption of junk foods decreased significantly from 4.3 (2.8) to 2.6 (1.8; p: 0.001) and baby foods decreased from 0.8 (0.7) to 0.2 (0.4; p: 0.001). CONCLUSION: Individualized nutritional counseling of mothers can improve complementary feeding practices and ensure food diversification.

Food Safety in Eating Establishments: Assessing Conformance of Eating Establishments to Food Safety and Standards Regulations.

INTRODUCTION: In view of the rising burden of the foodborne illnesses and the rise of eating out culture in India, food safety has assumed greater significance. The Food Safety and Standards Authority of India has prescribed food safety and standards regulations (FSSRs) for commercial eating establishments (EEs). The present study was carried out to ascertain conformance of the EEs to these regulations. METHODOLOGY: It was a cross-sectional study conducted on 74 EEs in a metro city in western Maharashtra from May to October 2019 using an interviewer-administered study tool based on FSSR 2011. The study tool covered critical domains such as food hygiene, equipments, health and personal cleanliness, training of food handlers, and product information. RESULTS: Seventy-four EEs included 29 restaurants, 21 bakeries, and 24 snack bars. The score ranged between 42.3% and 73.3%. Of 74, 20 (27%) EEs were placed in poor category (score <50%), Only 3 EE scored >70% and were rated as very good. Only 13 (17.6%) EEs were cleaning the food contact surfaces adequately, i.e. before and after each use, whereas 38 (51.4%) were not cleaning food contact surfaces at least daily. The knowledge regarding food handlers as potential carriers of disease was poor with 60.81% of the respondents having no knowledge about it. CONCLUSION: The study found significant gaps in EEs with respect to studied food safety domains of FSSR 2011.

Skin-to-skin contact at birth for vaginally delivered neonates in a tertiary care hospital: A cross-sectional study.

BACKGROUND: Neonates undergoing skin-to-skin contact (SSC) have shown to have better cardiovascular stability, improved duration of breastfeeding, temperature maintenance and bonding. The primary objective was to estimate the existing prevalence of SSC among mother-infant dyads in the first hour after vaginal delivery, and the secondary objective was to ascertain the factors affecting adherence of SSC after vaginal delivery. METHODS: This cross-sectional study was carried out in a tertiary care teaching hospital between September 2017 and December 2017. All mother-newborn dyads in the labour room were eligible for the study. Mothers with their newborns, who gave multiple births, or with major congenital malformations or those requiring any form of resuscitation or having respiratory distress or requiring observation in neonatal intensive care unit (NICU) were excluded. All included mother-newborn dyads, after exclusion, were observed for SSC, and the duration in each dyad was recorded. All enrolled mothers, the attending doctors and nurses were asked questions based on a prevalidated questionnaire for the possible barriers of implementation. RESULTS: Of a total of 164 mother-infant dyads studied, only 34 (20.7%) carried out SSC for more than 30 min. Sixty-two (37.8%) mother-infant dyads did not participate in any SSC. The commonest reason for non-adherence to SSC was unawareness about the practice in 82.25%, followed by pain and exhaustion after the labour process in 8%. CONCLUSION: The rate of SSC at birth is suboptimal, and the commonest reason is lack of awareness about this important step of essential newborn care.

Correlation of visceral body fat with waist-hip ratio, waist circumference and body mass index in healthy adults: A cross sectional study.

