Need For Local Data Research Articles

Etiology of Community Acquired Pneumonia at a Tertiary Care Hospital

Background: Data regarding etiological profile of community acquired pneumonia are sparse, and a variation is seen in studies from different parts of India, hence underlining the need for local data for better patient management. Methods: Retrospective database analysis was done. Patients aged >18 years admitted from August 2019 to February 2020 at AMRI Hospital, Salt Lake, Kolkata, India with a diagnosis of community acquired pneumonia were included in the study. Pneumonia Severity Index and CURB 65 were used to assess the severity. Chest radiographs were thoroughly examined. Upper and lower respiratory BIOFIRE panels, sputum culture, blood culture, urinary pneumococcal antigen, and Xpert Flu were used to identify the pathogens. Outcomes were recorded. Result: No pathogen could be isolated in 30 (36.14%) cases. Viral agents were isolated in 21 (25.3%) cases. Streptococcus pneumoniae was the most common pathogen, isolated in 17 (20.48%) cases followed by Haemophilus influenzae in nine cases (10.84%), influenza virus in six cases (7.2%), Moraxella catarrhalis, rhino virus, and parainfluenza virus in five (6.02%) cases each, Staphylococcus aureus and Corona virus in four cases (4.8%), Klebsiella pneumoniae in three cases (3.61%), Mycoplasma pneumoniae in two cases (2.41%), as well as RSV, adenovirus, pseudomonas, proteus, acinetobacter, and Aspergillus fumigatus were in one (1.2%) case each. Severity of pneumonia at presentation was significantly associated with outcome. Conclusion: A total of fifty-three cases, in which a pathogen could be isolated, viral agents were isolated in 21. S. pneumoniae was the most common pathogen isolated (17 cases) followed by H. influenzae (9 cases). More than 1 pathogen was isolated in 12 cases, of which nine had one viral and one bacterial agent; S. pneumoniae being the most common bacterial co-pathogen.

Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants

Background As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. Methods A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. Results There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. Conclusion Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.

Stakeholder perspectives around post-TB wellbeing and care in Kenya and Malawi.

There is growing awareness of the burden of post-TB morbidity, and its impact on the lives and livelihoods of TB affected households. However little work has been done to determine how post-TB care might be delivered in a feasible and sustainable way, within existing National TB Programmes (NTPs) and health systems, in low-resource, high TB-burden settings. In this programme of stakeholder engagement around post-TB care, we identified actors with influence and interest in TB care in Kenya and Malawi, including TB-survivors, healthcare providers, policy-makers, researchers and funders, and explored their perspectives on post-TB morbidity and care. Stakeholder mapping was completed to identify actors with interest and influence in TB care services in each country, informed by the study team's local, regional and international networks. Key international TB organisations were included to provide a global perspective. In person or online one-to-one interviews were completed with purposively selected stakeholders. Snowballing was used to expand the network. Data were recorded, transcribed and translated, and a coding frame was derived. Data were coded using NVivo 12 software and were analysed using thematic content analysis. Online workshops were held with stakeholders from Kenya and Malawi to explore areas of uncertainty and validate findings. The importance of holistic care for TB patients, which addresses both TB comorbidities and sequelae, was widely recognised by stakeholders. Key challenges to implementation include uncertainty around the burden of post-TB morbidity, leadership of post-TB services, funding constraints, staff and equipment limitations, and the need for improved integration between national TB and non-communicable disease (NCD) programmes for care provision and oversight. There is a need for local data on the burden and distribution of morbidity, evidence-informed clinical guidelines, and pilot data on models of care. Opportunities to learn from existing HIV-NCD services were emphasised. This work addresses important questions about the practical implementation of post-TB services in two African countries, exploring if, how, where, and for whom these services should be provided, according to a broad range of stakeholders. We have identified strong interest in the provision of holistic care for TB patients in Kenya and Malawi, and key evidence gaps which must be addressed to inform decision making by policy makers, TB programmes, and funders around investment in post-TB services. There is a need for pilot studies of models of integrated TB care, and for cross-learning between countries and from HIV-NCD services.

