Vol 11, Issue 1, Jan-Mar, 2021

Background: Iinjuries are an emerging global health epidemic. They claim more than 16,000 lives across the world daily and account for almost 50% of deaths in people aged 10 to 24 years. The burden of injuries is likely to grow in the coming years. Reliable data that would help in the analysis of injury problems are lacking in many countries. Police records are a potentially important source of data on injuries. Objectives: to summarise and present the worldwide literature on the proportions of injuries ascertained by police records; and the extent to which police records are utilised in injury surveillance systems. Methods: Peer reviewed and grey literature published between January 2000 to July 2020 in English language on ascertainment of unintentional injuries by police records, or on use of police records for injury surveillance was included. Databases searched were Medline, EMBASE, PubMed, Google Scholar, Cochrane database and the Database of Abstracts of Reviews of Effectiveness (DARE). Reference lists of eligible studies were also scanned. The review was not registered and a review protocol was not published. Results: Out of 754 unique studies identified, 712 were excluded after screening of the abstract and 10 were excluded after reading the full text. Four studies were included after screening the reference lists of eligible studies. Ascertainment of fatal injuries by police records was reported between 35% to 96.6% in High-Income-Countries (HICs) 46.4% to 56.2% in Upper-Middle-Income-Countries (UMICs), 4.2% to 77.8% in Lower-Middle-Income- Countries (LMICs) and 46.3% to 58% in Low-Income-Countries (LICs). Ascertainment of nonfatal injuries was reported between 16% to 82% in HICs, 4.7% to 51.5% in UMICs, 6.7% to 24.7% in LMICs and 17% in LICs. Police records are used for injury surveillance either alone or in combination with other data sources. Conclusion: Police records are a potentially useful source of information on unintentional injuries. Ascertainment was found to be higher for fatal injuries and in HICs as compared to LICs and LMICs. However, the use of police records as the basis of unintentional injury surveillance systems is presently at a nascent stage. Better enforcement of legal provisions regarding reporting of injuries to the police and increasing awareness is likely to improve the proportions of ascertainment. Key words: Ascertainment, Injuries, Police, Surveillance, Unintentional.

The paper presents a quantitative and qualitative profile of Thrombosis research in India, based on 4026 publications indexed in Scopus database during 2000-19. Indian research output on Thrombosis registered 11.64% annual growth, averaged 13.54 citations per paper and contributed 2.26% global share (with 13th rank) and 14.13% share devoted to international collaborative papers. Thrombosis research applications across subjects were the largest in medicine (87.93%), followed for other subjects with contribution from 5.84% to 10.08%), etc. The distribution by type revealed that Venous Thrombosis accounted for the highest share (52.36% share), followed by Arterial Thrombosis (29.01% share), Limb ischemia (1.49%) and Hepatic artery thrombosis (0.72%) during 2000-19. AIIMS- New Delhi (374 papers) and PGIMER-Chandigarh (280 papers) lead the country as the most productive organizations. Besides, GMCH-Chandigarh (66.80 and 4.93) and Fortis Healthcare Limited (47.82 and 3.53) lead the country as the most impactful organizations in terms of citation per paper and relative citation index. K. Ghosh (61 papers) and R. Saxena (51 papers) lead the contry as most productive authors and K. Sarin (115.32 and 8.52) and D. Dash (44.29 and 3.27) lead as the most impactful authors. Indian Heart Journal (with 160 papers), BMJ Case Reports (133 papers) and Neurology India (115 papers) topped the list of most productive journals. Key words: Thrombosis research, Indian publications, Scientometrics, Bibliometrics.