BACKGROUND: Visceral Fat (VF) is the underlying culprit for cardiovascular diseases, type 2 diabetes, breast cancer, etc. VF can be estimated at present only by using expensive instruments as Bio Impedance Analyzer (BIA), DEXA scanner, etc. Measurement of Waist-Hip Ratio (WHR) can be used as a proxy for VF. Hence, the present study was done to assess the role of WHR as appropriate technology for assessment of VF. The aim of this study was to find correlation of Visceral Fat Area (VFA) with (WHR), Waist Circumference (WC) and Body Mass Index (BMI) in young healthy adults. METHODS: It was a descriptive cross-sectional study conducted on 215 healthy adults over one year in Western Maharashtra. Biospace 720 was used to assess VF. Data was analyzed by using software SPSS version 20.0. In body 720 was used to assess VF of subjects. RESULTS: Majority 155 (73%) were males and 57 (27%) were females. Nearly half (42% of males, 49% of females) had VFA above cut off value (i.e. 100 cm2) and 42% of males had WHR >0.9 and 56% of females had WHR >0.8. We found a very strong correlation between VFA and WHR (r = 0.936, p < 0.05) among males and females (r = 0.920, p < 0.05) and correlation between WC and BMI with VFA (r = 0.739, r = 0.758) for males, (r = 0.774, r = 0.605) for females was modest. CONCLUSION: There is a strong correlation between VF and WHR. Measurement of WHR is simple, handy, and inexpensive tool which can be used as a surrogate to measure VF.

Maternal Ability to Correctly Detect Significant Jaundice in Indian Neonates.

BACKGROUND: The ability of mothers to correctly detect jaundice in their newborns is largely unknown. The objective was to ascertain the ability of mother to correctly detect the presence of significant jaundice in her newborn. MATERIALS AND METHODS: This cross-sectional study was conducted in a tertiary care hospital in eastern India from February 2015 to July 2016. All inborn neonates more than 34 weeks' gestation were included. Congenital malformations, perinatal asphyxia, neonatal sepsis, readmission after discharge, and isoimmunization were excluded. A total of 505 inborn newborns were independently assessed by the mother and the treating pediatrician for significant jaundice every day till discharge. Each newborn underwent total serum bilirubin estimation on suspicion of significant jaundice by either of the two or at discharge, whichever was earlier. RESULTS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of maternal detection of significant jaundice was 51.47%, 88.33%, 39.29%, and 92.12%, respectively. CONCLUSION: Mothers have poor sensitivity and PPV to detect significant neonatal jaundice in the Indian population.

Food poisoning outbreak in a religious mass gathering.

BACKGROUND: Food poisoning outbreaks are commonly seen in mass social events where food is prepared under temporary arrangements. This study reports a food poisoning outbreak in a city of western Maharashtra, India, where around 4000 people had consumed food during a religious community lunch and reported sick to the nearby hospital with complaints of diarrhea, abdominal cramps, fever with chills, and vomiting. METHODS: This was a retrospective-prospective study. Investigation of the food poisoning outbreak was conducted to identify the causes and recommend preventive measures. Interview method was used to elicit food history from the affected and non-affected persons. Inspection of the cooking area was conducted to find the likely source of contamination. RESULTS: A total of 291 patients reported sick after consumption of meal at a religious mass gathering. The range of incubation period was from 10 hours to 40 hours. Predominant features were diarrhea (100%), abdominal cramps (89%), fever with chills (81%), and vomiting (28.5%). Maximum relative risk of 14.89 was seen for green gram (moong dal) with 95% confidence interval of 2.16-102.6. Keeping the incubation period and clinical profile in view, the likely organisms are enteropathogenic Escherichia coli or Salmonella spp. CONCLUSION: Maintaining food safety during mass gatherings is a major challenge for public health authorities. The Food Safety and Standards Act (2006) in India brings the food consumed during religious gatherings such as 'prasad' and 'langar' under its purview and comprehensively addresses this issue.

Psychosocial determinants of stress among adolescents in an urban slum in a city of Western Maharashtra: a cross-sectional study.