Phase I of the DiaVACCS screening trial: Study design, methods, population demographics and baseline results

&#x0D; &#x0D; &#x0D; &#x0D; Background. Human papillomavirus (HPV)-based primary screening guidelines are based on screening test performance and prevalence data generated in high-resource areas with low HIV infection rates. There is an urgent need for local data on infection and disease prevalence, as well as screening test performance, among both HIV-positive and HIV-negative South African (SA) women, in order to inform updated screening guidelines.&#x0D; Objectives. This study describes the baseline characteristics of participants in the cross-sectional phase of the multicentric DIAgnosis in Vaccine And Cervical Cancer Screen (DiaVACCS) screening trial. The objective was to determine the prevalence of positive screening and pre-invasive disease using different tests and strategies in the SA HIV-positive and HIV-negative population.Methods. A total of 1 104 women aged 25 - 65 years and eligible for screening were included, 465 HIV positive and 639 HIV negative. Visual inspection and molecular and cytological screening tests were done on self-sampled and healthcare worker-collected specimens. All participants who screened positive and 49.1% of those who screened negative were invited for colposcopy and biopsy, and those qualifying for treatment were recalled for large loop excision of the transformation zone as part of the trial. The worst histology result for each participant was used, and for untested women, multiple imputation was used to estimate verification bias- adjusted histology values.&#x0D; Results. Visual inspection was positive in 50.4% of HIV-positive v. 20.9% of HIV-negative women, cytology (atypical squamous cells of undetermined significance) in 39.9% v. 17.0%, and high-risk HPV DNA in 41.2% v. 19.6%. Overall, high-grade squamous intraepithelial lesion-positive cytology peaked in the age group 30 - 39 years at 16.7%. After adjustment for verification bias, histological diagnosis of cervical intraepithelial neoplasia (CIN)2+ was suspected in 44.7% v. 23.5% and CIN3+ in 23.3% v. 10.2% of HIV-positive and negative women, respectively. Invasive cancer was diagnosed in 15 women (1.95% of histological studies performed), and verification bias adjustment suggested 20 cases (1.8% of the study population).&#x0D; Conclusion. The baseline findings from the DiaVACCS trial confirm a high prevalence of HPV-related cervical pathology in the SA HIV-negative screening population, showing a clear need to reach these women with a screening programme. Among HIV-positive women, prevalence values were almost doubled. The prevalence of existing invasive cervical cancer was 1 - 2% of all women. Further analysis of the performance of single and multiple screening tests between the two subgroups will contribute to the choice of the most effective strategies to identify women at risk of developing invasive cancer.&#x0D; &#x0D; &#x0D; &#x0D;

High Incidence of COL4A Genetic Variants Among a Cohort of Children With Steroid-Resistant Nephrotic Syndrome From Eastern India

High Incidence of COL4A Genetic Variants Among a Cohort of Children With Steroid-Resistant Nephrotic Syndrome From Eastern India

Growth, water use, and water use efficiency of Eucalyptus globulus and Pinus radiata plantations compared with natural stands of Roble-Hualo forest in the coastal mountains of central Chile

The water-use of plantations compared to alternative land uses is an important natural resource management issue in central Chile. The need for local data is heightened by a drying trend in the local climate, the potential for planted forests to store carbon and local plans to replace plantations of Pinus radiata D. Don with Eucalyptus globulus Labill. This paper compares the growth and water balance of P. radiata and native forest (Hualo – Nothofagus glauca (Phil.) Krasser) at a low rainfall site (1016 mm) and of P. radiata, E. globulus and native forest (Roble – N. obliqua Mirb.) at a medium rainfall (1395 mm) site.Evapotranspiration of plantations of P. radiata in the north and of P. radiata and E. globulus further south was greater than in the local native forest by about 100 mm per year. This difference in total water use was due to greater transpiration by the plantation species; the sum of interception and soil evaporation was very similar for all forest types. Pinus radiata used more water than native forest throughout the year, owing to a more than two-fold greater stand sapwood area in the P. radiata. The difference between E. globulus and native forest was due to much higher sap flux density in the E. globulus during spring and early summer. Although there was no annual difference between the water use of E. globulus and P. radiata, the much greater transpiration of E. globulus in spring may result in earlier drying of soils and catchments planted with E. globulus than P. radiata species.The annual growth rate of all forest types increased in the years after the end of Chilean mega drought. During the first year of this period, E. globulus produced significantly more wood per unit of water used (3.5 g wood kg−1) than P. radiata (2.1 g kg−1) which was, in turn, more than five times more efficient then the native forest (0.4 g kg−1).

A Sponsor’s View on Postmarketing Regulatory Commitments Involving Human Drug Products

A Sponsor’s View on Postmarketing Regulatory Commitments Involving Human Drug Products

Urban land-use analysis using proximate sensing imagery: a survey

ABSTRACT Urban regions are complicated functional systems that are closely associated with and reshaped by human activities. The propagation of online geographic information-sharing platforms and mobile devices equipped with the Global Positioning System (GPS) greatly proliferates proximate sensing images taken near or on the ground at a close distance to urban targets. Studies leveraging proximate sensing images have demonstrated great potential to address the need for local data in the urban land-use analysis. This paper reviews and summarizes the state-of-the-art methods and publicly available data sets from proximate sensing to support land-use analysis. We identify several research problems in the perspective of examples to support the training of models and means of integrating diverse data sets. Our discussions highlight the challenges, strategies, and opportunities faced by the existing methods using proximate sensing images in urban land-use studies.