Introduction: Digital screen usage has grown up rampantly and various ocular complaints arise as a result of the same. Digital eye strain causes constant trouble to people with prolonged digital screen usage and this study was done to find the factors in digital screen that could be modified to reduce the eye strain. Methods: In this study a validated questionnaire was used among computer users and various symptoms people experienced were analysed. Dry eye test i.e. Schirmer’s tests I and II were performed in all the study subjects and dry eye was confirmed among the users. Results: In our study grittiness was the most common complaint and questionnaire employed in this study was 85 % sensitive and 72 % specific for identifying Digital eye strain. It also has a high positive predictive value of 85.6% in identifying dry eye among the users. In this study it has been found that almost all people with computer screen usage of >5 hr had symptoms of dry eye and also test positive for the same. Conclusion: Digital eye strain present most commonly as minor complaints like grittiness of eyes and more symptoms are seen in people who used contact lens and used digital screen for prolonged duration. A self administered questionnaire will be a potential tool in diagnosing digital eye strain at the earliest among digital screen users. Key words: Digital eye strain, Digital screen, Dry eye, Questionnaire, Schirmer’s.

Background: The menace of COVID-19 has put a huge burden on health care system predisposing health care workers engaged in management to COVID-19 infections. The nonavailability of effective drug against COVID-19 warrants extra cover as prophylactic therapy for health care workers, especially against transmission from asymptomatic patients. Hydroxychloroquine (HCQ) for prophylaxis of COVID-19 had been advocated by some researchers. Hence, in this project, evaluation of HCQ as preventive strategy for healthcare workers against COVID-19 infection was studied. Materials and Methods: HCQ was prescribed as a prophylactic therapy as per the advisory of National Task Force of Indian Council of Medical Research, India. The data regarding consumption profile, COVID-19 infection and adverse drug reaction profile of HCQ in healthcare workers was collected. Results: Record of 4,239 health workers with hydroxychloroquine consumed was available till date. 139 subjects were dropped out of study as they did not consume the HCQ tablets. 93 heath workers (2.19%) were infected with COVID-19 infection but in early weeks of prophylactic therapy and were asymptomatic. A few of them (08 patients) had mild symptomatic manifestation with RT- PCR reported positive for SARS-CoV-2. No mortality was reported as among healthcare workers, engaged in management of COVID-19 patients at the tertiary care institute in Jaipur, India. HCQ prophylaxis in standard doses produced predominantly gastrointestinal side effects in 20 subject and headache in 10 health workers. Conclusion: The present study showed that HCQ prophylaxis is safe and effective in standard doses against COVID-19 infection. The frontline workers engaged in management of COVID-19 may be given HCQ prophylaxis as an extra cover. However, it’s broadening usage as preventive strategy, in general for people especially in cardiovascular incidences; require enhanced research and further validation. Key words: Adverse drug reaction, COVID-19, Health workers, Hydroxychloroquine, Prophylaxis.

Introduction: During old age physical strength and mental stability decreases, money power becomes bleak coupled with negligence from younger generation. In our modern society, where money is the scale of everything, the old age people are measured as an economic liability and a social burden. Aim and Objectives: 1. To assess the economical status of elderly population. 2. To associate the findings with present and past morbidities among the study subjects. Materials and Methods: A cross sectional study was carried out in urban and rural area of Surendranagar district among 611 elderly, using a predesigned and pre tested questionnaire. The study was carried out by directly questioning the subjects with oral and written consent. For selection of the area, in both the urban and rural areas, the sampling units were enumerated and samples were collected by using simple random sampling. Data was entered and analysed using MS excel 2007. Results: Nearly 60 % of the subjects in both area were currently unemployed and their current income less than 5000. Most of the subjects in the rural area had no saving whereas their counterparts in the urban areas having the savings of meager amount up to Rs.1,000. For the financial dependency, majority in the urban and rural area were dependents on their family members. And also, financial Dependency had a statistically significant correlation with presence of Morbidity. Conclusion: The economical independence should be one of the top priorities of the health managers, decision makers and policy makers and it must be evaluated in both the urban and rural areas thoroughly. A special status should be granted to them and shall help in provision of basic services like bare minimum of grocery, healthcare and medicines. Healthy aging being a very important indicator of a country’s health status should be of prime importance. Key words: Socio-economic status, Elderly, Economical independence, Morbidity, Depression, Urban-rural.

