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   Table of Contents - Current issue
January-March 2022
Volume 7 | Issue 1
Page Nos. 1-51

Online since Thursday, March 31, 2022

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Endocrine disruptors: A rising menace p. 1
Bhanu Malhotra, Sanjay Kumar Bhadada
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Chronic respiratory disease and coronavirus disease 2019 in developing countries: A systematic review p. 3
Ashutosh Nath Aggarwal, Ritesh Agarwal, Sahajal Dhooria, Kuruswamy Thurai Prasad, Inderpaul Singh Sehgal, Valliappan Muthu
The proportion of coronavirus disease 2019 (COVID-19) patients having a chronic respiratory disease (CRD), and its impact on COVID-19 related patient outcomes, is unclear. We conducted this systematic review to evaluate the proportion of patients with asthma or chronic obstructive pulmonary disease (COPD) among COVID-19 patients, and to assess if comorbid CRD worsens COVID-19 outcomes, in developing countries. We queried PubMed database for studies conducted in developing countries and provided data on the proportion of COVID-19 patients with CRD, or severe disease or mortality among COVID-19 patients with and without CRD. We calculated proportion of CRD patients and relative risk (RR) for each reported outcome of interest. We used random-effects models to summarize our data. We retrieved 1947 citations and included 22 studies from developing countries in our review. The pooled estimate for proportion of asthma and COPD was 2.32% (95% confidence interval [CI] 1.86%–2.83%) and 3.52% (95% CI 2.14%–5.20%), respectively. COVID-19 patients with asthma had a higher risk of severe COVID-19 (summary RR 1.21, 95% CI 1.17–1.25), but not of mortality (summary RR 1.01, 95% CI 0.80–1.28), as compared to COVID-19 patients without asthma. COVID-19 patients with COPD had a higher risk of severe COVID-19 (summary RR 1.48, 95% CI 1.30–1.69) and mortality (summary RR 2.69, 95% CI 1.57–4.61), as compared to COVID-19 patients without COPD. Patients with asthma (but not COPD) in developing countries may be less likely to acquire COVID-19. Both diseases may increase the risk of severe COVID-19, and COPD may increase risk of COVID-19-related mortality.
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Dyslipidaemia in Sri Lanka p. 13
Anne Thushara Matthias, Ruvan Ekanayake, Carukshi Arambepola
Cardiovascular diseases (CVDs) are the leading cause of mortality in South Asia. Although well-recognized as a major risk factor, dyslipidemia in such populations is not well-reviewed. To review the trends in dyslipidemia, phenotypes, underlying causes, treatment modalities, and management gaps in Sri Lanka. A narrative review was undertaken on published literature on dyslipidemia in Sri Lanka from 2000 to 2020, extracted using PubMed, Google Scholar, and locally published literature. Out of the 33 documents reviewed, only a limited number was available on large-scale population-based studies. High prevalence of metabolic syndrome along with moderately high low-density lipoprotein-cholesterol, low high-density lipoprotein-cholesterol, high triglycerides, and high ApoB and Lp(a) concentrations was seen. Familial hypercholesterolemia was an understudied area with a need for a national screening program. With dyslipidemia guidelines limited to the management of special disease groups, there is a chasm between guidelines and practice at present in Sri Lanka. Unlike in primary prevention, prescribing high-dose statins in secondary prevention of CVD has been satisfactory. Treatment gaps are identified, with room for improvements in lipid screening and achieving lipid goals. Considering the substantial burden identified, education of physicians, optimizing lipid testing, and aggressive treatment of lipids are key initiatives toward optimizing management of dyslipidemia.
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Quality of life of diabetes patients in North India: A comparison of different methodologies p. 22
Anuroop Kaur, Sushma Kumari Saini, Gunjeet Kaur, Shankar Prinja
Background: India is witnessing a dramatic rise in the prevalence of diabetes mellitus. In this study, quality of life (QOL) of patients with diabetes and its determinants were assessed. Second, the valuation of QOL using different methods of measurement was examined. Methods: A community-based survey comprising 306 adults diagnosed with diabetes was undertaken in an urban slum area of Chandigarh city. Direct methods of QOL assessment such as time trade-off (TTO) and Visual Analog Scale (VAS) along with indirect like EuroQol 5-Dimensional 5-Level Instrument (EQ-5D-5L) and the QOL Instrument for Indian Diabetes Patients (QOLID) were used. Multiple linear regression was used to compute coefficients to assess point estimate of QOL using the Indian QOLID tool. Results: Overall, health utility scores for a person with diabetes were 0.68 (with TTO method), 0.60–0.64 (with VAS) analog scale, and EQ-5D-5L method, respectively. Valuation of QOL using direct methods yielded utility values which were significantly higher than indirect methods (EQ-5D-5L). Conclusion: Overall, this study found that diabetes is responsible for physical, psychological, and social role disturbance among the patients. In addition, choice of using direct or indirect methods of utility estimation may have practical implications while calculating incremental cost-effectiveness ratios.
