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   Table of Contents - Current issue
January-April 2023
Volume 4 | Issue 1
Page Nos. 1-57

Online since Wednesday, February 15, 2023

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Developing framework toward one health approach: Relevance and future implications p. 1
Suraj Kapoor
Against a constant background of recognized infections, epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of emerging and re-emerging diseases. The emergence/re-emergence of these diseases is related to multifaceted factors, such as viral recombination and mutation, leading to more infectious and adaptive strains, industrialization and urbanization, and human activities such as deforestation creating a more permissive environment for vector-host interaction. A better knowledge of the causes and consequences of certain human activities, lifestyles, and behaviors in ecosystems is crucial for a rigorous interpretation of disease dynamics and to drive public policies. This article highlights the factors associated with emergence and re-emergence and in turn the importance and implementation of the One Health approach. Health-care professionals can prevent and control antimicrobial resistance by prescribing and dispensing antibiotics as per the laid down guidelines and indications. Sentinel surveillance at the point of entry should be strengthened. Successful One Health approaches require intersectoral coordination, with a team approach despite functioning in different sectors or domains. It is proposed that government and policy-makers should take scientific decisions about the creation of epidemiological surveillance centers at the district level on the concept of One Health. It should have facilities and infrastructure for ecosystem surveillance, namely air, water, soil, flora, and fauna, monitoring as well as investigation of the outbreak. Equally important is to empower the community and family members about the One Health concept and the matters concerned.
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Use of repurposed drugs in COVID-19 pandemic: Old drugs without new tricks? p. 4
Suraj Kapoor
Traditional drug development and discovery have not kept speed with warnings from emerging and re-emerging diseases such as Zika, Nipah, Ebola virus, MERS-CoV, and more newly the pandemic of COVID-19. The new drug discovery has a limitation of high attrition rates, substantial costs, and longer duration for discovery, so repurposing old drugs to treat the diseases becomes a popular and feasible proposition. In contrast, repurposed drugs may be beneficial for patients in a time of pandemics when the natural history of the disease remains unclear. It may be beneficial for the manufacturers as well to generate additional revenues. The use of repurposed drugs in primary care saves money as well as time, particularly important in pandemic times, which can be a cost-effective measure in the public health aspect. Review of literature was carried out about the repurposed drugs used in the COVID-19 pandemic using health bulletins, official handles of health ministries, WHO, published literature, etc. The use of repurposed drugs is beneficial, particularly in pandemic and rare diseases, but their use should be taken with due caution and thorough evaluation. Important public health aspect in primary care includes avoidance of unnecessary hoarding of such drugs. International collaboration in assessing the effectiveness of repurposed drugs is suggested.
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Monkeypox 2022: Emerging zoonotic epidemic threat, future implications, and way ahead p. 8
Suraj Kapoor, Ashvin Varadharajan
Introduction: Monkeypox is a rare zoonotic disease that is caused by a virus belonging to the Orthopoxvirus genus and is closely related to smallpox and cowpox viruses. The emerging epidemic amid the current COVID-19 pandemic is a matter of concern and warrants urgent public health attention with key issues discussed in the article. Aim: The aim of this study was to explore emerging zoonotic, epidemic threats, future implications, and the way ahead in respect of monkeypox. Methodology: Secondary data from official government sites, press information, latest articles, newspapers, and the WHO website were extracted and discussed in the article. The current epidemiology of monkeypox with the difference from the COVID-19 pandemic is highlighted in the study. The most probable factors for the emergence and recent outbreak are also discussed. The period of the study was from May 20, 2022, to May 27, 2022, and was conducted in the medical college of Western Maharashtra. Results and Discussion: Total number of 25 articles/government/international websites were assessed. While comparing the number of cases among different countries across the globe, the present outbreak has involved different countries with no geographical continuity, with a maximum number of cases from Portugal, Spain, and the United States of America. A comparison of epidemiological determinants of COVID-19 and monkeypox was done which reveals the lesser pandemic potential of monkeypox as compared to COVID-19. Conclusion: The present monkeypox outbreak scenario is different from the previous outbreaks, but with lesser pandemic potential as compared to COVID-19. However, with the increase in the incidence of monkeypox cases in different countries, the fear of cross-border transmission is real. Robust public health surveillance and control measures are vital to address this threat.