Prevalence of Clinical Spectrum of Cutaneous Adverse Drug Reactions in Patients Presenting at a Tertiary Care Hospital in Pakistan.

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common adverse drug reactions reported in the literature. CADRs have resulted in disabling infirmities during hospitalization and complications following outdoor drug therapy. The pattern of CADRs and the responsible drugs usually changes with the introduction of newer drugs and evolving clinical practices. Moreover, several international studies showed variable prevalence, emphasizing the need for local data in light of different socioeconomic and demographic practices. Therefore, the purpose of this study is to evaluate the prevalence of adverse cutaneous drug reactions and identify the clinical spectrum and any potential risk factors.Methodology: The current study is a descriptive cross-sectional study conducted at Aga Khan University Hospital, Pakistan. One hundred ninety-three patients who met the study inclusion criteria were included. Data were collected from patients on a proforma after taking informed consent. Quantitative data were presented as simple descriptive statistics giving mean and standard deviation, while qualitative variables were presented as frequency and percentages. Effect modifiers were controlled through stratification to highlight the effect of these on the outcome variable. The post-stratification chi-square test was applied and the p-value of ≤0.05 was statistically significant.Results: A total of 193 patients who had cutaneous adverse drug reactions were included in the study. The mean age in this study was 47.78±8.33 years. One hundred eight (56%) were male and 85 (44%) were female. Out of 193 patients, 135 (69.9%), 50 (25.9%), 24 (12.4%), 12 (6.2%), 20 (10.4%), 11 (5.7%) and six (3.1%) had maculopapular rash, acneiform eruptions, Stevens-Johnson syndrome, erythema multiform, urticaria, fixed drug eruptions and toxic epidermal necrolysis, respectively.Conclusion: CADRs are a common clinical presentation and awareness and knowledge about their diagnosis and prevention is important. It can be assumed that in our local setup, the clinical trends and medications causing ADRs are strikingly similar to those found in other countries. Physicians commonly come across these cases and they should be well aware of the clinical spectrum of skin reactions to enable early diagnosis and management.

Antimicrobial resistance (AMR) at the community level: An urban and rural case study from Karnataka.

Context:The emergence of antimicrobial resistance (AMR) is a major public health crisis in India and globally. While national guidelines exist, the sources of data which form the basis of these guidelines are limited to a few well-established tertiary care centres. There is inadequate literature on AMR and antibiotic mismatch from India at community level and even less literature on AMR patterns from rural India.Aims:The aims of this study were as follows: 1) to describe the patterns of AMR at an urban tertiary care hospital and a rural 100 bedded hospital; 2) to compare and contrast the AMR patterns noted with published ICMR guidelines; 3) to examine the issue of AMR and antibiotic mismatch; and 4) to identify local factors influencing drug-bug mismatch at the local level.Settings and Design:The data were obtained from two independently conceived projects (Site 1: Urban tertiary care hospital, Site 2: Rural 100-bedded hospital).Methods and Materials:Local antibiograms were made, and the antibiotic resistance patterns were compared between the urban and rural sites and with data published in the 2017 ICMR national guideline for AMR.Statistical Analysis Used:Descriptive statistics including means and medians were used.Results:Our data reveal: a) a significant mismatch between sensitivity patterns and antibiotics prescribed; b) The national guidelines fail to capture the local picture of AMR, highlighting the need for local data; and c) challenges with data collection/retrieval, access and accuracy of diagnostic tools, administrative issues, and lack of local expertise limit antimicrobial stewardship efforts.Conclusions:Our study finds the burden of AMR high in both rural and urban sites, reinforcing that AMR burden cannot be ignored in rural settings. It also highlights that national data obtained from tertiary care settings fail to capture the local picture, highlighting the need for local data. Mechanisms of linking rural practices, primary health centres, and small hospitals with a common microbiology laboratory and shared data platforms will facilitate antibiotic stewardship at the community level.

