Mahendra M Reddy
@aiimspatna.edu.in/community-and-family-medicine
Assistant Professor, Department of Community & Family Medicine
All India Institute of Medical Sciences Patna
RESEARCH INTERESTS
Epidemiology, Non Communicable Diseases, Health Economics
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Ayush Mishra, Mahendra M. Reddy, and Kamran Zaman
Springer Science and Business Media LLC
Bindu R. Madhavi, Anitha Deva, Mahendra M. Reddy, P.M. Beena, and S.N. Vijay Kumar
Elsevier BV
L Preethi, M S Alina, Lakshmi Chandran, S Asvin, M Jagadeesan, T M Vijayakumar, V Chitra, Ashok Kumar Pandey, Mahendra M Reddy, Brij Ranjan Misra,et al.
Oxford University Press (OUP)
Abstract Background Acute encephalitis syndrome (AES) is a major public health concern in India, and the Japanese Encephalitis (JE) virus is the most common cause of viral encephalitis in Asia affecting children under the age of 15 years. In India, despite the introduction of the JE vaccine (SA-14-14-2) in the immunization programme, JE continues to account for 15–20% of AES cases to date. This study evaluates the immunogenicity of live attenuated SA-14-14-2 JE vaccine in terms of persistence of the humoral response after two doses. Methods A cross-sectional study was conducted among 266 children belonging to one of the JE endemic regions of Uttar Pradesh, India. Blood samples were taken from children (2–10 years) and grouped according to the duration (in years) after two doses of the vaccine (5 groups with a class interval of 2 years). Informed written consent was obtained from the parents/guardians. All the samples collected were tested for the presence of anti-JEV-specific IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and further confirmed by micro neutralization test (MNT) and immunofluorescence assays. Results Of the 266 samples tested by ELISA for anti-JEV-specific IgG antibodies, 260 (97.74%) were negative and 6 (2.26%) were equivocal. The geometric mean immune status ratio across the five groups, 0–2 years (n = 59), 2–4 years (n = 73), 4–6 years (n = 65), 6–8 years (n = 48) and 8–10 years (n = 21) post-two doses of SA-14-14-2 JE vaccine was 1.143, 1.059, 1.138, 1.075 and 1.130, respectively, and the geometric mean titre obtained from MNT across the five groups was 10.77, 8.400, 8.453, 9.517 and 9.674, respectively. Conclusion The study showed a decreasing trend of anti-JEV specific IgG antibody titres across the five groups based on the duration following two doses of SA-14-14-2 vaccine. The results emphasize the significance of booster doses of vaccine for children living in endemic areas.
Sheela Godbole, Vishal Diwan, Saibal Das, Mahendra M. Reddy, Madhanraj Kalyanasundaram, Dilipkumar Rajendran, Dipankar Biswas, Megha Mamulwar, Rajnarayan R. Tiwari, Joydeep Majumder,et al.
Frontiers Media SA
IntroductionIndia launched the COVID-19 vaccination drive on 16th January 2021 by vaccinating the adult population above 18 years of age. This was followed by the introduction of an additional precaution dose. As on 18th October 2022, 1,02,66,96,808 (1.02 Billion) first dose and 94, 95, 39,516 (949 Million) second doses of COVID-19 vaccine were administered. However, when compared to the uptake of the primary doses, the precaution dose uptake lagged behind with only 21,75, 12,721 (217 million) doses administered. Even though, the uptake of the primary doses remained optimal, irrespective of different interventions by the Government of India, the uptake of the precaution dose remained poor. In this context, the Ministry of Health & Family Welfare wanted to understand the facilitators and Barriers for precaution dose uptake among adults so that future immunization campaigns could address these issues.MethodsAn exploratory qualitative study was conducted to assess the facilitators and barriers for COVID-19 precaution dose uptake at community level across 6 different states in India. From each of the states, two districts with the highest and lowest rates of COVID-19 vaccine precaution dose uptake were selected. In each of these districts, 2 block Primary Healthcare Centres (PHCs), one with high and one with low uptake were identified. Within these block PHCs, a PHC field area with high and low precaution dose uptakes was identified. From the identified sites a minimum of four IDIs, four FGDs were conducted among the community members. KIIs of the State Immunization Officers, District Immunisation Officers, PHC Medical Officers, healthcare workers like Accredited Social Health Activist/Auxiliary Nurse Midwife were also conducted. The data was audio recorded and it was transcribed, translated and analysed using framework approach.ResultsIt was observed that rise in COVID-19 cases prompted the community to take the precaution dose, this along with the cost of hospitalization and the number of productive days being lost as a result of being infected resulted in vaccine uptake. The fear of non-availability of COVID-19 vaccines latter on also prompted people for vaccine uptake. While the barriers were, poor accessibility to vaccination centers, long hours of travel, poor road connectivity and lack of transportation facilities. However, the most prominent barriers observed across all study sites was that a sense of pandemic fatigue and complacency had developed both among the providers as well as the beneficiaries. Other barriers include differences in vaccination schedules and longer duration between the primary doses of some vaccines. Media was identified to be both a barrier and facilitator for Covid-19 Precaution dose uptake. Even though media played an important role in disseminating information in the beginning of the campaign, it was soon followed by the circulation of both misinformation and disinformation.DiscussionThe study identified that dissemination of accurate information and community involvement at each stage of planning and implementation are crucial for the success of any campaign. Efforts should be constantly made to address and re-invent strategies that will be most suitable for the needs of the community. Therefore, in order to ensure successful vaccination campaigns, it is crucial that along with political will it is also important to have a decentralized approach with inter-sectoral coordination with different stakeholders such as healthcare workers, community members and the different departments such as the local self-governments, education department, law & order department etc. These lessons learnt from COVID-19 vaccination campaigns must not be forgotten and must be applied in future vaccination campaigns and while framing public health policies.
