Epidemiology of hepatitis C virus infection in a tertiary care hospital.

BACKGROUND: There are epidemiological lacunae in literature of hepatitis C virus (HCV) infection. We report a prospective observational study of asymptomatic HCV infected patients from a tertiary care Government Hospital. METHODS: All consecutive asymptomatic antibodies to hepatitis C virus (anti-HCV) positive patients were studied from July 2011 to April 2016. Patients were reviewed for demographic factors including symptom profile, risk factors, family screening, and point prevalence in relation to various districts of Punjab and Haryana. RESULTS: One thousand twelve patients were studied with median age of 52 years (range:13-85) with a male to female ratio of 0.87. Eight hundred (79.25%) patients were from Punjab and 110 (10.67%) from Haryana. Forty percent patients were in 40-60 age group. Six hundred seventy patients (66.21%) did not have any apparent risk factor, 274 (27.08%) had one risk factor, and 68 patients (6.72%) had > 2 risk factors. Commonest risk factor was h/o surgery in 243 patients (24.01%), 32 patients had h/o IV drug abuse and 29 among them were < 30 years. Three hundred and sixty-seven families and children were screened, and 27 spouses and 16 children were found to be anti-HCV positive. The risk factor of IV drug abuse was more common in the younger adults with age ≤ 30 years as compared with age > 30 years (p = 0.001). CONCLUSION: HCV infection was common in certain districts of Punjab and common in adults of 40-60 years. This finding needs to be confirmed in larger population-based study. The IV drug abuse is the risk factor of concern among young adults.

Pancreatitis and hyperparathyroidism: Still a rare association!

BACKGROUND: Among the multitudinous etiologies of pancreatitis, primary hyperparathyroidism (PHPT) is rarely associated with pancreatitis. However, the cause and effect relationship between the two still evokes controversy. We aimed to study and characterize the nature of pancreatic disease in PHPT. METHODS: A retrospective single-center study was carried out in North India over a period of 1 year (June 2015 to May 2016). All patients with pancreatitis were included. In patients with high calcium levels, Intact Parathyroid Hormone (iPTH) by Radioimmunoassay (RIA) and an Technetium 99m Sestamibi scintigraphy (MIBI-Tc-99m) scan were performed. RESULTS: During the study period, 70 patients with pancreatitis were admitted to our hospital (53 with acute pancreatitis [AP] and 17 with chronic pancreatitis [CP]). Of them, 5 patients (9.4%) were detected to have PHPT. The mean age of patients was 30.4 years (20-49 years) with 3 males and 2 females, including 1 pregnant female (29th week of gestation). Contrast enhanced computed tomography (CECT) abdomen was performed in 4 cases (excluding 1 pregnant patient) with mean Computed tomography severity index (CTSI) of 4.7 (2-8). Four patients were detected to have increased uptake in one of the parathyroid glands, and the fifth patient had an ectopic parathyroid uptake in the mediastinum. All the resected samples were identified as parathyroid adenoma on histology. The patients were followed up for 1 year with no reported recurrence of symptoms. CONCLUSION: The data suggest an association between pancreatitis (both acute and chronic) and hypercalcemia due to PHPT. A high calcium value during AP or CP should always draw suspicion and warrants corresponding investigations in search of endocrine or malignant cause.

Causes, consequences, and policy responses to the migration of health workers: key findings from India.

BACKGROUND: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been "sources" of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. METHODS: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. RESULTS: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. CONCLUSIONS: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

COVID-19 Vaccine Acceptance During Pregnancy, Women's Views, and Influencing Factors.

BACKGROUND: COVID-19 vaccination is advised for pregnant women all over the world; however, vaccine acceptance is variable across the globe. METHODS: This study was conducted by enrolling 292 antenatal women attending the outpatient department (OPD) in a tertiary care hospital in Delhi, India, between August 1, 2022 and October 31, 2022, with the aim to determine the acceptability of vaccination against COVID-19 disease in pregnancy, women's views regarding the vaccine and to ascertain reasons for acceptance or denial during pregnancy. RESULT: Of the 292 pregnant women who completed the questionnaire, 39.73% had received both doses of vaccination against COVID-19 disease before pregnancy, and 39.04% had received a single dose. Twenty-one percent of women did not receive any vaccine. Eighty-four percent of the unvaccinated and 35% of the women with a single dose of the vaccine refused further doses during pregnancy. The most common concern was the fear that the vaccine might cause harm to the fetus (35.3%), followed by the fear of vaccine-related reactions (25.4%). Also, 14.6% of women feared that the vaccine might cause them to abort the ongoing pregnancy. Thirteen percent of women stated their intent to receive the vaccine after they were informed regarding its safety and requirement. No difference was found in the acceptability of the vaccine based on the educational status of women or on the monthly income of the families. CONCLUSION: Adequate communication regarding safety information on COVID-19 vaccines is a must for pregnant women and their families to provide reassurance about the need and safety of the vaccines. It would facilitate making informed decisions and is likely to be helpful in increasing vaccine acceptance.

A Study of Prevalence of Occult Hepatitis B Virus Infection, Knowledge and Preventive Practices Against Hepatitis B Virus in Barbers Serving the Armed Forces.

