044948   AHUJA V, THAPA D, PATIAL S, CHANDER A, AHUJA A (Anaesthesia and Intensive Care Dep, Government Medical Coll and Hospital, Chandigarh, Email: vanitaanupam@gmail.com) : Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol 2020, 36(4), 450-7.

Chronic hip pain is distressing to the patient as it not only impairs the daily activities of life but also affects the quality of life. Chronic hip pain is difficult to diagnose as patients often present with associated chronic lumbar spine and/or knee joint pain. Moreover, nonorthopaedic causes may also present as chronic hip pain. The accurate diagnosis of chronic hip pain starts with a detailed history of the patient and thorough knowledge of anatomy of the hip joint. Various physical tests are performed to look for the causes of hip pain and investigations to confirm the diagnosis. Management of chronic hip pain should be mechanistic‑based multimodal therapy targeting the pain pathway. This narrative review will describe relevant anatomy, causes, assessment, investigation, and management of chronic hip pain. The focus will be on current evidence‑based management of hip osteoarthritis, greater trochanteric pain syndrome, meralgia paresthetica, and piriformis syndrome. Recently, there is emphasis on the role of ultrasound in interventional pain procedures. The use of fluoroscopic‑guided radiofrequency in periarticular branches of hip joint has reported to provide pain relief of up to 36 months. However, the current evidence for use of platelet‑rich plasma in chronic hip osteoarthritis pain is inconclusive. Further research is required in the management of chronic hip pain regarding comparison of fluoroscopic‑ and ultrasound‑guided procedures, role of platelet‑rich plasma, and radiofrequency procedures with long‑term follow‑up of patients.

4 illus, 3 tables, 54 ref

044947   CHILKOTI G T, JAIN N, MOHTA M, SAXENA A K (Anesthesiology and Critical Care Dep, Guru Teg Bahadur Hospital, Ghaziabad? 201 014, Uttar Pradesh, Email: geetanjalidr@yahoo.co.in) : Perioperative concerns in Pott’s spine: A review. J Anaesthesiol Clin Pharmacol 2020, 36(4), 443-9.

Pott’s disease is the most common granulomatous spine infection caused by tubercle bacilli and is a common site of osseous tuberculosis, accounting for 50–60 % of cases. The delay in establishing diagnosis and management results in complications such as spinal cord compression and spinal deformity. The aim of this narrative review is to discuss the perioperative concerns in patients for spine surgery. The literature source for this review was obtained via PubMed, Medline, Google Scholar, Cochrane database of systematic reviews, and textbooks until December 2019. On the literature search, we could not retrieve any review article specifically discussing the perioperative concerns of spinal tuberculosis. Therefore, the aim of the present narrative review is to discuss the perioperative concerns of patients for spine surgery along with the specific concerns related to spinal tuberculosis.

1 table, 76 ref

044946   MAHAJAN R K, PAUL G, MAHAJAN R, GAUTAM P L, PAUL B (Critical Care Medicine Dep, Dayanand Medical Coll and Hospital, Ludhiana, Punjab, Email: gunchan@gmail.com) : Systemic manifestations of COVID‑19. J Anaesthesiol Clin Pharmacol 2020, 36(4), 435-42.

Coronavirus disease 2019 (COVID‑19), caused due to a novel coronavirus SARS‑CoV‑2, has swept across the planet and has become a public health emergency of international concern. Like other coronaviruses, it predominantly involves the respiratory system. However, several atypical manifestations of the disease have been reported worldwide in a short span of time. Almost all organ systems (cardiovascular, gastrointestinal, renal, hepatic, endocrine, and nervous system) have been reported to be involved. This review concisely summarizes the systemic effects of COVID‑19, thus emphasizing that the disease can present in various forms and the healthcare workers need to be extra vigilant, approaching all patients with a high index of suspicion.

1 illus, 74 ref

044945   MADANGOPAL R M, DANG A, AGGARWAL M, KUMAR J (Anaesthesiology and Critical Care Dep, NDMC Medical Coll and Associated Hindu?Rao Hospital, Delhi- 110 001, Email: dradang007@gmail.com) : A comparative evaluation of different doses of dexmedetomidine as an adjuvant to bupivacaine in transversus abdominis plane block for postoperative analgesia in unilateral inguinal hernioplasty. J Anaesthesiol Clin Pharmacol 2020, 36(3), 398-406.

The present study is designed to evaluate addition of two different doses of dexmedetomidine (0.25 mcg/kg and 0.5 mcg/kg) as an adjuvant to bupivacaine in transversus abdominis plane block for post‑operative analgesia in patients undergoing unilateral inguinal hernioplasty.  A total of 90 patients scheduled to undergo elective unilateral open inguinal hernioplasty were divided into three groups in a randomized triple blind way. In group B (n = 30), patients received TAP block using 22 ml of solution, consisting of 20 ml of 0.25 % bupivacaine and 2 ml of normal saline; in group BD1 (n = 30), patients received TAP block using 22 ml of solution, consisting of 20 ml of 0.25 % bupivacaine and dexmedetomidine 0.25 mcg/kg dissolved in 2 ml of normal saline; while in group BD2 (n = 30), patients received TAP block using 22 ml of solution, consisting of 20 ml of 0.25 % bupivacaine and dexmedetomidine 0.5 mcg/kg dissolved in 2 ml of normal saline. Time to first analgesia was significantly prolonged in group BD2 (874.48 ± 118.28 minutes) as compared to BD1 (536.5 ± 60.35 minutes) and B (341.5 ± 46.22 minutes) (P < 0.0001). Total consumption of diclofenac was also reduced in BD2 (80.17 ± 19.34 mg) as compared with B (150 ± 0 mg) and BD1 (147.5 ± 13.69 mg) (P < 0.001). Patients in dexmedetomidine group were more sedated at 1‑hour (P < 0.05). None of our patients required any intervention for hemodynamic changes which were significantly more in dexmedetomidine group. Dexmedetomidine in a dose of 0.5 mcg/kg is better than dose of 0.25 mcg/kg as an adjuvant to 0.25 % bupivacaine in transversus abdominis plane block for post‑operative pain relief in unilateral inguinal hernioplasty. However, it causes mores sedation and hemodynamic changes.