Kamran Zaman, Anita M. Shete, Shailendra Kumar Mishra, Abhinendra Kumar, Mahendra M. Reddy, Rima R. Sahay, Shailendra Yadav, Triparna Majumdar, Ashok K. Pandey, Gaurav Raj Dwivedi,et al.
Frontiers Media SA
BackgroundRecent studies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reveal that Omicron variant BA.1 and sub-lineages have revived the concern over resistance to antiviral drugs and vaccine-induced immunity. The present study aims to analyze the clinical profile and genome characterization of the SARS-CoV-2 variant in eastern Uttar Pradesh (UP), North India.MethodsWhole-genome sequencing (WGS) was conducted for 146 SARS-CoV-2 samples obtained from individuals who tested coronavirus disease 2019 (COVID-19) positive between the period of 1 January 2022 and 24 February 2022, from three districts of eastern UP. The details regarding clinical and hospitalized status were captured through telephonic interviews after obtaining verbal informed consent. A maximum-likelihood phylogenetic tree was created for evolutionary analysis using MEGA7.ResultsThe mean age of study participants was 33.9 ± 13.1 years, with 73.5% accounting for male patients. Of the 98 cases contacted by telephone, 30 (30.6%) had a travel history (domestic/international), 16 (16.3%) reported having been infected with COVID-19 in past, 79 (80.6%) had symptoms, and seven had at least one comorbidity. Most of the sequences belonged to the Omicron variant, with BA.1 (6.2%), BA.1.1 (2.7%), BA.1.1.1 (0.7%), BA.1.1.7 (5.5%), BA.1.17.2 (0.7%), BA.1.18 (0.7%), BA.2 (30.8%), BA.2.10 (50.7%), BA.2.12 (0.7%), and B.1.617.2 (1.3%) lineages. BA.1 and BA.1.1 strains possess signature spike mutations S:A67V, S:T95I, S:R346K, S:S371L, S:G446S, S:G496S, S:T547K, S:N856K, and S:L981F, and BA.2 contains S:V213G, S:T376A, and S:D405N. Notably, ins214EPE (S1- N-Terminal domain) mutation was found in a significant number of Omicron BA.1 and sub-lineages. The overall Omicron BA.2 lineage was observed in 79.5% of women and 83.2% of men.ConclusionThe current study showed a predominance of the Omicron BA.2 variant outcompeting the BA.1 over a period in eastern UP. Most of the cases had a breakthrough infection following the recommended two doses of vaccine with four in five cases being symptomatic. There is a need to further explore the immune evasion properties of the Omicron variant.
Rohith Singareddy, Harjot Kaur Bajwa, Mahendra M. Reddy, Krishnam Raju Alluri, K. V. V. N. Raju, T. Subramanyeshwar Rao, and L. M. Chandrashekara Rao
Springer Science and Business Media LLC
To analyze the patterns of failure and factors affecting recurrence and overall survival in mucoepidermoid carcinoma of the salivary gland. The hospital records were retrospectively analyzed from October 2010 to January 2016. Patients diagnosed as mucoepidermoid carcinoma of the salivary gland were eligible for analysis. All patients received surgery as the primary treatment modality with or without post operative radiotherapy. Statistical analysis for factors affecting recurrence was done by cox regression analysis and p value less than 0.05 was considered significant. A total of 116 patients were diagnosed to have malignant salivary gland tumors of which 69 were mucoepidermoid carcinomas (69.5%). The median age was 43 years (8–75 years). Majority of the tumors occurred in major salivary glands gland (77%). 51% patients were females. Most common stage was stage II (36%) followed by stage I (27.5%), stage IV (20.3%) and stage III (16%). High grade carcinomas comprised 34.8%, intermediate grade 30.4% and low grade 34.8%. 36 patients (52.2%) received adjuvant radiotherapy (60 Gy in 30 fractions). At a median follow up of 42 months (8–70 months), 8 (11.6%) patients died (7 cancer related and 1 noncancer related). The locoregional recurrence rate was 4.3% whereas the distant metastasis rate was 11.6%. Most common site of distant metastasis was lung. The mean disease free survival time was 61.4 months and the mean overall survival was 62 months. On univariate analysis, age < 50 years, node positive, presence of PNI, high grade, presence of LVI and local recurrence were significant factors for distant metastasis ( p < 0.05). On multivariate analysis, high grade, presence of LVI and local recurrence were significant factors for distant metastasis ( p < 0.05). Mucoepidermoid carcinomas of salivary gland have good long term local control and overall survival. Majority of the recurrences are distant metastasis. High grade, LVI and local recurrence are significant risk factors for distant relapse.
