A comparative study of mortality differences and associated characteristics among elderly and young adult patients hospitalised with COVID-19 in India.

INTRODUCTION: Studies have shown that elderly have been disproportionately impacted by COVID pandemic. They have more comorbidities, lower pulmonary reserve, greater risk of complications, more significant resource utilization, and bias towards receiving lower-quality treatment. OBJECTIVES: This research aims to determine the characteristics of those who died inhospital due to COVID illness, and to compare these factors between elderly and young adults. METHODS: We conducted a large retrospective study at a government run center in Rishikesh, India, from 1st May 2020 till 31st May 2021, and divided study population into adults (aged 18 to 60 years) and elderly (aged 60 years). We evaluated and compared our data for presenting symptoms, vitals, risk factors, comorbidities, length of stay, level of care required, and inhospital complications. Long-term mortality was determined using telephonic follow-up six months after discharge. RESULTS: Analysis showed that elderly had 2.51 more odds of dying inhospital compared to younger adults with COVID. Presenting symptoms were different for elderly COVID patients. The utilization of ventilatory support was higher for elderly patients. Inhospital complications revealed similar profile of complications, however, kidney injury was much higher in elderly who died, while younger adults had more Acute Respiratory Distress. Regression analysis showed that model containing cough and low oxygen saturation on admission, hypertension, Hospital Acquired Pneumonia, Acute Respiratory Distress Syndrome, and shock, predicted inhospital mortality. CONCLUSION: Our Study determined characteristics of inhospital and long-term mortality in elderly COVID patients and compared them from adults, to help better triaging and policy making in future.

Assessment of Vitamin D Levels and Other Bone Related Biochemical Markers in Healthy Adults in Rural Population of Uttarakhand, India.

Despite being close to equator and receiving sufficient sun rays, evidences revealed that Indians have severe deficiency of vitamin D (vit D) ranging from 41 to 100% in different geographical locations. Therefore, in this study levels of 25(OH)D (physiologically measurable form) along with other bone metabolism associated biochemical markers were determined in serum sample of 300 apparently healthy study subjects (rural) from Doiwala block of Dehradun district in the state of Uttarakhand. Demographic data was also obtained based on a structured questionnaire to establish an association between 25(OH)D levels and various dietary and socio-cultural factors. Results demonstrated that of all study subjects, 197 (65%) had 25(OH)D levels below < 12 ng/mL (deficient) and 65 (21%) had 25(OH)D levels between 12 and 20 ng/mL (insufficient) with all other markers falling within respectively established reference ranges. Further, in univariate analysis, gender, occupation (indoor and outdoor), education were independently associated with vitamin D status. Additionally, parathyroid hormone associated significantly with gender and occupation, while calcium associated significantly with gender, occupation and education. Lastly, regression analysis revealed that gender and occupation independently associated with vitamin D status of subjects. In conclusion, apparently healthy subjects showed considerable vitamin D deficiency thereby generating an urgent need for formulating and implementing better government policies for enrichment of vitamin D levels among rural adults of Uttarakhand in future. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01048-6.

Predictive Value of Frailty Index in Comparison to Traditional Markers of Sepsis in Predicting Mortality among Elderly Admitted in Tertiary Care Hospital.

INTRODUCTION: The frailty index's potential as a prognostic marker of sepsis is so far been untapped. Here we studied the predictive value of frailty index in the elderly with sepsis. METHODS: This prospective cohort study was conducted in a tertiary level hospital in North India. The duration of the study was 18 months starting from January 2020 to July 2021. The frailty index was calculated along with traditional markers of sepsis such as sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), and systemic inflammatory response syndrome (SIRS) within 24 hours of admission in elderly patients suspected to have sepsis. The area under the receiver operating characteristic (AUROC) of frailty index, SOFA, qSOFA, and SIRS was compared for in-hospital and 3-month mortality. RESULTS: There was no significant difference between the performance of the frailty index and SOFA (DeLong's test p = 0.242) in predicting in-hospital mortality, but there was a statistical difference between the AUROC of SOFA score (AUC = 0.548) and frailty in predicting 3-month mortality (DeLong's test p ≤0.001). CONCLUSION: The frailty index had greater sensitivity and negative predictive value among the other scores in predicting in-hospital mortality, whereas SOFA had higher specificity in predicting in-hospital mortality. The frailty index was superior to SOFA and the other prognostic markers of sepsis in predicting 3-month mortality.

