Vol 6, Issue 4, Oct-Dec, 2016

In recent years, the medical community has come to acknowledge the limitations of solely relying on curative medicine to enhance the quality of life for patients grappling with chronic ailments. There has been a growing recognition of the significance of palliative care in attending to the needs of such patients. While traditionally associated with cancer care, palliative medicine is now understood as essential for individuals coping with a spectrum of conditions including HIV, severe kidney disease, heart failure, end-stage lung disease, progressive neurological disorders, and other life-limiting illnesses. Statistics from 2010 reveal a notable shift in the landscape of diseases necessitating palliative care in India. Non-communicable diseases emerged as the primary contributors, constituting 53% of all deaths. Among these, cancers represented only a small fraction at 6%, while cardiovascular diseases held the largest share at 24%, followed by respiratory diseases (11%), injuries (10%), and diabetes (2%).

Background: In the process of drug development and drug approval, the pharmaceutical industry is challenged with increasing cost constraints, a growing need for real-world evidence and heavier regulatory scrutiny. Patient advocacy groups can be a valuable partner to the pharmaceutical industry in speeding up drug access. Patient advocates possess practical rather than purely scientific knowledge that is valuable for both drug development and drug approval. It was recognized quite early the patient advocacy groups and the pharmaceutical industry have similar goals. This understanding resulted in supporting patient involvement across the entire process of drug development, from discovery to USFDA approval for marketing. Support received by the patient advocacy groups include fundraising for research and development, organizing patients to expedite clinical trials, lobbying government and payer organizations to create public awareness, building support for research funding, and so on. Patient advocacy groups also back research for “orphan” diseases where there is a desperate need for new therapies. The recent success of Vertex and Sprout Pharmaceutical highlights the power of the patient voice in healthcare decision-making especially for orphan diseases. Conclusion: Working with patient groups can thus lead to a win-win situation for both the FDA and pharmaceutical industry. Key Words: Patient Advocacy, Patient Voice, Drug Access, Health Outcomes, Drug Development

Background: Health of the children (5-11yrs) is of importance not only as these children have already survived the most difficult phase of their life but also their future development will affect the development of entire society. Nationwide data on under five children is routinely collected during national surveys, such as National Family Health Survey (NFHS), similar data for school age children is usually not collected, except by individual worker. Hence it was decided to carry out a health survey for school children in urban area along with their social determinants and compare those with World Health Organization (WHO) standards. Aim: To find prevalence of malnutrition in primary school children of urban India and their social determinants. Setting and design: School community setting and cross sectional design. Material and Methods: Anthropometric measurements were done in students of class one to five by two investigators. A self administered questionnaire was used to collect information about socio-economic factors. Statistical analysis used: Epi Info 6 software of CDC, Atlanta, USA. Student ‘t’ test for quantitative data along with 95% confidence interval and chi square test for categorical data. Results: The prevalence of stunting was 4.47% (95% CI, 3-5.94), wasting 6.32% (95% CI 4.59-8.05%) and under nutrition 5.00% (95% CI 3.45-6). Parent’s educational levels were significantly associated with the nutritional status of the child. However no statistically significant association was found with regard to family income and family size. Only wasting was significantly associated with mother’s working status. Conclusion: Mothers and fathers education are most important determinants of nutritional status of primary school children in Urban India. Key Words: Anthropometry, Nutritional status, Mother’s education, Father’s Education, India, Primary School Key Message: Malnutrition is prevalent in primary school children. Mothers and fathers education are two most important determinants.

