Disturbance and vegetational structure in an urban forest of Indian Siwaliks: an ecological assessment.

Urban forests face multiple human-mediated pressures leading to compromised ecosystem structure and functioning. Therefore, understanding ecosystem structure in response to ongoing pressures is crucial for sustaining ecological integrity and human well-being. We aim to assess the disturbance and its effects on the vegetation structure of urban forests in Chandigarh using a combination of remote sensing techniques and vegetation surveys. The disturbance was evaluated as a change in NDVI (Normalised Difference Vegetation Index) from 2001 to 2021 by applying the BFAST (Breaks For Additive Season and Trend) algorithm to the MODIS satellite imagery data. A vegetation survey was conducted to compare the species composition, taxonomic and phylogenetic diversity as measures of forest vegetational structure. While signals of disturbance were evident, the changes in vegetation structure were not well established from our study. Further, this analysis indicated no significant differences in vegetation composition due to disturbance (F1,12 = 0.91, p = 0.575). However, the phylogenetic diversity was substantially lower for disturbed plots than undisturbed plots, though the taxonomic diversity was similar among the disturbed and undisturbed plots. Our results confirmed that disturbance effects are more prominent on the phylogenetic than taxonomic diversity. These findings can be considered early signals of disturbance and its impact on the vegetation structure of urban forests and contribute to the knowledge base on urban ecosystems. Our study has implications for facilitating evidence-based decision-making and the development of sustainable management strategies for urban forest ecosystems.

High prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among unvaccinated children of Chandigarh, Northwest India, in a household-based paediatric serosurvey post-second wave of pandemic (June to July 2021).

OBJECTIVE: Current national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination policy covers children aged >12 years. Unvaccinated, uninfected children remain susceptible to SARS-CoV-2 and play a role in community transmission, as paediatric infection is mostly mild or asymptomatic. To estimate the proportion of susceptible children in a community for public health measures, there is a need to assess the extent of natural infection. STUDY DESIGN: We performed a cross-sectional household serosurvey of SARS-CoV-2 antibodies in unvaccinated children aged between 6 and 18 years after the second COVID-19 wave. METHODS: Anti-SARS-CoV-2 immunoglobin G (IgG) testing in serum was done using chemiluminescence immunoassay. We used a logistic regression model to investigate predicted factors of seropositivity. RESULTS: We observed a high prevalence (weighted average: 68.3%) of anti-SARS-CoV-2 IgG in 2700 enrolled children. Logistic regression for predictors of IgG seropositivity showed lower odds in households with completely vaccinated adults (adjusted odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.26-0.71, P = 0.0011) compared with households with unvaccinated adults. Other factors for low seropositivity included frontline workers as family members (adjusted OR: 0.69, 95% CI: 0.52-0.91, P = 0.0091) and non-crowded households (adjusted OR: 0.74, 95% CI: 0.61-0.89, P = 0.0019). CONCLUSION: A high SARS-CoV-2 IgG prevalence in unvaccinated children was indicative of previous exposure to potentially infected contacts. This implies in-person academic activities for children can be continued during future community transmission. Comparatively lower seropositivity in children of completely vaccinated households or frontline workers suggests decreased transmission due to vaccination-induced immunity of family members. Vaccination will still be required in these children to maintain protective IgG levels, particularly in low seroprevalence groups.

An updated checklist of mosquitoes (Diptera: Culicidae) from Chandigarh, India and its surrounding area.

Background & objectives: The affirmation about the prevalence of mosquito species at a particular place and time is very significant, not only to predict the danger of diseases or future outbreaks but also to control the vectors in time. Despite mosquitoes being medically important, the information about its faunal diversity is very scanty as far as Chandigarh in India and its nearby areas are concerned. So, this study was carried out to survey the mosquito fauna from areas in and around Chandigarh in northern India. Methods: Detailed mosquito surveys were carried out to explore the mosquito fauna from various habitats of developed urban areas, gardens, slums and surrounding villages of Chandigarh from June 2017-November 2019 using hand nets and oral aspirators. Results: A total of 34 mosquito species belonging to 8 genera viz; Anopheles, Aedes, Armigeres, Culex, Coquillet-tidia, Mansonia, Mimomyia and Verrallina were recorded, identified and preserved along with detailed collection data, of which eight are new records from Chandigarh. Interpretation & conclusion: The present checklist of mosquito fauna comprising 34 species provides information on the occurrence of mosquito vectors in Chandigarh and its adjoining areas which will be beneficial for the health authorities to adopt appropriate measures in time for the control of these vectors.

