Hospital In Pune Research Articles

Are rare hernias rarer: a ten-year observational study

Background: Hernia is one of the most common ailments encountered in general surgery practice. The inguinal hernia constitutes majority of cases. The available literature describes umbilical, femoral, lumbar, perineal and many others rarer varieties. Our preliminary observations indicated a changing scenario. With a view to ascertain it, investigations were made to find out the incidence of hernia with frequency data of different types and demographic details of patients during last decade at tertiary care teaching hospital in Pune and then comparing it with the existing literature.Methods: Ten years data from October 2008 to October 2018 of all the adult population suffering from hernia reporting to this center was collected from the archives of hospital records maintained in OPD, wards and the department.Results: Inguinal hernia was the most common constituting 76.9% of the total cases. The right side was more affected than the left side with 51.0% cases being on right side. This was followed by umbilical hernia, 12.26% of the total cases. Males were more affected than the females except in incisional hernia. Only two cases of spigelian hernia had undergone repair over last one decade. There were no cases of femoral hernia, lumbar hernia and perineal hernia encountered during the last ten years in this center.Conclusions: The relative frequency of the incidence of different types of hernia was inguinal, umbilical, epigastric; incisional which have been in descending order. In the last decade at this centre which is in contrast with hernia incidence figures quoted in common reference books and the available literature.

Delays and barriers to early treatment initiation for childhood tuberculosis in India.

BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.

Association of periodontal status with lung function in patients with and without chronic obstructive pulmonary disease visiting a medical hospital in Pune: A comparative study.

Background:The relationship between oral health and systemic conditions has been increasingly debated over recent decades with one such discussion existing about oral hygiene and periodontitis with chronic obstructive pulmonary disease (COPD). Hence, a study was conducted to assess and compare the oral hygiene status and periodontal status of age and gender-matched participants with and without COPD and to correlate oral hygiene status and periodontal status with lung function status among them.Materials and Methods:This hospital-based study included a study population of 117 participants (39 patients of COPD and 78 participants without COPD) 35–75 years of age with at least 20 natural teeth. Participant's demographic details and history of smoking were recorded. Lung function was recorded using a spirometer. Periodontal health was assessed by measuring Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), and Oral Hygiene Index (OHI) by a trained and calibrated examiner.Results:Higher mean of PPD, CAL, and OHI is being reported in the present study with 4.07 versus 3.50, 0.58 versus 0.24, and 5.24 versus 3.60, respectively, among patients with and without COPD which was statistically significant. The risk of having COPD was 0.4 times more in participants having poor oral hygiene and 0.07 times more in patients smoking. Smoking and oral hygiene, as independent variables, have a significant influence on COPD which is a dependent variable. A weak correlation was found of poor oral hygiene and loss of attachment among participants with COPD.Conclusion:Periodontitis and respiratory disease share a common risk factor, i.e., smoking. Smoking has a definite relation with periodontitis and COPD. Oral hygiene is significantly associated with increased risk for COPD when age and gender effects have been matched and when adjusted for smoking. However, no association was found of PPD with COPD.

