High prevalence of MAFLD in general population: A large cross-sectional study calls for concerted public health action

BACKGROUND

Metabolic associated fatty liver disease (MAFLD) is a relatively new term with limited studies done in South Asian population.

AIM

To determine prevalence and clinico-epidemiological characteristics of MAFLD in general population.

METHODS

A cross-sectional study was conducted in randomly selected regions across Delhi, India. Data were collected on socio-demographic particulars, health status and lifestyle factors. Anthropometric measurements, transient elastography, and laboratory investigations were carried out.

RESULTS

Altogether 6146 participants (mean age: 43.1 ± 13.9 years, 48.1% males) were included. The prevalence of MAFLD was 56.4% (n = 3468), of which lean MAFLD constituted 11.3%. Higher age (OR: 2.47; 95% CI: 2.21-2.76), low education level (OR: 1.23; 95% CI: 1.09-1.39), upper socio-economic class (OR: 1.32; 95% CI: 1.17-1.49), and low physical activity (OR: 1.15; 95% CI: 1.03-1.28) were more common in MAFLD. The association of female sex with MAFLD differed in age groups <40 years (OR: 0.64 and 95% CI: 0.55-0.75) and >40 years (OR: 1.40 and 95% CI: 1.22-1.62) in both magnitude and direction (p < 0.001). Liver fibrosis was present in 23% of the study population (32.2% among MAFLD group). Advanced liver fibrosis was three times more common in MAFLD group (6.2% vs 1.8%, p < 0.001). Obesity and fibrosis had a statistically significant relationship and 75.8% of the individuals with advanced stages of fibrosis had obesity.

CONCLUSION

Nearly half of study population was found to have MAFLD. Advanced hepatic fibrosis was three times more common in these subjects. Aggressive public health measures are urgently required to raise awareness and introduce interventional strategies.

The contribution of EUS to the management of endoscopic and surgical complications

Endoscopic Ultrasound (EUS) stands as a remarkable innovation in the realm of gastroenterology and its allied disciplines. EUS has evolved to such an extent that it now assumes a pivotal role in both diagnosis and therapeutics. In addition, it has developed as a tool which is also capable of addressing complications arising from endoscopic and surgical procedures. This minimally invasive technique combines endoscopy with high-frequency ultrasound, facilitating, high-resolution images of the gastrointestinal tract and adjacent structures. Complications within the gastrointestinal tract, whether stemming from endoscopic or surgical procedures, frequently arise due to disruption in the integrity of the gastrointestinal tract wall. While these complications are usually promptly detected, there are instances where their onset is delayed. EUS plays a dual role in the management of these complications. Firstly, in its ability to assess and increasingly to definitively manage complications through drainage procedures. It is increasingly employed to manage post-surgical collections, abscesses biliary strictures and bleeding. Its high-resolution imaging capability allows precise real-time visualisation of these complications.

Knowledge Dissemination for elimination Role of Academic Institutions in Eliminating Viral Hepatitis

INTRODUCTION

India is looking to achieve hepatitis elimination status by 2030 through vaccination, diagnostic tests, medicines, and education campaigns. Awareness generation is essential to orient people regarding hepatitis B and C. The present study was done to assess the knowledge regarding hepatitis among students and staff of academic institutions and raise awareness through a series of webinars.

MATERIALS AND METHODS

A cross-sectional study was conducted in 12 academic institutes from across the country between February and March 2022. The study included the dissemination of knowledge in the form of a webinar and the administration of a pre and postwebinar survey to assess the difference in the knowledge levels.

RESULTS

A total of 914 individuals participated in the sessions. The mean baseline score for general epidemiology (max = 13 points), treatment and complications (max = 7 points), and prevention (max = 5 points) were 10.9 ± 2.1, 4.6 ± 1.3, and 3.2 ± 1.3, respectively. Overall, the mean score increased from 18.5 ± 3.6 to 20.4 ± 3.4 postwebinar, with an increase of +7.3%.