Mid-term Risk for Subclinical Atherosclerosis and Chronic Myocarditis in Children with Kawasaki Disease and Transient Coronary Abnormalities.

There is evidence for premature atherosclerosis and systemic arterial stiffening during follow-up of children with Kawasaki disease (KD) and coronary artery abnormalities (CAA). Moreover, patients with KD may also have subclinical myocardial involvement and inhomogeneous ventricular repolarization. The inhomogeneous ventricular repolarization manifests as increased QT dispersion on electrocardiography. There is a paucity of studies in endothelial dysfunction and QT dispersion in children with KD and transient CAA. Twenty children with KD and transient CAA were studied at least 1 year after resolution of CAA. Mean follow-up period between KD onset and enrolment in the study was 53.7 months. Twenty age and sex-matched controls were enrolled. High-resolution B-mode ultrasonography was used to analyze brachial artery dilatation in response to reactive hyperemia (cases and controls) and sublingual nitroglycerine (cases only). Carotid artery intima-media thickness (cIMT) and stiffness index were calculated. The difference between maximum and minimum QTc intervals on 12 lead electrocardiogram was calculated as QTc dispersion (QTcd). No statistically significant difference was noted in percent flow-mediated dilatation of brachial arteries in response to reactive hyperemia between cases (13.31 ± 10.41%) and controls (12.86 ± 7.09%). Sublingual nitroglycerine-mediated dilatation in children with KD was 14.88 ± 12.03%. Mean cIMT was similar in cases (0.036 ± 0.015 cm) and controls (0.035 ± 0.076 cm; p = 0.791). No statistically significant difference between groups was observed in mean QTcd values (0.057 ± 0.018 s vs. 0.059 ± 0.015 s in controls, p = 0.785). No evidence of significant endothelial dysfunction or increased QT dispersion in patients with KD and transient coronary artery abnormalities was found in our cohort when studied at a mean follow-up of 53.7 months. This is reassuring, and indicates that risk of subclinical atherosclerosis and myocarditis in a subset of children with KD and transient coronary artery abnormalities is not significant.

Kawasaki disease incidence at Chandigarh, North India, during 2009-2014.

The aim of this study was to estimate incidence of Kawasaki disease (KD) in Chandigarh, North India, during 2009-2014. Diagnosis of KD was based on American Heart Association guidelines. Records of all children diagnosed with KD below 15 years at a large tertiary care referral centre from North India for paediatric immunology were analysed from January 2009 to December 2014. Children residing in Chandigarh were identified. Incidence rates were calculated based on population of Chandigarh in National Census 2011. Methodology was similar to our previously reported study from 1994 to 2008. Incidence of KD in children below 5 was also computed. A total of 258 children were diagnosed to have KD. Of these, 54 (43 boys, 11 girls) resided in Chandigarh. Coronary artery abnormalities on echocardiography were noted in 6. Incidence rate varied between 1.11 (in 2012) and 4.71/100,000 children below 15 (in 2009). In children below 5, incidence rate varied between 1.0 (in 2012) and 9.1/100,000 (in 2009). Peak incidence of KD was in third year of life. There was clustering of cases in February, April, June and October with a nadir in July. While the overall number of KD cases has increased, the 2009-2014 Chandigarh incidence is comparable to our previous figures. Our study is based on hospitalized children with KD and may be missing patients diagnosed elsewhere but that number is likely to be small. Further, patients in whom the diagnosis has never been made would also be missed. Median age at diagnosis has reduced as compared to our previous study. This is probably a reflection of increased awareness about KD amongst paediatricians and physicians in the region as a result of which the proportion of infants and young children diagnosed to have KD has shown a significant increase. Seasonal pattern of occurrence of KD is consistent with our previous observation.

The 2002 Chandigarh cholera outbreak revisited: utility of MALDI-TOF as a molecular epidemiology tool.