Comparison of home-based pencil push-up therapy and office-based orthoptic therapy in symptomatic patients of convergence insufficiency: a randomized controlled trial.

PURPOSE: To assess and compare the effectiveness of home-based pencil push-up therapy (PPT) and office-based orthoptic therapy (OBOT) in patients with convergence insufficiency. METHODS: In this randomized clinical trial, 176 symptomatic patients with convergence insufficiency, aged between 9 to 30 years, were randomly assigned to receive 6 weeks of home-based PPT (Group I) or OBOT (Group II) after determining refractive error, near point of convergence (NPC), convergence insufficiency symptom survey (CISS) score, near phoria and positive fusional vergences (PFV) at near. The participants of Group I underwent home-based PPT (pencil push-ups exercises15 minutes per day, daily for 6 weeks) and those of Group II OBOT (convergence fusional exercises on synoptophore for 20 min per day, 3 days a week, for 6 weeks) without home reinforcement. Patients were re-examined at 3 and 6 weeks after initiation of treatment. NPC and CISS score were the primary and secondary outcome measures, respectively. Statistical analysis was performed with the independent samples t-test, Friedman test and the analysis of variance (ANOVA). Statistical significance was indicated by p-value < 0.05. RESULTS: Participants of both the groups had statistically significant improvement in NPC, CISS score, PFV and near phoria (p < 0.001), but there was no statistically significant difference between the two groups (p > 0.05). However, patients of Group II had significantly better PFV after final visit than those of Group I (p < 0.001). CONCLUSION: Home-based PPT with good suppression control and with compliance ensured by log book entries, is a simple, cheap, less time consuming and comparably effective alternative to more expensive OBOT for patients suffering from CI. CTRI registration number: REF/2016/11/012,732, Date of registration 25/04/ 2016, Retrospectively Registered.

Utility of COVID-19 Seropositive Plasma as Convalescent Plasma: An Immune and Neutralization Antibody Seroprevalence Analysis in Blood Donors for Future Potential Pandemic Readiness.

OBJECTIVES: To analyze the seroprevalence of SARS-CoV-2 IgG antibodies and neutralizing antibodies in blood donors during the second wave of the pandemic and to explore the utility of COVID-19 seropositive plasma as convalescent plasma. MATERIALS AND METHODS: In this study, 696 blood donors were tested for anti-SARS-CoV-2 IgG antibodies using a chemiluminescence assay. By blinding, 271 samples were chosen randomly for testing of neutralizing antibodies by enzyme-linked immunosorbent assay (ELISA) in duplicate among the 696 blood donors tested for anti-SARS-CoV-2 IgG antibodies, irrespective of the positivity or negativity of the result of the anti-SARS-CoV-2 IgG antibodies by chemiluminescence assay. IgG antibody levels were analyzed in signal-to-cutoff (S/Co), while neutralizing antibody levels were analyzed in percentage inhibition. RESULTS: The seroprevalence of IgG antibodies based on the S/Co for the positive results ≥ 1.00 was 82.75%, while the seroprevalence of neutralizing antibodies based on the percentage inhibition for the positive results ≥ 30% was 89.59%. Frontline workers (FLWs) and Covishield-vaccinated individuals showed higher levels of the anti-SARS-CoV-2 IgG antibodies regarding higher S/Co. In comparison, levels of neutralization antibodies regarding percentage inhibition were higher only in FLWs. Covishield-vaccinated donors elicited a statistically higher seroprevalence of anti-SARS-CoV-2 IgG antibodies compared to the Covaxin-vaccinated, while the seroprevalence of neutralizing antibodies was not statistically different among this group. There was a positive correlation (0.762) between anti-SARS-CoV-2 IgG antibodies and neutralizing antibodies, and almost all donors' of S/Co ≥ 9.5 had neutralizing antibodies. CONCLUSION: This study showed higher seroprevalence in the blood donor population compared to published seroprevalence in India's second wave of the pandemic. In the current study, 328 donors (47.12%) of the 696 screened donors were neither vaccinated nor had previous SARS-CoV-2 infection, but many had antibodies. The seroprevalence of neutralizing antibodies (96.42%) was higher than the seroprevalence of the anti-SARS-CoV-2 IgG antibodies (85.71%) in the donors who had previous infection of COVID-19. On the other hand, vaccinated donors showed similar immune responses for neutralizing antibodies and the anti-SARS-CoV-2 IgG antibodies. Higher IgG immune reactivity in S/Co showed a good correlation with neutralizing antibodies and can be used to screen whole blood donors for convalescent plasma donations.

