Journal of the Indian Medical Association

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An Effective Management for Thalassaemic Patients during Pregnancy
(Indian Medical Association, 2023-04) Das, Arpita; Ghosh, Sangeeta; Ghosh, Sandip; Sur, Tapas Kumar
Background : Presence of thalassaemia is considered high risk in pregnancy. The present study find out the role of antenatal and intrapartum care to improve the outcome of pregnancy in thalassaemia. Materials and Method : The prospective longitudinal study was carried out on 25 patients. CBC, LFT, Ferritin, Hb electrophoresis, serial USG was done. Chorionic villous sampling was offered to thalassaemic women to decrease the number of babies born with Thalassaemia. Furthermore, management and treatment options provided to mother to overcome the incidence of maternal and neonatal complications during current pregnancy. Results : 44% of thalassaemic pregnant women had HbE ? thalassaemia, 8% ? thalassaemia major and others had thalassaemia carriers, while only 20% of their partners showed ? thalassaemia trait. All patients were anemic and during delivery mean Hb% were 8.42 g/dl, MCH 22.09 pg, MCV 73.56 fl, MCHC 29.86 g/dl and ferritin 241.51 ng/ ml. Third trimester USG exhibited 32% developed IUGR (Intrauterine growth restriction). 40% patients received blood transfusion after delivery. ? thalassaemia trait was identified in 20% babies at 6 month. Conclusion : Postpartum haemorrhage is a major complication of thalassaemia in pregnancy. After delivery a thorough neonatal check-up and haematological work-up is important for prevention of neonatal mortality and early detection of thalassaemia.
Reproductive Tract Infection : Challenges to Health Policy and Education, Research and Impact on the Socio-economic Situation of Indians
(Indian Medical Association, 2023-04) Dutta, Dilip Kumar; Dutta, Indranil; Dutta, Ipsita
Background : Reproductive Tract Infection (RTI) due to poor hygiene caused by faecal Bacteria or viruses which goes into the vaginal canal during and after defecation is not only damaging to the reproductive organ, but also causes indirect or direct impact on Socio-economic status of the patient and their family as well. Objective : This study highlights the importance of faecal hygiene in preventing damage to the reproductive tract and curbing the impact on social and economic problems in patients and their families. Materials and Methods : This study was conducted at GICE Nursing Home, Kalyani, Nadia, WB, between April 2016 and March, 2022. During this period, 11,872 cases were reported at GICE Nursing Home of which 10,000 cases were selected. Discussion : It was interesting to observe that those who wipe from back to front or vice versa are more likely suffering from Vaginitis (85%), Cervicitis (92%), Endometritis (55%), PID (60%), UTI (70%) and Tubal Block (17%) as compared to those who used Hand shower (10%) or Tissue Paper (9%). This is an indication that proper faecal hygiene can prevent damage to the reproductive system. Further analysis revealed that the inability to pay for medical expenses created a Socio-economic crisis among family members. Conclusion : It is concluded from this study that maintenance of proper faecal hygiene by women in Rural, Urban and Industrial areas, can not only help with prolonged illnesses but also prevent financial losses. As a result, Guardians, Teachers, Health Care Providers and Local Government should conduct outreach programs to teach the importance of faecal hygiene at home, in Schools, Colleges, Public health institutions and so on, etc
Antimicrobial Utilization Study in a Neurology Setting
(Indian Medical Association, 2023-04) Nasare, Namita Vilas; Bhardwaj, Ankit; Bablani, Vineeta; Gupta, Renu; Kushwaha, Suman; Sharma, Sangeeta
Background : Measuring antimicrobial consumption is necessary to understand the volume and patterns of use, to design appropriate interventions to reduce and rationalize its use. Materials and Methods : The antimicrobial consumption in Neurology ICU and IPD were measured over a 5-year period using WHO Defined Daily Dose (DDD) methodology. Results : There was an increasing trend in Antimicrobial Consumption (AMC) from 125.7 to 155.5 DDDs/100 days over 5 years with highest consumption in 2017-2018 (190.7 DDDs). The consumption of Watch group of antibiotics was higher than access group antibiotics both in ICU and IPD and constituted more than 75% of total antibiotic consumption. Conclusions : The initiation of empiric therapy though may be necessary depending on the patients condition, however, duration of antibiotic therapy and reducing usage of prophylactic antibiotics for aspiration pneumonia and reducing consumption of Watch group of antibiotics were identified as stewardship opportunities. Feedback on AMC data and persuasive educational interventions to rationalize and reduce antimicrobial use are required.