Introduction: During the COVID-19 pandemic the healthcare workers are most valuable resource for every country. They are going through a tough time exposing themselves at risk while working at hospitals and clinics. Along with the concerns for their own personal safety, they are anxious about passing the infection to their families. Health-care workers who care for elderly parents or young children will be drastically affected by school closures, social distancing policies, reverse quarantine needs and disruption in the transport facilities, food and other essentials. This study aimed to identify the psychological response of Healthcare workers and stigma experienced during initial phase of COVID-19 Pandemic in Kerala. Materials and Methods: A cross-sectional study conducted among doctors, nurses and other paramedical hospital staff in Kerala during May-June 2020. About 605 healthcare providers from different districts participated in the study by filling an online semi structured, self-administered questionnaire in Google forms. Data were analyzed by SPSS18 software, using descriptive statistics and chi square test used as test of significance. Results: About 70% reported that COVID-19 had a significant impact on their life. More than half (315) of the participants are worried about the “uncertainty about how the pandemic will progress and who will get infection next”. About half of the health care workers are worried about “Being exposed to COVID-19 at work and taking the infection home to your family”. And 10.6% of health professionals reported they experienced some form of stigma. About 38.8% experienced a change in sleep pattern. Conclusion: While nearly half of the participants are worried about the uncertainty about how the pandemic will progress, nearly half are confident that we can control the pandemic. Around 10% healthcare workers experienced stigma from neighborhood as they are exposed to COVID19. Key words: Psychological response, Mental health, Stigma, Kerala, Health care providers.

Background: Puerperium is well recognized as a period of increased susceptibility for thrombotic events like Cerebral Venous Thrombosis (CVT). In addition to the physiological changes, several other factors also cause dehydration in puerperium, making it a very vulnerable period for thrombotic events. Fluid intake may be restricted for mothers in early days after child birth in certain rural areas of southern India. The aim of this study was to estimate the fluid intake of patients with puerperium associated CVT. Materials and Methods: Interview was conducted among 35 patients with puerperal CVT and their primary caregivers to obtain the details of fluid intake during puerperium. Results: Most of the patients admitted with CVT hailed from rural areas (74.1%). Fluid restriction was practiced during post-partum period by 77.1% (.1500ml) of the patients admitted with CVT. Conclusion: Varying degrees of fluid restriction is traditionally practiced in several areas of South India, especially in rural areas. Education of mothers and their primary caregivers is essential to make them understand the importance of adequate fluid intake during puerperium. Key words: Cerebral venous thrombosis, Puerperium, Fluid restriction, Rural.

Background: Despite the unquestionable public health benefits of immunization, rare incidents of Adverse Events Following Immunization (AEFI) remain a cause of concern. Following few deaths after vaccination in a village of Jharkhand, India, an epidemiological investigation was carried out by the experts of a medical college to find out the cause of deaths and recommend state health further to prevent such incidences in future. Materials and Methods: The epidemiological investigation was conducted as a field study which comprised of observational visit of the AEFI site, key interviews of all stakeholders, verbal autopsy and desk review of all related documents to immunization. All relevant laboratory and autopsy investigations were done to exclude or include all possible causes. Results: On investigation, it was noted that there were five children who developed symptoms of severe gastro-enteritis within six hours of vaccination out of the total thirteen vaccines from the single immunization site and four of them died within 24 hr of vaccination suggestive of features of Toxic shock syndrome. All had a common exposure of Measles vaccine and Vitamin A giving hint towards contamination of vaccine during reconstitution or administration of vaccine. In autopsy findings, there was no external injury reported and the laboratory findings of vaccine vial didn’t reveal any significant findings. The attack rate of the event was 100% and case fatality rate was 80%. Conclusion: From investigation, it was concluded that the events are due to Immunization error related reaction (a type of AEFI) and causality association tool also classified the event to be consistent causal association to immunization. There is dire need of refresher training for service providers on various aspects of AEFI to avoid recurrences of such events. Key words: AEFI, Gum boot epidemiology, Immunization error related reaction, Programmatic error, TSS.

