Vol 6, Issue 1, Jan-Mar, 2016

Public health care in India in the last nearly seven decades since independence has been largely through the various national health programs targeting the major health‑related problems and issues. The progress so far in improving the health indicators has also been impressive in most areas. Life expectancy has increased from 32 years at the time of independence to 65 years in 2012.[1] The reductions in maternal and infant mortality are also remarkable; maternal mortality ratio having decreased from 398/lakh live births in 1991 to 167/lakh live births in 2013 and infant mortality rate down from 140/1000 live births in 1976 to 40/1000 in 2013.[2‑4] However, the pace of decline in mortality and improvement in other indicators, which was faster in the earlier decades, has now slowed down.[5] It is expected that further decline in the rates will be slower and more difficult to achieve.

This paper analyzes 1078 India’s publications on suicide research during 10 years, i.e., 2005–2014, as indexed in Scopus International Multidisciplinary Database. The study focuses on the various aspects of performance of India’s suicide research, such as the publication growth, citation impact, international collaboration, subject‑wise distribution of publications, contribution and citation impact of Indian organizations and authors, medium of communication, and characteristics of its high‑cited papers. This study reveals that India’s research output on suicides research witnessed an annual average growth rate of 10.49%, registered an average citation impact per paper of 9.75, and a share of 16.23% of international collaborative publications. India’s global publication and share to world suicide research was 2.47% during 1999–2014. Medicine contributed the largest publication share of 84.32%, followed by pharmacology, toxicology, and pharmaceutics and social sciences (19.94%), environment science (9.37%), biochemistry, genetics and molecular biology (8.35% share), psychology (7.05% share), neuroscience (4.36% share), economics, econometrics, and finance (2.23% share), and immunology and microbiology (1.95% share) during 2005–2014. About 294 organizations and 356 authors participated in 1078 Indian papers in suicide research, of which the top 15 most productive Indian organizations and authors together contributed 36.18% and 17.44% publications share and 49.58% and 56.06% citation share to the India’s publications and citation output on suicide research during 2005–2014. This study also suggests the need for taking up of measures at population, sub‑population, and individual levels to prevent suicide and suicide attempts. Suicide is a complex issue and therefore suicide prevention efforts require coordination and collaboration among multiple sectors of society. Key words: Bibliometrics, India, publications, scientometrics, Suicide research

Introduction: Breast cancer is on rise and cervix cancer is on declining mode according to the cancer registry data in India. The major mode of financing treatment is out‑of‑pocket (OOP) and this can push 25% of the cancer affected households below the poverty line. Materials and Methods: A cross‑sectional descriptive study with a household perspective was done in the state of Punjab. By using probability proportional to the size method and systematic random sampling, the sample was drawn from every district of Punjab. A face‑to‑face semi‑structured interview schedule was administered to 221 patients. Results: The direct cost contributed 79% toward the total cost‑of‑illness. The cost of drugs (36.23%) followed by cost of hospitalization (27.05%) and productivity loss (13.44%) were the main contributors toward the total cost of illness. The contribution of indirect cost is 21 per cent of the total cost. The cost of treatment depends upon type of facility used (more in private as compared to the public), stage of cancer (stage above first stage cost more than the first stage), and age at the time of diagnosis aged above sixty incurred more expenditure as compared to the aged below sixty. The 84% of the households had experienced the catastrophic health expenditure (CHE) and 51% of the households had faced distress financing (DF). The main financial coping strategies*(*multiple strategies) used were saving (74%), borrowing at low rate of interest (88%), social nets (55%), and selling financial assets (30%). Key words: Breast cancer, catastrophic health expenditure, coping strategies, distress financing

