Deaths In India Research Articles

Excess COVID-19 Mortality in India: An Estimation Using the Published Death Rate by the Civil Registration System

Background An unbiased estimate of the COVID-19 deaths is essential to compare and contrast the public health actions adopted by governments from time to time. It also helps them in their policy-making in the future. But unfortunately, there is gross underreporting of COVID-19 deaths across the world, and also from India, as reported by many researchers, which can be estimated by modelling exercises only. Methods In this article, we estimated the number of COVID-19 deaths among the Indian states using a time series analysis approach with the mortality data published by the civil registration system since 2011. We excluded the trend in non-COVID mortality due to the prevailing causes to prevent it from being counted erroneously as due to COVID-19. Results Accordingly, the number of COVID-19 deaths in India is estimated as 25.8 lakh (95% confidence interval [CI]: 11.1L, 35.4L), with Bihar being the largest under-reporter of COVID-19 mortality (98.4% [95% CI: 98.0, 98.7] deaths not reported). On the contrary, there are states with zero underreporting (Kerala, Goa, Mizoram, Sikkim, and all the union territories). We also found out that the measures of social and economic development, like the multidimensional poverty index, infant mortality, literacy rate, per capita state domestic product, and the NITI Aayog Health Index, are significantly correlated to the proportion of underreporting. Discussion and Conclusion The underreporting of COVID-19 deaths in India is very much linked to its social and economic development. There is intentional nonreporting of the deaths of children, women, and the poor for a much longer period of time. Poor quality of data-grabbing mechanisms, the social stigma associated with the disease, inadequate testing of the population, the inefficiency of the administration, and omission of the socially and economically vulnerable groups had intensified the scenario.

A Holistic Approach in Treating Heart Failure with Prosystole

Due to the rising interest in personal health, ageing population and promising solutions for individualised treatment, the market for nutritional supplements is anticipated to rise by more than 6% per year through 2018. Fish oil, vitamin D, multivitamins and coenzyme Q10 (CoQ10) are the most popular dietary supplements. Probiotics are also the supplement with the fastest rate of growth in this ranking. One of the largest global burdens of cardiovascular disease (CVD) is seen in India. According to projections, there would be 4.77 million CVD deaths in India annually by 2025, up from 2.26 million in 1990. Although the causes of increased CVD risk factor incidence rates are complicated, they probably involve urbanisation-related lifestyle changes as well as epidemiological and dietary changes brought on by economic development. This review brings in the significance of nutritional supplements as adjuvant therapy in the treatment of cardiovascular diseases.

Effectiveness of lockdown to mitigate the spread of COVID-19 pandemic during its first wave in India

Background: Countries across the globe had adopted various prevention and control measures ranging from social distancing and isolation, to shutting down of nonessential services and countrywide lockdowns. The objective of the study was to assess the effectiveness of the nation-wide lockdown to prevent or delay the spread of COVID-19 in India. Methods: This was a cross sectional and descriptive study. We used the secondary data from WHO website, from 01 January to 30 October 2020. We calculated mean, median number of new cases, deaths reported per day and case fatality rate, using Microsoft excel spreadsheet. Results: There was a steady rise in number of cases and deaths in India, during the lockdown and unlock period from phase-1 to phase-4. Approximately 10-fold increase in death was reported in the duration of 68 days of lockdown from phase-1 to Phase 4. The number of cases reported in unlock phase-4 were approximately 6 times more compared to unlock phase 1. The case fatality rate per day had declined during the lockdown period, from 3 .4% to 2 .5% deaths per day. The case fatality rate was lowest during the peak of pandemic, 1.27% in September 2020. Indicating good care of hospitalized patients compared to initial stage of pandemic in India. Conclusions: Indian government had imposed complete sudden lockdown at the right time. The peak of pandemic was delayed or slowed down. Indicating the timing of lockdown is an essential step to save the lives in pandemic, in resource limited settings.