UNLABELLED: In July 2002, an outbreak of cholera occurred in north India with two separate geographical foci. Pulsed field gel electrophoresis (PFGE) was previously used in typing a representative sample of these isolates. This study evaluates the usefulness of MALDI-TOF as an epidemiological tool for typing Vibrio cholerae isolates in comparison with PFGE and Amplified fragment length polymorphisms (AFLP). Forty-six isolates of V. cholerae isolated from stool of patients affected in the July 2002 outbreak were typed using MALDI-TOF. To validate its utility, clinical and environmental isolates previously characterized by PFGE and AFLP were included for dendrogram analysis. All 46 isolates were correctly identified by MALDI-TOF to species level. Two distinct clades appeared on dendrogram using MALDI-TOF corresponding to the two geographical foci of the outbreak. For the study of evolution of organisms from environment, AFLP was superior as it clearly demarcated clinical and environmental isolates. The outbreak was not due to a single clone but due to multiple clones circulating simultaneously, as was seen with PFGE also. SIGNIFICANCE AND IMPACT OF THE STUDY: MALDI-TOF appears to be a highly discriminatory, cost-effective and rapid epidemiological typing technique that can be used in the investigation of cholera outbreaks.

Incidence of Kawasaki disease among children in Chandigarh, India during 2015-2019: a trend analysis.

Background: Only limited information exists regarding the epidemiology of Kawasaki disease (KD) in low-income and middle-income countries. The present study provides the incidence of KD during 2015-2019 in Chandigarh, north India. Our centre follows the largest KD cohort in India. Methods: Children with KD at Chandigarh diagnosed during January 2015-December 2019 were enrolled in the study. Annual incidence rates were determined using decadal growth rates of the National Census 2011. We computed the incidence of KD in children aged <5, and <15 years. We also undertook linear trend analysis using our incidence data from 1994 to 2019. Findings: During 2015-2019, 83 patients (66 males, 17 females) were diagnosed with KD in Chandigarh. Incidence rates during these 5 years were 5.64, 9.25, 9.11, 9.87, and 9.72/100,000 in children aged <5 years, and 2.65, 4.44, 3.86, 5.07, 4.74/100,000 in children aged <15 years. The median age at diagnosis was 48 months (range: 12 days to 15 years). Compared to previous data (2009-2014), there was a 53.1% increase in annual incidence of KD in children aged <5 years, and a 53.7% increase in children aged <15 years. Coronary artery abnormalities during acute phase were noted in 16.9%, and in 7.2% of patients at 6 weeks of follow-up. The trend analysis indicated a monthly rise of 0.002 cases per 100,000 children aged <5 years, and 0.0165 cases per 100,000 children aged <15 years. Interpretation: The incidence of KD has continued to show an upward trend in Chandigarh over the period 2015-2019. This may indicate a true rise in the occurrence of KD or may reflect better disease ascertainment as a result of greater awareness about KD amongst healthcare professionals. Funding: None.

Unfavourable results in craniofacial surgery.

Craniofacial surgery is one of the newer subspecialties of plastic surgery and owes its birth to the pioneering work of Paul Tessier in the late sixties. Since then this challenging specialty work has been taken up by many centres around the word including India. Initial reports in late eighties and early nineties showed morbidity and mortality ranging from 1.6% to 4.3%. However over past few decades, with improved instrumentations, safer anaesthesia and cumulative experience of surgeons the morbidity and mortality has been brought down to as low as 0.1% in many centres in USA. In our centre at Post-graduate Institute, Chandigarh, the mortality rate is about 0.8% (4 out of 480 cases). The learning curve in this surgery is rather steep but with experience and a well-coordinated team work, results in this complex subspecialty can be improved. The infection is a major cause for worry but can be easily prevented by sound surgical principles and placing a vascularised tissue barrier between the extradural space and the nasopharynx/sinus mucosa.

Identification of prominent airborne pollen in a city situated in foot-hills of Himalayas, Chandigarh, India.