RECRUITMENT OF BABIES IN VACCINE TRIAL: A CHALLENGE

Introduction: The enrollment of children into clinical trials is challenging. India is increasingly recognized as a site for clinical research due to its large population and growing research capabilities, though data regarding barriers for recruitment into pediatric vaccine clinical trials are scarce. Objective: The objective of this study was to assess the barriers in recruitment and to find out parental factors for non-participation of their babies in the vaccine clinical trial. Materials and Methods: This was a prospective cross-sectional non-interventional study which was carried out in the pediatric clinical research unit of a tertiary care multispecialty teaching hospital in Pune. The study social worker visited postnatal ward to prime mothers regarding the pneumococcal vaccine clinical trial. Parents of babies aged 6–8 weeks, who were eligible for participation in the ongoing pneumococcal vaccine trial were explained the informed consent form of this clinical trial and their willingness for participation was sought. The reason for refusal of the parents, who declined the study participation of their baby, was documented. Results: Even though eligible inborn baby pool was large (n=384), only 148 (38.54%) inborn babies were brought to our clinical research unit showing a major barrier in the recruitment. Of 204 babies who presented to clinical research unit, 94 babies (46.08%) were enrolled in the ongoing clinical trial and the majority of them were inborn (89.36%), whereas only 10 of 56 (17.86%) outborn babies were enrolled. There was no gender difference noted in enrolled versus non-enrolled babies. There was no significant association between baby’s gender and place of delivery. The major reasons for non-enrollment were “unwillingness” for participation in clinical trial (68.18%) followed by mothers going outstation, staying far away from our hospital, lack of time, and concerns due to research vaccine. Conclusion: Our study has shown that even though eligible inborn baby pool was large, only 38.54% of inborn babies were brought to our clinical research unit, thus a major barrier in recruitment. More effective counseling and recruitment strategies are needed to scale up the enrollment more so for the outborn babies.

Knowledge, attitude and practice of fever and febrile illness among parents of under five children

Background: Fever in children is the commonest cause for outpatient and inpatient admissions in the health care setup. Though most fever episodes are benign with self-limiting course, it is often a reason for anxiety and concerning for parents. The aim of the study was to assess the parental knowledge, attitude and practice regarding fever in children under five years of age.Methods: A cross-sectional question based survey, conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra from parents of under five children, presenting for any consultation from July 2018 to December 2018.Results: There were 636 respondents who completed the study. 38.1% were males. Mean age of responders was 26.85 years (SD 5.12 Range 18 to 37 years). Most of the population were educated lot. 55.5% responders defined fever correctly. There was a huge gap in the parent’s knowledge attitude and practice in fever and it’s management. Lack of information and fear of any untoward incident occurring due to fever were the reason for parental anxiety, frequent medication & combination antipyretic use, and pressure on part of health professionals to increase antibiotic prescriptions.Conclusions: Lack of parental knowledge of fever and fever management in younger children is of concern in the community in spite of improvement in the educational level of parents. There is a utmost need to spread awareness in the community about the benign and the self-limiting nature of most febrile illnesses.

Knowledge, attitude and practice of acute diarrheal disease and use of oral rehydration therapy among mothers of under five children

Background: Acute diarrhea in children is among the commonest causes of outpatient and inpatient attendance in medical setup. Though enough has been done in imparting knowledge about diarrhea and its management, there is a gap between knowledge and practice in the population. Aim of the study is to assess the mother’s knowledge, attitude and practice about diarrhea in children.Methods: Cross-sectional survey, conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra.Results: Of the 305 mothers surveyed, their knowledge about diarrhea was good with 77.1% knowing correct definition, and most mothers knowing correctly about its mode of transmission, the positive role of good hygiene & sanitation, breast feeding and oral rehydration therapy (ORT) in prevention and management of acute diarrhea. However, their attitude and practice were found lacking, with higher rate of bottle feeding (59.3%) and lesser use of standard (46.3%) as well as home based (69.9%) ORT measures.Conclusions: There is discrepancy between the knowledge and practice. Hence, there is the need of sustained efforts in imparting both knowledge and practice among the population.

Early disappearance of maternal anti-measles, mumps, rubella, and varicella antibodies in Indian infants

