COVID-19 and tuberculosis co-infection: a neglected paradigm.

COVID-19 has been affecting mankind round the globe. The incidence of this infectious disease of respiratory origin is constantly on rise. Another infectious disease widely prevalent is tuberculosis (TB). During past corona virus pandemics of Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome, coinfection with TB was seen. We present this review as the co-infection of COVID-19 with TB has not been assessed yet, imposing a greater global threat. We suggest few measures to be implemented without delay for effectively screening the suspects of co-infection and also follow up of non-suspect patients in the post-pandemic phase.

Meta-analysis of efficacy of iron and iodine fortified salt in improving iron nutrition status.

BACKGROUND: Salt fortification with iron is a potential strategy to increase population-level iron intake. The current evidence regarding double-fortified salt (DFS) in improving iron nutrition status is equivocal. OBJECTIVE: To study the efficacy of DFS as compared to iodine fortified salt (IS) in improving iron nutrition status. METHODS: Randomized controlled trials comparing DFS and IS until August 2016 were systematically searched across multiple databases to assess for change in mean hemoglobin (Hb), prevalence of anemia, iron deficiency (ID), ID anemia (IDA), serum ferritin, and serum transferrin receptor (TfR). Meta-analysis was performed using R software. RESULTS: Of the initial 215 articles retrieved using the predetermined search strategy, data from 10 comparisons of DFS and IS across 8 randomized controlled trials are included. There was significant heterogeneity across included studies and the studies were of low to very low quality as per GRADE criteria. DFS significantly increased mean Hb by 0.44 g/dl (95% confidence interval [CI]: 0.16, 0.71) and significantly decreased anemia (risk difference -0.16; 95% CI: -0.26, -0.06) and ID (risk difference -0.20; 95% CI: -0.32, -0.08) as compared to IS. There was no statistically significant difference in change in ferritin levels (mean difference 0.62 µg/L; 95% CI: -0.12, 1.37), serum TfR levels (mean difference -0.23 mg/dL; 95% CI: -0.85, 0.38), and IDA (risk difference -0.08; 95% CI: -0.28, 0.11). CONCLUSION: DFS is a potentially efficacious strategy of addressing anemia as a public health problem at population level. There is a need for effectiveness trials before DFS can be scaled up in program mode at population level.

Sensitivity and Specificity of Pulse Oximetry and Ankle-Brachial Index for Screening Asymptomatic Peripheral Vascular Diseases in Type 2 Diabetes Mellitus.

OBJECTIVES: To compare pulse oximetry and Ankle-Brachial Index (ABI) with duplex ultrasonography as reference standard to determine the diagnostic accuracy for screening asymptomatic PVD in type 2 diabetes mellitus. METHODS: This cross-sectional study was conducted in 2012 at tertiary hospital in Madurai among diabetic patients attending the medicine outpatient department (OPD). Type 2 Diabetes Mellitus patients, asymptomatic with regards to symptoms and signs of PVD, aged above 40 years were included. Pulse Oximetry was performed using a pulse oximeter and ABI using sphygmomanometer cuffs and duplex ultrasonography of femoral, popliteal, tibial, posterior tibial and dorsalis pedis arteries. A diagnosis of PVD was based on: monophasic waveforms in any artery by duplex ultrasonography, toe saturation being less than finger saturation by >2% or if foot saturation decreased by >2% in an elevated position and an ABI <0.9. RESULTS: Among 120 patients included in the study, prevalence of PVD was 22.5% (95% CI: 15.9, 30.8). The PVD group had a higher proportion of elderly, males, current smokers, long-standing diabetics and comorbidities. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of pulse oximetry were 74.1% (95% CI: 55.3, 86.8), 95.7% (89.4, 98.3), 83.3% (64.1, 93.3) and 92.7% (85.7, 96.4) respectively, while those of ABI were 70.3% (51.5, 84.2), 87.1 (78.8, 92.5), 61.3% (43.8, 76.3) and 91.0% (83.3, 95.4) respectively. Parallel testing had net sensitivity increased to 92.3% and net specificity decreased to 83.3%. Performances did not differ across the subgroups. CONCLUSIONS: Pulse oximetry was atleast as good as ABI for the screening for asymptomatic PVD among diabetics.

