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   Table of Contents - Current issue
January-March 2020
Volume 64 | Issue 1
Page Nos. 1-95

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Disasters: Implications, mitigation, and preparedness Highly accessed article p. 1
Zile Singh
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Factors affecting disclosure of HIV-positive serostatus among people living with HIV/AIDS attending an antiretroviral therapy center of Eastern India p. 4
Rakesh Kumar, Madhutandra Sarkar, Alok Kumar, Jaya Chakravarty, Sangeeta Kansal
Background: HIV serostatus disclosure plays an important role in reducing the risk of HIV transmission. However, its negative effects may include rejection, assault, separation, divorce, stigma, and discrimination. Objectives: This study was undertaken to find out the proportion of HIV-positive serostatus disclosure to any family member and different factors influencing disclosure among people living with HIV/AIDS (PLWHA). Methods: A cross-sectional study was conducted among all patients aged 18–49 years with confirmed HIV infection registered at the antiretroviral therapy center of a tertiary care hospital in eastern part of Uttar Pradesh, India, for the duration of 1 year, from July 2017 to June 2018. Results: Most of the respondents were aged 30–49 years (79.9%), male (63.2%), married (85.4%), rural residents (60.4%), Hindu (96.5%), literate (84%), employed/driver (61.8%), and belonged to lower/lower middle class (62.6%). The rate of disclosure of HIV-positive status to any family member was quite high in this study (238/288 or 82.6%), among which 92.9% (221/238) to the spouse only. The number of sexual partners before disclosure, educational status, and socioeconomic status of the respondents were found to be independent predictors of disclosure of HIV-positive status to any family member (P < 0.05). Conclusions: This study indicates the need of giving more emphasis on creating awareness regarding the importance of HIV serostatus disclosure to any family member, especially to spouse, and encourage all PLWHA in the community to disclose their status. Effective strategies also need to be evolved that will target those not likely to disclose their status to anybody.
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Intravenous Iron sucrose and change in hemoglobin, ferritin, and oxidative stress markers among moderately anemic pregnant women attending a secondary care level Hospital in Northern India p. 11
Olivia Marie Jacob, Shashi Kant, Partha Haldar, Ravneet Kaur, Vatsla Dadhwal, Shyam Prakash
Background: Intravenous iron is associated with oxidative stress, and very few studies have assessed change in oxidative stress markers post infusion. Objectives: The study aimed to measure the change in levels of hemoglobin (Hb), serum ferritin, and select oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD], and ferric reducing ability of plasma [FRAP]) 4 weeks following the administration of intravenous iron sucrose (IVIS) among moderately anemic pregnant women who were attending a secondary-level health-care facility, Haryana, North India. Methods: An observational study was conducted (May 2016 to Jan 2018) among pregnant women receiving intravenous iron sucrose i.e., IVIS (300 mg per dose) diluted in 300 mL of normal saline over 20–45 min and were followed up for a period of 4 weeks after the last dose of IVIS (end line). The study outcomes were measured in the levels of Hb, serum ferritin, MDA, SOD, and FRAP from the baseline to the end line. Results: The mean (95% confidence interval) change in the Hb and serum ferritin level 4 weeks after the last dose of IVIS was an increase of 2.5 (2.1–3.0) g/dL (P < 0.001) and 63.0 (44.7–81.3) ng/mL (P < 0.001), respectively. There were no significant changes (baseline to end line) in mean (standard deviation [SD]) MDA level and mean (SD) FRAP level. The mean (SD) SOD level declined significantly (2.2 [0.4] U/mL to 1.6 [0.5] U/mL [P < 0.001]). No life-threatening adverse events were encountered during the study. Conclusion: IVIS was well tolerated and effective in treating moderate anemia in pregnancy. Body iron store was replenished following IVIS administration. There was no increase in oxidative stress following IVIS therapy.