Impact of the COVID-19 pandemic on the age-sex pattern of COVID-19 deaths in India

ABSTRACT The SARS-CoV-2 virus (termed COVID-19) raised the mortality trends and diminished life expectancy globally. This study analyzes the age-sex patterns of COVID-19 deaths in India during 2020–2021 and how the age-sex patterns have changed between 2020 and 2021. We calculated the losses in the male-female life expectancy at birth (LEB) induced due to the pandemic by projecting pre-pandemic mortality trends into 2020 and 2021. The finding suggested that mortality rates have increased substantially due to COVID-19 in India, implying almost four years of losses of LEB in 2021. The age pattern of mortality differs by the years of the pandemic. In 2020, the disease disproportionately killed older people. In 2021, with the outbreak of COVID-19 delta variant infection, mortality also rose among younger adults. Moreover, in 2020, COVID-19 deaths were higher among males, whereas in 2021, mortality increased for both sexes. In conclusion, COVID-19 triggered a significant increase in mortality in India between 2020 and 2021, dragging the country to a lower LEB level in 2010–2011. The future impact of the pandemic is yet to be seen. Also, distinct age and sex differential COVID-19 health and socioeconomic impacts compel future researchers to include demographic heterogeneity in their study.

Toxic mechanisms of cadmium and exposure as a risk factor for oral and gastrointestinal carcinomas.

Incidence and mortality rates of gastrointestinal (GI) and oral cancers are among the highest in the world, compared to other cancers. GI cancers include esophageal, gastric, colon, rectal, liver, and pancreatic cancers, with colorectal cancer being the most common. Oral cancer, which is included in the head and neck cancers category, is one of the most important causes of death in India. Cadmium (Cd) is a toxic element affecting humans and the environment, which has both natural and anthropogenic sources. Generally, water, soil, air, and food supplies are reported as some sources of Cd. It accumulates in organs, particularly in the kidneys and liver. Exposure to cadmium is associated with different types of health risks such as kidney dysfunction, cardiovascular disease, reproductive dysfunction, diabetes, cerebral infarction, and neurotoxic effects (Parkinson's disease (PD) and Alzheimer's disease (AD)). Exposure to Cd is also associated with various cancers, including lung, kidney, liver, stomach, hematopoietic system, gynecologic and breast cancer. In the present study, we have provided and summarized the association of Cd exposure with oral and GI cancers.

Abstract P567: Cardiovascular Health Awareness and Risk Assessment in Schoolteachers in Calcutta, India

Background: Cardiovascular disease (CVD) is the leading cause of death in India, surpassing all infectious causes. Early awareness of CVD and its risk factors and adoption of heart healthy lifestyle practices are crucial to reducing the impact of CVD in the community. Objective: To assess schoolteachers’ awareness of CVD and to compare the calculated ten-year risk of heart attack, stroke, and death by the Atherosclerotic Cardiovascular Disease (ASCVD) model to the observed event rates. Methods: We surveyed 4,150 schoolteachers out of 5,321 (78% response rate) from 400 schools in Calcutta during 2019 using a questionnaire assessing their awareness of CVD in five domains: prevalence, spectrum of CVD, its nature, risk factors, and benefits of a heart healthy lifestyle. The study population was stratified by risk tertile of their 10-year calculated ASCVD score. Results: Awareness about cardiovascular health among schoolteachers (male 41%, mean age 44 years) was low: 33 (mean score out of maximum 100), varying in different domains as shown below. Although most (86%) were at mild risk for CVD with ASCVD scores below five, nine percent had moderate risk, and five percent had high risk of CVD. There was no significant association between their risk score and their awareness of CVD health (correlation coefficient r = - 0.022, 95% confidence interval - 0.052, 0.009). Conclusions: Cardiovascular health awareness among schoolteachers in Calcutta is suboptimal, many of whom are at risk for CVD. Awareness of the disease, detection of risk factors at an early stage, and adoption of a healthy lifestyle may help reduce CVD in this community.

Lung Cancer Detection using Fusion, CNN and YOLO in MATLAB

Abstract: Lung Cancer is one of the major causes of deaths in India. Various data analytics and classification approaches have been used to diagnose and find lung cancer in numerous cases. Lung Cancer can only be cured by early tumour diagnosis because the basis of the diseases is yet unknown, making prevention impossible. In order to classify the existence of lung cancer/tumour in a CT picture and PET image, a lung cancer detection method using image processing and deep learning is applied. Using Fusion technique, we first obtain CT scans, then PET images of the same patient, then combine both images into one. The classification carried out using image feature extraction. As a result, the combined CT and PET scan images of the patient are classified as normal or abnormal. The tumour component of the abnormal photos is the focus of the detecting process. Using YOLO and CNN, an effective strategy to identify lung cancer and its phases is one that also seeks to produce more precise results.