Introduction: There is variability of data regarding seroprevalence and coinfection of hepatitis viruses. Our objective was to determine the magnitude, pattern and coinfection of hepatitis viruses in clinically suspected cases of acute infectious hepatitis. Methods: This descriptive study was conducted in the Department of Microbiology at Lady Hardinge Medical College, New Delhi, over a period of 1 year from January 2008 to December 2008. All the serum samples taken from subjects (n= 600 in study group and n=200 in control group) were tested for hepatitis B surface antigen (HBsAg), Immunoglobulin M (IgM) antibody against HAV, HCV & HEV using commercially available enzyme linked immunosorbent assay kit. Serum samples positive for HBs Ag were further tested for IgM capture anti hepatitis D virus (HDV) by ELISA methodology. We used SPSS Ver.10.0 (SPSS Inc. Chicago, Illinois) for the statistical analysis. The means of continuous variables among the groups were compared using the Student’s t-test while proportions were tested by Chi-square test. Results: Seroprevalence of acute viral hepatitis was 128/600 (21.3%) and 17/200 (8.5%) in study and control group respectively (p<0.05). HAV was the commonest cause 50/600 (8.3%) followed by HCV 33/600 (5.5%), HBV 24/600 (4%) and HEV 21/600 (3.5%). Coinfection rate among the study group was 11/128 (8.5%) and maximum coinfection rates were seen with HBV 8/11 (72%). 4/24 (16.6%) of the HBV infected cases were coinfected with HDV. Male predominance was seen for all the markers. Overall sex wise seropositivity in males was 81/362 (22.3%) and 47/238 (19%) in females in study group while it was 14/121 (11.5%) and 3/79 (3.7%) respectively in controls. Conclusions: Acute infectious hepatitis is a significant burden on the society. HAV is the predominant form of acute viral hepatitis. HBV, HCV and HEV were other leading causes of acute viral hepatitis. Coinfection of HBV with HDV is the commonest pattern. KEY WORDS: Seroprevalence, Co-infection, Hepatitis A virus (HAV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), hepatitis D virus (HDV)

Introduction: Teaching aids are tools which make teaching easier & learning more effective and enjoyable. Newer aids like computers and LCD (Liquid Crystal Display) projectors have been widely adopted in education system to make teaching process more effective. The study plans to assess the knowledge, attitude & practice of newer form of teaching aids & identify the barriers to use among faculty members of a newly established medical college. Methods: A cross sectional study was conducted using both quantitative and qualitative methods among faculty members of Jawaharlal Nehru Institute of Medical Sciences, Imphal during September 2014 to Feb 2015 using a self-administered semi-structured questionnaire along with interview guides for in-depth interview. Approval from the Institutional Ethics committee was obtained. Descriptive statistics and chi-square test were performed and qualitative data was grouped into domains and coded responses were analysed in consonance with stated objectives. Results: Out of the 88 respondents 55 (62.5%) were males and 23 (26.1%) faculty were above 65 years of age. Around 13.6% of the respondents said they do not have basic knowledge of computer. ‘Feel too old to learn’, 7 (58.3%) was main reason for not having knowledge of computers. Majority of the respondents, 78 (88.6%) used computer in taking theory/lecture class. One-third of the faculty, 33 (37.5%) said they need help/assistance in preparing power-point presentations and almost two third of them, 53 (60.2%) have undergone Basic training course in MET (Medical Education Technology). Senior faculty expressed that ‘Older generation thinks old is gold and are more habituated to older teaching methods’. Conclusion: Old age and lack of computer knowledge were the major barriers identified. Compulsory training in basic course on MET along with faculty development programs with short course on computer is the need of the hour. KEY WORDS: Medical Education, Computers, Teaching Aids, Information Technology, Faculty Development

Introduction: The primary goal of highly active antiretroviral therapy (HAART) is to reduce mortality and morbidity rates among HIV-infected people, and to improve their quality of life. As of May 2015, a total of 8, 69,576 HIV/AIDS patient are receiving free Antiretroviral Therapy (ART), in our country despite which, there has been high HIV prevalence and mortality in certain areas. The objective of this retrospective study was to determine the factors associated with mortality in patients on ART under routine programme conditions in an ART centre in Southern Odisha. Methods: Data of HIV positive patients under HAART in the ART centre during April 2014 to March 2015 time period were collected and analysed for various demographic variables, clinical profile and mortality. Results: A total of 956 patients were under HAART during the study period, of which 204 (21.33 %) expired. Even though in majority of patients who died [193 (94.6%)] ART was initiated early; only 56 (27.45%) were under regular treatment; 73 (35.8%) had missed (irregular) doses, 75 (36.8%) were lost to follow up (LFU). Majority (88.24%) of the deaths occurred in the first six months of therapy in patients who had associated tuberculosis or some other AIDs related complications. Conclusion: The study reveals poor survival during the study period in spite of no delay in ART initiation. The increasing number of missed dose cases and LFU cases early after initiation of therapy suggests immediate need to intensify the patient retrieval and counselling services in this region. Key words: Early ART, low CD4 count, HIV, co-infections, mortality, lost to follow- up cases