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Challenges encountered in community-based physiotherapy interventions for urinary incontinence among women in rural areas of Anand District of Gujarat, India p. 17
G Daxa Mishra, Dinesh Kumar, G Ajay Pathak, B Smruti Vaishnav
Background: It is necessary to understand the way women think about their health. There is a “culture of silence” among women regarding urinary incontinence (UI). Physiotherapy is proven effective mode of therapy in case of UI. Objectives: This study aimed to explore the attitude of the women toward UI, to understand the related sociocultural factors and health-seeking behavior, and to ascertain the challenges encountered in community-based physiotherapy interventions. Methods: A qualitative study was conducted among women who refused to participate in a physiotherapy intervention for UI in the rural community of Gujarat, India. Fourteen in-depth key informant interviews were conducted using an interview guide. The responses were noted and compiled into a composite interview script. Interviews were not recorded due to nonavailability of consent. Interviews were reviewed by investigators and content analysis was carried out. Key themes were identified after multiple iterations. Results: Most of the women were unaware of the UI and believed that it may be due to their gender or due to aging. Physiotherapy interventions were disregarded due to various reasons such as shy nature, lack of priority and privacy, dependency, self-neglect, and influence of social and cultural norms. Conclusion: Cultural and social systems were more important determinants of health seeking than health systems themselves particularly when sensitive issue such as UI in women of rural Western India was concerned.
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Assessment of cold chain equipments and their management in government health facilities in a District of Delhi: A cross-sectional descriptive study p. 22
Gaurav Kumar, Sanjay Gupta
Background: Cold chain equipments (CCEs) at health facilities (HFs) are an essential part of the immunization supply chain (ISC). The CCEs in government HFs of Delhi were never assessed using the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Effective Vaccine Management (EVM) tool except that of state vaccine store during National EVM assessment 2013. Objectives: The objective of the study was to assess the CCEs and their management in government HFs using the WHO-UNICEF EVM tool in a district of Delhi. Methods: The assessment was done during December 2017–March 2018 in one randomly selected district of Delhi. Sample size and site selection were done using the WHO EVM site selection tool. A total of 29 HFs were assessed along with District Vaccine Store. Questions on CCEs in EVM tool 1.0.9 were used for data collection. Results: Out of 56 electrical CCEs, 8.9% were nonfunctional, 48.2% were noncompliant with WHO standards, 5.4% were not chlorofluorocarbon free, 4.7% did not have temperature monitoring device, and 18.8% did not have stabilizer. Eighty-six percent of passive containers were compliant with the WHO standards. The storage capacity of electrical vaccine storage equipment was insufficient in 3.4%, passive container capacity in 65.5%, and ice packs preparation and storage capacity in 24.1% of HFs. There was no planned preventive maintenance of CCEs and no standard operating procedures for emergency event management. Conclusion: There was a shortage of vaccine storage, ice packs preparation and storage, and passive container capacity. Many CCEs used in ISC of assessed sites were noncompliant to the WHO standards. There was no PPM of CCEs and no guidelines for emergency event management.
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Evidence of natural infection of Orientia tsutsugamushi in vectors and animal hosts – Risk of scrub typhus transmission to humans in Puducherry, South India p. 27
Panneer Devaraju, Bhuvaneswari Arumugam, Iswaryalakshmi Mohan, Mariselvam Paraman, Mathivanan Ashokkumar, Gunasekaran Kasinathan, Jambulingam Purushothaman
Background: Scrub typhus infection is endemic in India and reported to be the major cause for acute encephalitis syndrome (AES) in humans. Periodic occurrence of scrub typhus cases and presence of pathogen in rodents were also reported in areas with human cases of scrub typhus in Puducherry. Objectives: This study was carried out to screen Orientia tsutsugamushi in rodent/shrew reservoirs and vectors in villages of Puducherry with no reports of human scrub typhus cases. Methods: This study was conducted during October 2017 to January 2018 in ten randomly selected villages in Puducherry. Rodents/shrews in the peridomestic area were trapped using Sherman traps. Screening of O. tsutsugamushi in rodents/shrews and mite vectors was done by polymerase chain reaction (PCR). Weil-Felix test was done to screen antibodies against O. tsutsugamushi in rodent serum samples. Results: Among the 54 rodents trapped, Suncus murinus was the major small animal and Leptotrombidium deliense was the major mite species retrieved. PCR screening revealed pathogen positivity in 8 rodent blood and 3 pooled mite samples. Phylogenetic analysis has shown that Kato was the circulating serotype of O. tsutsugamushi. None of the rodent serum samples was tested positive for antibodies against O. tsutsugamushi by Weil-Felix test. Conclusions: The presence of pathogen in both vectors and reservoir animal hosts imposes a risk for scrub typhus transmission to the inhabitants; hence, initiation of vector control measures before the start of winter is recommended in the study area. It is also recommended to screen scrub typhus in patients with undifferentiated acute febrile illness and AES.