Association between increased screen time, sedentary behavior, and insomnia among Indian adults: A cross-sectional nationwide online survey.

Context: During the "coronavirus disease 2019 (COVID-19)" pandemic, screen time saw a notable increase, ranging from 2.5 to 7.5 hours per day. Scientific evidence has demonstrated a strong correlation between heightened digital media usage and heightened levels of stress, anxiety, and depression. Research indicates that engaging in screen time for four hours or more daily can elevate the likelihood of experiencing symptoms of depression among children and adolescents by 46-80%. Despite this, there remains a paucity of medical evidence elucidating the intricate interplay between screen time, physical inactivity, and insomnia in adults. Aim: The aim of the study was to estimate the prevalence of increased screen time, insomnia, and physical inactivity among adults and their association during the COVID-19 pandemic. Settings and Design: A cross-sectional study through an online Google Form questionnaire was conducted among the Indian population. Methods and Materials: The study was conducted between June and August 2020 and comprised 658 participants aged 18 and above. Participants were recruited using a chain sampling procedure, with the majority being female, accounting for 54% (355 individuals). Statistical Analysis: The mean and standard deviation were calculated for numerical variables, while percentages and proportions were determined for categorical variables. The Chi-square test was employed to examine associations between variables. For assessing the predictors of screen time, a multivariate logistic regression analysis was conducted. Results: The majority of participants reported screen time exceeding 2 hours per day (85%), clinical insomnia symptoms (59%), moderate to high physical activity levels (92.8%), and low levels of sedentary behavior (60.5%). Variables such as gender, age, and screen time demonstrated significant associations with insomnia and physical activity. The odds ratio for insomnia in relation to screen time was 2.84 (95% confidence interval: 1.78-4.58) with a P value of 0.001. Multivariate logistic regression analysis indicated that increasing age was significantly associated with lower levels of screen time. Conclusions: Screen time showed a significant association with insomnia. Less screen time was reported with increased age.

Morbidity Profile and Healthcare Service Utilization Pattern Among Geriatric Population in the Rural Himalayan Region of Uttarakhand, India: A Cross-Sectional Study.

OBJECTIVES: The increasing elderly population, along with their health problems, is a matter of concern, especially in the difficult terrains of the hilly Himalayan region of northern India. Hence, the present study was conducted to assess the healthcare-seeking behavior of the elderly and adherence to medication. METHODS: The present community-based cross-sectional study was conducted on 250 elderly participants by a consecutive sampling method. Data were collected during the months of July 2021 to October 2021 after obtaining institutional ethical clearance. Bivariate logistic regression was done to assess factors associated with healthcare services utilization patterns and adherence to medications in chronic diseases. Significant factors were then analyzed with a multivariate logistic regression model. Variables with p-value <0.05 on multivariate analysis were considered statistically significant. RESULTS: The mean age of the study participants was 67.2 (±8.09) years, and 52% were males. Chronic illness was diagnosed in 45.6% participants. Only 121 (48.4%) participants were aware of health insurance schemes among whom 95 (38%) were registered. Appropriate healthcare-seeking behavior for acute illness episodes was seen in 68.9% of participants. A government healthcare facility was the most preferred facility. Low adherence to chronic disease medication was seen in 41.2%. Participants registered under any health insurance scheme had higher adherence to medications (OR=0.36; 95% CI, 0.15-0.86; p-value=0.02). CONCLUSIONS: The majority of the participants preferred government healthcare facilities. Registration under any health insurance scheme was found to significantly influence adherence to medications. Further qualitative studies can be of paramount importance in understanding the perspectives of the geriatric population in the study area.

Tenofovir-based first-line regimen in newly diagnosed HIV-patients: An experience from a Tertiary Care Hospital in India.