Context: Staphylococcus aureus is a common cause of community and hospital acquired infections. One of the important sources of nosocomial infection is staphylococcus, present in nasal carriage among hospital personnel. Emergence of drug resistant strains especially methicillin resistant Staphylococcus aureus (MRSA) is a serious problem in hospital environments. Aims: To isolate Staphylococcus aureus from the nasal swabs of healthcare workers (HCWs) and to study their antimicrobial susceptibility including methicillin resistance pattern. Settings and Design: A hospital based prospective study. Methods and Material: A total of 150 HCWs who were involved in the management of critically ill patients from the intensive care unit, Operation Theatre (OT) and postoperative wards were screened for MRSA by collecting their nasal swabs .All the samples were collected by trained second year MBBS student of the same institute. S. aureus was identified by standard methods. Antibiotic susceptibility test was performed by modified Kirby-Bauer disc diffusion method. MRSA was identified by using a cefoxitin 30 mcg disc and it was interpreted according to the CLSI guidelines. Statistical analysis used: The findings were statistically analyzed by using the Chi-square test. Results: Out of 150 healthcare workers, 33 (22%) were nasal carriers of S. aureus and among them 9 (27.2%) were carrier of MRSA. Overall nasal carriage rate of MRSA was 6 % (9/150).Highest MRSA carriage rate of 6.5% (3/46) was found among doctors. The antibiogram of the MRSA isolates revealed that resistance to Amoxiclav (100%), Erythromycin (45%) and Gentamycin (40%). All the MRSA isolates were sensitive to Linezolid (100%) and vancomycin (100%). Conclusions: Screening and decolonization may be effective in decreasing the MRSA carriage rate among the HCWs. Standard infection control precautions should be employed in the professional practice to minimize either the carriage or the transmission rate. Key words: Health care workers, Nasal swab, Nasal Carriage, Staphylococcus aureus, MRSA, Antibiotic Resistance.

Context: Coronary Heart Disease is the leading cause of mortality worldwide and in India with younger populations increasingly affected. The out-of-pocket (OOP) payment for health care being high in India, the burden of CHD expenditure falls on the households. The study aims to quantify the economic costs due to CHD, their effect on the household’s economic status and financial coping mechanisms. Methods: A descriptive quantitative crosssectional study among 204 households with CHD patients in Mumbai during April-May and October-November 2013. Non-probability sampling technique was used and data collection done using semi-structured interview schedule. Results: The total annual costs were INR 10180918 and annual direct costs contributed INR9736631.Major costs were on hospitalization (66%) and medicines (19%) of the total household health expenditure on CHD. About 44% households had suffered catastrophic health expenditure (CHE) due to CHD according to the 40% threshold criteria. Catastrophic Health Expenditure was 3.5 times more likely in the Lower income group (p<0.05); 4.4 times more likely when visiting a public hospital (p<0.05) and 20.6 times more likely when visiting a private hospital (p<0.01) as compared to no hospitalisation; 50% less likely for those with health insurance (p<0.05). Distress financing i.e. borrowing and selling assets was seen in 26% of the households to cover their costs for CHD treatment. Conclusions: Coronary Heart Disease puts significant economic burden on household in an urban city like Mumbai. All income groups incurred CHE implying that CHD is an expensive disease for the rich as well as poor households. KEY WORDS: coronary heart disease, catastrophic health expenditure, financial coping mechanisms

Introduction: The endemicity of rubella has been well established in India and immunity to rubella in pregnant women can indirectly hint at the risk of acquiring Congenital Rubella Syndrome CRS. In India Rubella vaccine has not been introduced in universal immunization program (UIP) at national level and has been used in only in private sectors which cover only a small proportion of population. In the state no community based studies were conducted among pregnant women to study the immunity against rubella which will reflect their vulnerability to future infection. Aims: The present study was carried out primarily to assess the IgG seroprevalence of rubella in pregnant women. Second, to identify potential predictors of rubella immunity like age, gravidity and previous abortions. Material methods: The study was conducted in Mavoor panchayath area of Kozhikode district, Kerala. The subjects were pregnant women (n=70) of any period of gestation who were permanent residents of the area were selected by systematic random sampling from antenatal register. The data collection, blood sample collection and estimation of Rubella specific I G antibody was done by enzyme linked immunesorbent assay (ELIZA) method. Results: The mean age was 24.7 ± (SD4.3) years. The mean titre value was 192.45 ± 102.58 IU and 94.3% (95%CI 86.2 - 97.8) were Ig G positive .There was no difference between IgG levels among different trimesters, age or gravidity. Among those with history of abortion 100% and those without history of abortion 96.4% were Ig G positive. Conclusion: This study indicates that rubella is still an endemic condition in India, majority of pregnant women have acquired immunity towards rubella. More detailed epidemiological studies by taking samples from different states may be needed for a basis of national immunization program. Key words: Pregnant women, Rubella immunity, IgG antibody, Congenital Rubella Syndrome, Prevalence.