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Contraceptive use and unmet need for family planning among HIV-positive women: A hospital-based study p. 32
Preeti Dugg, Pragti Chhabra, Arun Kumar Sharma
Background: For women living with HIV who do not want to become pregnant or who wish to delay pregnancy, contraception has the added public health benefit of reducing the number of infants who might acquire HIV. The unmet need for contraception must be addressed to prevent unintended pregnancies among HIV-positive women and consequently mother-to-child transmission of HIV. Objectives: The objectives of this study were to assess the contraceptive usage and its various determinants and to find out the unmet need for family planning among HIV-positive women. Methods: This was a cross-sectional descriptive hospital-based study conducted among 235 HIV-positive women attending the ART center of a medical college. Data were collected using a questionnaire-containing sociodemographic details, obstetric history, treatment information, contraceptive usage, and their fertility desires. Data analysis was performed using MS Excel and the SPSS version 20.0 using frequencies, Chi-squared test, and multiple logistic regression. Results: The mean (standard deviation) age of the study participants was 28.8 (5.5) years. Majority (96.6%) of them were married and were illiterate (34.4%). The prevalence of unmet need for family planning was found to be 17%, and the prevalence of consistent contraceptive use was 74.5%. The most common family planning method used by women was male condom. Not having HIV-positive children, HIV-negative partner, and discussing contraceptive with partner were observed to be significant predictor of consistent contraceptive use on multiple logistic regression. Conclusion: There is a need to boost family planning counseling and address the unmet need and contraceptive use among HIV-infected women.
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Prevalence and pattern of childhood injuries in Siliguri City, West Bengal, India p. 39
Moumita Basak, Romy Biswas, Sharmistha Bhattacherjee, Dilip Kumar Das, Sabyasachi Mitra
Background: Children are vulnerable to injuries, and childhood injury is a complex phenomenon precipitated by a set of factors. In India, the magnitude and nature of childhood injury are not clearly known owing to the absence of a proper injury surveillance system. However, in recent days few studies demonstrated a substantially high burden of childhood injury. Objectives: To find out the prevalence, pattern, and the factors associated with injury among children of 0–14 years in the Siliguri city of West Bengal. Methods: A cross-sectional study was conducted among 780 children aged 0–14 years residing in the Siliguri Municipal Corporation area selected through cluster sampling technique (30 clusters [wards] with a cluster size of 26). Relevant data were collected by interviewing the mothers of children as respondents and was analyzed using SPSS software, binary logistic regression was applied to test the association between injury and other risk factors. Results: Of total 780 children, 165 had reported a total of 220 injury events with an overall period prevalence of 21.2% and a mean of 0.28 injury events per child. Majority of injuries were superficial in nature (53.2%); due to fall (56.4%), extremities were mostly involved (62.3%), and 12.8% cases were moderate-to-severe grade. Under-five children were most vulnerable. Injury was significantly related to socioeconomic status, presence of siblings, outdoor activities, and the presence of supervising person during travelling. Conclusions: Childhood injury is still highly prevalent in the area with its unique pattern and few preventable risk factors requiring a multifaceted comprehensive approach.
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Quality of routine immunization service: Perception of clients p. 44
Reena Titoria, Madhu Upadhyay, Sanjay Chaturvedi
Background: Immunization prevents over 2–3 million deaths each year worldwide. In India, even though vaccines are offered free of cost at public health facilities the coverage remains low. Limited scrutiny has been conducted at health service and client interface for routine immunization (RI) services, which may have been affecting the acceptance of vaccines. This emphasizes the importance of assessing the level of satisfaction and perceived quality of clients regarding RI services. Objectives: This study aimed to assess the perceived quality and level of overall general satisfaction with RI services of clients. In addition, determine the association of factors influencing clients perceived quality and overall general satisfaction with RI services. Methods: A community-based cross-sectional study was conducted in an urbanized village of Delhi from November 2015 to April 2017. A total of 279 RI visits were covered in the study, and the clients were interviewed at their residence using a pretested tool. Results: The dissatisfaction toward the domains of perceived quality of RI services was reported to be 3.2% for vaccine availability, 9.7% for vaccine information, 3.2% for staff behavior, 6.1% for doctor behavior, and 7.5% for infrastructure. Multivariable-regression analysis indicated that distance to health facility, literacy and age of the client, doctor behavior, staff behavior, and infrastructure had an effect on overall general satisfaction of client toward RI services. Conclusions: The client's perception is multidimensional; improvement in one domain is likely to strengthen the other. By understanding the client's perspective toward quality of RI service, the health-care mangers may improve the level of overall satisfaction.