4 illus, 8 tables, 21 ref

044944   RAJASEKHAR M, YADAV M, KULKARNI D, GOPINATH R (Anaesthesiology and Critical Care Dep, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, Email: monubalbir@yahoo.co.in) : Comparison of hemodynamic responses to laryngoscopy and intubation using Macintosh or McCoy or C‑MAC laryngoscope during uniform depth of anesthesia monitored by entropy. J Anaesthesiol Clin Pharmacol 2020, 36(3), 391-7.

Laryngoscopy forms an important part of general anesthesia and endotracheal intubation. The aim of the present study was to compare the hemodynamic responses to Laryngoscopy and Intubation using Macintosh or McCoy or C‑MAC Laryngoscope with M‑Entropy module monitoring to ensure uniform and adequate depth of anesthesia, during and after intubation. A prospective, randomised, comparative study was done and patients included were of 18 to 60 years, ASA (American Society of Anesthesiologist) physical status I and II of both sexes undergoing elective surgery under general anesthesia. They were assigned to three groups using simple randomisation, after securing IV (intravenous) access, standard monitoring and Entropy leads were attached. General anesthesia was administered with glycopyrrolate 0.1 mg, fentanyl 2 ug/ kg and intravenous thiopentone, 4 mg/kg. Adequate muscle relaxation was achieved with atracurium 0.6 mg/kg IV. By titrating isoflurane concentration, Entropy maintained between 40 and 60, orotracheal intubation done, with Macintosh or McCoy or C‑MAC blades according to simple randomisation. Size of laryngoscope blade, time taken for laryngoscopy and intubation were noted. Heart rate, blood pressure, RE (Response Entropy) and SE (State Entropy) were noted before and during induction and laryngoscopy and post intubation up to 5 minutes. Statistical analysis done using NCSS 9 version 9.0.8 statistical software. Hemodynamic responses during laryngoscopy and intubation using Macintosh or McCoy or C‑MAC laryngoscope were statistically insignificant (p > 0.05) between the three groups, provided the depth of anesthesia is maintained constant. It is the depth of anesthesia that decides the magnitude of hemodynamic responses and not the choice of laryngoscope.

5 illus, 2 tables, 20 ref

044943   PONDE V C, CHAVAN D N, DESAI A P, GURSALE A A, BEDEKAR V V, PURANIK K A (Anaesthesia Dep, Children Anaesthesia Services, Mumbai- 400 050, Maharashtra, Email: vrushaliponde@yahoo.co.in) : Avoidance of deep anesthesia and artificial airways in 1000 neonates and infants using regional anesthesia: A retrospective observational analysis. J Anaesthesiol Clin Pharmacol 2020, 36(3), 386-90.

Current concerns related to the anesthetic neurotoxicity have brought a renewed interest in regional anesthesia. Regional anesthesia reduces the need for opioids and inhalational anesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of anesthesia, which minimizes the exposure to general anesthetics and reduces airway instrumentation because the operability is rendered by the regional block. This was a retrospective case series of neonates and infants undergoing common surface surgeries. We describe our technique of anesthesia where regional blocks are the mainstay. We also put up the data pertaining to block effectiveness, technique, end‑tidal sevoflurane concentration and complications. One thousand patients, including neonates and infants, received central and peripheral nerve blockade. The failure rate in upper extremity blocks 0 % without complications. 86.12 % were given under ultrasonography (USG) guidance and 13.89 % were given with peripheral nerve stimulation. The failure rate of sciatic block single shot and continuous was 0 %. 92.53% were given with USG guidance while 7.46 % received sciatic with nerve stimulation technique. Failure rate of caudal epidural block was 0. 78 % requiring a rescue analgesic, 1.4 % had blood in the needle. Out of the caudals, 33.33 % were done with USG guidance and 66.67 % blocks were given with traditional techniques. Out of the 322 penile + ring blocks given by traditional method, 1 block failed requiring rescue analgesics. The mean sevoflurane concentration was 1.2 +/‑ 0.32.  It is feasible to conduct surface surgeries in the most vulnerable population such as neonates and infants under regional anesthesia without intubation and airway instrumentation.

1 illus, 4 tables, 15 ref

044942   SHARMA A, VARGHESE N, VENKATESWARAN R (Anaesthesiology Dep, Kasturba Medical Coll, Manipal, Karnataka, Email: nitavarghese@gmail.com) : Effect of intrathecal dexmedetomidine versus intravenous dexmedetomidine on subarachnoid anesthesia with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol 2020, 36(3), 381-5.

Alpha‑2 agonists such as dexmedetomidine when given intravenously or intrathecally as an adjuvant potentiate subarachnoid anesthesia. We studied the difference in subarachnoid anesthesia when supplemented with either intrathecal or intravenous dexmedetomidine.  Seventy‑five patients posted for lower limb and infraumbilical procedures were enrolled for a prospective, randomized, double‑blind, placebo‑controlled study and divided into three groups: Group B (n = 25) received intravenous 20 mL 0.9 % NaCl over 10 min followed by intrathecal 2.4 mL 0.5 % bupivacaine + 0.2 mL sterile water; Group BDexIT (n = 25) received intravenous 20 mL 0.9 % NaCl over 10 min followed by intrathecal 2.4 mL 0.5 % bupivacaine + 0.2 mL (5 µg) dexmedetomidine; Group BDexIV (n = 25) received intravenous dexmedetomidine 1 µg/kg in 20 mL 0.9 % NaCl over 10 min followed by intrathecal 2.4 mL 0.5 % bupivacaine + 0.2 mL sterile water. Onset and recovery from motor and sensory blockade, and sedation score were recorded. Onset of sensory and motor blockade was assessed using Kruskal–Wallis test, whereas 2‑segment regression and recovery was analyzed using ANOVA and post hoc Tukey’s test to determine difference between the three groups. P value Group BDexIV > Group B (P < 0.001). Patients in Group BDexIT and Group BDexIV were sedated but easily arousable.  Intrathecal dexmedetomidine prolongs the effect of subarachnoid anesthesia with arousable sedation when compared with intravenous dexmedetomidine.