Background: Biomedical waste (BMW) is waste generated during diagnosis, treatment, or immunization of human beings or animals or in research activities. BMW is hazardous and can be injurious to humans or animals and deleterious to environment. Effective management of BMW is a legal as well as a social responsibility. Objectives: To assess the knowledge and practice regarding hospital waste management among healthcare providers of a tertiary care hospital. Materials and Methods: The study was conducted in the Departments of General Medicine, Surgery, Gynecology and Obstetrics, and Radiotherapy among 198 different hospital staff within 3 months with the help of a predesigned and pretested interview schedule to elicit the knowledge of BMW management. An observatory checklist is used to find out practices regarding BMW management prevailing in the above wards and staff of the hospital. Results: Majority (60.6%) of the study population belonged to the age group of 21–30 years. About one‑third of the total study population were junior doctors and nurses. 35.8% worked for 1 year in the hospital, and 29.8% worked within 2–5 years. All the participants had heard about BMW management, but only 1.5% had formal training. 6.6% knew about five‑color coding used for segregation of waste with red, black, yellow, blue bags and white puncture proof container. 31.3% knew correct disposal of sharps. All the participants knew about the use of personal protective measures while handling BMW and used in most of the time. 70.2% of respondents knew the use of gloves and mask together. In 33.3% of observation, it was seen that syringes were reused for the same patient. Four colored bins were used most of the time in the above‑studied wards. Conclusion and Recommendation: The above study revealed certain paucity of knowledge among the healthcare providers in the field of BMW management which adversely affected their practice. There should be regular comprehensive training programs regarding BMW management for all level of workers and strict implementation of them. Key words: Biomedical waste, healthcare providers, knowledge, practice

Introduction: Noncommunicable diseases (NCDs) are the leading causes of death globally; almost two-thirds of all deaths are due to NCDs. The International Diabetes Federation noted that India’s prevalence of diabetes among 20–79-year-old is 9.09%. India has 65 million of diabetes cases which will rise to 109 million by 2035, only second to China which has 98 million diabetics that will increase to about 142.7 million by 2035. Today’s investment in rupees on NCDs will save our millions lives and rupees in future attributed to NCDs. Ministry of health and family welfare survey of 2012–2013 districts levels survey-4 involved the variables of NCD’s risk factors. Materials and Methods: The present study analyzed the available data of NCD’s risk factors (17 states available data and district wise data of Maharashtra), particularly blood sugar and hypertension for these states, which were available on the websites of ministry. Results: Prevalence of “risk factors” of NCDs, particularly “raised blood sugar (hyperglycemia)” and “raised blood pressure (hypertension)” found more in North Indian people followed by South Indian and North-East people. In case of focused state of Maharashtra, percentages of people affected with hyperglycemia found in rest of Maharashtra (ROM) followed by Marathwada whereas raised hypertension were found more in ROM followed by Vidarbha region indicating future mortality and morbidity associated with NCDs. Conclusion: “Strong and separate health education program” is needed at central level for the intervention and prevention of “risk of future NCD’s risk factors” to tackle the upcoming burden and cost associated with NCDs. Key words: Blood pressure, blood sugar, hypertension, risk factors and noncommunicable diseases

Introduction: Health care workers (HCWs) are at risk of needlestick injuries (NSIs) due to the environment in which they work. Prevention is associated with the combination of availability of special retractable needle syringes, safety boxes, educational intervention, as well as supporting policy. This report is a part of a larger study which assessed the level of multifocused intervention for NSI and prevalence of NSIs among HCWs in State Specialist Hospitals, Ondo State of Nigeria. Materials and Methods: This cross‑sectional study was conducted among 642 HCWs comprising doctors, nurses, laboratory workers, and health attendants in selected hospitals. The study utilized structured questionnaire to assess experiences of NSIs, associated activities with injury and documentation. Results: Five hundred and twenty questionnaires retrieved were adequate for analysis NSIs were reported by 290 (55.8%) of the HCWs made up of 77.6% doctors, 68.3% nurses, 51.4% laboratory workers, and 30.0% health attendants. Syringe needles were responsible for 68.5% of all injuries. Activities associated with most injuries were the administration of intramuscular injections (52.4%). About half (51.4%) of injuries occurred during use while 23.4% of injuries were disposal related. Ninety‑three (32.1%) of the devices causing injury had been previously used. Only 25% of those injured reported the injury to appropriate authority. Conclusion: These findings implicate the need for a multifocused intervention to disabuse reuse of devices and encourage reporting of injuries. Key words: Doctors, health attendants, laboratory workers, needlestick injury, nurses, sharps