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Metabolic syndrome and its correlates: A cross-sectional study among adults aged 18–49 years in an Urban Area of West Bengal p. 50
Aparajita Dasgupta, Rajarshi Banerjee, Tania Pan, Sweta Suman, Utsa Basu, Bobby Paul
Background: The prevalence of metabolic syndrome (MetS) is increasing dramatically of late, across all ages irrespective of gender, socioeconomic status, and ethnicity. People with MetS have twice the likelihood of developing and dying from cardiovascular disease and more than seven times the risk of developing diabetes. Objectives: This study was undertaken to determine the prevalence of MetS among adults who were in their first three decades of adulthood and to find out the risk factors of MetS among them. Methods: This was a community based cross-sectional study among 388 subjects aged 18–49 years selected by multistage random sampling in an area of Kolkata, India, from November 2016 to October 2018 over 2 years. Data collection was done using a structured questionnaire along with anthropometry, blood pressure measurement, and relevant blood tests. Physical activity was classified by the International Physical Activity Questionnaire Short-Form questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (version 16.0), and descriptive statistics were calculated as frequency and percentage. Logistic regression was done to determine the strength of association between MetS and different risk factors. Results: The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females), and female gender, poor economic status, sedentary lifestyle, poor diet, and addiction of tobacco were found to be the risk factors of MetS in the final model using multivariable logistic regression. Conclusion: This research revealed the high prevalence of MetS in the community. The effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been employed to curtail the epidemic of MetS.
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Morbidity profile of children from birth to 18 years of age referred for intervention to the district early intervention centre in a District Hospital, Andhra Pradesh p. 55
Surendra Babu Darivemula, Khadervali Nagoor, KR John, P Shakeer Kahn, Chandra Sekhar Chittooru
Background: The “Child Health Screening and Early Intervention Services” program aims at early detection and management of the four dimensions prevalent in children-defects at birth, diseases in children, deficiency conditions, and developmental delays, including disabilities. Objective: The objective of the study was to assess the morbidity profile of children from birth to 18 years of age screened in the district early intervention center (DEIC). Methods: A record-based descriptive study was done in the DEIC in Chittoor, Andhra Pradesh. The data were retrieved for 1-year from April 2017 to March 2018 into the excel sheet, and the combined master sheet was prepared for analysis. The analysis was done with SPSS 21.0 Version. Results: A total of 10571 children were screened and referred to the DEIC during the period. Out of them, 5679 (53.7%) were male and 4892 (46.3%) were female. Among all the four types of morbidities screened, majority 4847 (45.9%) were having the childhood diseases, 4177 (39.5%) had developmental delays including disabilities, 1067 (10.1%) had different deficiencies, and 361 (3.4%) had birth defects. Among the adolescent health issues, 119 (1.1%) were screened and sent for the early intervention to the district hospital. Conclusions: A huge number of children were screened and referred to the DEIC every year for intervention. The health sector has to focus more on the resources like workforce, training of peripheral health workers at regular intervals about the different morbidities screened, that would help in identifying the morbidities at the earliest possible time and receive the intervention at the best center.
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Out of pocket expenditure and its associated factors in neonates admitted to neonatal intensive care unit of tertiary care government hospital of Agra District, Uttar Pradesh p. 60
Renu Agrawal, Rudresh Negi, Sunil Kumar Kaushal, Sunil Kumar Misra
Background: Neonatal health remains a thrust area of public health, and an increased out-of-pocket expenditure (OOPE) may hamper efforts toward universal health coverage. Public spending on health remains low and insurance schemes few, thereby forcing impoverishment upon individuals already close to poverty line. Objective: To determine catastrophic health expenditure (CHE) in neonates admitted to the government neonatal intensive care unit (NICU) and factors associated with of out-of-pocket expenditure. Methods: This cross-sectional study was conducted in a governmental NICU at Agra from May 2017 to April 2018. A sample of 450 neonatal admissions was studied. Respondents were interviewed for required data. OOPE included costs at NICU, intervening health facilities, and transport as well. SPSS version (23.0 Trial) and Epi Info were used for analysis. Results: Of the 450 neonates analyzed, the median total OOPE was Rs. 3000. CHE was found among 55.8% of cases with 22% spending more than their household monthly income. On binary logistic regression, a higher total OOPE of Rs. 3000 or more was found to be significantly associated with higher odds of residing outside Agra (adjusted odds ratio [AOR] = 1.829), delay in first cry (AOR = 1.623), referral points ≥3 (AOR = 3.449), private sector as first referral (AOR = 2.476), and when treatment was accorded during transport (AOR = 1.972). Conclusions: OOPE on neonates amounts to a substantial figure and is more than the country average. This needs to be addressed sufficiently and comprehensively through government schemes, private enterprises, and public–private partnerships.