Background: Since December 2019, Coronavirus disease (COVID-19) has rapidly spread to most places in China and other countries, which may exert further impacts on the physiological and psychological states of urban and rural residents. Therefore, itis necessary to explore their health status during the COVID-19 outbreak. Methods: Convenience sampling is selected for a crosssectional investigation and SHS questionnaires were distributed by WeChat. Results: A total of 15681 valid questionnaires from 4988 (31.8%) healthy participants, 9991 (63.7%) participants in SHS and 702 (4.5%) in a morbid state are incorporated. As shown by total scale, psychology and social aspect, SHS prevalence rate of rural residents is above that of urban residents; however, the contrary is the case for their physiological status. Regarding all participants, female gender, with low body mass index (BMI), or in the low-income group are account for the higher SHS prevalence rate. Based on ordinal Logistic regression analysis results, male gender and short time spend on electronic products are protective factors for SHS, while sleep deprivation is a risk factor for both urban and rural residents. (p<0.05). Conclusion: During the COVID-19 pandemic, the prevalence rate of SHS in rural residents’ psychology, society and total scale is higher than that of urban residents. Major influencing factors include gender, time spent on electronic products, sleep time, smoking and social roles. Residents should properly adjust their daily schedule; and related governmental departments should particularly focus on SHS of rural residents and provide diversified life and psychological support during the COVID-19 pandemic. Key words: Suboptimal Health Status (SHS), Urban Residents, Rural Residents, Influencing Factor, Coronavirus Disease (COVID-19).

Introduction: The world’s second most populous country–India, witnesses 20-30% pregnancies that belong to the high-risk category out of the total pregnancies in the country. 12% of the global maternal deaths are attributed to India. The Rural areas of the country are further vulnerable to high maternal and infant mortality rates due to a rural-urban divide and unavailability of health resources. Objectives: The rationale of this paper is to understand and illustrate common High Risk Pregnancies (HRPs) in the rural area of Shorapur and to gauge the preparedness of the health facility in the area to help deliver safe child birth for the mother and the child. Materials and Methods: A cross-sectional study was conducted in pregnant women attending the Antenatal Care (ANC) clinic in sub-district hospital of northern Karnataka over a period of 03 months. Results: A total of 601 high risk conditions were identified in ANC women. Of the total ANC women with HRP 44.1% (n= 265) had previous Caesarean Section, 15.1% (n=91) had RH incompatibility, 12.6% (n=76) were observed to be Short Primi, 9.7% (n= 58) experienced Bad Obstetric History/Antepartum Haemorrhage, 8.2%% (n=49) had Gestational Hypertension, 5.8%% (n=35), were severely Anaemic, 4.2% (n= 25) had Multiple pregnancy and the remaining 0.3% (n=3) had tumour, Gestational DM and Rheumatoid Arthritis. Discussion: As per the observed HRPs and respective health facility preparedness, two main barriers to safe pregnancy and childbirth emanated during the study - inadequate infrastructure and services for blood transfusion, dearth of trained health professionals. Conclusion: Direct referral of high risk cases to appropriate facilities that have the required capacity to support such cases must be made. Tele-medicine can be considered as an efficient alternative to connect the ANC women with the specialist doctor remotely for evaluation of HRPs. A blood storage unit must be established in all SDH hospitals as a minimum requirement. Key words: High Risk Pregnancy, Antenatal Care, Maternal Mortality Rate, Maternal Health, Health Facility Preparedness.

Introduction: The effectiveness of integrated approach using complementary therapies for children diagnosed with Autism spectrum Disorder (ASD) is poorly studied. This is due to limited objective assessments and lack of well-designed therapeutic module. Aim: This study examined the effect of yoga and naturopathy interventions on Electrophotonic Imaging (EPI) parameters in children with autism. Methods: This study consisted of three groups i.e., Yoga (YG), combination (Yoga and Naturopathy, YNG) and Control Group (CG) tested a 24 days intervention duration. Yoga group received series of yoga practices and combination groups received both yoga and naturopathy for the same duration. The control group maintained their daily usual activities. The EPI parameters included Activation Coefficient (AC, stress parameter), Integral Area (IA, general health parameter), Integral Entropy (IE, disorderliness parameter) were compared between groups and within group after interventions. Seventy-seven children with autism were randomized and 70 children completed the study with 95% adherence to the yoga and naturopathy interventions. Results: The results of the analysis showed that there was a significant improvement in energy level of YG and YNG in IAL (p<0.01; p<0.001), IEL (p<0.05; p<0.001) and no change in control group. Moreover, there were a significant difference in post assessment of YG and YNG from CG in IAL (p<0.001), IEL (p<0.05) and IAR (p<0.01) parameters of EPI. Conclusion: This study provides evidence that interventions of yoga and naturopathy may be useful to reduce the severity of symptoms and improve energy level that is required for children with autism and other neurodevelopmental disorders. Key words: Yoga, Naturopathy, IAYT, Neurodevelopmental disorder, Children, Electrophonic imaging.