Early prediction of cardiovascular disease using artificial neural network

Abstract In recent years, there has been a noticeable rise in the mortality rate, and heart disease is a significant contributor to this trend. According to the California Association for Diabetes Investigation, by 2015, cardiovascular disease would be the primary cause of death in India, where 62 billion people live. Deficiencies in the heart’s ability to pump blood to and from the rest of the body are the leading cause of cardiovascular disease. The healthcare industry is a prime example of a sector poised to greatly benefit from the availability of massive amounts of data and analytical insights. Increasingly, it will be important to extract medical data to predict and treat the high fatality rate caused by heart attacks. Every day, humanity generates terabytes worth of data. Medical errors with dire effects can be avoided only with high-quality services. Hospitals can reduce the price of expensive clinical testing by using decision support systems. Hospitals in the modern-day use hospital information systems to keep track of patient records. The health care sector generates vast amounts of data, but little of it is really put to good use. It will be important to adopt a new strategy to reduce costs and make accurate predictions about heart disease. To determine which machine learning and deep learning approaches are most useful and accurate for predicting and classifying cardiac illnesses, this article reviews the existing literature on the topic and subsequently tries to detect the most probable factors leading to heart disease. This study introduces and models an artificial neural network methodology for identifying potential cardiovascular disease risk factors. In this study, we examine and present the various full and partial correlations among risk attributes. In addition, a number of risk variables are analysed to generate a predicted list of risk features most likely to result in cardiovascular disease.

“TO ASSESS FETO-MATERNAL CIRCULATION BY DOPPLER STUDY IN WOMEN WITH THIRD TRIMESTER AND ITS CO RELATION WITH FETO-MATERNAL OUTCOMES.”

INTRODUCTION : Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity throughout the world, accounting for 24% of all maternal deaths in India. 1,2 In developed countries, it accounts for 7-10% of perinatal mortality and 20% in developing countries. Early detection of preeclampsia may allow for vigilant antenatal surveillance and timely foetal delivery to avoid serious complications. The aim of the study was to determine and compare the diagnostic performance of Doppler sonography of fetal middle cerebral artery (MCA) and umbilical artery (UA) in prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and severe PE. METHODOLOGY: 100 pre-eclampsia patients were taken in study at Sir T. General Hospital, Bhavnagar from January 2021 to July 2022. The various measures of central tendencies and graphical representations were used to analyse the data. RESULTS: Majority of patients were in the age group of 26-30 years. Maximum incidence was seen with primigravida (65%).Out of all patients maximum patients delivered normally (67%). Patients delivered low birth weight babies were around 38%. Umbilical Artery Doppler parameters such as abnormal S/D ratio,Elevated Resistivity index, and elevated Pulsatility Index were found as (78.72%), (80.85%) and (87.23%) in Adverse Outcome event which is statistically signicant compared to Good outcome(p<0.0001). Middle cerebral artery Doppler parameters such as abnormal S/D ratio, Elevated Resistivity index, and elevated Pulsatility Index are found as (25.53%),(76.59%) and (72.34%) in Adverse Outcome event which is statistically signicant compared to Good outcome(p<0.0001). In addition, Cerebro Placental Ratio have found signicantly high abnormality (89.36%) of neonates in adverse group. CONCLUSION: The Doppler technology is helpful in repetitive noninvasive haemodynamic monitoring of pregnancy. In an obstetric patient population with a high prevalence of complications like preeclampsia, the Doppler indices from the fetal circulation can reliably predict adverse perinatal outcomes. Thus the appropriate timing of delivery is to be made before these changes occur. However, the Doppler study of multiple vessels helps predict adverse outcomes , manage high-risk pregnancies complicated by preeclampsia

A Study on Police Accountability and Custodial Violence in India

The present study aims to critically analyse the cases of custodial violence in the nation and also crucially examine the reasons of custodial deaths in India. The study attempted to enrich the existing literature on “A Study on police accountability and custodial violence in India”. In the study, the custodial violence has been divided into three categories namely physical, sexual and psychological. Various reasons have been encountered for the custodial deaths such as suicide, death due to treatment in the hospital, injuries sustained prior to custody, physical assault by police, while escaping from custody, road accidents connected with the journey etc. The study gives various recommendations to improve the police administration and foster the need for reforms in the working of police officials.

Effect of tobacco taxation on smoking prevalence and smoking-attributable deaths in India.