Biometry of the Submandibular Salivary Glands in Indian Population Using Computed Tomography : A Retrospective Study
(Indian Medical Association, 2023-04) Rathod, Nitin Ratanrao; Onkar, Deepali Prashant; Onkar, Prashant; Dhok, Avinash Parashuram; Bodhankar, Shubham Baburao; Yadav, Tushar Suresh
Objectives : To study the biometric measurements of the submandibular salivary gland in the Indian population using Computed Tomography. Materials and Methods : From the available database, 300 patients who have undergone Computed Tomography without any salivary gland disease, the CT scans were retrospectively evaluated. The CT scans were obtained with TOSHIBA Activion 16 slice CT machine. The antero-posterior, transverse and cranio-caudal dimensions of bilateral submandibular salivary glands were measured in the axial, coronal and sagittal planes. Results : The mean CT measurements of the patients included was 2.0 ± 0.38 cm in Antero-posterior, 2.1 ± 0.31 cm in Transverse and 2.90 ± 0.27 cm in Cranio-caudal dimensions. The average volume of the submandibular gland was 6.68 ± 0.21 cc.
Analysis of Set Up Margin Required during Delivery of Conformal Radiotherapy in Head and Neck Malignancy Using On Board Imaging: Experience from Tertiary Care Center
(Indian Medical Association, 2023-04) Bera, Anjan; Dutta, Shatarupa; Banerjee, Chandrima; Banerjee, Saptarshi; Mandal, Srikrishna
Background : Adequate dose to Clinical Target Volume is needed to control tumour and to deliver adequate dose without missing the target, this Clinical Target Volume must be encompassed by two margins for uncertainties; first, Internal margin uncertainties and second, set up margin uncertainty will form Planning Target Volume. Three mm setup error of couch location resulted in 38% decrease of minimum target radiation dose and 42 % increase of minimal Spinal Cord and Parotid Gland radiation dose. Aims and Objectives : Objectives of this retrospective study are, before implementation of high precession radiotherapy technique for Head and Neck Malignancy, we want determine optimal 3-dimensional Clinical Target Volume to planning target volume margin and to assess our setup accuracy in our institute, NRS Medical College & Hospital, Kolkata. Material and Methods : We analyzed retrospectively set up error from 691 set Cone Beam CT images of 94 patients. According to Standard Guidelines Target Volume delineated and for creation Clinical Target Volume to Planning target volume margin, we have used 5-7 mm margin around Clinical Target Volume. Results : In 99% patients’ setup deviation were within 0.5 cm. The population systematic error (?) in in Super Inferior; mediolateral; and anterior posterior direction were 0.13 cm, 0.12 cm and 0.14 cm respectively. The population random error in Super Inferior; mediolateral; and anterior posterior direction were 0.021 cm, 0.022 cm and 0.173 cm respectively. Using van Herk formula Clinical Target Volume to Planning Target Volume margin in Super Inferior; mediolateral; and anterior posterior direction were 0.34, 0.47 and 0.32 cm respectively. Corresponding values with Stroom formula 0.28, 0.40 and 0.26 cm respectively. Conclusions : In our study Set up margin of 5mm all around the CTV to create PTV is found to be safe and adequete
Postoperative Comfort Score after Septoplasty among Patients Undergoing Nasal Packing versus Suturing of the Septal Flap by Modified Technique without Packing : A Randomized Controlled Trial
(Indian Medical Association, 2023-04) Srivastava, Abhinav; Mohan, Chander
Background : Septal surgery is one of the most common surgical procedures performed by an Otorhinolaryngeal surgeon since ancient times. Various modifications in the approach, changing concept of conserving septal cartilage, use of an endoscope and good antibiotics to control postoperative infection have played a key role in controlling the complication rates but still, one thing which is mostly practiced worldwide is nasal packing in the postoperative period which is a nightmare for many patients, as the pain threshold varies from patient to patient. It also causes dryness of mouth, throat irritation, facial heaviness, headache, excessive watering from