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Home-based newborn care voucher initiative in Assam: An evaluation p. 66
Tushar Manohar Rane, Tulika Goswami Mahanta, Sridhar Prahlad Ryavanki, Bivash Gogoi, Manjit Boruah
Background: An innovative home-based newborn care (HBNC) voucher system has been introduced in Assam to improve home visits of accredited social health activists (ASHAs), make them more accountable, and empower the community. Objective: This study aimed to evaluate the effectiveness of HBNC voucher initiative in Assam. Methods: A mixed methodology study was conducted in 2018 including 4 districts of Assam. A quantitative study was done among a sample of 836 lactating mothers by interviewing them through house-to-house visits. A qualitative study was done by in-depth interview of various health-care service providers. Results: Of 836 lactating mothers, 65% received HBNC voucher; 45.6% received at the time of discharge, and 5.3% during antenatal care. The purpose of HBNC vouchers as a tool of validating ASHAs' home visits was explained to only 14.5% of lactating mothers. Examination of newborn (44.6%), counseling on breastfeeding (57.1%), counseling on care of baby (39.2%), and counseling on immunization (49.2%) were the services commonly provided by ASHA during HBNC visits. Voucher system improved incentive payment system, but uninterrupted supply was a problem area as stated by ASHAs. Auxiliary nurse midwives and ASHA supervisors told that voucher system had improved ASHA home visits, payment system, and increased identification of danger signs of newborns. Conclusions: HBNC voucher system as an innovative approach was found to be effective. Coverage of services varied among different districts. Uninterrupted supply of the vouchers, periodic resensitization of health workers on its use, and increasing awareness among the community is needed to be sustained.
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Re-exposure animal bite management among incident animal bite cases in a secondary care Hospital in Delhi, India p. 72
Saurav Basu, Warisha Mariam, Sahadev Santra, Suneela Garg, Rajiv Singhal
Complete postexposure prophylaxis with 4 doses of anti-rabies vaccine (ARV) in a previously vaccinated (nonnaïve) individual results in administration of two extra ARV doses resulting in wastages of precious resources comprising vaccine logistics, human resources, physician, and patient time. This cross-sectional study conducted in a secondary care hospital in Delhi among 175 incident animal bite cases observed 39 (22.3%) had an animal-bite history within the previous 5 years. A total of 19 (10.8%) cases reported a history of complete ARV vaccination during a previous animal-bite exposure. However, in the absence of supportive patient medical documentation, all the animal bite cases without exception were prescribed a full course of ARV irrespective of their previous exposure status. Rabies immunoglobulins (anti rabies serum) were also re-administered in 13 (81.2%) cases. National guidelines for rabies prophylaxis should, therefore, consider the inclusion of an explicit decision-making algorithmic mechanism when the health-care provider is confronted with this situation carrying the potential for hidden vaccine wastage.
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Private sector vaccine share in overall immunization coverage in India: Evidence from private sector vaccine utilization data (2012-2015) p. 75
Habib Hasan Farooqui, Sanjay Zodpey
The objective of this research was to generate the evidence on the private sector's contribution to overall immunization coverage for selected pediatric vaccines in India. Using IMS Health's (now IQVIA) vaccine sales audit data and innovative methodological approach we estimated private-sector vaccine share in the total immunization coverage across selected pediatric vaccines in India. Our estimates suggest that private sector remains an important contributor to immunization services in India not only for Universal Immunization Program vaccines (Bacillus Calmette–Guérin [19.23%], HiB pentavalent [11.09%], hepatitis B [5.75%], oral poliovirus vaccine [5.48%], Diphtheria-Pertussis-Tetanus [2.66%], and measles [2.17%]) but also for newer vaccines (hepatitis A [4.2%], rotavirus [3.4%], typhoid [3.3%], and pneumococcal conjugate vaccine [2.5%]). As the private sector continues to remain an important access point for immunization services in the country, avenues for potential synergy between public and private sectors should be explored to improve the coverage and quality of immunization services.