Introduction: India has a huge burden of HIV/AIDS infection. Tenofovir-based first-line therapy is the preferred treatment for newly diagnosed cases of HIV infection. Materials and Methods: The present prospective study was done among newly diagnosed cases of HIV infection. The patients were followed up for 6 months from the day of enrollment. Sociodemographic parameters, CD4 counts, and adverse drug reactions (ADRs) were analyzed at baseline and after 6 months. Bivariate and multivariate logistic regression was performed with the occurrence of ADRs as outcome variable. Results: In this study, 67 patients were enrolled with a mean age of 32.75 (±14.39) years. Mean CD4 count at the start of treatment was 241.5/mm3. The mean difference in CD4 count was 383.05/mm3 (standard deviation = 274.9). Dizziness, tingling, numbness of extremities, and muscle cramps were the most common adverse effects. On multivariate logistic regression, the occurrence of ADRs was seen to be significantly higher only in illiterate patients. Conclusion: The present study highlights the importance of long-term follow-up of the patients on antiretroviral therapy. Adequate monitoring of the treatment parameters is of utmost importance.

Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India.

Background: Acceptance of vaccines has been on a decline in recent times, with vaccine hesitancy being listed as one of the top 10 global health threats. This study analysed vaccine hesitancy and belief towards vaccination among caregivers of children aged below 5 years. Methods: In this cross-sectional study, 196 caregivers of children aged 6 months to below 5 years who had attended an immunization clinic at a tertiary care institute of Eastern India from March to May 2019 were surveyed. Consecutive sampling was used to recruit eligible study participants. The survey assessed the attitudes of parents towards childhood vaccination by using the Vaccine Hesitancy Scale and their beliefs towards vaccination. Univariate analysis was performed to assess the association of various sociodemographic factors with vaccine hesitancy. Results: Among the caregivers, most (48%) mothers were aged 26-35 years, literate and homemakers. Vaccine hesitancy was observed in 9.18% of the participants. Only the age of the child was significantly associated with vaccine hesitancy. Nearly half (48.5%) of the participants were concerned about the serious adverse effects of vaccines, and a third (30.6%) agreed that newer vaccines are associated with higher risks than the older ones. Caregivers felt that vaccines are no longer required for uncommon diseases. Conclusion: Concerns regarding vaccine hesitancy are prevalent even among caregivers attending a tertiary care institute. Thus, additional studies are required to assess hesitancy in urban, rural, remote and inaccessible areas. Policymakers ought to conduct periodic assessments and implement necessary remedial measures for the long-term sustenance of the benefits of the national immunization programme.

Association between Gestational Diabetes Mellitus and Postpartum Depression among Women in Eastern India: A Cohort Study.

Background: The study was planned to evaluate the association between Gestational Diabetes Mellitus (GDM) and Postpartum Depression (PPD) in a rural population of Odisha, Eastern India. Material and Methods: Pregnant women in the first trimester were recruited and followed up till six weeks of postpartum. Gestational Diabetes Mellitus was assessed with 75 grams glucose challenge test and PPD was assessed at six weeks after delivery with Edinburgh Postnatal Depression Scale. Statistical difference between variables was assessed using Chi-square test, Fischer's exact test, and unpaired T-test. Covariates were adjusted using bivariate and multivariate logistic regression to estimate the association between GDM and PPD. Results: Out of 436 pregnant women recruited, 347 (89.6%) remained in the study. Prevalence of GDM was 13.9% (95% CI: 10.7-17.3) and PPD was 9.8% (95% CI: 6.6-12.9). Incidence of PPD in the GDM group was 14.58% (95% CI: 4.2-24.9) and in women without GDM was 9.06% (95% CI: 5.76-12.3). However, the association was not significant on multivariate logistic regression (Risk Ratio (RR) = 1.56, 95% C.I: 0.61-6.16; P-value = 0.35). Conclusion: This study demonstrated that women with GDM were at higher risk of developing PPD suggesting that an "at risk" approach should be implemented for screening.

Hypothyroidism in Pregnancy: An Alarming Concern in a Rural Community of Eastern India.