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Punjab substance abuse prevention model: Outcomes of key multistakeholder consultation in Punjab, India p. 30
JS Thakur, Nidhi Jaswal
Background: Extensive work has been done in the state of Punjab regarding the treatment of substance abuse, but focus on prevention was lacking. De-addiction services are being provided in almost each and every district of Punjab. A strong prevention and control component, i.e., prevention strategy along with de-addiction services, is crucial for desired impact. An attempt was made to develop a statewide prevention strategy against substance abuse in the state of Punjab, India, on the request of the state government. Materials and Methods: The plan of the prevention model was prepared based on the situation analysis, stakeholders' workshops, and consultative meetings with various key stakeholders from the state of Punjab. Results: One in seven (~15%) people in Punjab were currently dependent on any substance, including licit and illicit. This figure, when compared in a global context was much higher than expected. Overall substance use was predominant in men and significantly more common in rural areas. The prevention strategy in Punjab named 'Punjab Substance abuse Prevention Plan (P-SAP)' will have a holistic approach focusing on health promotion and continuum of care approach (Prevention-Treatment-Rehabilitation) targeting Supply-Demand-Harm reduction Measures. It is the first of its kind of inclusive multi-sectoral model that aims to prevent substance abuse at village, block, district and state level. Implementation requires political and administrative will with participation of all political parties and key stakeholders. Life skill education should be introduced in school education and should become part of curriculum. The state should ensure the institutional framework and mechanism for their participation and adequate resources for effective implementation. Conclusion: This model should be implemented in the state and can be tried and adapted in other states of India and low- and middle-income countries.
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Productivity loss and diabetes distress among patients with type 2 diabetes seeking out patient care at a tertiary hospital in Bengaluru, South India p. 36
Kavya Pinto, Sanjana Mathur, Farah Naaz Fathima, Belinda George, Soumya Umesh
Background: Type 2 diabetes contributes to significant productivity losses in paid work and unpaid work. Patients with Type 2 diabetes also feel distressed due to the concerns about disease management, its emotional burden, physician-related issues, and regimen-related distress. Objective: The objective of this study is to assess the productivity loss and diabetes distress among patients with Type 2 diabetes attending the outpatient department at a tertiary care setting and the association between productivity loss and diabetes distress in the study population. Materials and Methods: A cross-sectional study was done among 121 outpatients with Type 2 diabetes at a tertiary care hospital. A semistructured interview schedule that included questions on sociodemographic profile, details about diabetes, the Institute for Medical Technology Assessment Productivity Cost Questionnaire, and Diabetes Distress Scale was administered. Results: Around half of the study participants (47.1%) reported productivity losses either in paid and/or unpaid work. The total cost of productivity loss among 121 patients over 4 weeks was calculated to be Indian National Rupees 2,526,880. Individuals with diabetes distress levels worthy of clinical attention (moderate and high levels of distress) were found to be 20.6%. Significant emotional burden was seen among 40.5% of the study participants. Of the population who had distress due to diabetes, 60% had productivity loss. Conclusion: Patients with type 2 diabetes have high productivity losses and distress due to diabetes. Patients with productivity losses have significantly higher levels of diabetic distress.
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The readiness of frontline health workers in enhancing diabetes and hypertension self-management education and practice in the community settings in Delhi, India p. 42
Saurav Basu, Suneela Garg, Samar Hossain, Divya Gupta, Kushagr Duggal
The present study was conducted among accredited social health activists (ASHAs), female frontline health workers of India, to assess their knowledge of self-care management for diabetes mellitus (DM) and hypertension (HTN) and understand their readiness to promote medical adherence. Only 21 (41.2%) participants (n = 51) were aware of all the four major behavioral risk factors, including physical inactivity, unhealthy diet, tobacco smoking, and harmful alcohol use that increased the risk of development and progression of DM and HTN. The ASHAs were positively inclined toward participation in health education activities through home visits but were disinclined to be involved in the home distribution of medications.
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Burden of mental health disorders and synthesis of community-based mental health intervention measures among adolescents after the onset of COVID-19 pandemic time in low middle-income countries: Protocol for systematic review and meta-analysis p. 46
Indranil Saha, Joydeep Majumder, Bhavani Shankara Bagepally, Sujoy Ray, Asim Saha, Amit Chakrabarti
Adolescents have become victims of the COVID-19 pandemic, leading to the development of several mental health problems. This protocol is aimed to determine the pooled prevalence of mental health disorders among adolescents (10–19 years) during the COVID-19 pandemic time in low middle-income countries (LMIC) and to find different community-based mental health intervention measures in addressing adolescent mental health disorders during COVID-19 pandemic time in LMIC. Articles will be retrieved from databases such as PubMed, EmBase, Scopus, Cochran Central, and Google Scholar using Medical Subject Headings terms, keywords, and text words for each concept. Preprint search servers (MedRx, Cogprints, IndiaRxiv, medRxiv, SSRN) will also be accessed in addition to hand-searching of retrieved articles by forward and backward searching strategies. Data analysis will be conducted as per guidelines provided in the Handbook of Cochrane Systematic Review. RevMan version 5.4 or suitable software will be used for pooled analysis. This proposal is registered in the PROSPERO register (CRD42021278714). Pooled prevalence will depict the overall burden of these neglected health issues. The proposed study would further suffice in identifying evidence-based intervention measures in community settings among adolescents in the background of an ongoing highly infectious disease pandemic.
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