INTRODUCTION: Stress is a major underlying factor in the manifestation of many mental disorders. The prevalence of stress among Indian adolescents varies from 13% to 45%. Hence, the present study was done to assess the psychosocial determinants of stress among adolescents in an urban slum. METHODOLOGY: This was a cross-sectional analytical study (community based) in an urban slum from January to July 17 with a sample of 230 adolescents aged 10-19 years. An Indian Council of Medical Research (ICMR) tool validated for use in the community was self-administered. Data was analyzed using SPSS 20.0. RESULTS: The commonest stressors were perceived threat to economic position (84.3%), economic difficulty of meeting expenses for treatment of self/family members (63.5%), upcoming exams (61). The stressors that occurred significantly more often (p < 0.05) in males as compared to females were related to sexual desire, conflicts in love affairs, getting a job/employment issues, exam failure and interpersonal relationships within the family. Stressors that occurred significantly more often (p < 0.05) in females than in males were fear of sexual abuse/assault. Significant correlates of the presence of stress were male gender, nuclear family and low family income (p < 0.05). CONCLUSION: The stressors in adolescents in an urban slum are both internal and external. There are gender differentials in type of stressors faced by adolescents.

A Comparison of Stress Response between Insertion of Gastro-laryngeal Tube and Endotracheal Intubation in Patients Undergoing Upper Gastrointestinal Endoscopic Procedures for Endoscopic Retrograde Cholangiopancreatography.

BACKGROUND: Complex gastrointestinal (GI) endoscopic procedures like endoscopic retrograde cholangiopancreatography (ERCP) require deep sedation or general anesthesia. Comorbidities with the poor physiological condition warrant endotracheal intubation to prevent hypoxia and aspiration. The gastro-laryngeal tube (GLT), a new supraglottic airway device with a separate channel for endoscope looks promising. AIMS: The aim of the study is to compare the stress response during insertion of GLT and endotracheal intubation (ETT) in patients undergoing upper GI endoscopic procedures like ERCP. SUBJECTS AND METHODS: This control versus comparison study comprised two groups with 30 patients each who underwent ETT and GLT insertion. The standard general anesthesia technique was used. In GLT group, the device was inserted without neuromuscular blocker. In ETT group, injection atracurium 0.5 mg/kg intravenous was administered as muscle relaxant for aiding endotracheal intubation. Hemodynamic parameters and time taken for the insertion of GLT/ETT were recorded. STATISTICAL ANALYSIS: Data were analyzed using SPSS version 20. Student's t-test was used to compare quantitative data between the groups. ANOVA test was applied for intragroup comparisons between GLT and ETT groups. Categorical variables were analyzed using the Chi-square test. RESULTS: Heart rate and mean arterial pressure increased from baseline in ETT group, following laryngoscopy and endotracheal intubation as well as with GLT insertion. However, the stress response caused by endotracheal intubation was significantly greater than that caused by GLT insertion. CONCLUSION: GLT as an airway device is a safe alternative with decreased stress response compared to endotracheal intubation for upper GI endoscopy procedures.

A descriptive study of clinico-hematological profile of megaloblastic anemia in a tertiary care hospital.

BACKGROUND: Megaloblastic Anemia (MA) is a relatively common disease, yet the data on prevalence of MA remains scarce. This study was conducted to study the prevalence and clinico-hematological profile of MA. METHODS: This was a cross-sectional study done on 1150 adult anemic patients. All patients diagnosed to have MA were studied for clinico-hematological and etiological profile. Nerve conduction studies (NCS) were done in all. RESULTS: MA was present in 3.6% cases of anemia. Severe anemia was seen in 9.7% of anemic patients and 75% of MA cases (p < 0.05). Forty five percent of MA patients presented with pancytopenia. Vitamin B12 and folic acid deficiency were documented in 40% and 25% cases respectively while combined deficiency was noted in 35% of all MA cases. There was no co-relation between severity of anemia and deficiency of either of the vitamins (Fischer exact test: 0.530). Among MA patients, 35% were vegetarians while 65% consumed mixed diet. There was no association between vegetarian diet and Vit B12 deficiency (p = 0.3137). An additional etiology was more commonly found in patients on mixed diet [92%; 24/26] as compared to those on vegetarian diet [50%; 7/14] (p = 0.04). NCS was abnormal in 14 patients (35%). Overt clinical neuropathy was present in 12 cases of MA, while subclinical neuropathy was seen in 2 cases. CONCLUSION: MA is one of common causes of pancytopenia and severe anemia. Diet plays an important role in causation of MA in vegetarians. An alternative etiology is however, more likely to be found in patients on mixed diet. While overt neurological abnormalities are common in MA, subclinical neuropathy is uncommon.