eyes, aural fullness. There is a lack of proper evidence to prove whether nasal packing really decreases postoperative hemorrhage as the incision is properly approximated and sutured. The main reason for nasal packing was an approximation of nasal septal flap thereby reducing the chances of septal Haematoma and stabilization of septal flap in the midline. The present study has been taken to study and compare postoperative nasal packing and modified quilting suture of the septal flap without the nasal pack. Material and Methods : This one-year prospective comparative study was conducted on 149 patients who underwent septoplasty with 3 months follow-up. One group had Postoperative nasal packing and the other had only modified septal flap suturing without the nasal pack. Results : Out of the total of 149 patients, 88 underwent nasal packing in the postoperative period and 61 patients had undergone suture of the nasal septal flap without nasal packing. A statistically significant value of VAS score was found in the non-packing group of 61 patients, where the average postoperative VAS score was 1.46 against 3.7 among the packing group of 88 patients. An unpaired t-test was applied and a value of 15.431 was obtained with a pvalue less than 0.001. No cases presented with septal perforation in the postoperative period in patients without a nasal pack and there were 2 cases (2.2%) of septal perforation in the nasal packing group. There was no significant bleeding in the postoperative period in both groups of patients. Conclusion : Stabilization of the nasal septal flap by modified quilting technique is better option after septoplasty with good comfort score.
COVID-19 Pandemic and the Role of Control Room in the Tertiary Care Hospital
(Indian Medical Association, 2023-04) Chauhan, Preeti; Naik, Sanjukta; Wardhan, Neeta; Debnath, Ekta; Singh, H R; Kundra, Priyanka; Jain, Sameeksha; Basu, Dharmendra Kumar; Das, P K
COVID-19 has been labeled a serious public health emergency globally. Due to its high infectivity it has led to an increased burden to the Medical Fraternity as well as the Government. Therefore, the need for preparedness as well as conventional intervention strategies became integral during such health emergencies. To monitor the implementation of proper activities and to manage the patient load with adequate safety of the staff, COVID control rooms were established in the hospital premises. The main objective of the Control Room is risk mitigation, planning strategies, alleviating concerns and addressing issues associated with the health emergency across the hospital and further delegating the information to the higher authorities and the Ministry. Hereby in this review we have tried to summarize the administrative structure, functions and limitations of the 24x7 Control Room established in Tertiary Care Hospital, New Delhi.
Left Basilar Pneumonia Simulating Perforated Appendicitis with Peritonitis in a Child
(Indian Medical Association, 2023-04) Patel, Ramnik V; Anthony, Favour Mfonobong; Chhaniara, Rohan Ashit; Trambadi, Rajvi Anilkumar
We present an 8-year-old boy who presented with predominant abdominal symptoms initially to the referring hospital and the initial Chest radiograph being reported as normal. Inflammatory markers being sky high with abdominal symptoms and minimal Chest signs, he was referred to as an atypical case of Perforated Appendicitis. By the time patient was seen in the Tertiary University Teaching Hospital, he had developed classic clinical features of Left Basilar Pneumonia which was clearly evident on good quality repeat Chest radiograph and Ultrasound confirmed it and ruled out any abdominal pathology. The patient responded well to intravenous antibiotics followed by oral one with excellent recovery. Our case is a usual reminder of the fact that a patient is more likely to have a rare presentation of a common disease, than a common presentation of a rare one. Take a careful history and examine the child; consult the appropriate specialist resources and then, if necessary, extend your history and examination with review of available investigations especially being good at reading plain radiographs.