Introduction: Studies regarding etiological spectrum of recurrent jaundice are rare. We conducted this study to identify the causes of recurrent jaundice in a tertiary care center. Materials and Methods: Frequency of different causes of recurrent jaundice was assessed from 130 patients attended General Medicine Department over a period of 3 years. Recurrent jaundice was considered when patients had more than one episodes of jaundice with serum bilirubin ≥3 mg/dl since childhood. Recurrent jaundice was diagnosed from past medical records, records of follow-up visits, and current clinical presentation. Causes were identified from past and present medical records of history, clinical and laboratory examinations. Results: Causes of recurrent jaundice included prehepatic (30%), hepatic (59.23%), and posthepatic (10.77 %) disorders. Prehepatic disorders were Gilbert’s syndrome (GS), megaloblastic anemia, autoimmune haemolytic anemia, Wilson’s disease, G6PD deficiency, etc. Hepatic disorders were exacerbations of alcoholic hepatitis, hepatitis B and C, autoimmune hepatitis, congestive cardiac failure, sarcoidosis, benign recurrent intrahepatic cholestasis, eclampsia, pregnancy induced cholestasis, falciparum malaria, drug induced liver injury (DILI), etc. Posthepatic causes were choledocholithiasis, recurrent pancreatitis, periampullary carcinoma, choledochal cyst, ascariasis, hemobilia, HIV cholangiopathy, autoimmune pancreatitis, etc. Prehepatic jaundice cases were younger. The highest level of total bilirubin was seen in alcoholic hepatitis, DILI, and hepatitis B. Alcoholic hepatitis was the most common cause of recurrent jaundice (19.23%). GS was the most common prehepatic cause. Mean age was lowest in GS and highest in DILI. Conclusion: Etiological spectrum of recurrent jaundice includes many prehepatic, hepatic or posthepatic disorders. A larger study may enlarge the spectrum. Key words: Alcoholic hepatitis, congestive cardiac failure, drug induced liver injury, Gilbert’s syndrome, jaundice

Objective: To compare the efficacy and safety of cilnidipine and losartan in hypertensive patients with type 2 diabetes mellitus (type 2 DM). Materials and Methods: In this observational, prospective study, hypertensive patients with type 2 DM receiving cilnidipine and losartan were included. Demographic details, clinical history, serum potassium, and urinary albumin were recorded in a case record form. Patients were followed up every monthly up to 24 weeks and observed for clinical and laboratory parameters and adverse drug reactions (ADRs). Data were analyzed using paired t‑test, unpaired t‑test, and Fisher’s exact test. Results: Out of 114 patients, 59 received cilnidipine and 55 patients received losartan. By 24 weeks, both cilnidipine and losartan significantly (P < 0.01) improved mean blood pressure and urinary albumin. However, mean decrease in urinary albumin was significant (P < 0.005) with cilnidipine (20.6 ± 20.4 mg/day) as compared to losartan (18.3 ± 14.3 mg/day). Mean serum potassium was increased significantly (P < 0.05) in patients treated with losartan (0.9 ± 2.8) as compared to patients treated with cilnidipine. A total of 19 ADRs were observed in both groups and out of these, 36.8% ADRs were caused by cilnidipine and 63.2% ADRs by losartan. Conclusion: Cilnidipine is equally effective as losartan in reducing blood pressure in hypertensive patients with type 2 DM. However, cilnidipine is more effective in the prevention of albuminuria and better tolerated by patients as compared with losartan. Key words: Albuminuria, cilnidipine, essential hypertension, losartan, serum potassium, type 2 diabetes mellitus