Prevalence of unintentional injuries and its risk factors among under-five children residing in urban poor resettlements in Rishikesh.

Background: A community-based study on childhood injuries would provide valuable information on the epidemiology of injuries to undertake appropriate preventive measures. Therefore, the current study was conducted in urban poor resettlements of Rishikesh to estimate the prevalence of unintentional injuries and to document the sociodemographic risk factors associated with unintentional injuries among under-five children. Aims and Objectives: Estimation of the prevalence of unintentional injuries and their risk factors among under-five children of urban poor resettlements in Rishikesh. Materials and Methods: A community-based cross-sectional study was conducted in urban poor resettlement areas of Rishikesh for a period of 1 year. It included 300 children selected using a simple random sampling technique to collect data on injury status. Results: The prevalence of unintentional injury among study participants was 16%. Falls were (64.6%) the major cause of injury, followed by dog bites (12.5%). The major sites of the injury were the head (25%), face (22.9%), upper limb (27.1%), and lower limb (18.8%).75% of the injuries happened at home. 66% of injuries happened when the child was playing alone or playing with peers. About 20.8% of injuries were bruises or superficial injuries. 39.6% of children had cut/bite/open wound injuries. Fractures happened in 14.6% of injured children. More than half (54.2%) of children did not develop any physical disability due to injury. Among children who developed a disability, more than 90% are able to recover completely. The majority of study participants were taken to nearby hospitals (66.6%) or health centers (10.4%). Only one of them went to a traditional bone setter, rest all visited either a general practitioner or pharmacy. The median expenditure for the treatment of the injured child was INR 425 (175-2750). The age of the child and unintentional injury showed a statistically significant association. Conclusion: The prevalence of the injury was 16% (12-20.7%) similar to a number of similar studies. Although the majority of the injuries were mild in severity, injuries have also contributed to temporary disability among children and have led to loss of school days.

Efficacy of Teleconsultation Versus Usual Care in Improving Quality of Life Among Geriatric Patients Aged 60 and Above: A Randomized Controlled Trial.

Introduction The geriatric population, aged 60 years and older, is rapidly growing worldwide. This demographic shift has led to a higher prevalence of chronic diseases, comorbidities, and functional impairments, placing immense pressure on healthcare systems. Teleconsultation, which uses telecommunication technologies to deliver healthcare services remotely, offers a potential solution. This study aimed to assess the efficacy of teleconsultation versus usual care in improving the quality of life among the geriatric population aged 60 years and older. Methods A parallel, randomized controlled trial with a 1:1 allocation ratio was conducted. Eligible participants, aged 60 and above, were recruited at the triage emergency department (ED) following a baseline eligibility assessment. Inclusion criteria included the ability to communicate in English or Hindi, possession of International Organization for Standardization (ISO-certified) instruments for self-monitoring, and willingness to comply with study procedures and provide written consent. Participants were randomly assigned to experimental and control arms using a computer-generated sequence, with allocation concealment achieved through sequentially numbered opaque sealed envelopes (SNOSEs), which were opened in front of participants after obtaining baseline data. A total of 2,000 participants (1,000 per arm) were enrolled and randomly assigned to either the teleconsultation or usual care group. Results In the teleconsultation group (n=1,000), 36.5% of participants (365) were female and 63.5% of participants (635) were male. Similarly, in the usual care group (n=1,000), 37.1% of participants (371) were female and 62.9% of participants (629) were male. The teleconsultation group significantly outperformed the usual care group in several domains pre-intervention, with higher mean scores in the physical health domain (11.16 vs. 10.96, P = 0.009), psychological domain (11.74 vs. 11.62, P = 0.020), and environment domain (12.44 vs. 12.26, P = 0.0001). No significant difference was observed in the social relationships domain (P = 0.452). The teleconsultation group significantly outperformed the usual care group in all domains post-intervention, with higher mean scores in the physical health domain (14.49 vs. 12.74), psychological domain (13.75 vs. 12.35), social relationships domain (14.05 vs. 12.90), and environment domain (13.91 vs. 12.94) (P < 0.001 for all). Conclusion These findings suggest that teleconsultation significantly improves the quality of life for elderly patients by providing a more accessible and convenient means of healthcare delivery and addressing the physical, emotional, and social challenges associated with chronic illnesses.