CONCLUSION

The study observed significant improvement in knowledge among the participants following a low-cost 1-day training in webinar mode. Such training programs can be upscaled and help in educating the general public on hepatitis.

An Evaluation of Malaria Surveillance System in Punjab, India, 2020

Background

India accounted for 6% of global burden of malaria with 95% population residing in malaria endemic areas. However, Punjab is in the malaria elimination phase with annual parasite incidence (API) <1/1000 population.

Objectives

We evaluated malaria surveillance system in Punjab using CDC's updated guidelines for evaluating public health surveillance systems to provide recommendations for strengthening the existing system and to overcome the challenges in the path of malaria free Punjab.

Methods

We chose two districts of Punjab, Amritsar (lowest API) and Mansa (highest API), interviewed stakeholders, and performed a retrospective desk review. We evaluated the overall usefulness of the system and assessed seven attributes at state, district, health facility, and village level during July-August 2020.

Results

In Punjab, there was progressive decline in the malaria cases from 2,955 cases in 2009 to 1,140 in 2019 and no malaria deaths since 2011. Regarding various attributes, overall score for flexibility was good (85.9%); average for simplicity (77%), acceptability (74%), data quality (74%), and timeliness (70%); and poor for representativeness (59%) and stability (57%).

Conclusions

Malaria surveillance system was useful in analyzing the trends of morbidity and mortality and for generating data to drive policy decisions. To improve stability, representativeness, and acceptability, surveillance staff should not be engaged in supplemental work, and reports from private sector must be ensured. Supportive supervision and regular trainings should be carried out regarding reporting formats, guidelines, and timely epidemiological investigations to improve timeliness, data quality, and simplicity.

Evaluation of Scrub Typhus Surveillance, Alwar District, Rajasthan, India, July-August 2020

Introduction

Scrub typhus is one of the most underreported and fatal illnesses accounting for 23% of all febrile illness. Rajasthan reported cases during 2018-2019 in state reporting system but did not report any case to central Integrated Disease Surveillance Programme (IDSP) unit. We evaluated the Scrub typhus surveillance system in Alwar district, Rajasthan, with the objective of describing and evaluating the system and providing evidence-based recommendations to identify gaps.

Material and Methods

In cross-sectional study, we reviewed records and conducted key informant interviews at district- and block-level health facilities. Using US Centers for Disease Control guidelines, we evaluated the system by framing indicators for selected attributes for a defined reference period. Overall performance was ranked as outstanding (90-100%), excellent (80-89%), very good (70-79%), good (60-69%), and poor (<60%).

Results

Line list of confirmed cases was sent from district to block level for additional active case search (ACS) to implement control measures. We conducted 26 key informant interviews and reviewed records and calculated simplicity as 79%, flexibility 100%, data quality 46%, acceptability 92%, representativeness 48%, timeliness 43%, and stability 79%.

Conclusions

Epidemiological surveillance (active and passive) is a core intervention under scrub typhus surveillance system. Lab reports were incompletely uploaded on IDSP portal. Surveillance reports should be updated after each ACS. Reporting format under IDSP should be uploaded timely, and lab reports from state should be sent within 48 hours of diagnosis so that case investigation is not delayed.

Experience of setting up of Control room for COVID-19 at NCDC, New Delhi

Significant public health events of the 21^st century include epidemic prone diseases such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza A (H1N1), Ebola virus disease, and coronavirus (SARS-COV-2). Preparedness as well as risk mitigation strategies play an integral role for the success of responses to such health emergencies. An extraordinary cluster of cases of respiratory disease of unknown cause triggered a series of events that constituted a public health risk across the globe through international spread from China and was declared a Public Health Emergency of International Concern (PHEIC) on 30 January, 2020 by the World Health Organization (WHO). To monitor implementation of activities in order to contain the local transmission of COVID-2019 in India, a control room was established at the National Centre for Disease Control (NCDC), New Delhi on 23^rd January, 2020 under the Integrated Disease Surveillance Project (IDSP). The main objectives of the control room were to alleviate the concerns and address queries of passengers arriving from the affected countries and also to provide the general public information regarding the measures to be taken as well as the contact details of the respected district health authorities for further necessary action. A total of 183 hunting lines were established at the NCDC, Noida, TB Centre, and the National Health Authority (NHA) Hyderabad and Bengaluru by March 2020. A total of 79,013 calls, 1,04,779 emails, and 1,787 international calls were received w.e.f. 23 January to 30 March, 2020 at the NCDC control room. The NHA Bengaluru and Hyderabad Control room received 3,52,176 calls w.e.f. 15 March to 30 March and TB Noida control room received 55,018 calls w.e.f. 16 March to 30 March, 2020. This prompt action of the center to set up a control room at the NCDC gave the states enough grace period to train their staff and start their individual help lines for addressing people's queries and allay fears.

