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Background: The burden of diabetic retinopathy (DR) in people attending the public health sector in India is unclear. Thirty percent of the population in India is reliant on public healthcare. This study aimed to estimate the prevalence of DR and its risk factors in people with diabetes in the non-communicable disease registers who were attending the family health centres (FHCs) in the Thiruvananthapuram district in Kerala. Methods: This cross-sectional study was conducted over 12 months in 2019 within the framework of a pilot district-wide teleophthalmology DR screening programme. The age- and gender-adjusted prevalence of any DR and sight-threatening DR (STDR) in the whole sample, considering socio-demography, lifestyle and known clinical risk groups, are reported. Results: A total of 4527 out of 5307 (85.3%) screened in the FHCs had gradable retinal images in at least one eye. The age and gender standardised prevalence for any DR was 17.4% (95% CI 15.1, 19.7), and STDR was 3.3% (95% CI 2.1, 4.5). Ages 41–70 years, males, longer diabetes duration, hyperglycaemia and hypertension, insulin users and lower socio-economic status were associated with both DR outcomes. Conclusions: The burden of DR and its risk factors in this study highlights the need to implement DR screening programs within primary care to reduce health inequality.

PURPOSE We examined in a longitudinal study the role of sodium selenite in sepsis patients in strengthening the immune performance in whole blood samples using immune functional assays. MATERIALS AND METHODS This was a sub-study from a randomized, double blinded multicenter clinical trial (SISPCT) registered with www.clinicaltrials.gov (NCT00832039) and with data collected at our center. Full blood samples were incubated with various recall antigens and the supernatants were measured for their cytokine concentrations as markers for immune response. Data from days 0, 4, 7, 14, and 21 (from sepsis onset) were analyzed using a generalized least squares model in R to appropriately take the longitudinal structure and the missing values into account. RESULTS From the 76 patients enrolled in the study at our center, 40 were randomized to selenium therapy and 36 to placebo. The analyses of immune response assay data showed no statistical difference between the selenium and placebo groups at each of the time points. There was however an overall dampening of cytokine release, which tended to recover over time in both groups. CONCLUSION Selenium has long been an adjuvant therapy in treating sepsis. Recently, it was proven to not have beneficial effects on the mortality outcome. Using data from our center in this sub-cohort study, we identified no relative improvement in cytokine release of stimulated blood immune cells ex vivo from patients with selenium therapy over a three-week period. This offers a potential explanation for the lack of beneficial effects of selenium in sepsis patients.

Introduction Using a type 2 hybrid effectiveness-implementation design, we aim to pilot a diabetic retinopathy (DR) care pathway in the public health system in Kerala to understand how it can be scaled up to and sustained in the whole state. Methods and analysis Currently, there is no systematic DR screening programme in Kerala. Our intervention is a teleophthalmology pathway for people with diabetes in the non-communicable disease registers in 16 family health centres. The planned implementation strategy of the pathway will be developed based on the discrete Expert Recommendations for Implementing Change taxonomy. We will use both quantitative data from a cross-sectional study and qualitative data obtained from structured interviews, surveys and group discussions with stakeholders to report the effectiveness of the DR care pathway and evaluation of the implementation strategy. We will use logistic regression models to assess crude associations DR and sight-threatening diabetic retinopathy and fractional polynomials to account for the form of continuous covariates to predict uptake of DR screening. The primary effectiveness outcome is the proportion of patients in the non-communicable disease register with diabetes screened for DR over 12 months. Other outcomes include cost-effectiveness, safety, efficiency, patient satisfaction, timeliness and equity. The outcomes of evaluation of the implementation strategies include acceptability, feasibility, adoption, appropriateness, fidelity, penetration, costs and sustainability. Addition of more family health centres during the staggered initial phase of the programme will be considered as a sign of acceptability and feasibility. In the long term, the state-wide adoption of the DR care pathway will be considered as a successful outcome of the Nayanamritham study. Ethics and dissemination The study was approved by Indian Medical Research Council (2018-0551) dated 13 March 2019. Study findings will be disseminated through scientific publications and the report will inform adoption of the DR care pathway by Kerala state in future. Trial registration number NCT28942696.

Smoking tobacco is one of the leading and preventable cause of death worldwide. Apart from the responsibility of the Governments and the Non-governmental organizations, it is the duty of every health care professional to promote the awareness about the hazards of tobacco usage to their patients. This study was aimed to assess the knowledge, attitude and practice of tobacco control measures by the selected group of health care professionals. A self administered e-questionnaire was send to 106 health care professionals including Physicians, Dentists and Physiotherapists to their personal email address. E-responses were collected during the study period between September to November, 2015.Responses were analysed. About 89.6% of the healthcare professionals felt strongly that smoking is bad for health. Eighty one percent of the participants responded that they do not use any form of tobacco and 98.1% of the respondents accepted that it is the duty of a health care professional to advise people against the ill effects of tobacco usage. Also 94.2% of them suggested updated topics on tobacco control programmes to be inducted into the curriculum of their respective area of health care profession. Even though the health care professionals were found doing their role in tobacco control measures, their suggestion to incorporate more informations on tobacco control into the curriculum is an urgent concern.

Introduction: Smoking tobacco is one of the leading and preventable cause of death worldwide. Apart from the responsibility of the Governments and the non-governmental organizations, it is the duty of every health care professional to promote the awareness about the hazards of tobacco usage to their patients. Objectives: This study was aimed to assess the knowledge, Attitude and practice of tobacco control measures by the selected group of health care professionals. Material and methods: A self administered e-questionnaire(30questions) was send to 106 health care professionals which includes Physicians, Dentists and Physiotherapists to their personal email address. E-responses were collected during the study period which extended between September to November, 2015.Proportions of the responses were analysed. Results: About 89.6% of the healthcare professionals felt strongly that smoking was bad for health. 80.5% responded that they do not use any form of tobacco and 98.1% of the respondents accepted that it is the duty of a Health care professional to advise people against ill effects of tobacco usage. Also 94.2% of them suggested updated topics on tobacco control programmes to be inducted into the curriculum of their respective area of health care profession. Conclusion: Health care professionals were found to do their role in tobacco control measures, however they request more informations on tobacco control be added onto the curriculum which enables them to read and practice more on these hazards of tobacco use.