Higher taxes are the single most effective way to encourage tobacco users to quit tobacco use and prevent youth from initiation. The present study aims to estimate the effect of raising the tax on smoked tobacco products on its consumption and smoking-attributable deaths in India. A mathematical model was developed which used the projected population of India, taxation rates on smoked tobacco products, smoking prevalence, and price elasticity of demand of cigarette and bidi from 2017 to 2025. Four scenarios of tax increment (0%, 25%, 50%, and 100%) on smoked tobacco products were created which were modeled to calculate smoking prevalence and smoking-attributable deaths due to respiratory diseases, heart diseases, stroke tuberculosis, and cancer in country till 2025. A relative decrease of 6.2% in the prevalence of smoking was observed between the existing tax rates and its increment to 100% over the last increment of 6%. Similarly, smoking-attributable deaths (SAD) decreased by 6.04% on increasing the tax rates to 100% of the existing taxation rates. There has been a steady increase in SAD in scenario 1 which decreases effectively in scenario 4, which in turn leads to the saving of around 33,000 lives due to tobacco-related diseases by 2025. The consumption of cigarettes and bidis can be reduced by raising the price of these products. The model will help policymakers in deciding to fix the tax and ultimately the price of cigarettes and bidi to reduce its consumption and smoking-attributable mortality.

Spectrum of histopathological patterns of breast lesions in a tertiary care hospital

Background: Breast lesions are areas of abnormal breast tissue. It is estimated that 20% of women develop breast lesions. Breast lesions are either benign or malignant. Breast carcinomas are the most common cause of deaths in women accounting for 10.6% deaths in India, 6.9% deaths per year globally. Aims and Objectives: To study various histopathological patterns of breast lesions in women admitted in Government General Hospital. Materials and Methods: It is a prospective study in the department of pathology, Government General Hospital, Nizamabad, from December 2020 to July 2022. Grossing was done and details noted, tissue bits were processed and sections were stained with conventional H and E Staining. Results: Out of 70 cases of breast lesions, 55 (78.5%) are benign breast lesions and 15 (21.5%) are malignant breast lesions. Fibroadenoma is the most common breast lesion accounting for 33 cases, that is, 60 %, followed by fibrocystic diseases (21.8%). Infiltrating ductal carcinoma of No Special Type is the most common malignant breast lesion accounting for 10 cases, that is, 66.6%. Among invasive breast carcinomas, the majority of cases are Grade II (69%). Conclusion: Study of histopathological patterns of breast lesions plays an important role in diagnosis, treatment, and prognosis of breast lesions. This study highlighted incidence and pathological characteristics of a wide range of breast lesions.

Association Of Socio-Demographic Determinants with Economic Burden Among Road Traffic Accident Victims: A Longitudinal Study

Background: RTA are the sixth leading cause of death in India with a greater share of hospitalization, disabilities, deaths and socio-economic losses. The study was conducted to assess the socio-demographic determinants asso-ciated with households’ economic burden among RTA victims. Methods: A longitudinal study was conducted for 2 years in Puducherry employing simple random sampling to include 169 accident victims. Baseline data was collected with a semi-structured questionnaire on socio-demographic details, direct and indirect costs towards road traffic injuries. Follow up was at 6th and 12th month from the day of accident. Data entry and analysis were performed using Epi-data. Written informed consent from each participant was sought. Ethical clearance received. Results: Mean age of the accident victims was 36.2 (11.4) years. The median (IQR) for direct, indirect and total expenses were INR 1500 (1000-22100), 18000 (2400-46500) and 3000 (1037-47125) respectively. Association between the median (IQR) indirect expenses and marital status as well as socio-economic status of victims were found to be statistically significant. Conclusion: Accident victims and their family faced financial burden, as a large proportion of victims were from productive age group belonging to lower- and middle-class income group.

A cross sectional study on awareness about cancer screening methods for breast and cervical cancer in women of reproductive age from Jhansi, Uttar Pradesh

Background: Non-communicable diseases (NCDs) are responsible for 63% of all deaths in India of which 9% are due to cancers according to the World Health Organization (WHO) global profile 2018. One in eight men and one in eleven women die from the disease globally (Globocan 2020). To reduce the morbidity and mortality due to the disease early diagnosis of disease and risk factors by regular screening of asymptomatic people is recommended. Objectives of the study were: to assess the awareness about methods for breast and cervical cancer screening among women of reproductive age, and to assess their readiness to go for screening. Methods: In a health awareness session on cancer screening among women of reproductive age the participants (104 women) were given a self-designed questionnaire which was administered before the session. The questionnaire covered general awareness about cancer, the symptoms and the methods of screening for breast and cervical cancer. The results were expressed in frequency and percentages. Results: The mean age of participants was 29.8 years (range 21 years-45 years). 88% felt that early diagnosis would improve outcome. Only 11% had heard of Pap test and only 3 had gotten it done. Around 21% had heard about mammography and only 4% had heard about breast self-examination. 86% and 90% were ready to get themselves screened for cervical cancer and breast cancer respectively, if given the opportunity. Conclusions: This study highlights both the lack of knowledge and the high acceptance of cancer screening among women. Awareness campaigns at regular intervals backed by immediate access to screening facilities are required to address the problem.