4 tables, 24 ref

044941   JOSEPH B, ZACHARIAH S K, ABRAHAM S P (Anaesthesia Dep, MOSC Medical Coll, Kolenchery, Kerala, Email: sunutg97@yahoo.co.in) : The comparison of effects of fentanyl and dexmedetomidine as adjuvants to ropivacaine for ultrasound‑guided transversus abdominis plane block for postoperative pain in cesarean section under spinal anesthesia –A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2020, 36(3), 377-80.

Transversus abdominis plane (TAP) block has been effectively used for anterior abdominal wall analgesia. The aim of the study was to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to ropivacaine in TAP block under ultrasound‑guidance after lower segment cesarean section in a randomized controlled trial. Sixty‑four women of American Society of Anaesthesiologists (ASA) physical status II coming for cesarean sections were randomized to receive TAP blocks on each side of the abdomen using the local anesthetic drug 20 ml of 0.5 % ropivacaine with either fentanyl 25 mcg or dexmedetomidine 25 mcg. A ten point numerical pain score was done at baseline, at 1 h and then at intervals of 4 h postoperatively. The hemodynamic parameters such as heart rate, blood pressure, and pulse oximetry were also monitored as above. The time to first analgesia demand from the time of the block and the total analgesic consumption were recorded. The statistical analysis was done by Mann‑Whitney U test and the analgesics consumption by using Chi‑square test with R software. Our primary end‑point was to assess the duration of analgesia produced by fentanyl added to ropivacaine for ultrasound‑guided TAP block, which were 125 min with Q1–Q3 as 110–180 and dexmedetomidine 130 min with Q1–Q3 as 105–161 (P value = 0.47). The amount of analgesics used in the postoperative period in both the groups were analyzed using the Chi‑square test not found to have any significant difference between both the groups (P‑value = 0.512).  Fentanyl and dexmedetomidine as adjuvants to ropivacaine in ultrasound‑guided TAP block were equally effective in both prolongation of analgesia and reducing the total consumption of analgesics.

2 tables, 10 ref

044940   JINDAL S, SIDHU G K, BARYHA G K, SINGH B, KUMARI S, MAHAJAN R (Anaesthesia and Intensive Care Dep, Guru Gobind Singh Medical Coll and Hospital, Faridkot, Email: sugarsidhu2007@outlook.com) : Comparison of efficacy of thoracic paravertebral block with oblique subcostal transversus abdominis plane block in open cholecystectomy. J Anaesthesiol Clin Pharmacol 2020, 36(3), 371-6.

Sensory afferent nerve branches of lower six thoracic and upper lumbar nerves innervate the anterior abdominal wall and are the therapeutic focus of local anesthetics to provide analgesia for the abdominal surgical incision. Central neuraxial and regional analgesia can provide better control of pain due to right subcostal incision used in open cholecystectomy and attenuate the need for opioids. The earlier studies which showed the benefit of the thoracic paravertebral block (TPVB) for analgesia after upper abdominal surgeries did not compare TPVB with oblique subcostal transversus abdominis plane (OSTAP) block. Therefore, the current study compares the analgesic efficacy of TPVB and OSTAP block in open cholecystectomy. Seventy consenting adults scheduled for open cholecystectomy were allocated to one of the two groups: ultrasound‑guided TPVB (Group I) and ultrasound‑guided OSTAP block (Group II). The primary objective of this study is to assess and compare tramadol consumption in 48 h in both the groups along with VAS in post anesthesia care unit, and then at 2, 4, 6, 8, 12, 24, and 48 h. The secondary objective of the study is to assess the incidence of PONV.  The number of doses of rescue analgesia required was less in Group I when compared with Group II (P < 0.001). Patients in Group I had significantly lower pain scores than Group II. Although in the initial 8 h, both groups had comparable pain scores, after 8 h, these scores were significantly lower in patients in Group I. Less postoperative nausea and vomiting was seen in Group I patients (11.7 %) in comparison to Group II (18.1 %). Ultrasound‑guided TPVB is superior to OSTAP block because of its association with decreased postoperative opioid consumption, lower VAS score, and reduction in opioid‑related side effects. Thus, it should be strongly considered as a part of multimodal analgesia regimen in upper abdominal surgeries.

3 illus, 2 tables, 28 ref

044939   BAKHET W Z, WAHBA H A, FIKY L M E, DEBIS H (Anesthesia and Otolaryngology Dep, Ain Shams Univ, Cairo, Egypt, Email: Wahba_zak@hotmail.com) : Preemptive local anesthetic infiltration reduces opioid requirements without attenuation of the intraoperative electrical stapedial reflex threshold in pediatric cochlear implant surgery. J Anaesthesiol Clin Pharmacol 2020, 36(3), 366-70.

Total intravenous anesthesia using remifentanil provides good surgical condition without affecting the intraoperative electrical stapedial reflex threshold (ESRT). However, remifentanil results in hyperalgesia and increases postoperative opioid requirements. Local anesthetic infiltration is alternative methods to opioid for providing analgesia. However, otologists avoids its use as it can abolish the ESRT. We investigated the effect of the preemptive local anesthetic infiltration on intraoperative ESRT and opioid requirements in pediatric cochlear implant surgery performed under TIVA. Prospective, randomized, double‑blinded, controlled study including 70 child undergoing cochlear implant under TIVA were randomly assigned to a local anesthesia (LA group, n = 35) or control (CT group, N = 35). The primary outcome was the total tramadol consumption during the first 24 h postoperative, and the secondary outcomes were time to first analgesia request, postoperative pain scores, the ESRT and, propofol and remifentanil requirements. The incidence of postoperative vomiting was recorder as well. The total tramadol consumption during the first 24 h after surgery was significantly less in the LA group than in CT group (8.25 [4.3] vs. 16.5 [6.57] mg, P < 0.01). The time to first analgesic request was significantly prolonged in the LA group as compared with the CT group [8 [2–12] vs. 3 [0–8] h, P < 0.01). The postoperative Faces, Legs, Activity, Cry Consolability pain scores were significantly lower in the LA group at 15 min, 30 min, 2, 4 and 6 h postoperative. Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in in the CT group than in the LA group [0.7 (0.3) vs. 0.5 (0.2) µg/kg/min; P = 0.001).The ESRT response, propofol requirements, and the incidence of postoperative vomiting had no significant differences between both groups. Preemptive local anesthetic infiltration reduced opioid requirements without attenuation of the ESRT in pediatric cochlear implant surgery performed under TIVA.