Pollen allergy is considered one of the important critical thrust areas, as 20-30% of the world population suffers from allergic rhinitis. The increase in global surface temperature directly affects pollen physiological (e.g., pollen production) and morphological parameters and indirectly affects the distribution pattern, the allergenic potential of pollen, and plant species. Therefore, periodic sampling and pollen studies of a region have become necessary to assess the status of change in species and its morphological characteristics of different taxa. The current study is conducted to identify the airborne pollen based on studying their unique and distinctive morphological characters to serve as a reference pollen guide for future research. The airborne pollens were trapped using the Burkard volumetric sampler at three different locations in Chandigarh from 2018 to 2020 and analyzed under Leica DM5500B-Automated Upright Microscope System. The study investigated various pollen features such as shape, size, aperture type, and exine/surface pattern for taxonomic classification of plant groups. The majority of LM-analyzed pollen grains were prolate-spheroidal or oblate, whereas the aperture types were 3-zonocolporate, 3-colpate, and 3-zonocolporate. Exine patterns were predominantly psilate, reticulate, and straite and were easily discernible. Nonetheless, the vast majority of airborne pollen belonging to both arboreal and non-arboreal was quite small and fall into small pollen size classes, i.e., 10-24 µm. The exine pattern was readily apparent and were predominantly psilate, reticulate, and straight. The current study improved the knowledge on airborne pollen biodiversity, which will help to understand the regional distribution, long-range transport, and construct the current status of morphological features of species/taxa.

The Caregiver Reported Autistic Symptoms in Preschool Children: Findings of Chandigarh Autism Screening Instrument (CASI) Linked Screening from North India.

Background Autism is a neurodevelopmental disorder and can be early detected with the aid of screening tools. Chandigarh autism screening instrument (CASI) is a newly developed tool to screen autistic symptoms among children aged between 1.5 to 10 years in the north Indian Hindi speaking population. Objective In this study, we evaluated the caregiver report of autistic symptoms in preschool children (3-6 years) attending selected schools of Rohtak. Materials and Methods The index study was conducted among 225 caregivers of school-going children aged between 3 to 6 years. Social and communication disorders checklist (SCDC-Hindi) and CASI was used to measure autistic symptoms. The modified Kuppuswamy scale was used for assessing the socioeconomic status of the caregivers. Results The autistic symptoms varied from 2.2 to 18.7%, depending upon the CASI (cutoff score of 10) and SCDC (cutoff score of 9) measurements. The items in the shorter four-item version (CASI Bref) of CASI were found to be the predictors of autistic symptoms in this population. Children's gender, age, and socioeconomic status were not found to have any association with autistic symptoms in this setting. Conclusion The study provides preliminary evidence in relation to the CASI-linked screening for autistic symptoms among preschool children. The shorter version of CASI (CASI Bref) can be an efficient quick screener for autistic traits, but the full version of CASI needs to be validated as per age-appropriate autism screening tools.

Management of Type II Diabetes by Modulating the Modifiable Risk Factors: A Future Roadmap for Prevention of Cerebrovascular Complications.

BACKGROUND: Indian Diabetes Risk Score (IDRS) is a screening tool for quantifying the risk of diabetes mellitus (DM) development in the Indian population. The present study has evaluated the level of risk of developing DM in Chandigarh and Panchkula based on the IDRS score. METHODS: As a part of a national diabetes control trial funded by the Ministry of Health and Family Welfare (MoHFW) and the Ministry of AYUSH, Government of India, 1,916 participants from the Chandigarh and Panchkula regions were assessed for the risk of developing DM. Risk assessment was done on the basis of the IDRS score which includes age, family history, waist circumference, and physical activity as its contributing factors. Participants with an IDRS score <30 were in the low-risk category, those with 30 to 50 were in the moderate-risk category, and those with >60 were in the high-risk category for DM. RESULTS: Out of the 1,916 screened respondents (59.86% females and 40.14% males), 894 participants (46.65%) were at a high risk for DM (IDRS >60), 764 (39.87%) were at a moderate risk (IDRS = 30-60), and 258 (13.46%) were at a low risk (IDRS <30). Waist circumference contributed to 35.90% of the high-risk category followed by age (19.67%) and physical activity (11.67%). Age and waist circumference also showed a strong correlation with the total IDRS score. CONCLUSION: The Chandigarh and Panchkula population showed a high tendency to develop DM based on the IDRS score. Modifiable risk factors such as waist circumference and physical activity were the major contributing factors. Apart from the modifiable risk factors, age was also another major contributing risk factor. Based on these outcomes, lifestyle modifications like yoga and exercise can be proposed for this population as a preventive approach to reduce the risk of developing DM and other associated cerebrovascular complications.