Anemia in Indian Men: An Emerging Public Health Challenge.

Approximately one-quarter of the world's population is suffering from anemia, out of which 12.7% of men suffer from anemia around the globe. In India, anemia is a moderate public health problem (ranging from 20 to 39.9%). Prevalence of anemia is 25% in men and 31% in adolescent boys, in India. In recent years, there has been an alarming rise in anemia prevalence among adolescent boys (15-19 years) in 23 states, and among men (15-49 years) in 17 states. Anemia in the states of Jammu and Kashmir and Ladakh is a severe public health problem. Despite being a vital issue, indicators for anemia in men are not given due importance in national health statistics reports. This article highlights the issue to prioritize men's health in the context of anemia at state and national levels.

Effect of Yoga Therapy on Health Outcomes in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.

The purpose of this study was to assess the effect of yoga therapy (YT) on health outcomes of women suffering from polycystic ovary syndrome (PCOS). Interventional studies, with postmenarchal and premenopausal females with PCOS who received YT, with any health outcome reported, were included. Scopus, Cochrane, PubMed, Embase, and Medline databases were electronically searched. Systematic review included 11 experimental studies, representing 515 participants with PCOS, out of which 2 randomized controlled trials (RCTs) were included for meta-analysis. Random effects model was applied using Review Manager Software version 5.4.1 and strength of evidence was assessed using GRADEpro Guideline Development Tool, 2020. Meta-analysis showed that YT may significantly decrease menstrual irregularity (MD -.41, 95% CI -.74 to -.08), clinical hyperandrogenism (MD -.70, 95% CI -1.15 to -.26), fasting blood glucose (MD -.22 mmol/L, 95% CI -.44 to -.01), fasting insulin (MD -28.21 pmol/L, 95% CI -43.79 to -12.63), and homeostatic model assessment-insulin resistance value (MD -.86, 95% CI -1.29 to -.43). Strength of evidence was "low." In conclusion, YT may have beneficial effects on health outcomes in women suffering from PCOS. However, low strength of evidence suggests need of conducting well-designed RCTs to assess the efficacy of YT for PCOS.

Institutional awareness campaign: COVID-19 vaccination drive among nursing students.

Objectives: Possessing accurate knowledge and utilization of reliable information sources may play a vital role in adoption of positive health behaviours, including acceptance of vaccine. The present study was conducted with an objective to assess the awareness and attitude of undergraduate nursing students regarding COVID-19 vaccine. Methods: A cross-sectional survey was conducted in Mid May 2021 using Google Forms through Google platform on-line. A total of 354 nursing students participated in the survey. A validated and pre-tested structured knowledge and Attitude, questionnaire was used to collect data from undergraduate nursing students regarding COVID-19 vaccine. Chi-square test, followed by binary logistic, was applied to determine factors associated with knowledge scores. Results: The mean knowledge score was 11.31 (SD ± 2.31, range: 2-15), with a correct response rate of 75.4%. However, the mean attitude score was 40.56 (SD ± 5.10, range: 28-55) with an unfavourable response towards COVID-19 vaccination (54.8%). The knowledge level was found to be significantly associated with student's professional qualifications and Vaccination status (P < 0.05). In binary logistic regression analyses, the knowledge score found to be significantly associated with participant's professional qualification i.e., B.Sc. (Hons.) Nursing 2 nd Year (AOR: 2.45, CI: 1.43-4.19, P < 0.001) and B.Sc. (Hons.) Nursing 3rd Year (AOR: 2.69, CI: 1.50-4.83, P < 0.001) and students who has received COVID-19 vaccination (AOR:3.08 CI: 1.81-5.25, P < 0.000). Conclusion: The current study findings represent adequate knowledge among undergraduate nursing students which is a very good sign. However, efforts must be taken to develop positive attitude towards COVID-19 Vaccination.