Sense of coherence and self reported health amongst medical students: A cross sectional study.

BACKGROUND: In late 70s, Antonovsky proposed a salutogenic theory. This theory was based on the assumption that the human environment causes stress, and sense of coherence could serve as a stress-resisting resource. This study examined association between sense of coherence and self rated health of medical students. The aim of this study was to determine the association between sense of coherence and self reported health among medical students. METHODS: This was a cross-sectional analytical study conducted among medical students. The study tool used was a pre-designed, pre-tested, structured and self administered questionnaire (SOC scale and the SF 12 version 2 self-rated health measure). 172 medical students participated in the study. The data collected was entered into Microsoft Excel and analyzed using SPSS 20. All students were educated about sense of coherence after the study. RESULTS: Among the respondents, there were 99 (57.6%) female students, and 73 (42.4%) were male. The mean age of the students was 20.8 + 1.20 years. The mean (±SD) SOC scale score was 56.15 (±7.83). The mean self rated health score was 53.52 (±7.11). Pearson's χ2 test was used to determine the association and there was significant association between students SOC and self reported health (p < 0.000). CONCLUSION: There is a significant association between score of sense of coherence scale and self rated health among medical students.

'Jago Grahak Jago': A cross-sectional study to assess awareness about food adulteration in an urban slum.

BACKGROUND: Food adulteration includes various forms of practices, including mixing, substituting, concealing the quality of food, etc. One of the main causes for rampant adulteration is ignorance of consumer regarding their right and responsibilities resulting in faulty buying practices. Hence, the present study was done to assess the knowledge about adulteration among consumers in an urban slum. METHODS: A community-based cross-sectional study was done among residents of an urban slum over a period of 2 months. Adults responsible for purchasing groceries for the household were included. A sample size of 100 was taken and pilot-tested questionnaire was administered. All of them were made aware about adulteration. RESULTS: The mean age of the study subjects was 40.2 ± 11.7 years. Only 7% of the study subjects were illiterate. Good practices like checking of Food Safety and Standards Authority of India (FSSAI) logo (90%), Agmark logo (76%) and nutrition label (65%) are lacking among the majority. The most prominent source of knowledge about adulteration is mass media especially television (65%). Almost 40% of the study subjects are unaware about the consumer empowering initiative 'Jago Grahak Jago'. Factors which had a strong positive relationship with good practices like checking of nutrition label, FSSAI logo, Agmark logo, seal and expiry date are age, education status and socio-economic status (p value ≤ 0.05). CONCLUSION: Majority of study subjects are unaware about adulteration. 'Jago Grahak Jago' initiative which empowers the consumers has to be instilled in the minds of consumers. Awareness and motivation will lead to empowerment and end the menace of food adulteration.

A Longitudinal Study to Assess the Role of Sanitary Inspections in Improving the Hygiene and Food Safety of Eating Establishments in a Tertiary Care Hospital of North India.