With the recent upsurge of COVID-19, efforts are being made worldwide to target this coronavirus with certain specific target medication and millions and millions of dollars are being spent to curb this menace. Whereas, literature has stated that in all the reported major coronavirus outbreaks (SARS, MERS) preventive measures like hand hygiene, cough etiquettes, social distancing, personal protective measures, environmental cleaning have played an important role.1-3 Besides these measures ‘Namaste’ an Indian cultural salutation, a way practiced to greet each other is being given a lot of importance and recognition worldwide and is being opted as a measure to avoid contact, maintain hand hygiene and social distancing towards each other.

The large soft tissue defect in the lower leg and its treatment remain a challenge. The most suitably available type of tissue, the surgery timing, and the decision between free flap or local for the coverage still remain the subject of debate. One hundred and four patients were managed with a free flap or local cover for a lower leg soft-tissue defect. We compared the outcomes after treatment with free flaps versus local and musculocutaneous flaps versus fascio-cutaneous flaps. In this study, we also compared the results of our patients according to the timing of the surgery: patients managed within 3 days after the trauma versus patients managed after 3 days. Thirty-four patients (32.69%) were presented with chronic osteomyelitis and treated accordingly. Seventy patients (67.30%) with posttraumatic soft-tissue defects have been treated because of insufficient fracture coverage. The statistically significant difference in complications was not observed in free and local flaps in our study. Postoperatively. In our study group, patients managed with a musculocutaneous flap were associated with less postoperative complications than fascio-cutaneous. In the number of revisions after treatment with a free flap, a significant increase could be demonstrated in the results after early or late flap coverage. There was no significant difference observed. Equal outcomes were observed in patients treated with free flaps or local flaps except local flaps, which required a lesser number of revisions postoperatively. Regarding postoperative complications, Musculocutaneous flaps are preferable over fascio-cutaneous flaps. The operation timing is not to be proved a discriminating factor. Key Words: Tibial fracture, Leg, Soft-tissue defects, Fascio-cutaneous flap, Musculo-cutaneous flap.

Background: In recent years, hand surgery has become a well-established medical specialty; now a days, many highly trained hand surgeons practice in various cities throughout India. It is crucial to assess the public's awareness and knowledge regarding hand surgery specialists and to identify the existence of bias in the perception of the public toward plastic and orthopaedic surgeons. Material and Methods: Via Google Forms. A self-administered questionnaire was designed and scattered to adults in India. In the questionnaire, various hand-related issues were given and addressed participants' knowledge about which type of surgeon they would consult if asked for. Results: A total of participants surveyed were 1432. Most of the public opinion favours orthopaedic surgeons; they think orthopaedic surgeons are more qualified for hand surgeries than plastic surgeons. Furthermore, the public seemed to feel comfortable and safer with orthopaedic surgeons regarding complications. The majority also held misconceptions regarding orthopaedic surgeons' qualifications for hand surgery. There was a misconception regarding plastic surgeons' qualifications, with only 24.44% recognizing that all plastic surgeons could perform hand surgery. The responses were influenced by gender and educational level, with those with bachelor's degrees or higher or females showing slightly more knowledge. Conclusion: There is a need for increased public awareness and education regarding the capabilities and qualifications of both plastic and orthopaedic surgeons in hand surgeries. Both specialists are competent and well-trained in this area, and the choice should be based on the circumstances and specific needs of the patient. Keywords: knowledge and awareness, hand surgery, plastic surgery, orthopaedic surgery, India.