Optimal Tilt Angle Determination for PV Panels Using Real Time Data Acquisition.

Solar energy is one of the promising renewable energy sources which has the potential to meet the future energy demand around the world. To maximize the irradiance fall, solar panels are generally equipped with a motor tracking system and are placed at a specific tilt angle. However, tracking methods are not cost-effective and a fixed tilt angle is not productive. This study proposes a method for harnessing maximum output from photovoltaic (PV) panels throughout the year by determining the optimal tilt angle. The investigation is performed on real-time solar PV panels of 5 kWp rated capacity installed at 10°, 20°, 25°, 30°, and 40° angle on the rooftop of engineering institute situated at Chandigarh, India. The real-time power generation response for a year is used to find the optimal tilt angle. The results obtained from the practical setup are validated by comparing it with the simulation results of the regression analysis. In addition, the impact of the optimal angle on total power generation and carbon emissions is analyzed. The results reveal that the proposed approach is quite effective to increase the power generation of PV panels up to 7-8% and can be practically implemented in any location throughout the world.

Hepatic and Renal Profile of Scrub Typhus Patients at a Tertiary Care Center in India.

Introduction Scrub typhus is a resurging zoonotic infection prevalent in South Asia with many recent outbreaks in India. It can mimic other tropical infections and the disease spectrum ranges from subclinical illness to life-threatening disease with multiorgan dysfunction. This study was conducted to study the pattern of hepatic and renal injury. Methods A retrospective study was done on 176 patients diagnosed by detecting IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) over a period of three years at a tertiary center in Chandigarh, India. They were treated with doxycycline (azithromycin if pregnant) and supportive therapies. The patterns of hepatic and renal functions, along with the need of renal replacement therapy, were recorded and evaluated. The values were expressed as mean ± SD, and p values were calculated to establish statistical significance. Results Most of the cases were from the state of Haryana (37.5%), followed by Punjab (33.5%), Himachal Pradesh (13.6%), Uttar Pradesh (10.2%) and Chandigarh (5%). 30% of the study population was engaged in agriculture. The mean age was 32.3 ± 13.5 years with range of 13-65 years. A peak in the incidence was observed during monsoon months. Approximately 13% of the patients died. Urea, creatinine, bilirubin and aspartate transaminase were found to be higher in mortality group with statistical significance (p < 0.05). Alanine transaminase was higher and albumin was lower in the mortality group but without statistical significance. 27.8% had acute kidney injury, 90.9% had liver dysfunction and one patient had acute liver failure. All the pregnant patients had fetal loss. Conclusion Renal and liver dysfunctions are common in scrub typhus, and their occurrence adversely affects the outcome.

Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey.

BACKGROUND: Substance misuse is a matter of major public health concern in India. House-to-house survey, though an appealing method to generate population-level estimates, has limitations for estimating prevalence rates of use of illicit and rare substances. MATERIALS AND METHODS: In this rapid assessment survey (RAS), respondent-driven sampling was used to recruit substance-using individuals from the field. Size of the substance-using population was estimated using the "benchmark-multiplier" method. This figure was then projected to the entire population of the Union Territory (U.T) of Chandigarh. Focused group discussions were used to study the perceptions and views of the substance users regarding various aspects of substance use. RESULTS: Prevalence of any substance dependence in the U.T of Chandigarh was estimated to be 4.65%. Dependence rates on opioids, cannabinoids, and sedative hypnotics were found to be 1.53%, 0.52%, and 0.015%, respectively. Prevalence of injectable opioids was calculated to be 0.91%. Injectable buprenorphine was the most commonly used opioid, followed by bhukhi/doda/opium and heroin. A huge gap was found between the prevalence rates of substance-using population and those seeking treatment. CONCLUSION: RAS can be a useful method to determine the prevalence of illicit and rare substances. Our survey shows that the use of substance including that of opioids is highly prevalent in the U.T of Chandigarh. The findings of this survey can have implications for policymaking.

Prevalence of Depression, Anxiety and Stress among school going adolescent in Chandigarh.