Niraj Kumar, Brij Ranjan Misra, Mahendra M. Reddy, Hirawati Deval, Kamran Zaman, and Rajni Kant
Wiley
We read with interest the article by Kaur et al., 2022. The authors have reported high rate (27%) of SARS-CoV2 infections among ChAdOx1 nCoV-19 (AZD1222/Covishield) vaccinated participants (healthcare workers and elderly non-healthcare general public). Based on findings, we would like to share our experience at Indian Council of Medical Research-Regional Medical Research Centre (ICMR-RMRC), Gorakhpur (ICMR recognised nodal centre for COVID-19 diagnosis in eastern Uttar Pradesh) situated at Gorakhpur, a city near Varanasi in Uttar Pradesh, India during the same timeline (April 2021). This article is protected by copyright. All rights reserved.
Rajaram Yadav, Kamran Zaman, Ayush Mishra, Mahendra M. Reddy, Prem Shankar, Priyanka Yadav, Kaushik Kumar, and Rajni Kant
MDPI AG
Background: The healthcare infrastructure of a country determines the health-seeking behaviour of the population. In developing countries such as India, there is a great disparity in the distribution of healthcare institutions across urban and rural areas with disadvantages for people living in rural areas. Objectives: Our objectives were to study the health-seeking behavior and factors associated with the use of formal healthcare among the Gorakhpur Health and Demographic Surveillance System (GHDSS) cohort of North India. Methods: The study was conducted in 28 villages from two rural blocks in the Gorakhpur district of eastern Uttar Pradesh, North India. Structured questionnaires were used to collect the data with regard to demographics, health-seeking behaviour and healthcare utilization. An adjusted odds ratio with 95% confidence interval was used to report the factors associated with the utilization of healthcare. Results: Out of 120,306 individuals surveyed, 19,240 (16%) individuals reported having any health problem in the last 15 days. Of them, 90% sought healthcare for their health needs. The formal healthcare utilization was 79%. The use of public health facilities was very low (37%) with most of the people seeking treatment from private healthcare (63%). Females, people with a higher level of education (graduate and above), and those belonging to rich and middle tercile were more likely to use formal healthcare services. Among different ailments, respiratory problems, gastrointestinal problems, and musculoskeletal problems were associated with decreased use of formal healthcare. Conclusion: About four in five individuals surveyed who had health problems sought treatments from formal healthcare with three in five preferring private institutions to public healthcare facilities due to a perceived higher level of treatment quality and nearby availability. There is an urgent need to re-establish community trust among public healthcare facilities with a focus on delivering on-site health care and enhancing the quality of services offered by public healthcare institutions.
Mahendra M. Reddy, Kamran Zaman, Rajaram Yadav, Priyanka Yadav, Kaushik Kumar, and Rajni Kant
Frontiers Media SA
BackgroundNoncommunicable disease (NCD) multimorbidity throws a unique challenge to healthcare systems globally in terms of not only management of disease, but also familial, social, and economic implications associated with it.ObjectiveTo assess the prevalence of NCD multimorbidity and its associated risk factors along with health expenditures among adults (≥18 years) living in a rural area.MethodsA secondary data analysis of the first-round survey done as part of the Gorakhpur Health and Demographic Surveillance Site (GHDSS) was done. Information related to self-reported morbidity and other variables related to sociodemographics and out-of-pocket expenditure (OOPE) was captured using a pretested questionnaire. Multivariable cluster adjusted binomial regression analysis was done to identify factors associated with multimorbidity.ResultsThe overall prevalence of NCD multimorbidity was found to be 1.8% (95% CI: 1.7–1.9%). The prevalence of NCD multimorbidity was highest among elderly (≥60 years) [6.0% (95% CI: 5.5–6.5%)] and among women [2.4% (95% CI: 2.3–2.6%)]. Sociodemographic factors, such as age, gender, occupation, education, marital status, religion, caste, and household wealth, were all found to be independently associated with NCD multimorbidity. The median annual OOPE was found to be significantly higher among those with NCD multimorbidity (INR 20,000) compared with those with no NCD (INR 5,000) or having only one NCD (INR 8,000).ConclusionAmong the adults in GHDSS, about 13 in every 100 were suffering from at least one NCD and around two in 100 were having NCD multimorbidity. Those with NCD multimorbidity spent almost four times higher annual OOPE compared with those without NCDs.