BackgroundImmunization of children with vaccines against Measles, Mumps, Rubella, and Varicella (MMRV) is practiced globally with varied recommendations. In India, measles vaccine is administered alone or as MMR at 9 months age. Varicella vaccine is not routinely used. Immunization age is a function of disappearance of maternal antibodies and natural exposure of the children to the pathogens. In view of the measles-WHO-initiative, we aimed to assess if the current immunization age for measles is still valid. In addition, the kinetics of IgG and IgM antibodies against rubella, mumps and varicella viruses was also examined. MethodsThis cross-sectional study was conducted at a tertiary care hospital in Pune, India. A total of 600 children, 150 each in 6-month/9-month (no vaccination) and 12-month/15-month (minimum 4 weeks post-measles-vaccine) cohorts were included. History of these infections and birth status (term/preterm) was recorded. All serum samples were screened for IgG-anti-MMRV-antibodies while IgG-positives were tested for specific IgM antibodies (ELISA). ResultsAt 6-months, the prevalence of MMRV antibodies was 4.7%, 2.7%, 10.7%, 5.3% respectively depicting disappearance of maternal antibodies in majority of the children. Birth status did not influence antibody positivity. Despite vaccination at ∼9-months, >25% children were still susceptible to measles virus at the age of 12/15-months. The ratio of clinical:subclinical infections was 4:10 (measles) and 12:1 (varicella). All the mumps/rubella IgM positives (1 and 2 respectively) represented subclinical infections. ConclusionDemonstration of early disappearance of maternal antibodies against MMRV viruses leading to the risk of these infections at an early age emphasize need for early immunization of Indian children. Suboptimal response to measles vaccine needs to be seriously addressed especially in view of the WHO’s initiative for measles eradication.

Safety and efficacy of an herbal formulation in patients with renal calculi - A 28 week, randomized, double-blind, placebo-controlled, parallel group study

BackgroundUrolithiasis is a growing problem worldwide. Many a times, asymptomatic stones are kept under observation. Many herbal preparations are available for the same, but they lack proper scientific documentation. ObjectiveTo study the anti-urolithiatic effect of an herbal preparation, Subap Plus (IP) capsules in patients with asymptomatic renal calculi of size ranging from 4 to 9 mm. Material and methodsThis was a prospective, randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital in Pune, India.Patients with asymptomatic renal calculi of 4–9 mm size were randomized (1:1, block randomization) to one of the group Subap Plus (treatment group) or placebo (placebo group). The study outcome included change in visual analog scale (VAS), change in the surface area and density of calculi and their expulsion. Statistical analysis was performed using student's t-test and Chi-square test. ResultsA total of 120 patients were screened and 84 were enrolled who met the eligibility criteria, of which 65 patients completed the trial (treatment, n = 34; placebo, n = 31). The VAS score significantly decreased in the treatment group (6.9–1.8) than placebo group (7.2–6.8) (p < 0.001). The surface area and density were decreased by 47.58% (p < 0.008) and 43.01% (p < 0.001), respectively, in the treatment group than the placebo group. The expulsion of calculi was significantly higher in the treatment group than placebo group (20.59 vs. 3.23%, p < 0.03). ConclusionPatients treated with herbal formulation showed better expulsion rate and reduction in surface area and density than the placebo group.

Effectiveness of Demonstration on Neonatal Resuscitation Practices among the Nurses

The purpose of the study was to assess the effectiveness of demonstration program on neonatal resuscitation among the nurses at Pediatric and Obstetric and Gynecology departments of selected hospitals in Pune. A quasi experimental non-randomized pretest post-test control group design was used in the study. Population of the study comprise of all nurses working in the Pediatric and Obstetrics and Gynecology departments of selected hospitals in Pune. Purposive sampling technique was used to select 120 samples, 60 in the experimental group and 60 in the control group. Non standardized self-structured multiple choice questionnaire (Demographic Performa, Observation Checklist) was used to collect data. Descriptive statistics (Frequency, Percentage, Means and Standard Deviations) and inferential statistics (Chi square, Independent t-test, Correlation coefficient, and Paired t-test) were used to summarize the data and to test the hypothesis. There was a highly significant difference in the practices of nurses regarding neonatal resuscitation between the experimental and control group at P<.001 level. The study concluded that demonstration program is an effective method to increase the practices of nurses relating to neonatal resuscitation.

