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IntroductionAcute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients.MethodsWe searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis.ResultsPooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I2 = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I2 = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22).DiscussionDespite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698.

HIV self-testing (HIVST) plays a significant role in addressing the health care needs of high-risk populations, particularly men who have sex with men (MSM). The present systematic review and meta-analysis provide an assessment of the prevalence of HIVST among MSM within the last 5 years. Seven databases (PubMed, Web of Science, Cochrane, Scopus, EMBASE, ProQuest, and EBSCOhost) were searched systematically from January 1, 2018 to March 10, 2023. After an independent search and quality assessment, the pooled prevalence was calculated using a random-effects model. Eight relevant studies were finally included in our study from an initial pool of 288 articles identified through a systematic search. Our meta-analysis revealed that the pooled prevalence of HIVST among MSM is 8% (95% CI: 5%–14%). Significant heterogeneity was noticed among the studies, with an I 2 value of 99% and a 95% prediction interval of 3% to 11%. Geography emerged as a significant moderator of this heterogeneity ( p < .001). Specifically, studies from China reported a notably higher prevalence of 20% (15%–26%), while other countries reported a lower prevalence of 5% (3%–6%). A symmetrical Doi plot with a Luis–Furuya–Kanamori (LFK) index of −0.57 indicated no publication bias. HIVST has a low take-up among MSM globally. Factors leading to variation in HIVST need to be studied. The coordinated efforts of policymakers, health care providers, and affected communities are required in HIVST promotion.

Background: The National Noncommunicable Disease Program of India currently recommends population-based NCD screening (PBS) among people aged ≥30 years. The low turnaround for diagnosis confirmation is a consistent issue the program has faced since its launch. The current study assessed an expanded PBS (including people 18–29 years) and intensified (home-based) diagnosis confirmation strategy for hypertension (HT) and diabetes mellitus (DM) in a routine programmatic setting. Materials and Methods: This implementation research was conducted among all people aged ≥18 years in a rural health block in northern India. The eligible population was screened for HT and DM (using random blood sugar), and the screen positives were asked to visit a nearby public health facility (preferably) for diagnosis. An intensified home-based diagnosis confirmation was offered to screen positives who did not visit the health facility for diagnosis confirmation. Results: Of the 2004 participants screened, 1149 (57.3%) were female and 586 (28.2%) were aged 18–29 years. A total of 353 (20.2%) and 200 (10.9%) were found newly screened positive for HT and DM, respectively. The turnout rate for facility-based confirmation ranged from 69.6% to 91.2%. The prevalence of HT and DM in people aged 18–29 years and ≥30 years was 6.1% and 2.9% and 30.0% and 26.2%, respectively. The expanded screening and intensified home-based diagnosis confirmation strategies yielded an additional 12.8% HT and 24.1% DM among the total new cases detected. Conclusion: An expanded PBS and intensified diagnosis confirmation is feasible in a programmatic setting and has yielded additional new cases. Cost effectiveness of the above strategy must be assessed in future studies. Further, in-depth understanding of the risk perception, and potential cultural, social, and health system factors for improving the uptake of confirmatory tests is the need of the hour.

Background & aim: The monkeypox virus (MPXV), an Orthopoxvirus family member, is the zoonotic agent that causes mpox (formerly known as monkeypox). The ongoing mpox pandemic has caused cases across continents involving 110 countries. This study aimed to assess mpox knowledge and its determinants among healthcare personnel. Methods: This cross-sectional study was conducted from June 6 to June 25, 2022, among 17 Arab countries. The self-administered questionnaire consists of 53 questions assessing the knowledge about the monkeypox virus. Results: In total, 5874 medical students and clinical doctors from 17 Arab countries participated in this study. Only 13.8% (n = 812) of respondents have ever received information about mpox during their studies in medicine. The mean knowledge score was 13.84, and the median score was 15 (range 1–34). More than half (51.3%, n = 3012) have heard about mpox before. A low proportion of the participants had a good level of knowledge on mpox. Only 11.7% of respondents had correctly identified the natural host and the incubation period of mpox. More than half (58.9%) were aware of the signs and symptoms of mpox. Few respondents (28%) believed that mpox and smallpox have similar signs and symptoms. Specialist doctors had higher knowledge of mpox (AOR = 2.96, 95% CI = 2.24–3.92, p