MANIKANDAN SRINIVASAN, K.C. PREMARAJAN, MAHENDRA M. REDDY, VIKAS MENON, and S. GANESH KUMAR
Scientific Scholar
Background Experiencing poor mental health during adolescence predisposes an individual to psychiatric morbid conditions in adulthood. We estimated the prevalence of psychological morbidity and its associated factors, among school-going adolescents in higher secondary schools of urban Puducherry. Methods We did this cross-sectional study among adolescents studying in classes 11 and 12 from selected schools of urban Puducherry, including one government and three private schools. Study tools used were the General Health Questionnaire-12 and Perceived Stress Scale-10 to assess psychological morbidity and perceived psychological stress in adolescents, respectively. Risk factors in academic, environmental, personal and health-related domains were captured using a structured questionnaire. Study questionnaires were self-administered by the participants in classrooms. Bivariate and multivariate analyses were done to identify risk factors for psychological morbidity. Results Of the 820 adolescents surveyed, the prevalence of psychological morbidity was 25.4% (95% CI 22.4– 28.5). Academic factors such as reporting peer pressure for academic performance and lack of extracurricular activities at school were associated with psychological morbidity. Among health-related factors, adolescents who reported having difficulty in coping with pubertal changes, being worried about their physical appearance, reporting substance abuse and experiencing sleep disturbances had greater chances of having screened with psychological morbidity. Of note, adolescents with psychological stress had 2.5 times higher chances of having psychological morbidity. Conclusions We estimated that 1 in 4 school-going adolescents in urban Puducherry suffered psychological morbidity. Reducing the academic burden and advocating health promotion through a life skills approach may improve mental wellness in Indian adolescents.
Mahendra M. Reddy, Kamran Zaman, Shailendra Kumar Mishra, Priyanka Yadav, and Rajni Kant
Elsevier BV
Comparison of first and second waves of Coronavirus disease (COVID-19) showed varied differences including the peak and time distribution. Contrary to published reports of comparing two waves in India wherein the younger age group was affected more in the second wave in India; a secondary data analysis of around 0.5 million real-time reverse transcription-polymerase chain reaction tests conducted in COVID-19 diagnostic laboratory in eastern Uttar Pradesh, India showed an increase in positivity rate in older age groups in the second wave. The positivity rate among symptomatic cases was found to be three times higher in second wave compare to the first wave. Higher positivity rates were seen across older age groups, with a shift of 11 years in the mean age of positivity in the second wave compared to the first.
R. Kalyani, N. Arvind, N. Suresh Kumar, Mahendra M Reddy, and K. Dinesh
Journal of Pure and Applied Microbiology
Direct shedding of microbes by patients and health care workers results in contamination of Intensive care unit environment. Intensive care unit acquired infections due to microbial contamination is a major concern because the patient’s immunity is already compromised. To determine the rate of bacterial contamination on environmental surfaces of Intensive care unit and health care workers and to determine the antibiogram of the isolates. Air samples and swabs from healthcare workers, their accessories, surrounding environmental surfaces were collected randomly over a period of 2 months in Adult Intensive care units. Bacterial isolates were identified by standard microbiological techniques. Antibiotic sensitivity testing was performed by Kirby Bauer disc diffusion method and data analyzed by Statistical Product and Service Solutions 22 version software. A total of 208 samples were randomly collected over 2 months, of which 56 samples yielded positive bacterial growth. Of 56 growth, 12 isolates were detected from air sampling method and 44 isolates from swabs. Among 44 isolates identified from swabs, 10 were isolated from healthcare workers, 4 from health care worker’s accessories and 30 from environmental surfaces. Six different bacterial isolates were identified, Coagulase Negative Staphylococcus (24) and Micrococcus (15) were the major isolates followed by Non fermenters (6), Staphylococcus aureus(4), Bacillus species(4) and diphtheroids (3) The antimicrobial sensitivity pattern of these bacterial isolates were sensitive to commonly used antibacterial agents. Study results showed Intensive care unit staff and environmental surfaces as probable sources of bacterial contamination. Study highlights the importance of cleaning and disinfection process and educate the health care workers about the possible sources of infections within Intensive care unit.