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Mistreatment of women during child birth - A narrative review p. 12
Mamta Paliwal, Manisha Singh, Manju Khoja, Mansi Meghwal, Meena Jaitani, T Deviga, Himanshu Vyas
Respectful maternity care is the universal right of every woman all around the world but recent evidences show that women receive disrespectful care and face abuse during facility-based childbirth. It creates a negative impression of the institutional delivery and indirectly contributes to increases in the maternal morbidity and mortality rate; hence, this narrative review was conducted to identify the various forms of mistreatment, determinants and prevalence of disrespectful maternity care in India. (i) To explore the status of mistreatment of women during childbirth. (ii) To assess the factors responsible for mistreatment experienced by women. Keywords searches of PubMed, Google scholar, manual searches of other relevant journals and references lists of primary articles. Quantitative studies and mixed-method studies on women's experiences of factors responsible for mistreatment during labor were explored, study result revealed that factors affecting respectful maternity care (RMC) include age, religion, income etc., Various types of mistreatments experienced by women during labur were physical abuse (9.3%), nondignified care (14.25%), nonconfidential care (33.95%), neglect/ignore (9.35%), verbal abuse (19.72%), discrimination (7.36%), threats to with hold treatment (8.15%), lack of information (26.2%), delivered alone (9.25%), choice of position denied (10.5%), requested payment of bribe (46.3%), unnecessary separation from baby (4.3%), nonconsented care (49.05%). Mistreatment during labor is common in India and is commonly found in the form of verbal abuse, physical abuse, discrimination, threats to with hold treatment, lack of information, ignored, delivered alone, choice of position denied, companion not allowed, requested payment or bribe, unnecessary separation from body etc., Health care personal plays a major role for providing RMC and in preventing mistreatment during childbirth. They must be aware about the mistreatment during childbirth and its consequences such as increasing maternal mortality rate and decrease no. of institutional delivery.
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Knowledge, attitudes, and behaviors of Indian medical students and health-care providers on COVID-19: An Online Cross-Sectional Survey p. 18
Bhagyajyoti Priyadarshini, Shiba Sai Swarup, Trupti Rekha Swain, Joshil Kumar Behera, Naresh Kumar, Kumari Sandhya, Himel Mondal
Background: COVID-19 has created fear, misconception, and apprehensions among not just the public but also the present and future health-care providers. The COVID-19 pandemic has passed two waves, and currently, the third wave is waning. Aim: This study aimed to evaluate the knowledge, attitude, and practice toward COVID-19 among the health-care providers and medical students of India. Materials and Methods: This was a cross-sectional, observational study conducted with medical students, practicing doctors, nurses, ward attendants, and other health-care workers working all over India. The questionnaire used for the study was developed using the three-step modified Delphi method. It was prevalidated and standardized by conducting a pilot study. Then, the survey questionnaire was circulated via Google Forms. The collected responses were tested statistically by Kolmogorov–Smirnov test, Chi-square, and Spearman's rank correlation. Results: A total of 2211 (1137 medical students, 840 doctors, 126 nurses, 12 ward attendants, and 96 other health-care workers) respondents participated in the study. The mean score for knowledge was 5.93 ± 1.21, for attitude was 5.20 ± 0.84, and for practice was 2·38 ± 0·896. We found a significant positive correlation between knowledge and attitude, knowledge and practices, and attitude and practices. Conclusion: There is an average to a good level of knowledge, attitude, and practice toward COVID-19 among the medical students and health-care providers in India in the third wave of the COVID-19 pandemic. The positive correlation affirms that better knowledge can lead to a positive attitude. This ultimately helps build appropriate behavior.