Prevalence of Stunting and its Biosocial Determinants among Young Children Enrolled at Urban Anganwadi Centers in Rishikesh, Uttarakhand.

Background: Stunting is a significant public health problem in childhood in developing countries. Sustainable Developmental Goals have mandated that each country reduce stunting by 50% by 2030. However, despite various nutrition and health programs, India still faces a massive burden of stunting. With the increasing urbanization in the country and its typical challenges related to health and nutrition, chronic malnutrition is a massive problem in urban areas, especially among people in the lower wealth quintile. Hence, current study has attempted to estimate the prevalence of stunting among children (0-6 years) and its determinants. Methodology: A cross-sectional study was conducted in the Urban Anganwadi centers of Rishikesh, Uttarakhand, for 6 months, from December 2021 to May 2022. Three hundred ten children from 13 selected Anganwadi centers were included using random sampling. Data were collected using a semi-structured validated and pretested questionnaire using Epicollect 5.0. Data were analyzed using the SPSS 23.0 version to estimate the prevalence of stunting and associated risk factors. Results: Out of 310 participants, 71 (22.9%) were stunted. Female children were slightly more stunted (24.7%) than males (21.1%). Maximum stunting (33.4%) was observed among children in the 5-6-year age group, and children with higher birth order were much more stunted. Stunting was reported more in children who were breastfed on demand (33.8%) than those fed every 2 hours (19.3%). Conclusion: Stunting prevalence in urban areas of Rishikesh is 22.9%, which is almost similar to the state average of 24.3% for urban areas; however, it was higher in comparison to the SDG 2030 global target of ending malnutrition of all forms. Stunting was significantly associated with feeding on demand and eating frequency less than twice a day.

Assessment of quality of routine immunization in rural areas of Doiwala Block, Dehradun.

Background: India initiated Expanded Programme on Immunization (EPI) in 1978 and was renamed to Universal Immunization Programme (UIP) in 1985 and subsequently integrated with National Rural Health Mission (NRHM) in 2005. Many studies have shown that health workers involved in immunization are more concerned towards coverage than the quality of immunization services provided. Aims and Objectives: This study aimed to assess the quality of routine immunization services in rural areas of Doiwala Block of Dehradun, Uttarakhand. Material and Methods: It was a cross-sectional study conducted for a duration of one year. Study participants included Auxillary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs) and parents/caregivers of children aged 12-23 months residing in that area who had received immunization services on the day of the survey. Institutional ethics committee clearance was obtained before the start of the study. A P value of <0.05 was considered as statistically significant. Results: ASHAs at two centres in low-performing centres had never undergone any training for routine immunization but there was no statistically significant difference found between high and low-performing centres (P > 0.05). The most common vaccine not available was the Bacillus Calmette-Guérin (BCG) vaccine. The majority of clients at both high (92%) and low-performing centres (96%) said that they never waited for at least 30 min post-vaccination at the vaccination site for observation. Conclusion: The study highlights that most of the ANMs at the immunization centre were having good knowledge and were adequately trained for maintaining cold chains at session sites.

Coverage and Determinants of Birth Dosage of Newborn Immunization in Rural Areas of Dehradun District, Uttarakhand, India: A Community-Based Cross-Sectional Study.