Rohith Singareddy, Harjot Kaur Bajwa, and Mahendra M. Reddy
VM Media SP. zo.o VM Group SK
BACKGROUND: The objective of this study was To determine the dose volume parameters predicting acute haematological toxicity in carcinoma cervix patients undergoing concurrent chemoradiotherapy MATERIALS AND METHODS: All patients that presented to the hospital between Jan 2019 and Dec 2019 were prospectively analyzed. Patients diagnosed to have Carcinoma Cervix and planned for concurrent chemoradiation by volumetric modulated arc therapy (VMAT) were included for analysis. Patients were assessed at baseline and every week during treatment for acute haematological toxicities. Dose volume parameters from treatment plans were correlated with RTOG grade of haematological toxicities. RESULTS: A total of 34 patients diagnosed to have squamous cell carcinoma of cervix were treated by radical radiotherapy by VMAT technique and concurrent chemotherapy. The most common stage of presentation was stage IIB (61.7%). 29 patients (85.2%) completed five cycles of weekly cisplatin. Statistical analysis for sensitivity and specificity of dosimetric parameters was performed using receiver operating characteristic (ROC) curve. The probability of developing bone marrow toxicity was analyzed using T test. Mean dose to bone marrow exceeding 28.5 Gy was significantly associated with bone marrow toxicity (sensitivity — 82.4%, specificity — 70.6%). On analyzing dose volume parameters, volume of bone marrow receiving 20Gy, 30Gy and 40Gy (V20, V30 and V40) more than 71.75%, and 49.75% and 22.85%, respectively, was significantly associated with bone marrow toxicity. CONCLUSIONS: Our study concludes that mean dose to bone marrow exceeding 28.5 Gy has high sensitivity and specificity for predicting bone marrow toxicity in patients receiving IMRT. Volume of bone marrow receiving 20 Gy, 30 Gy and 40 Gy significantly correlated with acute haematological toxicity.
MahendraM Reddy, GowshikM Siddharthan, and BagepallyN Sunil
Medknow
BACKGROUND: “Stress” acts as both etiological link and also as an outcome in the case of diabetes mellitus. There is a paucity of literature regarding stress levels and also factors associated with it among diabetic patients in India. OBJECTIVE: To assess the perceived stress levels and their associated factors among diabetic inpatients in a rural tertiary health care center, South India. MATERIALS And METHODS: A facility-based cross-sectional analytical study was conducted among inpatient diabetics seeking care at a rural tertiary care center in Kolar district of Karnataka. A pre-tested semi-structured questionnaire was used to capture the sociodemographic, disease-related, treatment-related and behavior-related characteristics of the inpatients. The outcome of “perceived stress” was captured using a standard questionnaire of Cohen Perceived Stress Scale–10. Poisson regression was used for multivariable analysis, and the association was expressed as prevalence ratio with 95% confidence intervals (CI). RESULTS: Out of the 247 study participants analysed, “perceived stress” was seen among 97 (39.3%) of the participants (95% CI: 33.3%–45.5%). Multivariable analysis showed that factors like younger age, lesser duration of diabetes, presence of any comorbidity, being underweight, having conflicts at work place/home in the last 1 month, and not having enough money for treatment had shown higher levels of “perceived stress.” CONCLUSION: About two out of five inpatient diabetics seeking care from rural tertiary health centres had shown to have “perceived stress.” There is a need for the inclusion of stress management techniques in the diabetes education program at all levels of health-care systems.
Mahendra M. Reddy, Pruthu Thekkur, Nagesh Ramya, Prasanna B. T. Kamath, Suresh G. Shastri, Ravi B. N. Kumar, Palanivel Chinnakali, Abhay S. Nirgude, Chethana Rangaraju, Narasimhaiah Somashekar,et al.
Informa UK Limited
ABSTRACT Background: Isoniazid preventive therapy (IPT) has been shown to reduce the risk of tuberculosis (TB) among people living with HIV (PLHIV). In 2017, India began a nationwide roll-out of IPT, but there is a lack of evidence on the implementation and the challenges. Objectives: Among PLHIV newly initiated on antiretroviral therapy (ART) from January 2017 to June 2018, to: (i) assess the proportion who started and completed IPT and (ii) explore reasons for non-initiation and non-completion from health-care providers’ and patients’ perspectives. Methods: An explanatory mixed-methods study was conducted in two selected districts of Karnataka, South India. A quantitative phase (cohort analysis of routinely collected program data) was followed by a qualitative phase involving thematic analysis of in-depth interviews with providers (n = 22) and patients (n = 8). Results: Of the 4020 included PLHIV, 3780 (94%) were eligible for IPT, of whom, 1496 (40%, 95% CI: 38%-41%) were initiated on IPT. Among those initiated, 423 (28.3%) were still on IPT at the time of analysis. Among 1073 patients with declared IPT outcomes 870 (81%, 95% CI: 79%-83%) had completed the six-month course of IPT. The main reason for IPT non-initiation and non-completion was frequent drug stock-outs. This required health-care providers to restrict IPT initiation in selected patient subgroups and earmark six-monthly courses for each patient to ensure that, once started, treatment was not interrupted. The other reasons for non-completion were adverse drug effects and loss to follow-up. Conclusion: The combined picture of ‘low IPT initiation and high completion’ seen in our study mirrors findings from other countries. Drug stock-out was the key challenge, which obliged health-care providers to prioritize ‘IPT completion’ over ‘IPT initiation’. There is an urgent need to improve the procurement and supply chain management of isoniazid.