Objectives During the coronavirus disease 2019 (COVID-19) pandemic, countries around the world framed specific laws and imposed varying degrees of lockdowns to ensure the maintenance of physical distancing. Understanding changes in temporal and spatial mobility patterns may provide insights into the dynamics of this infectious disease. Therefore, we assessed the efficacy of lockdown measures in 16 countries worldwide by analyzing the relationship between community mobility patterns and the doubling time of COVID-19. Methods We performed a retrospective record-based analysis of population-level data on the doubling time for COVID-19 and community mobility. The doubling time for COVID-19 was calculated based on the laboratory-confirmed cases reported daily over the study period (from February 15 to May 2, 2020). Principal component analysis (PCA) of six mobility pattern-related variables was conducted. To explain the magnitude of the effect of mobility on the doubling time, a finite linear distributed lag model was fitted. The k-means clustering approach was employed to identify countries with similar patterns in the significant co-efficient of the mobility index, with the optimal number of clusters derived using Elbow’s method. Results The countries analyzed had reduced mobility in commercial and social places. Reduced mobility had a significant and favorable association with the doubling time of COVID-19—specifically, the greater the mobility reduction, the longer the time taken for the COVID-19 cases to double. Conclusions COVID-19 lockdowns achieved the immediate objective of mobility reduction in countries with a high burden of cases.

Summary: Background: Mpox (formerly known as monkeypox) is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease epidemiology. Oral lesions among mpox cases have been poorly reported. Our aim was to estimate the overall prevalence of oral manifestations among patients with mpox globally. Methods: In this systematic review and meta-analysis, an extensive literature search in PubMed, Scopus, Web of Science, Embase, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessment of all published articles, conducted across the world, until Nov 15 2022 as per the PROSPERO registration protocol (CRD42022371249), was undertaken. Primary studies (case series, cross-sectional, retrospective, prospective designs) that reported the oral/oropharyngeal symptoms among laboratory-confirmed mpox cases were included. The characteristics of the study, information on the number of cases, and symptomatic status were extracted from the included studies. The quality of the included studies was assessed for bias. Random-effects meta-regression with DerSimonian & Laird estimator, and subgroup analyses were conducted using STATA (v17.0). The degree of funnel plot asymmetry was assessed using Egger's test when at least 10 estimates were available. The heterogeneity between studies was assessed using the I2 statistic. The primary outcome was the pooled prevalence of oral manifestations in the examined population. Findings: 19 studies were included with 4042 laboratory-confirmed patients with mpox for qualitative and quantitative synthesis. The pooled prevalence of oral manifestations in the investigated population was 36.75% (95% confidence interval [CI]: 23.77–50.65). Heterogeneity was found to be high in the current meta-analysis (I2 = 98.24%; p

Objectives Physical distancing is a control measure against coronavirus disease 2019 (COVID-19). Lockdowns are a strategy to enforce physical distancing in urban areas, but they are drastic measures. Therefore, we assessed the effectiveness of the lockdown measures taken in the world’s second-most populous country, India, by exploring their relationship with community mobility patterns and the doubling time of COVID-19. Methods We conducted a retrospective analysis based on community mobility patterns, the stringency index of lockdown measures, and the doubling time of COVID-19 cases in India between February 15 and April 26, 2020. Pearson correlation coefficients were calculated between the stringency index, community mobility patterns, and the doubling time of COVID-19 cases. Multiple linear regression was applied to predict the doubling time of COVID-19. Results Community mobility drastically fell after the lockdown was instituted. The doubling time of COVID-19 cases was negatively correlated with population mobility patterns in outdoor areas (r = −0.45 to −0.58). The stringency index and outdoor mobility patterns were also negatively correlated (r = −0.89 to −0.95). Population mobility patterns (R2 = 0.67) were found to predict the doubling time of COVID-19, and the model’s predictive power increased when the stringency index was also added (R2 = 0.73). Conclusions Lockdown measures could effectively ensure physical distancing and reduce short-term case spikes in India. Therefore, lockdown measures may be considered for tailored implementation on an intermittent basis, whenever COVID-19 cases are predicted to exceed the health care system’s capacity to manage.