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Assessment of mother and child protection card utility in a rural block of Odisha p. 25
Susmita Dora, Debjyoti Mohapatra, Manish Taywade, Binod Kumar Patro, Vikas Bhatia
Background: Mother and Child Protection card was introduced for accelerating reduction in maternal, neonatal, and infant mortality and child under-nutrition & meant to be used by both beneficiaries and health care providers. It is a folding pictorial tool designed to assist mothers' understanding and monitor individual progress of maternal and child health and also enable the large networks of ASHAs, AWWs, and ANMs to converge their efforts and utilize the critical contact opportunities more effectively. Objective: To assess the completeness of information in MCP card filled by the AWW, ANM, and Beneficiary. Material and Methods: Twelve villages in mendhasal block of Khurdha district were selected for this study by multistage stratified random sampling method. MCP cards of Pregnant women from the second trimester onwards and Mothers of children 0-2 years of age were assessed for completeness using a Checklist. Results: A total of 34 and 46 items were checked for completeness in the MCP cards of Antenatal and post-natal women. The median entries found to be complete in Antenatal and Post-natal women were 34 and 26. Recording information on demographic details and antenatal care details was high but there was poor maintenance of other records like post-natal care, immunization, and growth chart. It was also found that beneficiaries are not marking the circles in the tablets consumption part. Conclusion: The study reported a gap in the maintenance of records in the Mother & Child Protection Card. Training for both the health care providers and mothers is needed for adequate use of the MCP card.
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Attitude of adults toward COVID-19 vaccination in India: An online cross-sectional study p. 30
Bandana Rath, Amit Kumar Mishra
Introduction: As on January 12, 2022, India had 955,319 active cases and 484,655 COVID-19-related deaths. In this alarming situation, COVID-19 vaccination is the key in reducing morbidity and mortality. The vaccination could be a game-changer in India and it is critical to understand the attitude of the people toward currently available COVID-19 vaccines. Materials and Methods: An online cross-sectional study was conducted to assess the attitude of adults toward COVID-19 vaccination and reasons for vaccine acceptance/reluctance. A predesigned-pretested structured questionnaire was shared through WhatsApp with the target population and responses were recorded. The analysis was done using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 21.0. (developed by IBM Corp, Armonk, New York), and results were presented in percentages/proportions. Results: In the current study, 552 responses were analyzed. Most of the participants (58.5%) were between 18 and 30 years of age with 55.4% males. Among the study participants, 96.6% already had received COVID-19 vaccine and 2.5% were waiting for their turn to come, only 5 participants (0.9%) were not interested for the vaccine. The most common reason for vaccine acceptance was that the vaccinated people can protect unvaccinated people from COVID-19 (43.7%) by breaking the chain-of-transmission. The reasons for vaccine reluctance were noted as the available vaccines had low efficacy and were associated with severe adverse events. Conclusion and Recommendations: The current study showed a high COVID-19 vaccine acceptance and a very low vaccine reluctance among the study participants. The factors associated with reluctance could be addressed by proper Institutional Ethics Committee practices. Information from the current study could be used to plan a better vaccination drive in the country.
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Age-appropriate vaccination and its determinants among children <24 months in Kano, Nigeria p. 36
Hajara I Maizare, Fatimah Isma'il Tsiga-Ahmed, Shahida Labaran Faruk, Abdulmajid Yakubu Ahmad, Aisha Aliyu Abulfathi
Background: Administration of vaccines at recommended ages and according to recommended intervals between doses of multi-dose antigens provides optimal protection, ultimately reducing the possibility of propagating the transmission of vaccine-preventable diseases. A sizable discrepancy in the median age at vaccination has been shown in Nigeria. This study assessed age-appropriate vaccination and related factors among children aged 0–23 months attending immunization clinics in the Kano metropolis. Materials and Methods: An adapted and pretested semi-structured interviewer-administered questionnaire was used to obtain information from a cross-section of 384 pairs of mothers/babies who presented to the immunization clinics of selected primary health centers within Kano metropolis. Results: The median ages at vaccination were 13, 49, 91, 122, and 282 days for BCG, pentavalent-1, pentavalent-2, pentavalent-3, and measles antigens, respectively. Proportions of children who had received age-appropriate vaccines were 83.8%, 81.6%, 64.9%, 60.4%, and 40.3% for BCG, pentavalent-1, pentavalent-2, pentavalent-3, and measles vaccinations, respectively. Children who were 4 months or older were 80% less likely to be age-appropriately vaccinated compared to those 3 months or younger (adjusted odds ratios [aOR]: 0.2, 95% confidence interval [CI]: 0.1–0.7). Furthermore, children with a previous experience of an adverse event following immunization were 50% less likely to be age-appropriate for the index vaccination (aOR: 0.5, 95% CI: 0.3–0.9). Conclusion: Many children in the Kano metropolis were not age-appropriately vaccinated. The measles vaccine had the least proportion of age-appropriately vaccinated children. Sensitization and health education of caregivers on timely vaccination cannot be overemphasized.