Prolonged Stay in Intensive Care Unit and Its Predictors in a Tertiary Care Centre of West Bengal, India
(Indian Medical Association, 2023-04) Mayur, Nairita; Mondal, Shatanik
Background : Intensive Care Unit (ICU) is considered as one of the most expensive and complex medical resources of any hospital. Research on ICUs may provide valuable inputs in developing an improved model of patient-care and hospital management and a better utilisation of the scarce resources especially in this ongoing pandemic crisis. ICU Length of Stay has long been used as a surrogate marker for resource utilisation. The following study was conducted in a Tertiary Care Hospital of West Bengal to find out the prevalence of prolonged ICU stay and their related factors. Methodology : This was an Observational, descriptive type study conducted in an intensive care unit of a teaching hospital of West Bengal during April-September 2021. Potential predictors were analysed along with various clinicodemographic profiles of the study subjects for possible association with prolonged ICU-Length of Stay (LOS >14days). Results and Discussion : Out of total 287 patients almost 19% patients had a Length of Stay (LOS) of more than 14 days. The patients admitted in the ICU due to surgical trauma, respiratory or neurological cases were more likely to have a prolonged LOS. Patient who had Coagulopathy, Infection, Oliguria or needed Mechanical ventilation or Vasopressor therapy in the first 24-hour following admission had higher ICU stay. The patients having LOS of >14 days had a higher mean APACHE II score. Conclusion : The predictors identified in this study can be used in targeting this particular group to improve resource utilization and efficiency of ICU
Patient Safety Attitude among Indian Medical Students — A Comparative Cross-sectional Questionnaire Study
(Indian Medical Association, 2023-04) Sreekumar, Kavita; Bhoomkar, Nikhil; Gaunkar, Ridhima; Sardessai, Mohnish; Rodrigues, Megan; Satarkar, Esha
Introduction : Medical errors in Healthcare is now a global concern and patient safety is become a significant priority. Despite the escalating need for patient safety curriculum in Medical Education, few Medical Schools have a structured training in place. We did this study to evaluate the attitudes of Indian Medical Students towards patient safety. Methods : This was a descriptive, cross-sectional, questionnaire based study done over 6 months among cohorts of 2nd and 3rd year Medical Students. The Attitudes to Patient Safety Questionnaire-III was used. The responses were noted using a 7-point Likert scale. Mean scores were analysed for 9 domains consisting of 26 items and compared for the two groups using Students 't' test. The sample was set at 95% confidence interval. p < 0.05 was considered statistically significant. Results : Total of 190 students participated, 70 second year and 120 third year students with response rate of 46.6% and 80% respectively. Both groups showed positive response for domains of working factors as an error cause, team functioning and error inevitability. Lowest score was received for professional incompetence as an error and disclosure responsibility. There was a significant difference between the two groups in one domain and 6 individual items. Discussion : The results of the study reveal that there is a need to include structured patient safety curriculum in Undergraduate Medical Education which was strongly acknowledged by the participants. Non-technical skill training would help student develop positive attitudes towards teamwork, error reporting and disclosure responsibility
MR Imaging in Eclampsia
(Indian Medical Association, 2023-04) Rishadha, Ainun; Onimi, Syamala; Rani, Usha; Chandrasekharan, Anupama; R, Rajeswaran