Antibiotic-resistant Enterobacteriaceae in healthy gut flora: A report from north Indian semiurban community

Background & objectives

Rampant use of β-lactam antibiotics in both community and hospitals has transformed the human healthy intestinal gut flora into a reservoir of antibiotic-resistant organisms. This study was conducted to find the faecal presence of antibiotic-resistant Enterobacteriaceae in faecal samples in the community in north India.

Methods

In this prospective study, 207 stool samples were collected from apparently healthy individuals residing in a semiurban community in Chandigarh, India, from August to October, 2015. Isolates belonging to family Enterobacteriaceae were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and antibiotic susceptibility was determined using Clinical Laboratory Standard Institute disc diffusion method. Detection of extended spectrum β-lactamases (TEM, SHV, OXA-1, CTXM 1, CTXM 2, CTXM 9 and CTXM 8/25), carbapenemases (IMP, VIM and KPC) and New Delhi metallo-β-lactamase was done by multiplex PCR.

Results

Of the population studied, 55.5 per cent were females and 60 per cent were illiterate or had only primary education; 43.4 per cent individuals were aged <20 yr. Overall, 70.5 per cent of stool samples had antibiotic-resistant isolates. Maximum resistance was seen for cephalosporins (60.4%) followed by fluoroquinolones (41.5%). The multidrug-resistant (MDR) isolates were 2.4 per cent. The most commonly detected genes were TEM, SHV, OXA-1, CTXM-1, CTXM-2, CTXM-9 and CTXM-8/25 β-lactamases. Escherichia coli was the most common resistant isolate, and TEM was the most common gene detected.

Interpretation & conclusions

Overall, 70.5 per cent members of Enterobacteriaceae had antibiotic resistance in the community and 2.4 per cent were MDR. Higher resistance rates were observed for most commonly used drugs such as cephalosporins and fluoroquinolones. High rate of antibiotic-resistant Enterobacteriaceae in gut of healthy individuals points towards the need for active screening and prevention of dissemination.

A review on peptide functionalized graphene derivatives as nanotools for biosensing

Peptides exhibit unique binding behavior with graphene and its derivatives by forming bonds on its edges and planes. This makes them useful for sensing and imaging applications. This review with (155 refs.) summarizes the advances made in the last decade in the field of peptide-GO bioconjugation, and the use of these conjugates in analytical sciences and imaging. The introduction emphasizes the need for understanding the biotic-abiotic interactions in order to construct controllable peptide-functionalized graphitic material-based nanotools. The next section covers covalent and non-covalent interactions between peptide and oxidized graphene derivatives along with a discussion of the adsorption events during interfacing. We then describe applications of peptide-graphene conjugates in bioassays, with subsections on (a) detection of cancer cells, (b) monitoring protease activity, (c) determination of environmental pollutants and (d) determination of pathogenic microorganisms. The concluding section describes the current status of peptide functionalized graphitic bioconjugates and addresses future perspectives. Graphical abstractSchematic representation depicting biosensing applications of peptide functionalized graphene oxide.