Backgrounds: The Universal Immunization Program of India is one of the most cost-effective interventions in public health. Missing or delaying vaccination may elicit an uncertain immune response in the body, making the population susceptible to vaccine-preventable diseases. The objectives of this study were to determine the coverage of newborn immunization for birth doses under the National Immunization Schedule and its epidemiological determinants in the rural areas of the Dehradun district, Uttarakhand. Materials and Methods: A community-based cross-sectional study was conducted for a period of one year with a sample size of 570. World Health Organization (WHO) 30 Cluster sampling technique was used with 19 children in each cluster. The data on determinants were collected using a semi-structured, pre-designed schedule through a house-to-house survey. Multivariate analysis was conducted to identify factors associated with immunization coverage, taking the significance level as P < 0.05. Results: The coverage of the Bacillus Calmette-Guérin vaccine, oral polio vaccine zero dose and hepatitis B birth dose were 100%, 91.9%, and 58.8%, respectively in the study area with an overall prevalence of incomplete coverage of newborn immunization as 42.5%. The most cited reason for children being unimmunized with birth doses was the unavailability of vaccines at the birthplace center (29.6%). Conclusions: The prevalence of incomplete coverage of newborn immunization was quite high, which was undermining the holistic approach of the National Immunization Program. Vaccine availability and accessibility at the birthplace with capacity building and training of the healthcare workers may be considered to ensure coverage of birth doses.

Effectiveness of Kabasura Kudineer tablets in the management of asymptomatic and mild cases of COVID-19: A pilot double-blinded, randomized controlled trial.

INTRODUCTION: COVID-19 was declared a pandemic in 2020. It has had a devastating effect on human life and the global economy. To date, there is no proven therapy for COVID-19, even though rigorous research is ongoing to test multiple compounds across all systems of medicine. A need was felt to systematically explore the Indian system of medicine to assess its efficacy against COVID-19. The objective of the present study was to examine the effect of Kabasura Kudineer as a standalone therapy on the following: time required to achieve symptom relief & resolution, virological clearance, and levels of IL6, CRP and IgG, and compare it to the standard therapy available for treatment of COVID-19. METHODOLOGY: A double-blinded randomized controlled trial was conducted in 110 participants. 55 participants were enrolled in the Kabasura Kudineer arm and 55 in the control (standard therapy + Kabasura Kudineer placebo) arm. Study participants were randomly allocated into the two study arms. They were assessed for symptoms at baseline, and on Day 5 and Day 10. RT PCR, CRP, IL6 and IgG levels were measured at baseline, Day 5 and Day 10. On day 28, participants were interviewed telephonically for symptom assessment alone. STATISTICAL ANALYSIS: A per-protocol approach was used. Significant difference between two groups was assessed at baseline, day 5 and day 10 using the Chi-square and Mann Whitney test. RESULT: A total of 110 patients participated in study. Four patients in the Kabasura Kudineer arm and 9 in the Standard therapy arm were lost to follow-up. Baseline characteristics for both the groups were matched at baseline. 83.9% and 93.9% patients were relieved of all symptoms by the 10th day in Kabasura and standard therapy groups respectively. Decrease in CRP level was more pronounced in the Kabasura group compared to standard therapy viz. 3 mg/l and 1.26 mg/l. No significant difference was found in IgG level and IL6 levels in both the study groups. However, it was noticed that among the unvaccinated group, the surge in IgG levels was much higher in Kabasura Kudineer group than the standard therapy group. CONCLUSION: Kabasura Kudineer as a standalone therapy was as effective and safe as the standard therapy among patients with asymptomatic to mild COVID-19.

Effectiveness of ayurvedic formulation, NAOQ19 along with standard care in the treatment of mild-moderate COVID-19 patients: A double blind, randomized, placebo-controlled, multicentric trial.