Virtual conferences are environment-friendly alternatives to physical conferences. COVID-19 pandemic has increased the use of virtual conferences. However, they are not without their share of impact on the environment. We assessed the carbon emissions (CE) of a three day national public health conference with 1474 attendees held in virtual mode and the potential CE saved compared to the physical mode. The CE of the virtual conference were estimated to be 6.44 Metric Tonne (MT) carbon dioxide (CO 2 ) Equivalent (Eq). Potential CE that would have resulted from the physical mode of the conference were 355.85 MT CO 2 Eq which is 55 times higher than the virtual mode. The live video streaming of the proceedings was the highest contributor to the virtual conference’s overall CE (81.5%). A digitally sober conference would have emitted 1.27 MT CO 2 Eq, translating to a CE reduction of 80.3% from the estimated virtual conference emission. Academic conferences should strive to become carbon neutral by adopting the virtual mode of conferencing, and within that, digital sobriety should be the policy of action. Policies to motivate the adoption of virtual conferencing and digital sobriety need to be undertaken at the organizational and individual levels.

Understanding the demographic and clinical characteristics cases and deaths is essential for better clinical and public health management of coronavirus disease-2019 (COVID-19) in resource-limited settings. We analyzed the COVID-19 deaths reported from India, to describe the demographic and clinical characteristics and identify the factors associated with early hospital deaths (within one day of hospitalization) and survival duration. We conducted a record review of the publicly available data on COVID-19 deaths reported between January 30th and November 30th, 2020. After imputation for missing data, we calculated unadjusted and adjusted prevalence ratio, and regression coefficient for factors associated with early hospital death and survival duration. Of the 20,641 COVID-19 deaths analyzed, a) 14,684 (71.1%) were males; b) 10,134 (50.9%) were aged < 65 years; c) 9,722 (47.1%) treated at public hospitals and d) 5405 (27.1%) were early hospital deaths. Breathlessness was the most common presenting complaint. Diabetes (11,075,53.7%), hypertension (95,77,46.5%) and coronary artery disease (2,821,13.7%) were the common comorbidities. After adjustment, early hospital death was significantly higher among patients aged 10% of India's COVID-19 deaths, providing essential information regarding the COVID-19 epidemiology. The characteristics associated with early hospital death and survival duration among the COVID-19 fatalities may be deliberated as markers for prognosis and compared with survivors.

Background: The transition from secondary school to university is a critical period in student’s life which can influence their nutri- tional status impacting health in later life. The study conducted to assess changes in BMI after 8 months of admission among first year undergraduate students of a Medical College. Methodology: A descriptive longitudinal study was conducted among 150 MBBS students of a Government Medical College, New Delhi, during April-May 2018 in which their weight and height were measured at the time of admission and at 8 months of follow up. Results: There was significant decrease in mean BMI from the base- line (24.02 kg/m2) to follow-up (23.02 kg/m2) [t=-5.76,

Summary: Background: Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes. Methods: For this systematic review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence. Findings: Screening 2161 records retrieved 20 RCTs (56,381 participants). Intrapartum azithromycin may make little or no difference to neonatal mortality [5 RCTs, 44,436 participants; Risk Ratio (RR): 1.02, 95% CI 0.86–1.20, I2 = 0%, very low certainty], and maternal mortality [3 RCTs, 44,131 participants, RR: 1.26, 0.65–2.42, I2 = 0%, low certainty]. Similarly, antenatal azithromycin may have little or no effect on neonatal mortality [3 RCTs; 5304 participants; RR: 0.74, 0.35–1.56, I2 = 43%, very-low certainty] and maternal mortality [3 RCTs; 8167 participants RR: 1.62, 0.67–3.91, I2 = 0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance. Interpretation: Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality. Funding: None.

Background: Rheumatic heart disease/Rheumatic fever is a non – communicable disease being a major neglected health problem. Recurrent attacks of rheumatic fever can have catastrophic outcomes, therefore regular administration of antibiotics is recommended. During COVID 19 pandemic, people were afraid to approach hospitals hence the compliance and follow up of patients were affected. This study had planned to assess the treatment adherence of patients diagnosed with rheumatic fever/rheumatic heart disease during COVID 19 pandemic and to describe the socio demographic factors, clinical characteristics. This study also determines the factors associated with the treatment adherence. Methods: A cross sectional study was conducted among Rheumatic Fever/Rheumatic Heart Disease patients, attending Outpatient department at tertiary care hospital during COVID 19 pandemic. Mean score with confidence interval was calculated for quantitative data. P value less than 0.05 is significant. Results: The Mean (SD) age of the study participants was 41 ± 14.17 years. Treatment adherence was found to be 94.5 percent among Rheumatic Fever/Rheumatic Heart Disease patients during COVID 19 pandemic. 89.5% of injection benzathine penicillin users had an adherence rate above 80 percent. It was found that the presence of comorbidities (Diabetes/Hypertension/both Diabetes and Hypertension) had a statistically significant association with treatment adherence. Conclusions: Rheumatic Heart Disease is a disease of young and middle -age population affecting predominantly females. The overall adherence rate among Rheumatic Fever/Rheumatic Heart Disease patients was high. High time to maintain hospital-based registry to have follow up of patients.