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Addressing the health needs of people with disabilities in India p. 79
Suraj Singh Senjam, Amarjeet Singh
In India, the number of people with disabilities is continuously growing over the past few decades. The figure is expected to increase due to population aging, with a resultant increase in chronic health conditions. The health of people with disabilities is a relatively neglected and ignored area. Further, the disabled face poor access to healthcare and frequently encounter discrimination or stigmatization. These situations make them more vulnerable to many comorbidities in their health, making severe compromises in their quality of life. Therefore, people with disabilities need special healthcare than people without disabilities. There is a need for sensitization of all health-care providers to ensure quality, affordable, and accessible health-care services for people with disabilities. To address the health-care needs of people with disabilities to the maximum, Ministry of Health, Government of India should incorporate appropriate guidelines in various national health programs and work together with a relevant ministry.
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Prenatal diagnosis: A connotation on genetic counseling being indispensable p. 83
Anuradha Ramesh, Venkatachalam Deepa Parvathi
Prenatal testing and diagnosis are gaining a strong foothold in a progressively developing country like India, and an estimated boom in the market of noninvasive prenatal testing is predicted by the year 2024. Having said this, every technique needs an adequate amount of supplementation to increase its worth and that is where genetic counseling proves to be indispensable. Postdiagnosis, the women classified as high-risk individuals likely to give birth to infants inflicted with congenital and structural anomalies are appropriately counseled regarding the clinical aspects of the disease, life expectancy associated with the same, and the consequences associated with the decision to go ahead and conceive the child. Genetic counseling is majorly done for Down syndrome as the other aneuploidies have a highly reduced life expectancy. Although there are a variety of techniques available for testing various chromosomal anomalies, information regarding the appropriate time of the test and emphasis on pre- and posttest counseling is usually not supplied to primary physicians. A considerable amount of confusion dominates the decision of which test should be employed for testing of which anomaly as an array of rather efficient techniques has been identified. Furthermore, there is no nation-wide consensus of the timing and nature of these screening protocols. Moreover, ambiguous guidelines along with an impending lacuna in terms of awareness have led to India being at the backseat of the era that has ushered in tons of technological advancement in this field.
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An insight into predatory journals p. 86
Vikas Jaysing Pawar, Jasmine Jawade
The impact of scholarly journals has increased with invent of Internet due to improved access, faster dissemination, and ease of searching a variety of publications. With the increasing trend of research, open access (OA) publishing has increased intensely over the last few years. The core intent of OA is faster dissemination of research by making it available to readers free of cost. However, some publishers exploited this novel idea for their own benefit. Beall termed them as predatory publishers/journals. In this article, authors have made efforts to understand the predatory publishers/journal, reasons behind their upsurge, their modus operandi, their common targets, and the points which will help readers to identify them. The aim of this article is to expose facts behind the predatory journal and to create awareness among not only budding researchers but also faculty members, authors, and editors about the threat predatory journals carry toward scientific world and to their own curricula.
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Strongyloides hyperinfection in a patient with solid malignant tumor a case report p. 90
Shanmugaraj GeethaBanu, Krishnarao Arthi
Strongyloides stercoralis is unique among the nematodes, in which it completes its life cycle inside a single human host by causing autoinfection in the host, and it causes hyperinfection leading to persistent and fatal disseminated infections in immunocompromised hosts. The present case report is about strongyloidiasis fatal hyperinfection in a patient with malignant tumor of the tongue on radiotherapy treatment, to highlight the need for clinical suspicion of strongyloidiasis in an immunocompromised host. As per the Centers for Disease Control and Prevention, the mortality in strongyloides hyperinfection syndrome is alarmingly high, a case fatality rate that is almost 90%. Hence, the clinicians should be well equipped to diagnose, treat, and also prevent the fatal consequences of this lethal nematode. Detailed workup for this parasitic infection is crucial, and this case report emphasizes that a simple wet mount stool microscopic examination can clinch the diagnosis.
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Sickle cell disease presenting in the third trimester of pregnancy: Delayed detection heralding a public health problem? p. 93
Ankita Sharma, Kavita Gaur, Vandana Puri Tiwari, Shailaja Shukla
We report the case of a 22-year-old primigravida detected as having sickle cell disease (SCD), initially presenting in the third trimester (30th week) of pregnancy. The patient came to our center with a complaint of severe lower limb pain. The peripheral smear showed marked anisopoikilocytosis, numerous leptocytes, sickle cells, and target cells. High-performance liquid chromatography corroborated the diagnosis of SCD, showing a significant peak in the sickle window. The patient was conservatively managed and delivered a healthy baby through normal vaginal delivery. Delayed presentation of SCD in the third trimester of pregnancy is unusual. This report aims to bring attention to the possible causes of such a lag in detection. We also suggest measures to refine the antenatal healthcare screening at multiple levels, with regard to the detection of sickle cell hemoglobinopathy.
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