BACKGROUND: Medicines in indigenous systems such as Ayurveda have strong antimicrobial activity but double-blind randomized control trials are infrequent in this system of medicine. The efficacy of a new ayurvedic formulation was evaluated during the pandemic. METHODS: 150 mild-moderate COVID-19 patients were enrolled and randomized in 1:1 to NAOQ19 and placebo group. RT-PCR was done on Day 3, 5 and 7. CBC, CRP, LFT, and KFT were assessed at baseline and exit. Duration of hospital stay was noted and clinical assessment was also performed. RESULT: The results demonstrated more people turning RT-PCR negative in the NAOQ19 group compared to the placebo group on day 3 (p-value = 0.033). The mean time duration to turn RT-PCR negative was significantly lower in the NAOQ19 group (4.6 days) compared to placebo group (5.2 days) (p-value = 0.018). There was significant reduction in hospital stay among patients in the NAOQ19 arm who were discharged earlier (5.6 days) compared to placebo group (6.4 days) (p-value = 0.046). Patients in NAOQ19 arm did not show any adverse life-threatening events. CONCLUSION: The ayurvedic preparation given along with standard of care therapy reduced the duration of hospital stay and there was earlier conversion to RT-PCR negative.The integrated approach can help to reduce patient workload in the hospitals as well as limit the transmission of the virus in the community. STUDY REGISTRATION: CTRI/2021/05/033790.

Clinical validation of aneroid sphygmomanometer.

Recent concerns about the mercury toxicity and its ill effects on the environment and health has led to widespread use of aneroid manometers. Present study was conducted to analyse whether this change would lead to any systematic shift in measured blood pressure or consistency of blood pressure measurement in clinical setting. The clinical accuracy of the Welch Allyn aneroid sphygmomanometer model 7670-04 was studied against the mercury sphygmomanometer on 83 volunteers from Dehradun. Two blood pressure reading of each study subject was recorded with pretested instruments (aneroid and mercury sphygmomanometer). Data analysis showed the difference of means between the reading of two devices against mean of the observer reading for both systolic (-3.62 +/- 4.88) and diastolic (-2.36 +/- 3.77) blood pressure were not statistically different. The corresponding values of the SBP and DBP from both the instruments showed significant correlation. Regression analysis of mercury versus aneroid showed regression line (Y = 9.52 + 0.95X for SBP, Y = 0.36 + 0.96X for DBP) significantly different from line of equality (P < 0.001). The study has demonstrated that the aneroid device (model: 7670-04) achieved grade B performance according to the British Hypertensive Society criteria.

Clinical Characteristics and Outcomes in Elderly Patients With COVID-19: A Single-Centre Retrospective Study.

BACKGROUND: Even with the wide base of knowledge that has been accumulated regarding coronavirus disease 2019 (COVID-19), only limited studies have tried to establish differences in outcomes of elderly patients hospitalized with COVID-19. We, thus, conducted a retrospective study on a large cohort of hospitalized patients with COVID-19 to improve the understanding of such differences and add to the evidence available regarding this age group.  Methods: This is a single-centre retrospective study conducted at a tertiary level hospital in the state of Uttarakhand in North India to determine clinical characteristics and outcomes in elderly patients (≥ 60 years) hospitalized with COVID-19 between May 1, 2020, and May 31, 2021. Our study included a retrospective follow-up at six months to also determine rehospitalizations and post-discharge mortality. RESULTS: There was a statistically significant difference (p<0.05) in in-hospital mortality, various in-hospital complications, duration of stay, number of rehospitalizations at six months, and post-discharge mortality up to six months in the elderly age group hospitalized with COVID-19. CONCLUSIONS: This retrospective study demonstrates that the clinical characteristics and outcomes in hospitalized elderly with COVID-19 differ significantly from the younger adult population and demonstrates a need for greater hospital resource utilization in this age group. These results will help policymakers be better prepared for future pandemics.

Association between the physical activity and metabolic syndrome in residents of a foot-hill area in India.