Surendran Veeraiah, Vidhubala Elangovan, Jaya Prasad Tripathy, Arvind Krishnamurthy, Tanu Anand, Mahendra M Reddy, Revathy Sudhakar, Niraimathi K, Divyarajprabhakar Subramani, Swaminathan Rajaraman,et al.
BMJ
ObjectivesTo determine current tobacco use in 2018/2019, quit attempts made and to explore the enablers and barriers in quitting tobacco among tobacco users identified in the Tamil Nadu Tobacco Survey (TNTS) in 2015/2016.SettingTNTS was conducted in 2015/2016 throughout the state of Tamil Nadu (TN) in India covering 111 363 individuals. Tobacco prevalence was found to be 5.2% (n=5208).ParticipantsAll tobacco users in 11 districts of TN identified by TNTS (n=2909) were tracked after 3 years by telephone. In-depth interviews (n=26) were conducted in a subsample to understand the enablers and barriers in quitting.Primary and secondary outcomesCurrent tobacco use status, any quit attempt and successful quit rate were the primary outcomes, while barriers and enablers in quitting were considered as secondary outcomes.ResultsAmong the 2909 tobacco users identified in TNTS 2015/2016, only 724 (24.9%) could be contacted by telephone, of which 555 (76.7%) consented. Of those who consented, 210 (37.8%) were currently not using tobacco (ie, successfully quit) and 337 (60.7%) continued to use any form of tobacco. Of current tobacco users, 115 (34.1%) have never made any attempt to quit and 193 (57.3.8%) have made an attempt to quit. Those using smoking form of tobacco products (adjusted relative risk (aRR)=1.2, 95% CI: 1.1 to 1.4) and exposure to smoke at home (aRR=1.2, 95% CI: 1.1 to 1.3) were found to be positively associated with continued tobacco use (failed or no quit attempt). Support from family and perceived health benefits are key enablers, while peer influence, high dependence and lack of professional help are some of the barriers to quitting.ConclusionTwo-thirds of the tobacco users continue to use tobacco in the last 3 years. While tobacco users are well aware of the ill-effects of tobacco, various intrinsic and extrinsic factors play a major role as a facilitator and lack of the same act as a barrier to quit.
Pramod Sagar, Chanaveerappa Bammigatti, Tamilarasu Kadhiravan, K.T Harichandrakumar, Rathinam Palamalai Swaminathan, and Mahendra M Reddy
Elsevier BV
The dose of Anti Snake Venom (ASV) in hemotoxic snake bite depends on the amount of venom injected and species of snake. All trials in South East Asia have studied different doses of ASV, wherein the ASV in high dose group itself was lower than the dose that is recommended in Indian National protocol. These studies favored low dose protocol, as there was no difference in mortality and morbidity between the groups. So, this study intended to assess the efficacy of National protocol in reducing morbidity and mortality in hemotoxic snake bite in comparison to current protocol followed in institution. This was an open label randomized trial of 140 hemotoxic snakebite patients. Group A received national protocol: initial dose of 100 ml followed by 100 ml 6th hourly till 20-min Whole Blood Clotting Time (20WBCT) was negative or 300 ml of ASV was given, whichever was earlier. Group B received 70 ml followed by 30 ml every 6th hourly until two consecutive 20WBCT were negative. There was no statistical difference in the amount of ASV required in both the groups. Mortality and acute kidney injury were higher in group A (statistically not significant), probably due to sicker patients in that group. There was no relapse of clotting time abnormality in both the groups. In a significant number of patients (12%), clotting time was persistently prolonged till death. We found that the use of National ASV dosing protocol did not decrease the mortality and morbidity.