Assessment of Patient Safety Culture in a Tertiary Care Hospital In Pune

Assessment of Patient Safety Culture in a Tertiary Care Hospital In Pune

Adherence to therapy in adult patients with bronchial asthma

Background: The global prevalence of bronchial asthma according to the WHO is 235 million and adherence to therapy is now becoming one of the main issues in its effective management all over the world. In developing countries such as India, easy accessibility to drugs and inadequate health services results in increased use of self-medication. Over-the-counter drugs though meant of self-medication, their inappropriate use can be potentially hazardous, and there is always a risk of interaction with other prescription drugs. Very few studies have been published regarding self-medication pattern in India and hardly any studies regarding their interactions with prescription drugs in asthma, hence this study was proposed. Methods: One hundred adult ambulatory patients aged above 20 years were randomly selected from the respiratory outpatient department of a tertiary care government teaching hospital in Pune. The participants were subjected to a semi-structured interview with the help of a questionnaire. Results: Ninety-one percent were adherent to therapy. The main reasons for not adhering to therapy as suggested by the questionnaire and interview were old age and difficulty in using the inhaled medications appropriately. Self-medication was in 16% of the patients and the most common drugs being proton-pump inhibitors, H2 blockers, and antihistaminics, but no significant interaction was observed. Conclusions: In our study, the adherence was well above the global figures. Nonadherence to therapy is estimated to be 50% for chronic illnesses. A multidimensional approach by proper management and increasing interaction time with the patients will go a long way in improving the management of such conditions. Elderly people should be specially targeted as they have multifactorial reasons for not adhering to therapy. Effective but simple and uncomplicated regimens, convenient dosing and route of administration, less expensive, and safer drugs should be the aim in the treatment of bronchial asthma.

428. Mobile Phone Access and Comfort: Implications for HIV and Tuberculosis Care in India and South Africa

BackgroundIndia and South Africa shoulder the greatest global burden of TB and HIV, but care retention in these countries is suboptimal. Integration of mHealth into the health system has potential to strengthen retention. We conducted a study in two high burden yet disparate settings, Pune, India and Matlosana, South Africa, to (1) identify factors associated with mobile phone access, comfort of use and (2) understand long-term behavioral patterns of mobile phone access.MethodsWe conducted a cross-sectional study to assess demographics, mobile phone access, and comfort of use, followed by a longitudinal study to determine long-term access among adult participants (≥18 years) from 2014 to 2016. Participants were recruited from the TB clinic at Sassoon Government hospital in Pune and from four public clinics serving the general population in Matlosana. Univariate odds ratios compared characteristics of participants with discomfort texting to those who expressed comfort, as well as those unable to be contacted at six months vs. those contacted. We included variables significantly associated at the univariate level (P < 0.10), and those determined of importance a priori, in a multivariable logistic regression.ResultsWe enrolled a total of 261 participants; 136 in India, 125 in South Africa. The ability to contact participants steadily decreased from 90% (n = 122) contacted at week one to 57% (n = 75) contacted at six months in India and 93% (n = 116) at week one and 70% (n = 88) at six months in South Africa (Figure 1). For India, adjusted analysis revealed that texting discomfort was significantly higher in unemployed (OR 4.97, 95% CI: 1.12, 22.09) and 35+ year old (OR 1.10, 95% CI: 1.04, 1.16) participants, while significantly lower in those with higher education (OR 0.04, 95% CI: 0.01, 0.14). In South Africa, 91% of participants (n = 114) reported comfort with text messaging.ConclusionThe ability to maintain contact with participants by mobile phone in India and South Africa was poor at the 6 month timepoint. While mHealth has the potential to transform HIV and TB care in endemic countries, alternative approaches may be needed for certain subpopulations, including those who are older, unemployed and with lower education.Figure 1.mHealth CallbacksDisclosures All authors: No reported disclosures.

808. Perinatal Depression Among HIV- and TB-Infected and Uninfected Women in an Urban Slum in India: Prevalence and Associated Birth Outcomes