BACKGROUND AND AIMS: Physical inactivity, has been linked to development of metabolic syndrome, which increases the risk of developing cardiovascular disease. Aim of the study was to assess the level of physical activity and it's association with prevalence of metabolic syndrome and oxidative stress in a semiurban foothill population of India. METHODS: Participants (n = 288), >18 years of age were enrolled. Their demographics and clinical details were recorded. Fasting plasma glucose, triglycerides, cholesterol and erythrocyte glutathione peroxidase activity were measured. Physical activity was estimated using Global Physical Activity Questionnaire and converted into metabolic equivalent in minutes per week. RESULTS: 37.5% of study population was found to be physically active, with more males (43.3%) being active than females (23.3%). Inactivity was associated with higher triglycerides levels in males and with higher hip circumference, diastolic blood pressure, triglycerides and fasting plasma glucose in females. No significant difference was found in the oxidative stress, indicated by decreased glutathione peroxidase activity, between active and inactive persons or persons with normal and increased body mass index. CONCLUSIONS: There is a high prevalence of physical inactivity in this region of India, with prevalence of physical inactivity higher is females as compared to males. No significant co-relation was found between the levels of activity and components of metabolic syndrome and oxidative stress in the study population.

Assessment of Infant and Young Child Feeding (IYCF) practices in rural areas of Dehradun, Uttarakhand.

Introduction: The practice of infant and young child feeding (IYCF) is critical for a child's growth and development throughout the first two years of life. Poor feeding habits in early childhood contribute to malnutrition and child mortality in India. Aim and Objective: To assess the IYCF practices in children under the age of 2 years. Material and Methods: In rural Uttarakhand, India, a cross-sectional study was undertaken from March 2021 to May 2021. A probability proportional to size (PPS) method was used to select 400 children under the age of 2 years. The World Health Organization IYCF questionnaire, was used to collect house to house data. An appropriate statistical test was used for analysing the data. Results: According to the findings, 47.5 percent of babies under the age of six months were nursed within the first hour of delivery. About 73.9 percent of babies were exclusively breastfed. Approximately 22 percent infants were given pre-lacteal feeds and 20 percent were bottle fed. In addition to breast milk, half of babies aged 6 to 8 months had solid, semi-solid, or soft meals, however minimum acceptable diet was provided to only 33.5 percent children. Odds of male child who were bottle fed in the age group of 6-23 months were 2.02 times higher to that of female child. Also the odds of male child in the age group of 6-8 months to be introduced with solids, semi-solid, or soft food were 4.91 times higher to that of female child. Similarly, odds of male child received minimum dietary diversity (2.35), minimum meal frequency (1.82), and minimum acceptable diet (2.35) in the age group of 6-23 months were found to be higher to that of female child in the similar age group. Total of six mothers reported coronavirus disease (COVID) positive status and only two of them breastfed their babies using COVID appropriate behavior. Conclusion: Exclusive breastfeeding (EBF) has been practiced in more than two-thirds of children, but early breastfeeding is practised in less than half of children. Only one third children of more than six months of age are getting minimum acceptable diet.

Development and validation of 20-min yoga module for reducing burnout among healthcare worker(s).

BACKGROUND: A high prevalence of burnout has been reported among healthcare worker(s). During the current pandemic, such burnout has increased due to excessive load of patient care, use of personal protective equipment (PPE) kits, working in long shifts, staying away from family due to isolation norms, and disrupted social life. Existing yoga techniques used for reducing burnout include 45 min to hour-long sessions, which may not be feasible for regular practice by the healthcare worker(s). OBJECTIVE: The proposed study aimed to develop a 20-min yoga module to reduce burnout among healthcare worker(s). METHODS: To develop a 20-min yoga module, we reviewed yoga texts and relevant scientific research articles. Components of the 20-min yoga module include sukshma vyayama (loosening exercises), pranayama (regulated breathing), and dhyana (meditation). Nineteen yoga experts validated the 20-min yoga module with an average (SD) of 11.47 (6.77) years of research and clinical experience in yoga. Content validity ratio (CVR) was calculated according to Lawshe's method. Items having a CVR of 0.47 and above were retained in the module. RESULTS AND CONCLUSION: The content validity index (CVI) of the entire module was 0.83. CVR results of the elements of the 20-min yoga module indicated that experts consider these practices to be essential for reducing burnout among the healthcare worker(s). The strength of the 20-min yoga module lies in its short duration and easy-to-learn practices. 20-min yoga module can be implemented in practice by the healthcare worker(s) for reducing burnout following efficacy studies through further clinical trials.