3 illus, 2 tables, 25 ref

044938   SAGAR M, SHARMA S, CHAUDHARY A, SHARMA S (Community Medicine and Critical Care Medicine Dep, DMC, Ludhiana, Email: shrutisharmadr@yahoo.co.in) : A mixed‑method study to assess the knowledge‑practice gap regarding hand hygiene among healthcare providers in a Tertiary Care Hospital. J Anaesthesiol Clin Pharmacol 2020, 36(3), 359-65.

The burden of healthcare‑associated infections (HAIs) is very high and compliance with infection control practices is poor in low and middle‑income countries (LMICs). Hand hygiene (HH) being the most important measure to prevent HAIs, the present study was conducted to assess the gap in knowledge, perceptions, and practices of healthcare providers (HCPs) regarding HH and also to know the barriers in adherence to HH practices. This questionnaire‑based cross‑sectional study was carried out among 400 HCPs for 1 year. HH practices of HCPs were observed by a trained investigator followed by filling of the preformed proforma by HCPs. The quantitative data were analyzed using Epi info (Version 7) statistical software while qualitative analysis was done to generate themes.  The compliance to HH was higher among nurses (78.3 %) than consultants (49.5 %) and residents (39.1 %). Compliance was more in ICUs (71.4 %) than wards (58.3 %). Knowledge about HH was found to be 73.8 % among consultants and 71.6 % among residents, whereas HH opportunities availed by them were only 49.5 % and 39.1 %, respectively revealing a knowledge‑practice gap. The main barriers to adherence to HH as perceived by HCPs were lack of awareness despite adequate knowledge, time constraints, heavy workload, and so on. In our study, we found that despite adequate knowledge, consultants and residents showed lower compliance with HH practices as compared to nurses. Increasing awareness regarding HH guidelines through frequent sensitization sessions decreased workload, and strict surveillance may help in bridging the knowledge‑practice gap.

3 illus, 5 tables, 26 ref

044937   DUGGAL S, AHUJA B, BISWAS P S, CHOUDHURI A H (Anesthesiology and Intensive Care and Psychiatry Dep, GB Pant Institute of Medical Education and Research, New Delhi- 110 002, Email: anirban.homchoudhuri@gmail.com) : A survey of physicians’ appreciation and knowledge about airway safety measures in the wake of COVID‑19 pandemic. J Anaesthesiol Clin Pharmacol 2020, 36(3), 350-8.

The implementation of safety measures during airway management is a major concern to prevent COVID‑19 transmission during pandemic. Various guidelines and advisories are in vogue to ensure safe practices. However, their success depends on the caregivers’ knowledge and understanding. This survey was conducted to assess the knowledge and safety concerns amongst physicians towards airway management in the background of COVID‑19 pandemic.  A survey instrument of thirty questions covering three timelines of airway management viz. ‘before’, ‘during’ and ‘after’ airway intervention was created. The questionnaire was electronically mailed to the eligible physicians over a period of one month via a web‑based platform and the responses were analyzed. The responses were depicted numerically as percentage. A multiple discriminant analysis was used to test the accuracy of responses after adjusting for common variables. Out of 407 responses, 300 were eligible for analysis. The respondents with correct answers to questions with single correct response were 46 %, 69 % and 57.3 %, along the three timelines and the respondents with more than 75 % correct responses in questions with multiple correct responses were 49 %, 58 % and 31 % along the same timelines. About 75 % of the participants became aware of transmission through aerosols aftermath pandemic. About two‑third of the participants had knowledge about the safety guidelines and recommendations. Majority of the respondents were aware of the safety measures ‘during airway intervention’. Our study found satisfactory knowledge and appreciable concern among the practicing physicians regarding airway safety measures in the wake of COVID‑19 pandemic. However, more physicians were aware about the measures required to be adopted ‘during’ airway intervention. The survey highlights the need for a more focused training of the caregivers about safety measures ‘before’ and ‘after’ airway intervention.

10 illus, 2 tables, 20 ref

044936   BAJAJ J S, SOLANKI S L (Anesthesiology Dep, Seth GS Medical Coll and KEM Hospita, Maharashtra, Email: me_sohans@yahoo.co.in) : Study of risk factors and psychological impact in physicians diagnosed with COVID‑19: An online, postexposure, cross‑sectional survey. J Anaesthesiol Clin Pharmacol 2020, 36(3), 345-9.

Healthcare workers (HCW’s) who have contracted the disease while working in the hospital may have a deep psychological impact in the form of depression and anxiety, along with the stress of passing the infection to their family members. This study attempts to highlight the risk factors and psychological impact on doctors who have tested positive for coronavirus disease‑2019 (COVID‑19).This online cross‑sectional survey‑based study enrolled all level doctors of all specialities of in Mumbai, India, who had tested positive for novel coronavirus. The survey questionnaire was a 26‑item self‑administered anonymous set of questions in English language only. This validated questionnaire was distributed by a link via Google forms for 1 week. We received 51 completed responses. Most of them were (67 %) postgraduate students. Forty‑three (85 %) respondents were working in a COVID‑19 center. Twenty‑three (45 %) had a history of contact with these patients without proper personal protective equipment (PPE) with unknown COVID‑19 status of the patient at the time of contact. Ten percent regretted their decision of becoming a doctor. Only half (51 %) had family support during their illness and 45 % relied on friends and colleagues in the hospital. Twenty‑six percent mentioned having a low mood throughout the illness. A major portion of people (32 %) having fear of severe illness and death. Medical doctors working in direct contact with confirmed cases of COVID‑19 are at increased risk of contracting the infection and it has a major impact on physical and mental health of medical doctors.

3 illus, 1 table, 15 ref

044935   PAUL G, SHARMA S, SINGH G, SINGH G, SHARMA S, PAUL B S, GAUTAM P L (Critical Care Medicine Dep, Dayanand Medical Coll and Hospital, Ludhiana, Email: shruti_sarit@yahoo.co.in) : Assessment of knowledge gaps and perceptions about COVID-19 among health care workers and general publicnational cross-sectional study. J Anaesthesiol Clin Pharmacol 2020, 36(3), 337-44.