BackgroundIn low- and middle-income countries, depression during pregnancy is three times more common than in the United States and is more common than postpartum depression. There have been few studies on the prevalence of antepartum and postpartum depression in India. The objective of this study was to describe the prevalence of antepartum and postpartum depression among HIV-infected and uninfected pregnant women in an urban slum in India, and to evaluate associated pregnancy and birth outcomes.MethodsThis study was a longitudinal cohort study of HIV-infected and HIV-uninfected pregnant women at Sassoon General Hospital in Pune, India. Enrolled women answer questions about sociodemographics and medical history, including obstetric history. The PHQ-9 depression scale is administered during pregnancy and at 6 months postpartum.ResultsOf the 189 pregnant women enrolled, 113 (60 %) exhibited at least one symptom of depression on the PHQ-9 scale with 23 (12%) women having moderate or severe depression. However, significantly fewer postpartum women had evidence of depression (60% antepartum vs. 26% postpartum, P < 0.001). Of the 77 women who had a postpartum visit, 20 (26%) also had symptoms of depression prior to delivery, but only 2 (10%) had more severe depression scores while 18 (90%) had improved scores. Thirty (39%) women with antepartum depression had resolution of symptoms postpartum and no women developed incident depression in the postpartum period. There was a trend toward increased rates of antenatal depression among HIV-infected vs. uninfected women (69% vs. 57%, P = 0.13). Both depressed and nondepressed pregnant women experienced low rates of intrauterine fetal demise, intrapartum hypertension, and preterm delivery. However, women with depression had 3-fold higher incidence of intrauterine growth restriction on prenatal ultrasound (4.4% vs. 1.5%).ConclusionWe found that the majority of pregnant women in our population experience some form of depression during pregnancy. Most women with antepartum depression experienced improvement in their mood postpartum, which contrasts with patterns of perinatal depression in developed countries. We are planning qualitative studies to understand the social contributors for antepartum depression in India, and to identify potential solutions.Disclosures All authors: No reported disclosures.

Molecular Genetic and Functional Analysis of pks-Harboring, Extra-Intestinal Pathogenic Escherichia coli From India.

Colibactin, a genotoxin, encoded by the pks pathogenicity island of Escherichia coli belonging to the B2 phylogroup has been reported as a determinant of bacterial pathogenicity. The present study was carried out to detect the pks pathogenicity island in extraintestinal pathogenic E. coli (ExPEC) isolated from a tertiary hospital in Pune, India. Of 462 isolates analyzed, the pks genomic island was detected in 35 (7.6%) isolates, which predominantly belonged to pathogenic phylogroup B2 (97%), and harbored virulence genes such as fimH, sfaD/E, and usp. Biofilm formation assay revealed 21 of the 35 pks-carrying isolates to be strong (SBF > 1.0), 10 isolates to be moderate (SBF = 0.5–1.0), and 4 as weak (SBF < 0.5) biofilm formers. All of the pks-carrying isolates proved resistant against bactericidal activity of human serum. Assays carried out to detect antimicrobial susceptibility revealed 11% of these isolates to be multidrug resistant, 37% producing ESBL and 25% were positive for blaCTX-M-15. The observed prevalence of multidrug resistance and colibactin producing characteristics among pathogenic E. coli belonging to phylogenetic group B2 advocate urgent need for broader surveillance in order to understand and prevent transmission of these ExPEC in community and hospital settings.

Drug-resistant Enterobacteriaceae colonization is associated with healthcare utilization and antimicrobial use among inpatients in Pune, India

BackgroundHealthcare exposure may increase drug-resistant Enterobacteriaceae colonization risk. Nascent antimicrobial stewardship efforts in low- and middle-income countries require setting-specific data. We aimed to evaluate risk factors for inpatient drug resistant Enterobacteriaceae colonization in a resource-limited setting in India.MethodsPatients age ≥ 6 months admitted with ≥24 h of fever to a tertiary hospital in Pune, India were enrolled in a prospective cohort. Perirectal swabs, collected on admission and hospitalization day 3 or 4, were cultured in vancomycin- and ceftriaxone-impregnated media to assess for ceftriaxone-resistant Enterobacteriaceae (CTRE) and carbapenem-resistant Enterobacteriaceae (CPRE). Multivariable analyses assessed risk factors for drug-resistant Enterobacteriaceae colonization among participants without admission colonization.ResultsAdmission perirectal swabs were collected on 897 participants; 87 (10%) had CTRE and 14 (1.6%) had CPRE colonization. Admission CTRE colonization was associated with recent healthcare contact (p < 0.01). Follow-up samples were collected from 620 participants, 67 (11%) had CTRE and 21 (3.4%) had CPRE colonization. Among 561 participants without enrollment CTRE colonization, 49 (9%) participants were colonized with CTRE at follow-up. Detection of CTRE colonization among participants not colonized with CTRE at admission was independently associated with empiric third generation cephalosporin treatment (adjusted odds ratio [OR] 2.9, 95% CI 1.5–5.8). Follow-up transition to CPRE colonization detection was associated with ICU admission (OR 3.0, 95% CI 1.0–8.5).ConclusionsPatients who receive empiric third generation cephalosporins and are admitted to the ICU rapidly develop detectable CTRE and CPRE colonization. Improved antimicrobial stewardship and infection control measures are urgently needed upon hospital admission.