Pracheth Raghuveer, Tanu Anand, Jaya Prasad Tripathy, Abhay Subhashrao Nirgude, Mahendra M. Reddy, Subhashree Nandy, Habeena Shaira, and Poonam Ramesh Naik
F1000 Research Ltd
Background: Opportunistic screening for individuals aged ≥30 years at all levels of healthcare for early detection of diabetes mellitus (DM) and hypertension (HTN) is an integral strategy under the national program to control non-communicable diseases. There has been no systematic assessment of the screening process in primary care settings since its launch. The objective was to determine the number and proportion eligible for screening, number screened, diagnosed and treated for DM and HTN among persons aged ≥30 years in two selected primary health centres (PHCs) in Dakshina Kannada district, Karnataka, India during March-May 2019 and to explore the enablers and barriers in the implementation of screening from the perspective of the health care providers (HCPs) and beneficiaries . Methods: This was a sequential explanatory mixed-methods study with a quantitative (cohort design) and a descriptive qualitative component (in-depth interviews and focus group discussions) with HCPs and persons seeking care. Those that were not known DM/HTN and not screened for DM/HTN in one year were used to estimate persons eligible for screening. Results: Of 2697 persons, 512 (19%) were eligible for DM screening, 401 (78%) were screened; 88/401 (22%) were diagnosed and 67/88 (76%) were initiated on treatment. Of 2697, 337 (13%) were eligible for HTN screening, 327 (97%) were screened, 55 (17%) were diagnosed with HTN; of those diagnosed, 44/55 (80%) were initiated on treatment. The documentation changes helped in identifying the eligible population. Patient willingness to undergo screening and recognition of relevance of screening were screening enablers. Overworked staff, logistical and documentation issues, inadequate training were the barriers. Conclusion: Nearly 19% were eligible for DM screening and 13% were eligible for HTN screening. The yield of screening was high. We noted several enablers and barriers. The barriers require urgent attention to reduce the gaps in delivery and uptake of services.
Manikandan Srinivasan, Mahendra M. Reddy, Sonali Sarkar, and Vikas Menon
Georg Thieme Verlag KG
Abstract Background The burden of common mental disorders (CMDs) which includes depression, anxiety, and stress-related disorders are on the rise in India. Women in rural areas form one of the high-risk groups with respect to CMDs due to their compromised status of living. Objective The aim of the study was to estimate the prevalence of depression, anxiety, and stress, and the predictors to depression among women in rural Puducherry. Methods A community-based, cross-sectional study was performed in 2016, among women aged 18 to 59 years, residing in the rural area of Puducherry. Prevalence of CMDs was determined using the Depression Anxiety Stress Scale (DASS)-21. Using a systematic random sampling method, women were interviewed in their houses. The socio-demographic characteristics along with risk factors for depression were captured using a semi-structured proforma. A multivariable logistic regression model was used to determine the predictors of depression. Results A total of 301 women were surveyed and their mean age (SD) was 34.9 (10.2) years. The prevalence of depression, anxiety, and stress was found to be 15% (95% CI: 11.3–19.3), 10.6% (95% CI: 7.5–14.5), and 5% (95% CI: 3–8), respectively. Multivariable analysis identified that lesser education and living separately/divorced to be significant predictors for depression in these women. Conclusion About one in six adult women living in a rural area was found to be depressed, which is considerably high. This emphasizes the need for screening among women for common mental disorders in primary care settings, especially in rural areas so that early diagnoses happen and thus reduce the impact due to mental disability.
SS Kar and MM Reddy
Medknow
Background: Unconditional probability of dying because of four major non-communicable diseases (NCDs) between 30 and 70 years of age is the selected global indicator to measure the impact of NCD prevention and control programs. Objective: To calculate the unconditional probability of dying and age-specific mortality rate because of major NCDs in India from 2001 to 2013. Methods: This study used multiple data sources that are available in the public domain—Census 2001 and 2011, Sample Registration System, causes of death reports in 2001–03, 2004–06, and 2010–13. Unconditional probability of dying between ages 30 and 70 years during 2001, 2006, and 2013 was calculated by the formula suggested by the World Health Organization. Line graphs were used to depict time trends in age-specific mortality rates over the years in four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases). Results: The age-specific mortality rate because of four NCDs showed a decrease of 51 deaths per 100,000 population from 2001 to 2013. Of the four NCDs, age-specific mortality rate was highest in cardiovascular diseases (238.2/100,000 population) and least in diabetes mellitus (21.9/100,000 population); it was 76.3 and 58.2/100,000 population for cancer and chronic respiratory diseases, respectively. The probability of dying was very less and was almost the same from 30 to 44 years of life and increased steeply after that till 70 years of life; and it was more in males (24%) compared with females (17.4%). Conclusion: Although India has shown a decreasing trend in premature mortality because of NCDs in the past decade, the rate of decrease is not on par to achieve the global “25 × 25” target.