Background: Guillain–Barré Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy and an important cause of acute flaccid paralysis (AFP) worldwide. Respiratory insufficiency requiring ventilator occurs in 30% of patients that prolong the hospital stay, leading to morbidity and mortality. There had been relatively few studies of Guillain-Barre syndrome in adults from South India. Aim: To evaluate clinical profile, epidemiological, laboratory, and electro diagnostic features of patients with GBS in adults. Settings and design: A prospective study was conducted over a period of 4 years at ESIC Superspeciality Hospital, Hyderabad. Materials and methods: Total 36 patients were identified and data was collected. We studied the epidemiological, clinical, electrophysiological features and their outcome. We subdivided Hughes grade 5 into 5A and 5B based on the requirement of ventilator. Statistical Analysis: Data obtained in the study were subjected to statistical analysis with Statistical Package for Social Sciences (SPSS) version 18. Bivariate analysis was done using chi-square test. Results: Of 36 GBS patients, 21(58.3%) were males; the mean age was 35 years. Antecedent infection was found in 23(63.8%). Majority 12 (33%) were in Hughes grade 4, 10 (27.7%) were in Hughes grade 5A. 97.2% had limb weakness. A significant association was found between low Medical research sum score (MRC) and respiratory failure. Most predominant neurophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 12 (33.3%). Duration of illness was less than 1week in 19 (52.7%) of cases. Asymmetry was observed in 5 (13.8%) and recurrence of Guillain-Barre Syndrome seen in 2 (5.5%) cases. Complete recovery was noted at 6 months in 34 (94.4%) cases. Conclusion: Early diagnosis of respiratory failure and prompt intervention improves patient outcome. Further large sample studies are required to assess respiratory failure and subdivision of Hughes grade 5. Key words: GBS, Hughes grade,Clinical profile.

This paper examines 3,653 Indian publications on lung cancer research, as covered in Scopus database during 2005–14, experiencing an annual average growth rate of 18.81% and citation impact of 4.20. The world lung cancer output (169,352 publications) came from several countries, of which the top 15 most productive countries (United States, China, Germany, Japan, United Kingdom, Italy, France, Canada, and South Korea) accounted for 93.17% share of the global output during 2005–14. India’s global publication share was 2.16% and holds 12th rank in the global output during 2005–14. India’s share of international collaborative publications on lung cancer was 17.79% during 2005–14, which decreased from 19.89 to 17.06% from 2005–09 to 2010–14. Breast cancer in the field of medicine accounted for the largest share (63.62%) of output, followed by biochemistry, genetics and molecular biology (28.77%); pharmacology, toxicology, and pharmaceutics (23.87%); chemistry (9.31%); agricultural and biological sciences (3.26%); and immunology and microbiology (2.23%) during 2005–14. Diagnosis, chemotherapy, surgery, and radiotherapy among treatments methods together accounted for a share of 61.20% publications in Indian lung cancer research during 2005–14. Among the different states, Maharashtra, Delhi, Karnataka, Chandigarh, and Telangana together account for 53.41% share during 2005–14. In India’s cumulative lung cancer publications output during 2005–14, the most productive 14 Indian organizations, 15 authors, and 15 journals together contributed to 33.71, 11.27, and 20.23% share, respectively. The 31 high-cited papers in lung cancer research registered an average citation per paper of 294.74. Of the 31 high-cited papers (19 articles and 12 reviews), 7 were single institution, 3 national collaborative, and 21 international collaborative papers. The 31 high-cited papers have appeared in 23 journals. In light of this, the authors suggest the need to develop a National Cancer Prevention Policy, which should make specific recommendations for national action by governments and non-government organizations, including programs and strategies, to reduce the incidence of specific preventable cancer types. Keywords: lung cancer, publications, India, scientometrics, bibliometrics

Hepatitis A virus associated meningoencephalitis in childhood is an extremely rare condition with only few cases in literature. HAV belongs to the Picornaviridae family and other members of this family are well known to cause encephalitis; so this association is not astonishing. On the other hand, direct invasion of the central nervous system by the virus, accumulation of toxic metabolites and activation of immunologic mechanisms may be suggested to play a role in the neurological manifestations of the disease.1-3 Though HAV associated encephalitis and seizures are very rare; in cases with seizure and elevated liver function tests or jaundice; HAV should be kept in mind as an etiological agent.