Utility Of Salivary CA-125 And LDH As Tumor Markers In Oral Malignancy

Background: The mortality and morbidity associated with oral squamous cell carcinoma(OSCC) can be greatly reduced if tumor markers which can detect OSCC at an early stage are available. This study attempts to use saliva as the diagnostic medium to determine the correlation of salivary CA 125 and LDH in tobacco users with and without potentially malignant disorders. Changes in CA 125 and LDH level can be used as a marker in patients with and without premalignant disease and can be used as a deterrent in continuation of the habit. Aims: To assess the role of CA 125 &amp; LDH as a tumour marker in Oral cancer patients. Materials and methods: Cross sectional observational study .Time period: December 2015 to August 2017. Study area: OPD of tertiary care hospital in pune. Total participants: 150 persons. Under non-stimulatory conditions whole saliva sample was collected from each individual and was centrifuged. The resulting supernatant was used for estimation of CA 125 and LDH levels. Results: In present study, mean Salivary LDH level was found to be lowest among cases of healthy individuals while it was highest among individuals who were diagnosed and underwent treatment for malignancy. However there was insignificant difference seen between levels of diagnosed case of oral malignancy and the ones who underwent treatment for oral malignancy. Also mean Salivary CA-125 was lowest in healthy individuals and highest in individuals diagnosed with oral malignancy and the levels were seen to be reduced significantly in the one who underwent treatment for oral malignancies than those who didn't. Conclusion: Salivary CA 125 and LDH has a role in early detection of oral malignancies and can be used as a diagnostic marker. However LDH levels are persistently raised even after treatment for oral malignancy.

Addressing knowledge gaps and prevention for tuberculosis-infected Indian adults: a vital part of elimination

BackgroundIndia plans to eliminate tuberculosis (TB) by 2025, and has identified screening and prevention as key activities. Household contacts (HHCs) of index TB cases are a high-risk population that would benefit from rapid implementation of these strategies. However, best practices for TB prevention and knowledge gaps among HHCs have not been studied. We evaluated TB knowledge and understanding of prevention among tuberculin skin-test (TST) positive HHCs. While extensive information is available in other high-burden settings regarding TB knowledge gaps, identifying how Indian adult contacts view their transmission risk and prevention options may inform novel screening algorithms and education efforts that will be part of the new elimination plan.MethodsWe approached adult HHC to administer a questionnaire on TB knowledge and understanding of infection. Over 1 year, 100 HHC were enrolled at a tertiary hospital in Pune, India.ResultsThe study population was 61% (n = 61) female, with a mean age of 36.6 years (range 18–67, SD = 12). Education levels were high, with 78 (78%) having at least a high school education, and 23 (24%) had at least some college education. Four (4%) of our participants were HIV-infected.General TB knowledge among HHC was low, with a majority of participants believing that you can get TB from sharing dishes (70%) or touching something that has been coughed on (52%). Understanding of infection was also low, with 42% believing that being skin-test positive means you have disease. To assess readiness for preventive therapy, we asked participants whether they are at a higher risk of progressing to active disease because of their LTBI status. Fifty-four (55%) felt that they are at higher risk. Only 8% had heard of preventive therapy.ConclusionOur TB knowledge survey among HHCs with evidence of recent exposure found that knowledge is poor and families are confused about transmission in the household. It is imperative that the Indian program develop tools and incentives that can be used to educate TB cases and their families on what infected HHCs can do to prevent disease, including preventive therapy.