Objectives Considering the rising menace of coronavirus disease 2019 (COVID-19), it is essential to explore the methods and resources that might predict the case numbers expected and identify the locations of outbreaks. Hence, we have done the following study to explore the potential use of Google Trends (GT) in predicting the COVID-19 outbreak in India. Methods The Google search terms used for the analysis were “coronavirus”, “COVID”, “COVID 19”, “corona”, and “virus”. GTs for these terms in Google Web, News, and YouTube, and the data on COVID-19 case numbers were obtained. Spearman correlation and lag correlation were used to determine the correlation between COVID-19 cases and the Google search terms. Results “Coronavirus” and “corona” were the terms most commonly used by Internet surfers in India. Correlation for the GTs of the search terms “coronavirus” and “corona” was high (r > 0.7) with the daily cumulative and new COVID-19 cases for a lag period ranging from 9 to 21 days. The maximum lag period for predicting COVID-19 cases was found to be with the News search for the term “coronavirus”, with 21 days, i.e., the search volume for “coronavirus” peaked 21 days before the peak number of cases reported by the disease surveillance system. Conclusions Our study revealed that GTs may predict outbreaks of COVID-19, 2 to 3 weeks earlier than the routine disease surveillance, in India. Google search data may be considered as a supplementary tool in COVID-19 monitoring and planning in India.

India is home to an estimated 57 million people (18% of the global estimate) affected by depression. We conducted a cross-sectional study to determine the prevalence of depression and associated factors among software professionals in Delhi National Capital Region, during 2017–2018 with a sample size of 310. Two-stage cluster sampling was used. A predesigned, pretested, semi-structured, English questionnaire was used. Patient Health Questionnaire 9, CAGE, CAGE Adapted to Include Drugs (CAGE-AID) questionnaire, Fagerstrom test for nicotine dependence questionnaire was used. Forty percent (124) of the participants were screened to have major depressive disorder. There was a statistically significant association between depression and marital status (P = 0.041), family type (P = 0.008), alcohol use (P < 0.001), substance use (P = 0.014), multiple roles in a project (P < 0.001), and shift of work (P < 0.008). Considering the high prevalence of depression, mental health screening program, sensitization, and promotion must be incorporated into the IT industry to prevent and detect depression early.

Background: A woman's satisfaction with childbirth services can have a significant impact on her mental health and ability to bond with her neonate. Indian women's satisfaction with childbirth services has been explored qualitatively, or by using nonstandard local questionnaires, but quantitative data gathered with standardized questionnaires are extremely limited Objective: The aim of this study is to assess the birth satisfaction level among women of South Delhi with institutional normal vaginal delivery and to determine the factors associated with it. Materials and Methods: A cross-sectional study was conducted among the 102 mothers attending the immunization clinics of a primary care and a tertiary care center in South Delhi during March 2018–April 2018. A prevalidated, semi-structured, Hindi version 36-item Scale, with 10 domains, Scale for Measuring Maternal Satisfaction in normal birth was used. Statistical Analysis: Pearson Chi-square, Mann–Whitney test, and Fisher's exact test were applied as tests of significance. Results: The median age in completed years of the respondents was 24 years (interquartile range = 5). Majority, 58 (61.1%), of the participants, were more satisfied. Bribes were asked from 61.1% of the mothers. Demanding bribes, perceived competence of healthcare providers by the mothers, and the motivation given by others were significantly associated with the individual domains of birth satisfaction such as postpartum care satisfaction and overall support received. No significant association between the sociodemographic, birth time events and overall birth satisfaction levels was obtained. Conclusion: About 38.9% less satisfied mothers and the domain-specific associated factors give the scope for the areas to be worked on to improve the quality of maternal and patient-centric services. Hospitals should publicly declare and implement zero tolerance for bribes in the care of mothers.