COVID‑19 has impacted everyone’s life and livelihood in one way or the other. Individual response to measures taken to control the rapid spread of this disease depend on their knowledge and perceptions. Hence, we proposed to evaluate responses about COVID‑19 among the health care workers (HCWs) as well as general public participants (GPPs). Material and Methods: This was a cross‑sectional, observational survey conducted during the peak of the pandemic. The 35‑items questionnaire was prepared using Google forms and distributed through e‑mails and social media. The 1,026 responses comprised of 558 HCWs (54.4 %) and 468 GPPs (45.6 %). The most reliable source of information was TV news for 43 % GPPs, whereas it was HCWs/Local health authorities for 36.8 % HCWs. HCWs had sufficient knowledge regarding COVID‑19, while it was relatively low among GPPs (average correct response 65 % and 53 %, respectively). Intra‑group analysis with respect to age, sex, qualification, and socioeconomic status showed that knowledge about mode of transmission by airborne aerosols was significantly low with respect to qualification among GPPs while younger age group (<40 years) HCWs had significantly more knowledge about mode of transmission and asymptomatic carriers. Paranoia of contracting the infection was significantly higher in GPPs with upper and middle socioeconomic status and younger HCWs. HCWs had moderate level of knowledge, whereas GPPs had low to moderate knowledge, with large scope of improvement in both groups. Continued education, both at professional and community level will not only be helpful but also necessary to improve knowledge, avert negative attitudes and control the devastating pandemic.

3 illus, 4 tables, 21 ref

044934   GANGAKHEDKAR G R, SOLANKI S L (Anesthesiology, Critical Care and Pain Dep, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra, Email: me_sohans@yahoo.co.in) : Impact of the COVID‑19 pandemic on anesthesiologists in India: A cross‑sectional online survey of the practices, preparedness, and mind‑set. J Anaesthesiol Clin Pharmacol 2020, 36(3), 331-6.

India is one of the five worst hit countries in the world due to COVID‑19, by the fourth week of June 2020. The impact of COVID‑19 on the health practices is well‑documented but there are no studies assessing its impact on anesthesiologists in India. This study aims at assessment of the impact of COVID‑19 on the practices followed, the preparedness, and mindset of anesthesiologists in India. Using Google forms, a cross‑sectional, questionnaire‑based survey was conducted between the 5th and 22nd of May, 2020, among trainees and practicing anesthesiologists, in India. The anesthesiologists were invited to participate, using their e‑mail addresses and through the social media platforms such as Facebook and WhatsApp. The responses that were generated, were analyzed using SPSS version 23 (IBM, Armonk, NY).  Of the 707 anesthesiologists who participated, 68.3 % had already worked in a COVID‑19 specialty unit. Only 41.7 % of the anesthesiologists felt confident that they had sufficient knowledge to deal with COVID‑19 infected patients. Fear of catching the infection and infecting loved ones were important causes of anxiety, which was seen in 95 % of the participants. Majority of the participants, (64.5 %) did not think that elective surgical procedures could be restarted at this point. COVID‑19 has had grave impact on anesthesiologists, on the professional and personal front, and will possibly cause near‑permanent changes in the work culture. Restarting elective surgical procedures, will require meticulous planning. In spite of their self‑perceived under‑preparedness to combat COVID‑19, an overwhelming majority of participating anesthesiologists were prepared to contribute to the management of COVID‑19

3 tables, 23 ref

044933   GUPTA R, MOHAN B, GARG K, TANEJA A, VIRK S S, GREWAL A, MAHAJAN R ( Microbiology Dep, Dayanand Medical Coll and Hospital, Ludhiana, Punjab, Email: drkamakshigarg@gmail.com) : A rational approach to manage surgical procedures in COVID Era – A perspective based on experience in a private referral hospital. J Anaesthesiol Clin Pharmacol 2020, 36(3), 325-30.

COVID‑19 disease has imposed challenges in caring for non‑Covid elective surgical patients. As elective surgeries become essential, we propose to evaluate our approach and outcomes of surgical procedures performed during the initial period of COVID‑19 pandemic so as to provide a road‑map for safer approach.  We retrospectively evaluated outcomes in patients who underwent essential elective and emergency surgeries during the 5‑week period between April 18, 2020 and May 28, 2020. All patients were screened at the front desk on their arrival to identify possible exposure to SARS‑ CoV‑2. Nasopharyngeal swab of patients requiring hospital admission was tested for COVID‑19 by quantitative RT‑PCR. Patients needing essential elective surgery were taken up for surgery if they tested negative for COVID‑19. Emergency procedures were undertaken in a demarcated theatre for COVID after taking level‑3 protection without delay. The clinical data was reviewed and analysed. A total of 764 surgical procedures were conducted, of which 70.7 % were elective essential surgeries, with 95.4 % of these patients being discharged in stable healthy condition. Approximately 23 % of the elective and 26 % of the emergency surgeries was categorised in the surgical difficulty category III and majority of these were performed under general anesthesia. Postoperative mortality was 1.04 %, but the overall mortality rate was approximately 2.5 %. Only two patients (0.3 %) tested positive for COVID‑19 in our series. A robust preoperative screening and testing can enable safe scheduling of essential elective surgeries.

1 illus, 3 tables, 24 ref

044932   PRASAD G V K (Military Hospital Kirkee, Pune- 411 020, Maharashtra, Email: drkaypee99@yahoo.com) : Shared decision making in peri‑operative medicine: Miles to go in Indian scenario. J Anaesthesiol Clin Pharmacol 2020, 36(3), 316-24.

Shared Decision Making (SDM) in peri‑operative medicine is increasingly encouraged as an ideal model of treatment decision making in the medical encounter. Moreover, it has the potential to improve the quality of the decision‑making process for patients and ultimately, patient outcomes. This review focuses on several published literature on SDM in peri‑operative medicine, its Implementation, barriers faced by Patient and the Provider, Myths regarding SDM and current scenario of SDM in India. Within the anesthetic community, patient consent is vigorously guided. However, this community suffers from lack of advancements in implementing the patient‑focused rather than doctor‑focused characteristics of SDM. Out of the several barriers, the most common barrier towards the implementation of SDM is the lack of time from the provider community. Within the anesthesia domain, the consultations discussed directly preceding the surgery do not pursue the customary and highly organized stages of typical outpatient consultations. Under these backgrounds and to be successfully implemented, it becomes imperative to begin the process of SDM pre‑operative assessment clinic targeting both the high‑ and low‑risk patients. It is critical to summarise that SDM does not end at the time of anesthesia for the peri‑operative healthcare professional, but it gets to carry forward until patient discharge. Therefore, it is carried as the Pinnacle of Patient‑Centred Care.