Impact of COVID-19 pandemic on maternal and neonatal outcomes: A narrative review and evidence from the PregCovid registry

More than 533 million Coronavirus Disease 2019 (COVID-19) cases and associated 6 million fatalities were reported globally whereas 43 million cases and 0.5 million deaths in India were reported till June 2022. Maharashtra state alone reported about one-third of the total cases of COVID-19 in India in the early period of COVID-19 pandemic. The lack of epidemiological, demographic, and impact data of COVID-19 on pregnant women and newborns, advocated the need for recording and documenting population specific data for clinical management and policy decisions in India. The PregCovid registry was launched in April 2020 by the Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health, Mumbai, in collaboration with the Medical Education and Drugs Department, Government of Maharashtra, and Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital to gain insights into clinical and socio-epidemiological characteristics of pregnant women with lab confirmed COVID-19 and assess its impact on maternal and neonatal outcomes. The registry has collected data of 8428 pregnant and postpartum women with COVID-19 from 19 participating centers across Maharashtra in a near real-time manner. The registry first reported that the delta variant (B.1.617.2) dominant second wave was more lethal (case fatality rate 5.7%) to pregnant and postpartum women than the alpha (0.7%) dominant wave of COVID-19 in India. There was also a higher incidence of moderate to severe cases, intensive care admissions and maternal complications including pre-eclampsia, low birth weight and preterm deliveries during the delta wave. The omicron dominant third wave of the COVID-19 pandemic exhibited a higher transmission rate compared to the previous two waves, causing a surge in cases but minimally impacting adverse outcomes. The registry further analyzed and reported the impact of COVID-19 on pregnant and postpartum women with comorbidities, coinfections, twin pregnancies, and neonatal outcomes, while providing crucial policy inputs to improve maternal and newborn health during the pandemic. The registry model can be replicated at tertiary care hospitals across India to understand various maternal-neonatal outcomes. The evidence generated from PregCovid registry was useful for improved clinical management and also contributed to a policy decision on COVID-19 vaccination in pregnant women in India. The registry envisions a collaboration with similar regional, national and international registries to form an international consortium for data sharing and reporting to promote global policy level interventions and advocates a sustainable and collective response to improve the COVID-19 global vaccination coverage.

Impact of diet type on the anemia level of adolescent girls

Adolescence is the most vulnerable stage in human life for malnutrition. When the need for nutrients increases during the growth phase. The prevalence rate of malnutrition among adolescent girls (11-18 years) in 11 states and 16 districts, of which 7.1 per cent, was found to be severe anemia, in India, by the recent state-level nutrition plan. Malnutrition is affecting about 50 per cent of the population in India. This problem is affecting women more than men. An estimated 20-40 per cent of maternal deaths in India are due to malnutrition and one out of every two Indian women (56 %) suffers from some form of malnutrition. According to several studies, the prevalence of malnutrition is very high (80-90 %) among pre-school children, pregnant and lactating women and adolescent girls in India. According to a report, more than half (56 %) of adolescent girls in India suffer from malnutrition. Comparing the nutritional status of adolescent girls in India, it was found that 47 per cent of adolescent girls in the age group of 15-19 years in India are victims of undernutrition.

Protocol for the implementation and evaluation of a community-based behavior change intervention to reduce dietary salt intake in India.

Excess dietary salt intake is well established as a leading cause of high blood pressure and associated cardiovascular disease, yet current salt intake in India is nearly 11g per day, more than twice World Health Organization maximum recommended intake of 5g per day. Although dietary survey data from India indicate that the main sources of dietary salt are salt added during cooking at home, and few salt reduction efforts have focused on interventions at the household level. As a result, there is little evidence of the effectiveness of behavior change programs to reduce salt intake at the household level. The study aims to develop and implement a community based behavioral change intervention to reduce salt intake delivered by front line community-based health volunteers; and evaluate the preliminary effectiveness, acceptability, and feasibility of delivering a salt reduction behavior change program and potential to support future scale-up. The study is a pre-post intervention design, and outcomes will be evaluated from a random sample of 1500 participants from 28 villages in two primary health centers in Siddipet, Telangana. Primary outcome is change in salt-related KAB (knowledge, attitude, and behavior) score, and secondary outcomes will be changes in salt intake measured by 24h urinary sodium excretion and change in scores using the subscales of the COM-B ("capability", "opportunity", "motivation" and "behavior") tool. Findings will be used to inform future public health policies to support implementation of scalable community-based interventions to reduce salt intake and control hypertension, the leading-cause of death in India.