INTRODUCTION: Food safety inspections serve two purposes; determine compliance with the law and gather evidence for enforcement if there is noncompliance. The present study was conducted to assess the role of regular inspections on food safety in hospital premises. METHODOLOGY: This was an intervention based before and after study. A tool was prepared based on the Food Safety and Standards Regulations (FSSR) (in India) 2011. This included major, critical, and highly critical domains. Each item in the tool scored between 1 and 3 (poor, satisfactory, and good). Based on this, each eating establishment (EE) was given a score on conformance to FSSR 2011. Monthly inspection was made over a year and corrective actions were suggested. RESULTS: The minimum preintervention score was (41.28%), and maximum was (77.25%). There was no significant association between type of meal services and score EE (P > 0.05). Higher proportion of EEs within the hospital building had a satisfactory and good score as compared to EEs outside the hospital building but within hospital premises (P < 0.05). Postintervention, there was a significant change (increase) in the scores of EEs. There was a significant increase in mean scores of EEs under major domains namely maintenance, layout of equipment, monitoring an detection, and elimination of food sources to the pests. Under critical and highly critical domains personal cleanliness, training, and self-inspection by food business operators improved significantly. CONCLUSION: Regular inspections can improve the food safety standards in EEs.

Performance of Indian Diabetes Risk Score (IDRS) as screening tool for diabetes in an urban slum.

BACKGROUND: India is diabetic capital of world, with maximum number of diabetic patients. There is large burden of undetected diabetic cases in community. There is increasing risk of diabetes in urban slum, because of illiteracy, lack of awareness, low socioeconomic status and unhealthy life style. Madras Diabetes Research Foundation (MDRF) has developed Indian Diabetes Risk Score (IDRS) to detect undiagnosed Type 2 diabetes. The aim of this article is to study the performance of IDRS as screening tool for undiagnosed cases of Type 2 diabetes and to find the prevalence of undiagnosed Type 2 diabetes in an urban slum. METHODS: Screening for diabetes was carried out in an urban slum. The sample size was 155 (assumed prevalence of undiagnosed diabetes 9%). IDRS tool comprising of two modifiable (waist circumference, physical activity) and two non-modifiable risk factors (age, family history) for diabetes was used to assess the risk of diabetes anthropometry data was obtained. Conformation of diabetes was done using blood sugar levels on fasting venous sample. RESULTS: Mean and SD for age of study subjects were 49.68 ± 14.80 years, BMI 26.60 ± 8.51 kg/m2, waist hip ratio (females) 0.87 ± 0.06 cm, waist hip ratio (males) 0.95 ± 0.06 cm, waist circumference (females) 89.99 ± 10.95 cm, waist circumference (males) 89.44 ± 10.9 cm. IDRS predicted the risk of diabetes mellitus with sensitivity of 95.12% and specificity of 28.95% in individuals with score >60. CONCLUSION: IDRS can be used as an effective tool for screening undiagnosed diabetes in the community.

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women.

BACKGROUND: The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women. METHODS: 20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year. RESULTS: The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% (n = 1), urethral injury in 5% (n = 1) and urethral tape exposure in 10% (n = 2), at 3 months requiring tape sectioning. CONCLUSIONS: These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.

Effectiveness of an intervention package on knowledge, attitude, and practices of food handlers in a tertiary care hospital of north India: A before and after comparison study.

BACKGROUND: Food-borne illnesses have been a recognized hazard for decades. Recent promulgation of Food Safety and Standards Act (FSSA), 2006, indicates the concern of our Govt. for food safety. Research on effectiveness of food safety interventions in our country is remarkably scarce. Hence, the present study was conducted in a tertiary care hospital of north India to create evidence-based results for food safety interventions. METHODS: The study was before and after intervention trial which was registered with CTRI. Data collection was paperless using a software. All food handlers (n = 280) working inside the hospital were recruited. Intervention package comprised Self-Instructional Manual in Hindi for food handlers, short film for sensitization of food handlers on food safety titled 'Gravy Extra', and a documentary titled 'Food Safety from farm to Fork'. Chi square test, paired t test, and Wilcoxon sign rank test were used. RESULTS: The mean age of food handlers was 35 ± 2 years. Majority (61.7%) of food handlers were educated less than 10th standard. Nearly 60% of them had up to five years of experience. At base line majority (68.9%) had a fair knowledge about food safety issues. There was a significant improvement in food safety knowledge and practice score of food handlers after the intervention (p < 0.05). Their attitude toward food safety changed in a positive direction (p < 0.05). CONCLUSION: The intervention package was useful in improving the knowledge, creating a positive attitude and enhancing the food safety practices of food handlers working inside a tertiary care hospital.