Background : The aim of this study is to determine the distribution and nature of Cranial MRI findings in eclamptic patients, and to correlate them with clinical and laboratory data. Materials and Methods : This study was conducted in the Department of Obstetrics and Gynecology in Sri Ramachandra Institute of Higher Education and Research. A total number of 35 Eclamptic patients were included in this study and they were analyzed retrospectively. Laboratory parameters, Blood Pressure and Cranial MRI was performed for all and the same were analyzed statistically. Results : Out of 35 Eclamptic patients, MR Imaging was normal in 6 patients. Among the 29 patients with abnormal MRI, Cortical-subcortical Lesion, appeared iso/hypo-intense in T-1 weighted images and hyper intense in T-2 weighted images. In most of the patients, occipital lobe was involved followed by involvement of other lobes such as Parietal, Frontal, Temporal, Basal Ganglia and Cerebellum. When patients with and without positive MRI findings were compared regarding clinical features such as Headache, Blurred Vision, Nausea and Vomiting, Epigastric Pain, Loss of Consciousness, Reduced Urine Output there was no statistically significant difference between the two groups. Similarly, there was no statistical difference in mean arterial pressures between MRI positive and MRI negative patients (p=0.218) however, it was found that those with MR imaging positive features had a higher Blood Pressure than those with MRI negative findings. Among the laboratory parameters, in the patients with abnormal MRI findings Fibrinogen was found to be significantly low than those with normal MRI findings (p=0.0002).
Burkholderia Pseudomallei Infection in a Diabetic Patient Presenting as Multiple Splenic Abscesses — A Case Report
(Indian Medical Association, 2023-04) Meenakumari, P B; R, Rekha; PS, Neena; R, Suresh
Background : Meliodosis is an infection by Burkholderia Pseudomallei, is now endemic in India. It can have varied clinical manifestations. We report a case of Meliodosis in a diabetic patient presented as multiple Splenic Abcesses. Case Report : A 56-year-old male patient, manual labour, diabetic with uncontrolled glycemic levels presented with prolonged Fever and abdominal pain which on evaluation revealed multiple Splenic Abscesses. Culture of aspirate from abscess grew Burkholderia Pseudomallei. He improved with appropriate antibiotic therapy and Splenectomy. Conclusion : The case is presented to highlight the importance of making early clinical and microbiological diagnosis for a better outcome
Image in Medicine
(Indian Medical Association, 2023-04) Angirish, Bhoomi; Jankharia, Bhavin
AL Amyloidosis with Polycythemia, Leucocytosis and Thrombocytosis : A Case Report
(Indian Medical Association, 2023-04) Anandh Urmila; Vaswani Bharat; Hurmath Syeda
A young lady presented to us with clinical and biochemical evidence of Nephrotic Syndrome. Her laboratory investigations also revealed Erythrocytosis, Leucocytosis and Thrombocytosis. A renal biopsy revealed a diagnosis of Amyloidosis which was further characterized as AL amyloidosis with further investigations (kappa chain monoclonal gammopathy). She was started with appropriate therapy and she showed significant decline in her monoclonal Proteins on follow up. Her Erythrocytosis, Leucocytosis and Thrombocytosis also normalized with the decline in the levels of monoclonal light chains. We postulate a link between the monoclonal protein associated growth factors and inflammatory markers which were responsible for this unique association between AL Amyloidosis and tri-lineage hematopoietic cell proliferation.