CONTEXT: Depressive disorders often start at a young age. There is a need for early identification of depression, anxiety, and stress (DAS) and prevention. The present study was undertaken to find the magnitude of DAS among adolescents. AIMS: To find the mental health status of school going adolescents in Chandigarh. The objectives were (i) to study the prevalence of DAS among school going adolescents and (ii) to study the correlates of DAS. SETTINGS AND DESIGN: A Cross-sectional survey of students of four classes from 9th to 12th studying in government schools. SUBJECTS AND METHODS: Ten government schools in Chandigarh were randomly selected through lottery method. In each school, for each of the four classes, a section was randomly selected again by the lottery method. Forty students were selected from each school reaching sample size of 470. DAS scale 21 questionnaires were used. STATISTICAL ANALYSIS USED: The data entry was done in MS Office Excel 2007. The analysis was done in the form of frequency tables, charts cross tables. For statistical significance, Chi-square test and correlation was found between various factors. RESULTS: The prevalence of DAS was 65.53%, 80.85%, and 47.02%, respectively. Overall, comorbidity between depression and anxiety was 57.65%. Extremely severe depression was very less (3%). The prevalence of DAS was higher in females. For depression and anxiety, the peak age was 18 years. CONCLUSIONS: The prevalence of DAS was high among school going adolescents in Chandigarh. There is a need for early and effective identification of DAS that can prevent many psychiatric disorders at their nascent stage.

Substance use and dependence in the Union Territory of Chandigarh: Results of a household survey using a multistage stratified random sample.

BACKGROUND: Substance misuse is a global health and social problem with major adverse consequences. A number of regional studies on prevalence of substance use and dependence have been carried out in India; but methodologically robust data from Chandigarh are sparse. METHODOLOGY: A house-to-house survey was carried out to estimate the prevalence of substance use and dependence in an adequate multistage-stratified random sample in the Union Territory (UT) of Chandigarh, using standardized instruments and predefined measures. Two thousand individuals (1000 each from urban and rural sites) from 743 households were interviewed. RESULTS: Lifetime use of any substance was reported in 21.26% households (8.01% of all respondents; 13.6% males and 1.01% females). Current use was reported in 6.55% of respondents. Prevalence rates of both lifetime and annual/current substance dependence were 2.96% (4.74% for males and 0.72% for females). Alcohol (6.72%) was the most common substance to be ever used by respondents, followed by tobacco (3.34%), opioids (0.17%), and hypnotics (0.04%). Lifetime dependence rates were found to be 1.76%, 2.28%, 0.04% and 0.17% for alcohol, tobacco, hypnotics, and opioids, respectively. None reported the use of cannabinoids, inhalants, or stimulants. Substance users were more likely to be married, employed, and in higher income group as compared to those who never used substance. Only 3.78% substance users had ever sought treatment for the same. CONCLUSION: Substance use is prevalent in the UT of Chandigarh, with a higher prevalence in males. Substance users hardly ever seek treatment for substance use. This highlights the need of awareness and community-level services for the treatment of substance use disorders.

Electronic health record use in an affluent region in India: Findings from a survey of Chandigarh hospitals.

OBJECTIVES: To characterize the electronic health record (EHR) systems in use in an affluent region of India in order to understand the state-of-the-art within the Indian market. METHODS: A survey on EHR features was created by combining an instrument developed by the Organisation for International Cooperation and Development and an instrument developed by an American team of researchers. An interviewer directly administered the survey to leaders from hospitals in greater Chandigarh which possessed electronic health information systems. Summary statistics from the survey are reported. RESULTS: 24 hospitals offering multi-specialty inpatient care were identified in greater Chandigarh. 18 of these hospitals had electronic health information systems, 17 of which were interviewed. Of the hospitals with systems, 17 (100%) could access patient demographic information internally, but 12 (71%) could not access vital sign, allergy, or immunization data internally. 11 (65%) of the systems were capable of sharing patient summaries internally, but 13 (76%) could not send electronic referrals internally. Among organizations which have adopted systems, major barriers tend to have been around financial and staff matters. Concerns over interoperability, privacy, and security were infrequently cited as barriers to adoption. CONCLUSIONS: EHRs are ubiquitous in at least one region of India. Systems are more likely to have capabilities for intra-organizational information sharing than for inter-organizational information sharing. The availability of EHR data may foster clinical research.

Kawasaki disease in infants below 6 months: a clinical conundrum?