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Studying the association between cigarette smoking and serum copper, zinc, and magnesium concentrations: A cross-sectional study p. 42
Asmaa Mahmoud Mohammed, Adel F Hashish, Gamila S El-Saeed
Background and Objectives: Tobacco smoking causes damages almost for every organ in the body. Based on the literature review, the relationship between smoking, including nicotine dependence, and the serum zinc (Zn), copper (Cu), magnesium (Mg) status has not been studied sufficiently. The aim of the present study was to determine the relationship of cigarette smoking, including the nicotine dependence state of the smokers, with serum Cu, Zn, and Mg concentrations. Subjects and Methods: Overall, 41 active smokers and 44 nonsmokers were investigated for serum Cu, Zn, and Mg concentrations; in addition to urinary cotinine/creatinine ratio. The eight-item Fagerstrom test for nicotine dependence (FTND) questionnaire has been used to determine the nicotine dependence status of the smokers. Results: A significant hypozincemia has been detected in 34.1% of the smokers versus 9.1% of nonsmokers, with a five-fold higher risk than nonsmokers. Moreover, a significant hypomagnesemia has been detected in 24.4% of the smokers, with 6.7 fold higher risk than the nonsmokers. The serum Cu concentrations of the smokers were significantly higher (102.4 ± 17.5 μg/dl) than the nonsmokers (70.7 ± 17.1 μg/dl), (P < 0.0001). Each 1 year decrease in the initial age of starting smoking was associated with an increase in the serum Cu concentration by 0.016 μg/dl. Each increase in the serum Cu concentration by 1 μg/dl was associated with a decrease in the serum Zn and Mg concentrations by 0.4 μg/dl and 4 μg/dl, respectively. Conclusion: Cigarette smoking is a significant risk factor for hypozincemia, hypomagnesemia, and high Cu concentrations regardless of the nicotine dependence status of the smokers. Early management of hypozincemia may be a preventive measure to decrease the incidence of the oxidative stress-induced diseases.
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Mental health issues during COVID-19 pandemic p. 48
Neethu George, Rock Britto, S Mani Prabhu, A Selvamathi, T A. Shaik Yehya Suhail, S Sharmila
COVID-19 is a disease which invariably challenges all fundamental systems and organizations, economical patterns, and also the infrastructure in almost all the countries of the world. People in this period are facing both boon and ban in various aspects of surviving. The various milestones that were created as well as creating against the deadliest diseases and breakouts in this era give new perceptiveness to humanity. These newer areas unknown till to humans make some alterations in the normal life. Particularly, health systems are suffering more than other systems. In this global humanitarian crisis of COVID-19 pandemic, mental health issues are sometimes ignored or kept aside as a secondary issue. This article highlights some of the hidden, yet understudied parts of mental health issues.
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Topical ivermectin in ophthalmomyiasis: Literature review and a case report p. 52
Gayatri Dasari
Ocular myiasis is a rare condition affecting orbital and ocular tissues infected by fly larvae of the order Diptera. This clinical case report highlights the importance and requirement of topical ivermectin eye drops for treating external ophthalmomyiasis. A 55-year-old female patient presented to the hospital who had a history of worms in her right eye in the last 6 months and was diagnosed with right eye external ocular myiasis. Mechanical removal of worms done under topical anesthesia and treated with oral tablet ivermectin 12 mg stat, ivermectin topical drops prepared by dissolving ivermectin 12 mg tablet in 10 ml distilled water and advised to instill four times a day, and oral tablet metronidazole 400 mg twice a day for 5 days. The patient effectively responded to the treatment with complete resolution and there was no recurrence. The treatment modality of ophthalmomyiasis depends on the clinical presentation and severity of tissue destruction and is planned on an individual patient basis. Mechanical debridement of worms under topical anesthesia with adjuvant oral ivermectin is recommended. Topical ivermectin eye drops can be used to kill the worms in places where they cannot be manually reached. Further studies are needed to study the efficacy of topical ivermectin.
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It's time to focus on noncommunicable diseases amid the COVID-19 pandemic p. 55
Suraj Kapoor
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COVID-19 pandemic and original antigenic sin: Future implications on vaccination policy p. 57
Suraj Kapoor
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