5 illus, 1 table, 73 ref

044931   KUMAR R, KUMAR S, MISRA A, KUMAR N G, GUPTA A, KUMAR P, JAIN D (Anesthesiology and Intensive Care Dep, Maulana Azad Medical Coll and Lok Nayak Hospital, Delhi- 110 034, Email: rakeshrampal@hotmail.com) : A new approach to airway assessment—“Line of Sight” and more. Recommendations of the Task Force of Airway Management Foundation (AMF). J Anaesthesiol Clin Pharmacol 2020, 36(3), 303-15.

Assessment of airway is recommended by every airway guideline to ensure safe airway management. Numerous unifactorial and multifactorial tests have been used for airway assessment over the years. However, there is none that can identify all the difficult airways. The reasons for the inadequacy of these methods of airway assessment might be their dependence on difficult to remember and apply mnemonics and scores, inability to identify all the variations from the “normal”, and their lack of stress on evaluating the non‑patient factors. Airway Management Foundation (AMF) experts and members have been using a different approach, the AMF Approach, to overcome these problems inherent to most available models of airway assessment. This approach suggests a three‑step model of airway assessment. The airway manager first makes the assessment of the patient through focused history, focused general examination, and focused airway assessment using the AMF “line of sight” method. The AMF “line of sight” method is a non‑mnemonic, non‑score‑based method of airway assessment wherein the airway manager examines the airway along the line of sight as it moves over the airway and notes down all the variations from the normal. Assessment of non‑patient factors follows next and finally there is assimilation of all the information to help identify the available, difficult, and impossible areas of the airway management. The AMF approach is not merely intubation centric but also focuses on all other methods of securing airway and maintaining oxygenation. Airway assessment in the presence of contagion like COVID‑19 is also discussed.

2 illus, 5 tables, 37 ref

044930   SUN J Y (Anesthesiology, Perioperative Care and Pain Medicine Dep, NYU Langone Health, New York- 10016, USA, Email: Jeffrey.sun@med.nyu.edu;) : Anesthesia and Alzheimer’s: A review. J Anaesthesiol Clin Pharmacol 2020, 36(3), 297-302.

As early as 1955, it was Bedford who provided description of cognitive changes in elderly patients following anesthesia and surgery. Reports of individuals with catastrophic, non‑stroke‑related decline in cognitive functions following anesthesia and surgery lead to a perception in the lay population that anesthesia and surgery have the potential to greatly exaggerate the progression of dementia, particularly Alzheimer’s disease (AD). There is a concern that anesthesia and surgery could cause irreversible impairment, leading to AD. This could also explain the accelerated decline in patients with mild cognitive impairment. We seek to explore the relevant literature to determine whether a correlation exists and then propose a possible pathophysiologic mechanism.

38 ref

044929   NEETHIRAJAN S G R, MANICKAM A (Anesthesia and Pain Medicine Dep, Sri Ramachandra Medical Coll, Chennai, Tamil Nadu, Email: drsoms@gmail.com) : Scheduling elective surgeries following COVID‑19: Challenges ahead. J Anaesthesiol Clin Pharmaco 2020, 36(3), 291-6.

Evolving and conflicting information about pathophysiology, clinical course and impact of corona virus disease (COVID‑19) on perioperative outcome of patients has brought in new challenges while restarting elective surgeries. A roadmap to resume elective surgeries should detail timings for reopening elective surgeries, COVID‑19 testing facilities, adequate PPE supplies, conservation policies for PPE and case prioritization and scheduling. We suggest a six‑pronged strategy of minimizing chances of exposure, adherence to standard protocols, perioperative patient care, precautions while performing aerosol generating procedures, limiting movement of personnel within operating room and monitoring and managing health care professionals while scheduling elective surgeries to overcome the challenges this COVID‑19 pandemic has brought in.

45 ref

041190   ANJALI, MOHAPATRA I, BANERJEE A (Community Medicine Dep, KIIT Univ, Bhubaneswar, Odisha - 751 024, Email: dr_ipsa@yahoo.co.in) : Screen dependency disorders in children under two years of age: A parent report measure. Indian J Comm Health 2020, 32(2), 427-31.

Screen dependency disorder is a growing concern. The rising trend in use of digital devices among young children being less researched, the study was done to find out the prevalence and pattern of total and device-specific screen viewing (SV), in a well baby clinic among children less than two years of age, Data was collected through in-person interviews from mothers of the children. Increasing child age and type of family were found to be significantly associated with higher prevalence of SV. Smart phones had similar usage rates at par with TVs; reiterating the fact that mobile devices have become widely available in the entire population, being second source of SV. Parental knowledge and parental practices were also found to influence the SV and screen-time in children. Modifiable factors like parental knowledge on SV, parental SV practices can help in designing health promotion strategies and recommendations on SV.

1 illus, 2 tables, 9 ref

041189   VERMA P, KANSAL S, SARKAR M, KESH N, KUMAR A (Community Medicine Dep, Banaras Hindu Univ, Varanasi - 221 005, Uttar Pradesh, Email: sangeetakansalbhu@gmail.com) : Study on technical, behavioral and organizational factors affecting the performance of mother and child tracking system in rural area of Varanasi district, Uttar Pradesh: A qualitative study. Indian J Comm Health 2020, 32(2), 423-6.

The Mother and Child Tracking System (MCTS) portal captures and tracks all pregnant women right from conception up to 42 days after delivery and all children below five years. This study was conducted to find out the technical, behavioral and organizational factors that affect the process and performance of MCTS. This was an exploratory qualitative study conducted in Varanasi district by using multistage random sampling method. Data were collected by in-depth interviews of 48 health care providers. Majority of the ANMs and ASHAs were not aware of the meaning of “Tracking System” and the use of MCTS ID. Inappropriate training of ASHAs, absence of supervision and monitoring by ANMs, overburdened DEOs and ANMs, poor internet connection, slow server speed, software problem and frequent power failures were identified as major factors for poor performance of MCTS. The most effective measure to improve the performance of MCTS would be to properly train grass root level workers so that more efficient data can be fed into MCTS.