“Risk approach strategy” in diabetics on fasting-evidence base through narrative review with a special focus on Ramadan fasting

The past two decades have seen a rise in the number of investigations examining the health-related effects of religiously motivated fasts. The fact that fasting is a common religious practice observed not only among Muslims, but among many other religious communities as well underlie a long felt need for drafting recommendations on fasting in diabetic patients as there are no substantial guidelines for the same. An extensive review of the work involving studies across populations in India and other nations across the world was conducted, with the aim to arrive at some broad consensus highlighting on the need for developing strict guidelines for patients with diabetes during fasting, before fasting and afterwards.

The need of Palliative care model in cancer patients in India-A long overdue

WHO defined palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.” (1) The concept of palliative care was introduced in the mid-1980s in India. McDermott E et al found Kerala to have 83 palliative care services as against 139 in the whole of the country in 2008.  (2) The community palliative care projects of northern Kerala and the Neighborhood Network in Palliative Care (NNPC) is a solution to achieve meaningful coverage and care for the terminally ill. They demonstrate the way to "Palliative Care for All". (3)

Validity of Madras Diabetes Research Foundation: Indian Diabetes Risk Score for Screening of Diabetes Mellitus among Adult Population of Urban Field Practice Area, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

INTRODUCTION

IDRS is based on four simple parameters derived from known risk factors for diabetes; two modifiable risk factors (waist circumference and physical inactivity) and two non-modifiable risk factors (age and family history of diabetes), which may be amenable to intervention. The present study has been planned as the region specific validation is important before it can be used for screening in this part of the country.

AIMS

The aim of the present study was to validate MDRF-IDRS for screening of diabetes mellitus among adult population of urban field practice area, IGMC, Shimla, Himachal Pradesh, India.

METHODS

The present community based cross sectional study was conducted among 417 adults fulfilling the eligibility criteria using a two stage sampling design.

RESULTS

In the present study IDRS value ≥70 had an optimum sensitivity of 61.33% and specificity of 56.14% for detecting undiagnosed type 2 diabetes in the community. At an IDRS score of ≥70, the PPV was 23.47%, NPV as 86.88%, the diagnostic accuracy as 57.07%, LR for positive test as 1.398, LR for negative test as 0.69 and Youden's index as 0.17. However Youden's index was 0.19 at a cut of ≥60 i.e. higher than what was at ≥70. Higher IDRS scores increased the specificity but the sensitivity dramatically decreased. Conversely, lower IDRS values increased the sensitivity but the specificity drastically decreased. Area under the curve = 0.630 and a P value < 0.001.

CONCLUSIONS

MDRF IDRS is user friendly screening tool but the criteria of including the parameter of physical activity for the calculation of the risk score needs to be clearly defined. In the present study the maximum sensitivity of 100% was seen at a cut off of ≥30. Hence we would recommend that all those in the medium and high risk group should be screened for type 2 Diabetes.

Community health orientation of Indian Journal of Endocrinology and Metabolism: A bibliometric analysis of Indian Journal of Endocrinology and Metabolism

BACKGROUND

Endocrine and metabolic diseases especially diabetes have become focus areas for public health professionals. Indian Journal of Endocrinology and Metabolism (IJEM), a publication of Endocrine Society of India, is a peer-reviewed online journal, which covers technical and clinical studies related to health, ethical and social issues in field of diabetes, endocrinology and metabolism. This bibliometric analysis assesses the journal from a community health perspective.

MATERIALS AND METHODS

Every article published in IJEM over a period of 4 years (2011-2014) was accessed to review coverage of community health in the field of endocrinology.

RESULTS

Seven editorials, 30 review articles, 41 original articles, 12 brief communications, 20 letter to editors, 4 articles on guidelines and 2 in the section "endocrinology and gender" directly or indirectly dealt with community health aspects of endocrinology. Together these amounted to 17% of all articles published through these 4 years. There were 14 articles on general, 60 pertaining to pancreas and diabetes, 10 on thyroid, 7 on pituitary/adrenal/gonads, 21 on obesity and metabolism and 4 on parathyroid and bone; all community medicine related.

CONCLUSION

Community health is an integral part of the modern endocrinology diabetology and metabolism practice and it received adequate journal space during the last 4 years. The coverage is broad based involving all the major endocrine disorders.