Introduction: Hypothyroidism exerts a multitude of effects on pregnant women and newborns. This study aimed to estimate the prevalence of hypothyroidism and its associated factors among pregnant women. Material and Methods: This cross-sectional study was done at a community health center in Tangi, Eastern India. A total of 436 pregnant women ≤24 weeks gestation attending the ante-natal clinic were recruited by consecutive sampling after obtaining written informed consent. Those who were a known case of any psychiatric disorder and were not able to comprehend interview questions were excluded. Estimation of serum thyroid stimulating hormone levels was done at the central laboratory of the All India Institute of Medical Sciences, Bhubaneswar. Analysis was done using STATA 17.0 and presented as means or proportions. The association of hypothyroidism with various sociodemographic factors was analyzed with bivariate logistic regression. Results: Mean age of the study participants was 23.9 years (SD: 3.65). About 31.4% of participants were found to have hypothyroidism. On bivariate logistic regression, the presence of hypothyroidism was not associated with any variable. Conclusions: Hypothyroidism is widely prevalent in pregnant females in rural India. Screening of high-risk pregnant females followed by appropriate management is essential.

Safety and efficacy of Vitamin D3 supplementation with Imatinib in Chronic Phase- Chronic Myeloid Leukaemia: an Exploratory Randomized Controlled Trial.

OBJECTIVES: The study aimed to compare early molecular response (EMR) rates at 3 months of imatinib therapy with and without vitamin D3 supplementation in patients newly diagnosed with chronic-phase chronic myeloid leukaemia (CML-CP). The secondary objective was to assess the effects of vitamin D3 on complete haematological response (CHR) and its safety. DESIGN: Double-blind, placebo-controlled, exploratory randomised trial. SETTING: Tertiary care hospital in northern India. PARTICIPANTS: Treatment-naive patients with chronic phase chronic myeloid leukaemia (n=62) aged >12 years were recruited from January 2020 to January 2021. Patients with progressive disease, pregnancy and hypercalcaemia were excluded. INTERVENTION: Oral vitamin D3 supplementation (60 000 IU) or matched placebo was given once weekly for an initial 8 weeks along with imatinib after randomisation with 1:1 allocation ratio. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was to compare EMR (defined as BCR-ABL1 transcript level ≤10%, international scale) at 3 months. The secondary outcomes were to compare effect of the intervention on CHR, correlation of 25(OH)2D3 levels with treatment response and safety according to Common Terminology Criteria for Adverse Events (CTCAE) version 5. RESULTS: At baseline, 14.5% of the patients had normal vitamin D3 levels. EMR at 3 months was attained in 24 patients (82.7%) of the vitamin D3 group and 21 (75%) of the placebo group (OR 1.6, 95% CI 0.37 to 7.37, p=0.4). A significant difference in vitamin D3 levels from baseline to the end of study was observed. Patients with vitamin D3 supplementation did not achieve higher CHR in comparison with placebo (OR 1.3, 95% CI 0.25 to 7.23, p=1.0). Vitamin D3 levels were not significantly correlated with BCR-ABL1 levels. No dose-limiting toxicities were observed. CONCLUSION: Vitamin D3 levels were low among patients with CML-CP in this study. Vitamin D3 supplementation with imatinib therapy did not have significant effect on EMR or CHR. Further clinical trials could be undertaken to assess the effective dosage and duration of vitamin D3 supplementation in these patients. TRIAL REGISTRATION NUMBER: CTRI/2019/09/021164.

Association of Serum Hepcidin With Preeclampsia: A Systematic Review and Meta-Analysis.

The objective of the present systematic review and meta-analysis was to compare the levels of serum hepcidin in women who developed pre-eclampsia with those who did not. The databases PubMed, Embase, Scopus, Cochrane, and references of retrieved articles published till September 2020 were searched with no language restriction. Mean differences in iron regulating protein (hepcidin) were compared using a random-effects model based on the level of heterogeneity. A total of 760 individuals were included in the analysis from seven studies. The pooled estimate showed that mean hepcidin levels were significantly higher in women who developed pre-eclampsia [0.3 ng/ml, 95% confidence interval (CI): 0.01-0.59, p=0.003] as compared to women who did not develop pre-eclampsia. Further research can be done to assess the levels of various iron parameters in different trimesters of pregnancy and their association with pre-eclampsia.