Life before Death in India: A Narrative Review.

Palliative care is an ever-increasing need in India, with its large population and rising burden of chronic illness. India ranks 67th out of 80 countries in the quality of death index, which measures the availability and quality of palliative care. Community-led projects in Kerala have proven successful in improving palliative care access with modest resources and volunteer involvement. In India, the number of hospice facilities is increasing; however, <1% of the Indian population has access to palliative care. Financial and human resources limitations in the health-care system, poverty and high health-care expenditure, the lack of awareness among the public about end-of-life care, hesitance to seek care due to social stigma, strict laws regarding opiates that hinder adequate pain relief and the apparent conflict between traditional social values and western values regarding death are the major obstacles to improving palliative care. Significant efforts focused on public awareness of end-of-life care and locally-tailored programmes with family and community involvement are necessary to address this issue and integrate palliative care into the primary care system. Furthermore, we discuss the effects of the COVID-19 pandemic that has been managed effectively by palliative care involvement.

Driving factors behind the continuous increase of long-term PM2.5-attributable health burden in India using the high-resolution global datasets from 2001 to 2020

Air pollution is the fourth leading global risk factor, whereas in India air pollution is reported as the highest risk factor with millions of premature deaths every year. Despite implementation of several air pollution control plans, PM2.5 levels over India have not noticeably reduced. PM2.5-associated health burdens in India have increased significantly in past decades. A fine resolution (0·01° × 0·01°) analysis of PM2.5-attribulable premature deaths (rather than the coarse-level analysis) may elucidate the reason for this increase and inform and effective start-of-the-art state-level and national emission control strategies. This study quantified the spatiotemporal dynamics of PM2.5-attributable premature deaths from 2001 to 2020 and applied a decomposition analysis to dissect the contribution of various associated parameters, such as PM2.5 concentration, population distribution and disease-specific baseline death rate. Results show significant spatiotemporal variations of PM2.5 and associated health burden in India. During the study period, population weighted PM2.5 value increased from 46.0 to 59.5 μg/m3 and associated non-communicable death increased around 87.6 %, from 1050 [95 % (CI): 880–1210] thousand to 1970 (95 % CI: 1658-2259) thousand. The states of Uttar Pradesh, Bihar, West Bengal, Maharashtra, Rajasthan, and Madhya Pradesh had the highest PM2.5-attributable deaths. In these states, non-accidental deaths increased from 232.1, 112.7, 81.4, 79.1, 66.3 and 58.5 thousand in 2001 to 424.1, 226.7, 156.2, 154.5, 123.3 and 119.7 thousand in 2020. In per capita population (/105 population), the highest PM2.5-attributable deaths were observed in Delhi, Uttar Pradesh, Bihar, Haryana and Punjab. Throughout the study period, demographic changes outweighed the health burden and were responsible for ~62.8 % increase of PM2.5-related non-accidental deaths across India, whereas the change in PM2.5 concentration influenced only 18.7 %. The change in baseline mortality rate impacts differently for the estimation of disease-specific mortality changes. Our findings suggest more dynamic and comprehensive policies at state-specific level, especially for North India is very indispensable for the overall decrease of PM2.5-related deaths in India.

Hyponatremia in sepsis and its association with SOFA score: An observational cross sectional study

Background: Sepsis is the one of the leading causes of hospital admissions and death in India and hyponatremia in sepsis is known to be an independent risk factor for mortality. Aim of the study was to determine the prevalence of hyponatremia in sepsis and its association with SOFA (sequential organ failure assessment) score. Methodology: This is an observational cross-sectional study in a tertiary hospital of New Delhi India. A total of 95 patients with sepsis and more than 18 years of age were enrolled in the study over 18 months period. Blood samples were drawn for estimation of serum sodium and other investigations within 24 hours of admission of patients presenting with sepsis or diagnosis of sepsis if it develops during the hospital stay. Results: Prevalence of hyponatremia in sepsis patients were 69.47% (n=95). No significant association was seen in SOFA with severity of hyponatremia (p value &gt;.05). Conclusion: No statistically significant correlation was observed between SOFA score and presence of hyponatremia or the severity of hyponatremia in the study subjects. Hyponatremia is a common in sepsis patient.