Indian Journal of Medical Research最新文献

Background objectives: This study aimed to compare the admission characteristics and outcomes of tribal and non-tribal neonates admitted to a level II special newborn care unit (SNCU) in rural Gujarat.

Methods: This was a retrospective observational study that looked at all neonates admitted to a high-volume SNCU between 2013 and 2021. A series of quality improvement measures were introduced over the study period. Admission characteristics, such as birth weight, gestational age, gender and outcomes for tribal and non-tribal neonates, were compared.

Results: Six thousand nine hundred and ninety neonates [4829 tribal (69.1%) and 2161 (30.9%) non-tribal] were admitted to the SNCU. Tribal neonates had lower mean birth weight (2047 vs . 2311 g, P <0.01) and gestational week at birth (35.8 vs . 36.7 weeks, P <0.01) compared to non-tribal neonates. Common causes of admissions were neonatal jaundice (1990, 28.4%), low birth weight (1308, 18.7%) and neonatal sepsis (843, 12%). Six hundred and thirty-eight (9.1%) neonates died during the treatment in the SNCU. The odds of death among tribal neonates was similar to non-tribal neonates [adjusted odds ratio: 1.12 (95% confidence interval [CI]: 0.89, 1.42)]. The tribal neonates had significantly higher cause-specific case fatality rate from sepsis [relative risk (RR): 2.18 (95% CI: 1.41, 3.37)], prematurity [RR: 1.98 (95% CI: 1.23, 3.17)] and low birth weight [RR: 1.83 (95% CI: 1.17, 2.85)]. The overall case fatality rate in the SNCU decreased from 18.2 per cent during the year 2013-2014 to 2.1 per cent in the year 2020-2021.

Interpretation conclusions: There was a reduction in the case fatality rate over the study period. Tribal and non-tribal neonates had similar risk of death. Sepsis prevention and management, mechanical respiratory support and timely referral to a higher centre might help further reduction in mortality for these neonates.

Background objectives: The prong 2 of 4 prong strategy introduced by the World Health Organization aims at averting unintended pregnancies among people living with HIV (PLHIV). This systematic review aimed to generate evidence on the effectuality of facility-based interventions in improving uptake of modern and dual contraception, for reducing unmet family planning (FP) needs and unintended pregnancies among PLHIV.

Methods: Articles evaluating facility-based interventions to integrate human immunodeficiency virus (HIV) and FP published in English language were included. Eligible studies were identified from electronic and lateral search from three databases (PubMed, Cochrane Library and Web of Science) and grey literature. HIV care with no/minimal focus on FP was considered a comparator. Quality was assessed using design-appropriate tools. Descriptive analysis was presented in tables. Uptake of dual methods, unmet FP needs and unintended pregnancies were included in the meta-analysis to estimate pooled odds ratio (OR) with random effect model, P and I2 values.

Results: The search yielded 2112 results. After excluding duplicates and unfit articles, 17 were found eligible for review and nine for meta-analysis. The pooled OR for uptake of dual contraception was 1.69 (1.14, 2.5) ( P =0.008; I2 =90%), for unmet FP needs was 0.58 (0487, 0.69) ( P <0.00001; I2 =0%) and for unintended pregnancies was 0.6 (0.32, 1.1) ( P =0.1, I2 =38%).

Interpretation conclusions: The results of this meta-analysis suggest that health facility-based interventions to integrate HIV and FP services do result in improved uptake of dual methods and reduce unmet need for contraception along with a protective trend on incidence of unintended pregnancies. Such facility-based integration would ensure universal access to effective contraception and facilitate in achieving Sustainable Development Goals that aim at ending epidemics like HIV.

Background objectives: Cannabis use has long been associated with celebration and hospitality, although abuse must be confirmed through testing. It has always been difficult to develop an accurate and reliable confirmatory method for the quantification of tetrahydrocannabinol carboxylic acid (THC-COOH) that meets local requirements. The goal was to develop a rapid, cost-effective analytical technique that can handle large batches.

Methods: Because of the wide metabolite detection window and ease of collection, urine was preferable sample. The extraction of a pre-screened urine sample (adulteration and multidrug screening) was done on Bond Elut cartridges using a positive pressure vacuum manifold, followed by quantification using a gas chromatograph and mass spectrometer.

Results: The assay was linear between 15 and 300 ng/ml ( r2 of 0.99). The intra-day precision was 8.69 per cent and the inter-day precision was 10.78 per cent, respectively with a 97.5 per cent recovery rate for the lowest concentration. A total of 939 urine samples were examined, with 213 detecting cannabis. Sixty per cent of the total individuals tested positive for simply cannabinoids, 33 per cent for cannabinoids and sedatives, five per cent for cannabinoids and morphine and one for cannabis, morphine and cocaine.

Interpretation conclusions: Assay characteristics included modest sample preparation, rapid chromatography, high specificity and small sample volume with a processing time of 12 h. The assay described here can be applied for diagnostic laboratories and in forensic settings as well.

Background objectives: Injuries occurring from contaminated sharps are a major occupational health hazard. It carries a risk of transmitting blood-borne diseases such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C. Healthcare workers (HCWs), including personnel handling biomedical waste, are at risk. The objective of this study was to determine the incidence and details of needlestick injury (NSI) among HCWs.

Methods: We analyzed data of all HCWs who reported NSI over the past three years. Demographic details, type and source of injury, use of personal protective equipment (PPE), immediate post-exposure measures, hepatitis B vaccination status and HCWs and source's HIV, hepatitis B and hepatitis C serological status were studied.