Psychosocial Distress and Quality of Life Among Patients With a Chronic Skin Disorder at a Tertiary Care Hospital in Eastern India: A Hospital-Based Case-Control Study.

Background Chronic skin disorder affects the physical and psychological well-being of patients. The impact of psychological burden ranges from low self-esteem and stress to anxiety and depression. Hence, this study was conducted to compare the psychological distress and quality of life (QoL) of patients with a comparative group without any apparent skin disorders. Methods This hospital-based case-control study was done on adult patients (≥18 years) suffering from any chronic skin disorder for three or more months and attending the dermatology out patient department (OPD) of a tertiary care institution of Eastern India. Data was collected from 101 patients and 101 controls (matched for age, gender, and place of residence) after obtaining written informed consent in May and June, 2017. Depression was assessed using the Patient Health Questionnaire-9, anxiety was assessed using the Generalised anxiety disorder-7 scale, and health-related quality of life (HRQoL) was assessed using the World Health Organization Quality-of-Life Scale (WHOQoL-BREF). Prevalence and mean scores were compared using Chi-square test and t-test. Results About half (49.5%) of the cases had clinically significant impairment of their dermatological quality of life. Clinically significant depression and anxiety was found in 45.54% and 41.58% patients respectively. Depression (OR=4.13, 95% CI 2.06-8.45) and anxiety (OR=4.42, CI=2.13-9.51) were significantly higher in cases as compared to the controls. No significant difference was seen in HRQoL scores. Conclusion Screening for anxiety, depression, and QoL should be done for patients of chronic skin disorders attending dermatology OPD so that appropriate psychiatric consultation can be offered to those in need.

Frequency of anemia and micronutrient deficiency among children with cleft lip and palate: a single-center cross-sectional study from Uttarakhand, India.

BACKGROUND: Children with cleft lip and/or palate can be undernourished due to feeding difficulties after birth. A vicious cycle ensues where malnutrition and low body weight precludes the child from having the corrective surgery, in the absence of which the child fails to gain weight. This study aimed to identify the proportion of malnutrition, including the deficiency of major micronutrients, namely iron, folate and vitamin B12, in children with cleft lip and/or palate and thus help in finding out what nutritional interventions can improve the scenario for these children. METHODS: All children less than 5 years with cleft lip and/or cleft palate attending our institute were included. On their first visit, following were recorded: demographic data, assessment of malnutrition, investigations: complete blood count and peripheral blood film examination; serum albumin, ferritin, iron, folate, and vitamin B12 levels. RESULTS: Eighty-one children with cleft lip and/or palate were included. Mean age was 25.37± 21.49 months (range, 3-60 months). In 53% of children suffered from moderate to severe wasting, according to World Health Organization (WHO) classification. Iron deficiency state was found in 91.6% of children. In 35.80% of children had vitamin B12 deficiency and 23.45% had folate deficiency. No correlation was found between iron deficiency and the type of deformity. CONCLUSION: Iron deficiency state is almost universally present in children with cleft lip and palate. Thus, iron and folic acid supplementation should be given at first contact to improve iron reserve and hematological parameters for optimum and safe surgery.

Yellow fever vaccination: how much do travelers from Eastern India know?