OBJECTIVE: Hepatitis B virus (HBV) infection is a major health problem in the world. Barbers deal with frequent abrasions/lacerations due to sharp equipment, making them a high-risk group. Determination of HBsAg positive status excludes most reservoirs of transmission in the population. However, Occult Hepatitis B continues to be a source of transmission. The aim of this study was to study the prevalence of occult HBV infection in barbers serving the armed forces clientele and evaluate their knowledge and preventive practices against HBV transmission. METHODS: Seventy-nine HBsAg negative barbers were included in this study and interviewed for the status of immunisation and preventive practices. Anti-HBc total and HBV DNA levels were measured along with a complete haemogram, LFT, PT INR, ultrasound abdomen and Fibroscan of the liver. RESULTS: The prevalence of occult Hepatitis B status was 3.79%. Among barbers who were anti-HBc total positive, 100% were found to have replicative HBV DNA status. All barbers (100%) were unaware of the existence and modes of HBV transmission and were never screened for HBV; 98.73% of barbers followed improper disinfection practices and were never immunised. CONCLUSION: The prevalence of occult HBV infection in barbers, absence of immunisation, unawareness and improper disinfection practices are significantly at risk for transmission to the unaware clients. It is important to educate barbers, establish a universal disinfection procedure and implement a system of compulsory Hepatitis B vaccination before the commencement of their trade work.

Microbiology of bile in extrahepatic biliary obstruction: A tropical experience.

PURPOSE: Bile is considered sterile, but in obstructed biliary system, growth of micro-organisms results in bacteraemia and toxaemia. We analysed bacterial profile of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and evaluated antibiotic resistance patterns to formulate strategy for antibiotics in patients undergoing ERCP. MATERIALS AND METHODS: Patients with cholestasis who underwent ERCP were enrolled. Bile, collected aseptically, was cultured. Positive cultures were processed for isolate identification and antibiotic susceptibility. RESULTS: One hundred and sixty-three patients (78 females; mean age - 55.1 ±â€¯15.8 years) were enrolled and divided into two groups: Group I (n = 99) were naïve and Group II (n = 64) had undergone ERCP and stenting previously. Positive culture was seen in 68.1% (n = 111) with monomicrobial growth in 74.8% (n = 83) and poly-microbial growth in 25.2% (n = 28). Culture positivity was common in Group II vis-a-vis Group I (84.4% vs. 57.5%). Poly-microbial growth was significantly more common in Group II (35.2% vs. 15.8%, P = 0.028). Gram-negative bacilli were the predominant organisms isolated with Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae comprising 70% of the isolates. The most sensitive antibiotics were piperacillin-tazobactam and imipenem. The sensitivity of vancomycin, against Enterococcus spp. was in the range of 60%-70%. CONCLUSION: Cholestasis leads to bacterial colonisation in most cases, regardless of the presence of a biliary stent. Biliary stent however predisposes to a polymicrobial growth. Most of the commonly used antibiotics continue to have significant sensitivity and may be used empirically. However, previously stented patients may have a higher incidence of infection with Enterococcus spp. and may require specific therapy.

Intestinal myiasis due to Musca domestica: a report of two cases.

Myiasis is the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a certain period, feed on the host's dead or living tissue, liquid body substances, or ingested food. Intestinal myiasis is usually an accidental phenomenon, which occurs due to the ingestion of eggs or larvae present in food. Usually the patient is asymptomatic and the larvae are excreted harmlessly in the feces. In some cases, however, the passage of larvae may be associated with symptoms. The present paper describes two such cases.

Acute pancreatitis with gliptins: Is it a clinical reality?

There are reports of acute pancreatitis with the use of dipeptidyl peptidase-4 inhibitors (gliptins). This class of drugs is widely being prescribed for type 2 diabetes mellitus (DM) in our country. We evaluated the incidence of acute pancreatitis with the use of gliptins during the period January 2012-June 2013. Patients of type 2 DM on treatment with any of the gliptins (Sitagliptin, vildagliptin, or saxagliptin) for at least 1 month duration were included. A total of 185 patients were included (205.3 patient years of follow-up). Five of them had history of acute pancreatitis (all mild) >6 months prior to inclusion with complete resolution and no chronic pancreatitis. One patient (0.48 per 100 patient years) presented with mild acute pancreatitis which resolved in 8 days. Asymptomatic elevation of serum amylase > 3× upper limit of normal was noted in five patients (2.4 per 100 patient years), without any sonological evidence of pancreatitis, which resolved on withdrawal of gliptins. None of the patients with previous history of pancreatitis had a recurrence of pancreatitis. In a group at low risk of acute pancreatitis, incidence of acute pancreatitis is low with the use of gliptins.

Sublingual misoprostol to reduce blood loss at cesarean delivery.

OBJECTIVE: This prospective randomized controlled study was carried out with the purpose of assessing the efficacy of sublingual misoprostol in decreasing intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery. METHODS: One hundred seventy-four women undergoing elective or emergency cesarean delivery were assigned randomly to receive either 400 µg misoprostol or placebo sublingually at the time of cord clamping. An intravenous infusion of 20 units of oxytocin was started in all women at the same time. The primary outcome measures were intraoperative blood loss, need for additional uterotonic agents, and perioperative hemoglobin (Hb) fall. RESULTS: The maternal demographic factors, indications for cesarean delivery, and high-risk factors were similar between the two groups. Mean intraoperative blood loss was significantly less in misoprostol group as compared with placebo group (595 ± 108 vs. 651 ± 118 ml, P = 0.025). Fewer women needed additional uterotonic agents in misoprostol group (22.2 vs. 42.8 %; P = 0.0035; RR 0.52, 95 % CI 0.33-0.82). Perioperative Hb fall was significantly less in misoprostol group (0.87 ± 0.29 vs. 1.01 ± 0.26 g, P = 0.0018). CONCLUSION: Sublingual misoprostol decreases intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.