8 ref

041188   MODI B V, MODI B, DAVE P V (Community Medicine Dep, Dharamsinh Desai Univ, Nadiad, Gujarat - 387 001, Email: dr.bhautikmodi@gmail.com) : Financial incentive- does this have impact on outcome of tuberculosis?. Indian J Comm Health 2020, 32(2), 418-22.

Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Out of total 1430 patients inquired, 896 (62.7 %) patients were found eligible for the scheme, while only 87 (9.7 %) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit.

6 tables, 10 ref

041187   HEDAOO R, GAVARAVARAPU S M (Extension and Training Div, ICMR-National Institute of Nutrition, Hyderabad – 500 007, Email: subbarao.gm@icmr.gov.in) : Understanding body image perception and body image discontentment in early adolescence. Indian J Comm Health 2020, 32(2), 411-7.

The mounting trends of beauty perceptions have contributed to distorted body image among adolescents. This demands understanding about current pointers of body image satisfaction to prevent eating disorders associated with mismanagement of weight in adolescents. The objectives of this cross-sectional study were to apprehend body image perception and dissatisfaction among adolescents (12-14years) across the genders and associate it with their actual BMI along with identifying the factors influencing body image perception. A structured questionnaire was developed and administered on randomly selected 112 adolescents (68 % boys & 34 % girls, 12-14 years), mean age=12.8 ±0.45 from urban coeducational school of western India. Anthropometric measurements were taken with standardized tools and BMI z-scores were calculated. The actual and perceived weight was compared using paired t-test and descriptive statistics. Association between body image indicators, gender, and BMI were assessed using Chi-square test and One-way ANOVA. Factor analysis was done by Principal component analysis. There was a significant difference in the perceived (M=2.31, SD=0.93) and actual BMI (M=1.96, SD=0.69), p=0.002. A significant association between gender and the influence of media idols, discrimination due to physical appearance and BMI was observed (p≤.0.005).   Self-perception and judgements of others, behaviors related with self-fixation, social influence and inappropriate dietary practices and comparison with models and actors were the emerging factors identified. The body image perception was distorted among adolescents of both sexes, with higher body image discontent shown by girls. The perceived body image, when compared with their BMI was found to be incongruent across sexes.

1 illus, 4 tables, 30 ref

041186   JOSHI K J, KISHOR S M, KARTHA G P (Community Medicine Dep, C. U. Shah Medical Coll, Surendranagar, Gujarat - 363 020, Email: dr.krupaljoshi@gmail.com) : A cross-sectional study on the level of job stress among nursing staff and its relation with demographic variables and their work pattern in a tertiary care teaching hospital in Surendranagar, Gujarat. Indian J Comm Health 2020, 32(2), 404-10.

The nursing profession is known to be stressful throughout the world. It contributes to various physical and psychological health problems in nurses, which ultimately influencing on their performance and efficiency of work. To measure the level of job stress among nurses and to find out its relationship with demographic variables and working pattern. Study was done among 102 nurses in a tertiary care hospital of Surendranagar district from February to March 2020. The level of job stress was measured by a set of 14 questions which are directly related to job stress and response was collected on a five-point Likert Scale. This study revealed, moderate and severe level of job stress among 53 % and 45 % of nurses respectively. The job stress had no statistically significant association with demographic variables like age and gender. However, job stress had an inverse correlation with the factors like work experience, shift timings and working hours. All the study participants were suffering from mild to severe level of job stress. Younger age group and female nurses were commonly affected with job stress. Work stress was also found more prevalent in nurses with lesser experience, rotational shift and more working hours.

1 illus, 5 tables, 24 ref

041185   SADANA P, VERMA V, NAGPAL M (Community Medicine Dep, Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar, Punjab - 143 501, Email: sadanapooja@hotmail.com) : A study on predictors of treatment outcome among children registered under DOTS in district Tarn Taran, Punjab. Indian J Comm Health 2020, 32(2), 399-403.

Globally, tuberculosis remains an important cause of morbidity and mortality for children. Diagnosis and management of childhood TB especially Extra pulmonary tuberculosis is challenging.  A cross-sectional study was conducted on 0-14 year children who were registered and being treated, in district Tarn Taran, Punjab from 1st January 2018 to 31st December 2018. The treatment outcome with their clinico-demographic determinants was ascertained. Data management and analysis was done by using Microsoft excel and SPSS. Out of 62 registered patients, 62.9 % of the children were in age group of 11-14 years. 67.7 % were females. The various treatment outcomes observed were-cured 32.3%, treatment completed 61.3 %, lost to follow up 1.6 %, regimen changed 1.6 %, not evaluated 3.2 %. The success rate (cured+ treatment completed) was 93.6 %. On statistical analysis, it was observed that age (p= 0.002), site of disease (p=0.000), contact history (p=0.012) and diagnostic method (0.000) was significantly associated with the treatment outcome whereas gender, area of residence and type of case had no association with the treatment outcome in children. We also found that the overall treatment success rate was 93.6 %. Increased focus be on those with household contact with TB.

3 tables, 19 ref

041184   ESHWARI K, KULKARNI M M, BHAGAWATH R, MULLAPUDI S, SELVARAJAN T, KAMATH V G (Community Medicine Dep, Kasturba Medical Coll, Manipal - 576 104, Karnataka, Email: murali.kulkarni@manipal.edu) : Ban on sale of loose cigarettes: Awareness, perceptions and practices among vendors and smokers in Karnataka, India. Indian J Comm Health 2020, 32(2), 394-8.

The Government of Karnataka banned loose cigarettes sale effect from September 2017 and is punishable under Cigarettes and Other Tobacco Products Act (COTPA) with fine and imprisonment in case of violation. Study aims to assess awareness, perceptions and practices about ban among tobacco vendors and smokers. Cross sectional survey was carried using pre-tested questionnaire to collect information regarding awareness about ban among vendors and smokers. Data were analyzed using SPSS version 15.0. Ninety-five percent of the tobacco vendors continued to sell loose cigarettes despite the ban. Among vendors, 49.7 %, were aware of ban and of them 53.5 % knew it is a punishable offense. Vendors opined that they would stop selling loose cigarettes if ban is strictly enforced with frequent checks on periodical basis. One-fourth smokers opined they will reduce cigarettes consumption with few making an attempt to quit. Awareness about ban on sale of loose cigarettes was unsatisfactory among vendors and smokers including lack of knowledge regarding legal actions in case of violation. However, vendors responded favorably towards obeying the law. Smokers are likely to reduce or even quit smoking if the law is strictly enforced which highlights the need for creating awareness drives and strong enforcement of the policy.