Introduction: International tourism has grown tremendously in the past 2-3 decades in India resulting in exposure of travelers to varied spectrum of diseases prevalent in different parts of the world. Immunization plays a prominent role in protection of the exposed individuals. The objective of the present study was to assess the awareness and knowledge regarding yellow fever and other travel vaccinations amongst travelers of eastern India. Materials and methods: In the present cross-sectional study, participants attending Yellow Fever Vaccination Clinic at All India Institute of Medical Sciences, Bhubaneswar, during August-September 2018 were approached. Newly registered participants aged 15 y and above were interviewed consecutively till the required sample size of 300 was fulfilled. Awareness and knowledge regarding travel vaccinations and their adverse effects were assessed with pretested structured interview schedule. Bivariate and multivariate logistic regressions were done to assess the association of various factors with awareness of travel vaccinations. Results: Among the participants, most of them were males (90.7%), belonged to the age group of 15-45 y (87.3%), married (64.3%), graduates (19%), and were working (78.3%). Most of the participants were traveling to South Africa (85.4%). Only 57.3% participants were aware of any travel vaccinations. Only 37.5% participants knew that yellow fever vaccine confers lifelong immunity. On multivariate logistic regression higher education, working occupation and history of previous vaccination were significantly associated with awareness of travel vaccinations. Conclusion: Awareness regarding travel vaccinations is important to prevent fatal diseases like yellow fever. Vital information pertaining to diseases in different locations and availability of vaccines for prevention needs to be disseminated to the travelers to prevent occurrence of travel bound diseases.

A study of adherence to antiretroviral therapy in a tertiary care hospital at Allahabad, India.

INTRODUCTION: India has a large proportion of the global HIV-infected patients. Antiretroviral therapy (ART) is the cornerstone of HIV treatment. Antiretroviral drugs are highly toxic and lead to diverse adverse drug reactions (ADRs). Adherence to medications plays a prominent role in success of the therapy. This prospective study was done to study the adherence and analyze its associated factors. METHODOLOGY: The present study was conducted at ART Centre, Swarup Rani Hospital, Allahabad, Uttar Pradesh, India. Selection of the patients was done based on systematic random sampling method. Baseline enrollment was done over 2 months and follow-up was done monthly over 6 months. Information regarding sociodemographic profile, ART regimen, occurrence of ADRs, adherence to ART and factors affecting adherence was collected. Bivariate logistic regression was done to analyze the association of selected variables with adherence. RESULTS: This study enrolled 163 participants among which 152 participants completed the study. During the study period, 94 participants reported the occurrence of at least one ADR. Nonadherence to ART therapy was seen in 31.6% of patients. The most common reason was forgetting to take the medicine (21.8%) followed by occurrence of ADRs (18.3%). No statistically significant association of nonadherence was found with the selected variables. CONCLUSION: Comprehensive research to assess nonadherence to ART therapy is the need of the hour. Policy formulations ought to be made to assess and promote effective adherence to enhance the longevity and quality of life of people living with HIV/AIDS. Concerted efforts by government and intersectoral collaboration are further needed to sustain promotive measures.

Acute morbidity profile and treatment seeking behaviour among people residing in an urban resettlement colony in Delhi, India.

BACKGROUND: Rapid urbanization has resulted in increased burden of communicable and non-communicable diseases, especially among urban poor population. In the absence of a well-functioning three tier health care system in urban India, health needs of urban poor are rarely fulfilled. The objective of this study was to assess primary health care services utilization pattern and its associated selected socio-demographic determinants in an urban population of Dakshinpuri Extension, South-east district of Delhi. MATERIALS AND METHODS: A community based cross-sectional study was done from November 2013 to November 2014 with a sample size of 440 households through simple random sampling. Information was obtained regarding the socio-demographic characteristics and morbidity pattern of all the members of household in the preceding one year of the conduct of the present study through a pretested semi structured interview schedule. Association of various socio-demographic characteristics with primary and secondary health care facilities utilisation was studied with bivariate and multivariate logistic regression. RESULTS: In this study, 42% of the household members suffered from acute illnesses and symptoms in the preceding one year. Secondary/tertiary health care facilities were approached mostly for seeking treatment. Majority of the household members sought treatment from private health care facilities. Significantly higher utilisation of secondary/tertiary health care facilities was found by head of households and household members who are married. CONCLUSION: Primary health care system needs to be revamped to improve healthcare delivery among urban population. Strategies to decongest secondary/tertiary health care facilities in urban India needs focus.