Comparison of PFN (Proximal femoral nail) and DHS (Dynamic hip screw) in treatment of Intertrochanteric femur fractures

Introduction: Intertrochanteric femur fractures are common in the elderly people. The frequency of these fractures has increased primarily due to the increasing life span and more sedentary life style brought on by urbanization. The incidence of Intertrochanteric femur fractures is more in the female population compared to the male due to osteoporosis. Aim and Objective- To compare outcome of intertrochanteric femur fractures treated with DHS and PFN. Methodology: comparative study of proximal femoral nail and dynamic hip screw in the treatment of 50 cases of intertrochanteric femur fractures in the Department of orthopedics, DY Patil Hospital Pune was done from July 2015 to July 2016. Result: Result were almost similar in both groups. Conclusion: It is most difficult task to assess and decide as to which technique is better out the two. Some studies reveal DHS to be better than PFN, while some studies show vice versa. Both the techniques are precise, time tested & require reasonable amount of surgical skill. Final decision depends on operative surgeon’s preference to specific technique.

Vector-Borne Disease is a Common Cause of Hospitalized Febrile Illness in India.

Acute febrile illness (AFI) is a major cause of morbidity and mortality in India and other resource-limited settings, yet systematic etiologic characterization of AFI has been limited. We prospectively enrolled adults (N = 970) and children (age 6 months to 12 years, N = 755) admitted with fever from the community to Sassoon General Hospital in Pune, India, from July 2013 to December 2015. We systematically obtained a standardized clinical history, basic laboratory testing, and microbiologic diagnostics on enrolled participants. Results from additional testing ordered by treating clinicians were also recorded. A microbiological diagnosis was found in 549 (32%) participants; 211 (12%) met standardized case definitions for pneumonia and meningitis without an identified organism; 559 (32%) were assigned a clinical diagnosis in the absence of a confirmed diagnosis; and 406 (24%) had no diagnosis. Vector-borne diseases were the most common cause of AFI in adults including dengue (N = 188, 19%), malaria (N = 74, 8%), chikungunya (N = 15, 2%), and concurrent mosquito-borne infections (N = 23, 2%) occurring most frequently in the 3 months after the monsoon. In children, pneumonia was the most common cause of AFI (N = 214, 28%) and death. Bacteremia was found in 68 (4%) participants. Central nervous system infections occurred in 58 (6%) adults and 64 (8%) children. Etiology of AFI in India is diverse, highly seasonal, and difficult to differentiate on clinical grounds alone. Diagnostic strategies adapted for season and age may reduce diagnostic uncertainty and identify causative organisms in treatable, fatal causes of AFI.

Gender-based violence screening methods preferred by women visiting a public hospital in Pune, India

BackgroundGender-based violence (GBV) is a major global public health concern and is a risk factor for adverse health outcomes. Early identification of GBV is crucial for improved health outcomes. Interactions with health care providers may provide a unique opportunity for routine GBV screening, if a safe, confidential environment can be established.MethodsBetween November 2014 and February 2015, a cross-sectional, observational study was conducted where women were interviewed about their opinions concerning GBV screening in a tertiary health care setting in Pune, India. Trained counsellors interviewed 300 women at different out-patient and in-patient departments using a semi-structured questionnaire.ResultsTwenty-three percent of these women reported experiencing GBV in their life. However, 90% of women said they had never been asked about GBV in a health care setting. Seventy-two percent expressed willingness to be asked about GBV by their health care providers, with the preferred provider being nurses or counsellors. More than half (53%) women reported face-to-face interview as the most preferred method for screening. There were no major differences in these preferences by GBV history status.ConclusionsOur study provides evidence for preferred GBV screening methods and optimal provider engagement as perceived by women attending a public hospital.