Results: Fifty-six cases of NSI were recorded over three years, accounting for an incidence of 10.4/100 occupied beds per year. Maximum cases (73.2%) occurred between the 20 and 40 yr age group. The distribution among the work category was doctors (37.5%), nursing staff (26.8%), phlebotomy technicians (12.5%), housekeeping/subordinate staff (12.5%) and others (10.7%). Appropriate PPE was donned by 66 per cent of the HCWs. The majority of cases (46.4%) occurred in wards and operating rooms (23.2%). Phlebotomy (35.7%), followed by procedures, such as hemoglucotest (HGT) measurement, intravenous cannula insertion and operative procedures (33.9%), were the most common situation during which HCWs suffered NSI. While 64.2 per cent HCWs were vaccinated for hepatitis B, only 5.4 per cent of the HCWs completed post-exposure anti-retroviral regimen.

Interpretation conclusions: We conclude that a relative lack of awareness towards preventive measures and inexperience among HCWs may be contributory to high occurrence of NSI events. This study emphasizes upon ensuring active hospital-wide hepatitis B vaccination of all HCWs and supportive therapy to improve compliance towards post-exposure prophylaxis.

Background objectives: The Cigarette and Other Tobacco Products Act (COTPA) limits the sale of tobacco products, promotion and advertising and packaging of tobacco products in India. Periodic monitoring of the level of compliance with all sections of COTPA is obligatory to assess the effectiveness of the act.

Methods: This pre-post study aimed to assess the change in the level of compliance with different sections of COTPA in selected States. A total of 3849 and 2176 samples were assessed during the study in November 2020 and October 2021, respectively; using the EpiData Software.

Results: Average compliance with section 4 of COTPA was highest in Puducherry during baseline [51.88%, prevalence ratio (PR)=0.72, 95% confidence interval (CI): 0.51-1.02] and in Telangana during endline assessment (66.1%, PR=0.6, 95% CI: 0.48-0.74). A visible change with section 5 of COTPA was observed in Telangana (40.08 to 93.12%, PR=0.04, 95% CI: 0.02-0.07). Compliance with section 6a of COTPA decreased in Puducherry (81.34 to 71.83%, PR=1.84, 95% CI: 1.14-2.95) and increased for Meghalaya and Telangana. The average compliance with sections 7, 8 and 9 (for Puducherry 51.09 vs . 48.8%, Meghalaya 54.94 vs . 46.18% and Telangana 73 vs . 51.91%, respectively) decreased in all States. An increase in average compliance was observed with sections 4 and 5 ( P =0.19 and 0.11, respectively) and a decrease with sections 7, 8 and 9 ( P =0.02) of COTPA in all three States. For sections 6a ( P =0.06) and 6b ( P =0.01), a mixed response was noted.

Interpretation conclusions: The findings of this study suggest that the level of compliance with sections 4 and 5 of COTPA increased because they are strictly monitored compared to sections 7-9, which are less enforced by the States. There is a need to monitor sections 7-9 (pack warning) to fulfill the objectives related to the World Health Organization (WHO) Framework Convention on Tobacco Control.

Background objectives: Smokeless tobacco (SLT) product consumption has profound public health implications for its users. The p H and moisture of SLTs determine the bioavailability of nicotine, the microbial structure dynamics and the amount of microbial conversion of tobacco alkaloids to carcinogenic tobacco-specific nitrosamines. This study aimed to characterize and compare the p H, moisture and alkaloid content of various SLT products.

Methods: Thirty-seven SLT samples including khaini , snus, moist snuff, gul , pan masala , zarda , Mainpuri kapoori and qiwam were collected from the retail market around the National Capital Region in north India and their p H, moisture, nicotine and alkaloid content were measured. The p H and total nicotine were used to calculate the amount of free nicotine, the readily absorbed form, for each product by applying the Henderson-Hasselbalch equation.

Results: The investigation showed that the SLTs varied drastically in their p H (5.36 to 10.27), moisture content (4.7 to 51.7%) and alkaloid content (0.82 to 35.87 mg/g). The p H and free nicotine levels of a product were found to be positively correlated, and the highest free nicotine content was reported in snus samples. Further, the moisture content was seen to impact the bacterial and fungal diversity in these samples.

Interpretation conclusions: Studies to detect the presence of pathogenic microbiological genera as well as potentially toxic constituents are warranted. The use of SLTs as an alternative to cigarette smoking should be discouraged, and cessation programmes must call attention to their detrimental effects and emphasize on benefits of quitting SLT consumption.

Links between tobacco use and poor pregnancy outcomes are well established. Despite various tobacco control measures taken by the government, nearly 5-8 per cent of pregnant women consume tobacco in India. Antenatal check-ups are an opportunity to assess and assist women in quitting tobacco during pregnancy. This review highlights the challenges faced in identifying pregnant tobacco users and providing cessation counselling to them in a formal healthcare setup in the Indian context. For this narrative review, open access databases like PubMed and Google Scholar were searched, using the following search terms: challenges, quitting tobacco use, smokeless tobacco, pregnancy and India. Original articles published between 2010 and July 2022 were included in the English language with available free full text. Out of the thirty articles found to be eligible, seven were included in the review. Official websites of the National Health Mission and National Tobacco Control Programme were also searched to retrieve available data on health education and training material for healthcare workers: medical officers, Auxiliary Nurse and Midwives (ANMs), Accredited Social Health Activists (ASHAs) and list of tobacco cessation centres. This review identified the factors such as myths surrounding tobacco use, lack of targeted screening, inadequate training of healthcare workers and inaccessibility of cessation services, which are posing as challenges in controlling tobacco use in this vulnerable section of the population. Specific strategies to address these issues at the micro, meso and macro levels can prove to be vital in controlling tobacco use in pregnant women. This review also identified the vital role of gynaecologists and healthcare workers such as ANMs and ASHA in identifying and providing brief tobacco cessation counselling to pregnant users.