Haematological Profile of Pregnant Women Attending Antenatal Clinic in Bauchi, Nigeria

Introduction: Haematological profile of pregnant women provides vital information on physiological changes in pregnancy progress, outcome and possible maternal-foetal complications. The study assessed the haematological profile of pregnant women attending the antenatal clinic. Methodology: The cross-sectional study was conducted at the antenatal clinic of Abubakar Tafawa Balewa Teaching Hospital, Bauchi between July and September 2018 among pregnant women attending the antenatal clinic. Study participant was recruited on voluntary basis and study questionnaire and informed consent administered. Blood samples are collected and analysed using System x haematology autoanalyser. Result: A total of 191 study participants comprised of 141 pregnant women at different trimester stages and 50 non-pregnant. Mean haematocrit, haemgloblin, white blood count and platelet count of 35.8 ± 9.0, 11.6 ± 1.6, 7.7 ± 5.7, and 234.0 ± 74.6 respectively. Significant difference was observed between pregnant and non-pregnant women in neutrophil (0.016), mixed (eosinophil, basophil and monocyte, 0.05), lymphocyte (0.000), platelets (0.002) and RDWSD (0.025). Comparing haematological profile with trimester stages, significant association was observed with white blood cells count and mixed cell counts. Conclusion: The reduction in mean white blood cells count and increased haemocrit concentration with the trimester stages contradict patterns in other similar studies. This further highlights the need for local data for early diagnosis of pregnancy-associated clinical conditions and management approach.

Towards Estimating Childhood Obesity Prevalence Using Electronic Health Records

Towards Estimating Childhood Obesity Prevalence Using Electronic Health Records

Prevalence of visual impairment in adults aged 18 years and above in a rural area of coastal Karnataka

BACKGROUND: Vision loss and age-related eye diseases are major global public health problems. The burden of visual impairment worldwide varies depending on the methods of assessment. The need for local data on the prevalence of visual impairment in adults coupled with limited resources necessitated the conduct of the study in a limited geographical area. METHODS: A cross-sectional study was conducted in the field practice area of Department of Community Medicine of a Medical College. Study patients included adults aged ≥18 years, identified through purposive sampling. A semi-structured questionnaire was used to collect sociodemographic data. Snellen's chart for distant vision; reduced Snellen's chart for near vision and Ishihara chart for color vision was used. Data were analyzed using SPSS software version 15. RESULTS: The study included 411 patients. Nearly 40% of the patients were ≥50 years. Among the patients, 195 (47.4%) had H/o refractive error, 78 (19%) had H/o hypertension, 56 (13.6%) had H/o diabetes, and 43 (10.5%) had H/o cataract. The most common ocular morbidity was arcus senilis 113 (27.5%) and cataract 28 (6.8%). Using Snellen's distant vision chart low vision ( CONCLUSIONS: Farsightedness was detected among a quarter of the population, while impaired near vision was detected among two.fifths of the study group. Nearly 7% of patients had cataract and were referred for further evaluation. Advancing age and the presence of comorbidities were significant determinants of visual impairment.

Diet and habitat selection in Cantabrian Capercaillie (Tetrao urogallus cantabricus): ecological differentiation of a rear-edge population

Cantabrian capercaillie Tetrao urogallus cantabricus is a peripheral population with distinctive phenotypic, biogeographic, and genetic characteristics. Hence, the population may also show substantial ecological differentiation associated with its habitat in purely deciduous forests. We assessed seasonal diet selection, small-scale habitat selection, and patterns of trophic niche width in Cantabrian capercaillie over two years. Diet was found to be a driver of small-scale habitat selection, a result consistent with previous studies of stand-scale habitat selection. Diet and habitat selection showed the importance of beech Fagus sylvatica, holly Ilex aquifolium, bilberry Vaccinium myrtillus, and ferns in Cantabrian capercaillie’s resource selection. Conversely, the abundant oaks Quercus petraea, birches Betula pubescens, and heaths Erica sp. were used below their availability. The reliance on bilberry appears as a unifying characteristic between central and peripheral capercaillie populations. Cantabrian capercaillie showed stronger reliance on understory resources than range-central populations. It also showed wider trophic niche and higher specialization of feeding events. Trophic niche patterns and reliance on ground resources indicated a marked ecological differentiation, which stresses the need for local data and specific conservation actions.

Age-related prevalence of cytomegalovirus IgG antibody in north-west England

We assessed the prevalence of cytomegalovirus (CMV) IgG antibody in north-west England. The prevalence of antibody was low in pre-school children, but rose rapidly on school entry (age 5 years). About 40% of female blood donors of child-bearing age were seropositive. Hospitalised young adults had a higher prevalence of antibody than blood donors of similar age. Our results emphasised the need for local data on CMV seroprevalence when planning the counselling of women about acquisition of CMV during pregnancy and when planning the provision of CMV seronegative blood and blood products.