AIM: Kawasaki disease (KD) is a medium vessel vasculitis of childhood. In infancy KD is often characterized by incomplete and atypical forms. There is paucity of literature on KD in children below 6 months and there are no data from any developing country. This study defines the profile of children with KD below 6 months at our centre. METHODS: During January 1994 to March 2015, 460 children were diagnosed with KD and 17 (3.6%) were below 6 months. Diagnosis was based on American Heart Association (AHA) criteria. All children were treated with intravenous immunoglobulin and aspirin; three also received infliximab. RESULTS: Mucosal changes were present in 11 patients (64%); extremity changes in 11 (64%); rash in nine (53%); conjunctival injection in eight (47%); and cervical lymphadenopathy in three (17%). Irritability was noted in 15 patients (88%); four (23%) had respiratory symptoms; and two (11%) had bacille Calmette-Guérin scar reactivation. Fifteen (88%) had incomplete KD. Twelve patients were diagnosed beyond day 10 of illness. Thrombocytopenia was seen in four. Coronary artery abnormalities were present in six (35%) patients. Two children died from disease-related complications - one of these had giant coronary artery aneurysms. CONCLUSION: Our data show that incomplete forms of KD are commonly seen in children below 6 months of age, thereby resulting in delayed diagnoses. Pediatricians need to have a high index of suspicion of KD when dealing with a young infant with unexplained fever beyond 5 days. The AHA criteria appear to be inadequate for diagnosing KD in infants below 6 months.

Process evaluation of community monitoring under national health mission at Chandigarh, union territory: Methodology and challenges.

BACKGROUND: Community monitoring was introduced on a pilot mode in 36 selected districts of India in a phased manner. In Chandigarh, it was introduced in the year 2009-2010. A preliminary evaluation of the program was undertaken with special emphasis on the inputs and the processes. METHODOLOGY: Quantitative methods included verification against checklists and record reviews. Nonparticipant observation was used to evaluate the conduct of trainings, interviews, and group discussions. Health system had trained health system functionaries (nursing students and Village Health Sanitation Committee [VHSC] members) to generate village-based scorecards for assessing community needs. Community needs were assessed independently for two villages under the study area to validate the scores generated by the health system. RESULTS: VHSCs were formed in all 22 villages but without a chairperson or convener. The involvement of VHSC members in the community monitoring process was minimal. The conduct of group discussions was below par due to poor moderation and unequal responses from the group. The community monitoring committees at the state level had limited representation from the non-health sector, lower committees, and the nongovernmental organizations/civil societies. Agreement between the report cards generated by the investigator and the health system in the selected villages was found to be to be fair (0.369) whereas weighted kappa (0.504) was moderate. CONCLUSION: In spite of all these limitations and challenges, the government has taken a valiant step by trying to involve the community in the monitoring of health services. The dynamic nature of the community warrants incorporation of an evaluation framework into the planning of such programs.

Periodontal health status of transport workers of a union territory in India: A cross-sectional study.

BACKGROUND: Periodontal disease is one of the most prevalent dental diseases, which affects the adult population of the world, varying only in degree from mild to severe. Transport industry is considered an important pillar for socioeconomic development of any nation. The present study was carried out to assess the periodontal health status of transport workers working in Chandigarh Transport Undertaking (CTU) buses, Chandigarh (Union territory). MATERIALS AND METHODS: A cross-sectional study was conducted on all available CTU workers at all three bus depots. The data were recorded on a modified WHO format (1997). A total of 998 subjects were included for community periodontal index (CPI) and attachment loss computations after doing necessary exclusions. Periodontal status was evaluated using CPI. RESULTS: About 8.13% of the subjects had healthy periodontium while maximum subjects (73.2%) had a score 2 (calculus) as evaluated by CPI. 3.4% (12) of the subjects belonging to upper middle class had deep pockets as compared to 1.9% (10) of the subjects in the lower middle class. None of the subjects in the upper high, high, and upper middle socioeconomic status (SES) category had a loss of attachment score 4. 25.9% of the postgraduates had a CPI score of 0 whereas 0.7% high school subjects had a loss of attachment score 4. CONCLUSION: Advanced periodontal disease (CPI score, 4) affected small number of subjects with maximum subjects (73%) having a CPI score of 2. There was statistically significant association of SES and education level with the CPI score and loss of attachment level.