Introduction: Multidrug‑resistant tuberculosis (MDR‑TB) is an emerging public health problem. The study was done to evaluate the clinical profile of MDR TB patients and to study the diagnostic parameters in a cohort. Materials and Methods: All MDR‑PTB patients admitted in a tertiary level TB institute for initiation of treatment for study period were enrolled. Various clinical parameters such as symptomatology profile, past treatment details, details of diagnosis, and methods of diagnosis were studied retrospectively in these patients. Results: A total of 125 patients were enrolled. An average age was 29.5 ± 12.2 years. The average duration of chest symptoms was 2.4 ± 0.6 years; cough and expectoration were the most common symptoms present in all (100%) the patients. Two patients were treatment naïve, and 123 were retreatment cases, in which, 63 were relapse, 42 were treatment after default, and 18 were failure cases, just prior to being diagnosed as MDR‑TB. Forty‑three patients have received at least one of the reserve line drugs as part of anti‑TB treatment in past. The average courses of treatment taken prior to been labeled as MDR‑TB were 3.15 times. Majority of patients (99) had been diagnosed by using molecular‑based tests. Conclusion: Use of reserve line drugs is common for treatment of TB, even without being diagnosed as MDR‑TB. Both physicians‑ and patient‑related factors responsible for the development of MDR‑TB may be prevented by improving understanding of the disease and by early and proper treatment of both drugs susceptible and drug resistant TB. Key words: Antitubercular treatment, molecular tests, multidrug‑resistant tuberculosis, reserve live drugs

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that usually affects skin and nerves. Although it is well‑controlled by multidrug therapy but the disease may be aggravated by acute inflammatory reaction that causes permanent tissue damage, particularly to peripheral nerves. Cutaneous tuberculosis (CT) is a variant of extrapulmonary tuberculosis. Both mycobacterial infections are endemic in developing countries like India, but the simultaneous occurrence of CT and leprosy is very rarely reported. Here, we are reporting a case of borderline lepromatous leprosy and CT (lupus vulgaris) co‑infection in an immunocompetent patient, diagnosed simultaneously and managed accordingly. Key words: Borderline lepromatous leprosy, cutaneous tuberculosis, extrapulmonary tuberculosis, multidrug therapy

Although efficacy and safety data from randomized clinical trials (RCT) is considered to be the key to evidence generation, it is no longer adequate to meet all needs of Indian healthcare decision makers. Supplementing RCT data with robust observational studies data (OSD) as a decision making tool is being increasingly used by many payer advisors. Health Technology Assessment (HTA) agencies and healthcare bodies meaningfully use OSD for numerous purposes including, to confirm results of RCTs, justify utility estimates in economic models and demonstrate durability of effects of healthcare interventions. The phenomenal growth of Indian healthcare field has necessitated the need for robust HTA involving RCT data and OSD for better decision making. OSD may come a long way in supplementing Indian stakeholders in making rational healthcare decisions. It will be interesting to see how frequently OSD will be utilized in the Indian healthcare sector, and also how meaningfully, in the future. Key words: Health technology assessment, healthcare decision making, observational study, real world evidence

Lips hold a pivotal role in both functional and aesthetic aspects of human life, being crucial for tasks like food manipulation and speech articulation. However, they are susceptible to various disorders stemming from environmental factors, trauma, infection, and intrinsic conditions. These disorders range from simple, benign conditions to complex and alarming pathologies, impacting not only physical health but also social acceptance and self-esteem. This article reviews common lip disorders, including angular cheilitis, contact cheilitis, exfoliative cheilitis, cheilitis glandularis, cheilitis granulomatosa, and cleft lip, among others. Furthermore, it highlights the challenges in classifying lip diseases and proposes a simplified classification scheme to aid in diagnosis and treatment. Effective management of lip abnormalities is essential not only for preventing morbidity and mortality but also for restoring quality of life and psychological well-being.