HarjotKaur Bajwa, Rohith Singareddy, MahendraM Reddy, KrishnamA Raju, SubramanyeshwarT Rao, and SenthilJ Rajappa
Medknow
Background: Esophageal cancer is the fourth most common cause of cancer-related deaths in India. In 2012, the CROSS trial evaluated the benefit of induction therapy using weekly carboplatin-paclitaxel with 41.4 Gy radiation versus surgery alone. Pathological complete response (pCR) rates were 28%. Overall survival was improved in the combined therapy arm. However, there is limited data regarding the outcomes of preoperative chemoradiation in Indian scenario. This study was conducted to determine the response to preoperative chemoradiation at a tertiary cancer center in India. Aims: Primary objective was to evaluate the rates of pCR. Secondary objective was to determine recurrence rate and patterns of recurrence. Materials and Methods: We retrospectively reviewed patients with locally advanced esophageal cancer and gastroesophageal junction treated from September 2013 to July 2015. Patients who received preoperative radiotherapy 41.4 Gy with chemotherapy (weekly paclitaxel-carboplatin or cisplatin-5 FU or cisplatin-capecitabine) were included in this study. Chi-square test and Fischer's exact test were used for analysis. Results: Fifty patients were included in the analysis (76% – squamous cell carcinoma [SCC] and 24% – adenocarcinomas [ACC]). About 60% patients received weekly paclitaxel-carboplatin (CROSS protocol), 32% cisplatin-5 FU, and 8% cisplatin-capecitabine. pCR rate was 39.6%. pCR rate was higher in SCC versus ACC (44.7% vs. 20%) and in paclitaxel-carboplatin than cisplatin-5FU or cisplatin-capecitabine (48.3% vs. 25% vs. 33.3%). At a median follow-up of 12 months, 38 patients were alive, 8 died, and 4 lost to follow-up. Of the 10 patients that recurred, 8 were distant recurrences. Conclusion: Our study results show favorable pCR rate after preoperative CRT with significant higher rate in SCC and patients receiving CROSS regimen. Majority of the recurrences were distant recurrences.
N Arvind, K Prabhakar, N Savitha, and M Mahendra
Journal of Pure and Applied Microbiology
Acute Febrile illnesses are caused by diverse microbial pathogens and are associated with significant morbidity and mortality. The methodical evaluation of area-specific etiologies of AFI helps in the rapid diagnosis, treatment and prevention and control strategies. To investigate the causes of AFI, their clinical spectrum and the seasonal trend through the year. A facility based prospective study was conducted in a tertiary care hospital in Kolar, Karnataka, South India; between January 2016 to December 2016. A total of 432 patients with AFI were enrolled and screened for specific etiological agents. The etiological agents were identified in 351 (81.25%) of AFI cases. The etiological agent could not be established in 81(18.75%) of cases. Dengue was the most common cause of AFI (52.1%) followed by Scrub typhus (9.02%), Leptospirosis (6.48%), Chikungunya (5.32 %), Enteric fever (4.16%), Malaria (3.93%) and Brucellosis (0.23%). The most common symptoms reported by enrolled patients included headache (93.1%), malaise (89.4%), joint pain (80%), chills (73.7%). In our study, AFI occurred most commonly during rainy and autumn seasons accounting for 272 (77.5%) cases. Laboratory based syndromic data of AFI can make clinicians vigilant regarding the potential pathogens in local area and further aid to establish the epidemiologic database of different etiologies.
Adhisakthi Rajalatchumi, ThanjavurS Ravikumar, Kaliaperumal Muruganandham, Mahalakshmy Thulasingam, Kalaiselvi Selvaraj, MahendraM Reddy, and Balachander Jayaraman
Medknow
Introduction: Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. Aim: The aim of the study was to assess the perceptions on patient safety culture among health-care providers (HCPs) at a public sector tertiary care hospital in South India. Settings and Design: A hospital-based cross-sectional study was conducted 1 year after patient safety initiatives were implemented. Materials and Methods: Participants were selected through proportionate stratified random sampling. The Hospital Survey on Patient Safety Culture was used to assess perception of patient safety culture. Responses were collected on a Likert scale and were categorized into four types as negative, neutral, positive response, and nonresponse. Statistical Analysis Used: The data were entered in EpiData Version 3.1 and analyzed using SPSS Version 17. “Composite positive response rate” for the various dimensions was calculated. Results: The overall response rate in the study was 91.6%. Average composite positive response rate was 58%, and it varied among different cadres of HCPs ranged from 53% to 61%. The dimensions “teamwork within the unit,” “organizational learning and continuous improvement,” and “supervisor or officer-in-charge expectations” showed highest positive responses (80.1%, 77.8%, and 71.5%, respectively). Conclusions: This survey conducted after implementation of patient safety drive showed that, in many dimensions, the patient safety culture has taken roots. The dimensions such as “hand-off and transitions,” “frequency of events reporting,” and “communication openness” had scope for further improvement.