Study of the Prevalence of Type 2 Diabetes Mellitus in Patients with Heart Failure in a Tertiary Care Hospital in Eastern India
(Indian Medical Association, 2023-04) Chatterjee, Torsha; Maisnam, Indira; Kundu, Prabir Kumar; Bandyopadhyay, Sudipta; Ray, Aniruddha; Mukherjee, Apurba Kumar
Heart Failure and Type 2 Diabetes Mellitus are closely related. Diabetic patients have an increased risk of developing Heart Failure and those with Heart Failure are at higher risk of developing diabetes. The objective of the study was to estimate the prevalence of Type 2 Diabetes Mellitus in patients with heart failure. This analytical observational type of epidemiological study with case control design was conducted at in patient department of General Medicine of RG Kar Medical College & Hospital, Kolkata, West Bengal, India from July, 2019 to June, 2020. 100 study subjects by purposive sampling method were taken as per inclusion and exclusion criteria. Data were collected based on History, Clinical examination, relevant investigations and review of records. In this study proportion of Diabetes was much higher among cases with Heart Failure (30%) than controls (10%), among cases with NYHA class IV (56.3%) and among cases with reduced Ejection Fraction (100%). Thus pre-existing or newly development of Type 2 Diabetes Mellitus should be kept in mind in all hospitalized Heart Failure Patients.
The Prevalence of Isolated Systolic Hypertension at a Tertiary Care Hospital in Eastern India : An Observational Study
(Indian Medical Association, 2023-03) Brahmachari, Ram Krishna; Chakraborty, Supratik; Nandi, Shiladitya
Background and Objectives : Hypertension is a significant public health issue. Isolated Systolic Hypertension (ISH) was once considered to be a benign aspect among the aging population, but an association with an increased risk of Cardiovascular Disease is now known. ISH shows an increasing prevalence with increase in age. This study was undertaken to determine the incidence of ISH among adults in Eastern India. Methods : This study evaluated the adult population (aged 18-70 years) attending the NRS Medical College and Hospital, a Tertiary Care Center in East India. The clinical characteristics and echocardiographic findings were also evaluated. Results : A total of 800 patients met the inclusion criteria, of whom 75 (9.37%) had ISH. Blood Pressure increased with age. The most common echocardiographic change observed in ISH patients was increased Left Ventricular Mass Index (LVMI), while concentric Left Ventricular Hypertrophy (LVH) was more common in women than men with isolated Systolic Hypertension. The incidence of LVMI increased as the severity of ISH increased. Furthermore, patients with stage 3 ISH were nearly 4 times more likely to develop Proteinuria. Conclusion : The findings of this study are in line with previous studies evaluating the presence of ISH in the adult Indian population. There is need for effective population screening along with effective treatment for Blood Pressure to reduce morbidity and mortality. Primary prevention strategies may be the need of the hour in the Indian population which is at risk of cardiovascular Disease associated with Hypertension
Validation of Glasgow-Blatchford Score in Predicting Management of Upper Gastrointestinal Bleeding
(Indian Medical Association, 2023-03) Navgale, Shantanu Shirish; Deshpande, Akshay Shirish; Agarwal, Sunny; Dhara, Satish Balkrishna; Patil, Rajesh
Background : Upper Gastrointestinal Bleeding is a common emergency with varying degrees of severity. Haemorrhage is managed by Therapeutic Endoscopy, Radiological Intervention or Surgery and Blood Transfusion which are available only in Tertiary Care Centre. So, when patient presents in primary healthcare setting, it is important to recognize the patients who need this treatment. Glasgow-Blatchford Score is a score which is used for this purpose. The purpose of this research was to validate its reliability in identifying such high-risk patients. Materials and Methods : This study was prospective and observational, conducted in Medical College and Hospital, from December, 2017 to May, 2019. All adult patients presenting to Emergency Department with sudden onset Upper Gastrointestinal Bleeding were included. Glasgow-Blatchford Score was computed. Patients were followed up till their discharge (or death) from the hospital. The therapeutic management needed and its relationship with the score and treatment modalities were noted. Area under Receiver Operating Characteristic (ROC) Curve was calculated. Results : Total 100 patients were included in study. 85% were male and 15% were female. Glasgow-Blatchford Score was found as a good predictor in discriminating patients. Patients with score 14. Interventional radiology or surgery was never used. The area under ROC Curve was 0.738 suggesting fair reliability. Conclusion : Glasgow-Blatchford Score is good predicting tool in cases of Upper Gastrointestinal bleeding and patients with score >7 should be transferred to speciality centres