Low prevalence of anaemia among the wives of serving personnel in a military station: A community-based study.

BACKGROUND: Various studies in India have reported the prevalence of anaemia to be more than 50% among women of the reproductive age group. A community-based study was done to find out the prevalence of anaemia in non-pregnant, non-lactating wives of serving soldiers in a military station. METHODS: It was a cross-sectional study. The sample size was 600. Venous blood was collected for haemoglobin and ferritin levels. Analysis was done by SPSS 20. RESULTS: The mean age at marriage was 19.8 years (SD + 2.76). The average age at first childbirth was 20.88 years. Major symptoms reported were weakness (24.34%), giddiness (23.47%), fatigue (20.17%) and heavy bleeding (3.13%). Prevalence of anaemia in our study was 13.9%, which is much below the national prevalence. Prevalence of iron-deficient status was reported in 153 (26%) individuals. Out of these, 81 subjects were non-anaemic (Hb > 12d/dL) but were iron deficient (ferritin <15 µg/L). Sixty out of these 81 subjects reported presence of fatigue and 36 had weakness. Statistically significant associated observations of anaemia were low Body Mass Index, irregular menstrual pattern, shortened menstrual cycle and increased duration of bleeding (p < 0.05). Low ferritin levels were significantly associated with low BMI, not using Oral Contraceptive Pills and bleeding for more than 3 days during menstrual cycle (p < 0.05). CONCLUSION: The scenario of low prevalence of anaemia in women under the cover of the Armed Forces Medical Services represents an 'island of excellence'.

A cross-sectional study to assess awareness about menstruation in adolescent girls of an urban slum in western Maharashtra.

INTRODUCTION: Reproductive health of adolescent girls is crucial as it determines the health of future generations. School girls when experiencing menarche find themselves in a setting without water, toilets or a supportive female teacher to explain the changes happening in their body. An important concern for adolescent girls is to have adequate, correct knowledge along with facilities and the cultural environment to manage menstruation hygienically and with dignity. Hence, the present study was done to assess knowledge and practices about menstruation in adolescent school girls of an urban slum. METHODOLOGY: This was a descriptive cross-sectional study conducted among girls of a Government School located in an urban slum of western Maharashtra. A total of 250 girls participated. Data collection was through a pilot-tested questionnaire. The data thus collected were entered into Microsoft Excel and analyzed using the SPSS 20 software. All girls were educated about menstrual hygiene after the study. RESULTS: The mean age of the students was 14.9±1.75 years. The mean age at menarche was 11.97 (95% CI: 11.94-11.99). It was observed that only half (56.4%) had acquired prior knowledge about attaining menarche. Out of these in a large proportion, the knowledge was imparted to them by their mothers (60.7%), followed by friends (31.8%). There was no significant association between educational status of mother and awareness in respondent about menstruation. Regarding the organ of menstrual blood flow, half (50.7%) knew the correct answer (i.e. uterus); whereas the rest believed that it was stomach/kidney, etc. Most of the school girls (90.5%) used sanitary pads. Almost 90% of the young women faced physical complaints or health problems during menstruation. Most of the participants had some kind of restrictions on them during the menstruation and most of these were religious restrictions (69.7%) followed by physical (41.2%) and social restrictions (22.3%). All of them were unsatisfied with the toilets and hand washing facilities available inside the school premises. CONCLUSION: Correct knowledge in adolescent young girls regarding menstruation is lacking. Lack of awareness is a roadblock in adopting safe and hygienic menstrual practices. It also hinders them from overcoming traditional beliefs, misconceptions and restrictions regarding menstruation. This will empower them as they transition into womanhood.