Evaluation of Risk Factors of Postoperative Urinary Retention in Male Patients Undergoing Surgery Under Spinal Anaesthesia : A Prospective Study
(Indian Medical Association, 2023-03) Lal, Tusharindra; Sivaraman, Vigneshwar Kumbakonam; Singh, Prabhath Jagath; Sanniyasi, Saravanan
Background : Postoperative Urinary Retention (POUR) is common after regional anaesthesia with a reported incidence between 5% and 70%. POUR can lead to significant morbidity with additional surprise and mental trauma to the patient when unwarned. This study aimed to assess the occurrence of POUR in male patients undergoing Surgery under Spinal Anaesthesia and to study the risk factors related to it. Methods : 692 male patients were analysed prospectively for the need for catheterisation which was defined as 搕he inability to void in the immediate Postoperative period with accompanying discomfort and a palpable Bladder.� All such patients were catheterised as an emergency. A record was made about the mean age, surgical condition, comorbidities, duration of Surgery, use of intra-operative sedatives, intra-operative fluid infused and International Prostate System Score (IPSS). Results : The overall mean age of patients with POUR was 46 years. The incidence of POUR was highest among Perianal Surgeries ie, 52/70 (13%) followed by Hernia Surgeries, 18/70 (6.3%). An appreciable reduction was observed in urinary retention after administration of intra-operative sedatives (p=0.022) and lower IPSS (p=0.001). Factors such as age, intra-operative fluid administration, duration of Surgery and previous history of Diabetes did not reach statistical significance as being predictive of urinary retention. Conclusion : An IPSS greater than 7 increases the risk of Postoperative Urinary Retention while the use of intraoperative Sedative in combination with Spinal Anaesthesia decreases the risk. In high-risk patients undergoing perianal procedures, pre-operative patient counselling about the possibility of Postprocedure retention is recommended.
Variation in COVID Mortality with Different Demographic Factors in Districts of India
(Indian Medical Association, 2023-03) Goel, Ashish; Wason, Rhea; Gera, Raghav
Background : Descriptive data suggests significant disparity in the COVID-19 related deaths across different demographic zones. Several studies have examined these factors at the intra-country or intrastate level. Our study analyzed the data at a District level. Methods : This cross-sectional study analyzed the association between Socio-demographic factors and COVID19 Mortality at a District level using Univariate and Multivariate linear regression models. Data for sixty randomly selected Districts was collected and compiled from free sources available in the public domain. Linear regression models were built and factors that were found to be significant were used in the model. Results : Univariate analysis revealed that COVID Mortality has a positive correlation with the literacy rate and a negative correlation with the percentage Rural population of the District. No significant relation was found with primary Health Center accessibility, Sex Ratio and the percentage of chronic illness. On Multivariate analysis, it was negatively correlated to only the percentage of the Rural population. Conclusion and Relevance : Our study concluded that as the rural population increased in a district, COVID 19 mortality decreased. There was no significant association with other sociodemographic variables.
Footwear Usage and Practice in Indian Healthcare Centres
(Indian Medical Association, 2023-03) Vignesh, Nawin Jai; Britto, Rock; S, Santhosh; S, Senthilnathan; Praveen, Saravana; Stanley, Shamma; J, Selvapriya
Healthcare Centres are where the patients get treated, but most of the time, we ignore that it is also a major source of Infections, to both patients and visitors. In India, many hospitals don抰 allow patients & visitors to enter with their Footwear on, whereas, Doctors & other Health Care Workers can. There are no specific guidelines for visitors and patients for wearing Footwear in India. Also, the Indian National Guidelines of infection prevention & control doesn抰 provide sufficient protocol regarding the importance of wearing Footwear for patients and visitors in Healthcare Centres. This article focuses on finding the risk of acquiring Infection & transmission of microorganisms when a patient walks barefoot within the hospital.

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