1 illus, 1 table, 16 ref

041183   KHANNA P, AERI B T (Food and Nutrition Dep, Delhi Univ, Delhi - 110 021, Email: bani.aeri@ihe.du.ac.in) : Association of depression and anxiety symptoms with body mass index (for age cut offs) in non-clinical sample of adolescents studying in public schools of delhi; cross sectional study. Indian J Comm Health 2020, 32(2), 386-93.

The present study was designed with the objective to study the prevalence of depression and anxiety symptoms among adolescents and to explore the association of these disorders with Body Mass Index. School setting and Cross-Sectional study design. 546 adolescents, aged 13-15 years, studying in public schools (n=5) in Delhi (Purposive sampling). Anthropometric measurements: Height of the subjects was measured using a stadiometer in cm (to nearest 0.5cm). Weight was assessed using TANITA’s Body Fat Monitor (UM-076). After gathering height and weight data, BMI (kg/m2) Z scores were calculated and classified into four categories: Underweight, Normal weight, Overweight and Obesity based on WHO’s growth standards for BMI for age cutoffs. For this purpose, we used the Child Behavior Checklist (CBCL) for ages 6-18 years; parent report version. A V shaped curve (trend) was observed between the association of depression and anxiety scores in four BMI categories; with majority of the malnourished adolescents having higher scores for depression and anxiety symptoms. It was interesting to note that any deviation from normal weight, either underweight or overweight/obese was significantly associated with depression (p = <0.001) and anxiety (p = <0.001) scores. The study emphasizes the association between body weight and depression and anxiety symptoms among adolescents studying in public schools of Delhi. It adds to the growing body of research in the area of nutritional psychiatry which needs to be promoted for the prevention and management of these disorders through a healthy diet.

3 illus, 4 tables, 27 ref

041182   BISWAS B, KUMAR A, AGARWAL N (Community and Family Medicine Dep, All India Institute of Medical Sciences, Patna - 801 507, Bihar, Email: neeraj502@rediffmail.com) : Predictors of male sterilization among eligible, modern method of family planning users in India: Evidence from a nationwide survey. Indian J Comm Health 2020, 32(2), 378-85.

Male sterilization despite being more cost-effective compared to female sterilization is opted by very few Indian eligible couple as family planning (FP) method. To find out attributes of male sterilization among current eligible modern family planning methods users in India. It was an observational study, cross-sectional in design based on fourth round of national family health survey (NFHS-4) 2015-16 men’s datasheet. There were in total 112122 data, of which 11772 sample population who had completed their family, been using modern methods of family planning and wife in reproductive age (15-49) were selected for analysis. Among the study subjects, 377(3.2 %) underwent male sterilization. In multivariable model those who were residing in southern India; Hindu by religion; scheduled caste (SC)/scheduled tribe (ST) by caste; belonged to lower quintile of wealth index; covered by a health insurance scheme; perceived ≤2 children as ideal number of children; husbands not working and employed seasonally/occasionally were more likely to undergo male sterilization adjusted with the age of husband, wife, their place of residence and property ownership status. Male sterilization in the sample population was significantly predicted by the region, religion, ethnicity, socioeconomic status, husbands employment status etc.

2 illus, 2 tables, 23 ref

041181   CHAITANYA A, RANA R K (Preventive and Social Medicine Dep, Patliputra Medical Coll and Hospital, Dhanbad, Jharkhand - 826 005, Email: bakwasandsony@gmail.com) : Evaluating the lumbar nerve root stretching using straight leg raising technique a cost effective treatment option for patients of lumbar disc disease. Indian J Comm Health 2020, 32(2), 371-7.

Lumbar disc disease is one of the most important cause of lumbar radiculopathy. Even a normal healthy disc may rupture by sudden heavy load if it is beyond the tensile limit of annulus fibrous. The lumbo-sacral radicular pain due to lumbar disc herniation, is responsible for DALY loss in terms of work absenteeism and disability. For a developing country like ours it’s a major health issue often ignored as patients don’t require hospitalization. In a developing country a cost effective method which is not increasing any out of pocket expenditure for the patient for relief from the lumbar disc disease suffering must be hailed as a boon considering its effectiveness as well as feasibility of administration everywhere. Starting March 18 till Dec 19 records of patients coming as per our eligibility criteria after IEC clearance were evaluated for the effectiveness of straight leg raising technique with data being analyzed using the measures of central tendency and other appropriate tests. Out of 72 patients 69 achieved improvement in pain while 68 achieved improvement in their ability to move along. Given the zero cost of exercise technique this technique is an easy to master technique. if larger studies can validate our findings this can be taken at grass root levels to bolster the health care systems and train front line health care service givers so that last mile beneficiary too gets the benefit and relief from chronic pain owing to lumbar disease.

5 tables, 20 ref

041180   BHATIA V, PARIDA S P, MAHAJAN P B, SAHOO D P, BHATTACHARJEE S (Community and Family Medicine Dep, All India Institute of Medical Sciences, Bhubaneswar, Odisha - 751 019, Email: swayam.aiims@gmail.com) : A community based study of anaemia burden using hemocue 201 in Eastern India. Indian J Comm Health 2020, 32(2), 365-70.

India is facing a serious burden of anemia where majority of the women (51 %) of reproductive age suffer from anemia. Though there are many programs being run for decades to fight anaemia, it still persist to be a major health challenge in Odisha where around half of the women and children are anemic (children age 6-59 months; 44.6 %, pregnant women of age 15-49; 47.6 %, all women of age 15-49 years; 51.0 %). AIIMS Bhubaneswar, in partnership with Govt. of Odisha and UNICEF aimed to assess the burden of anaemia in the state. This cross-sectional study was conducted amongst 3974 beneficiaries between March to July 2016. Hemoglobin estimation was done using Hemocue 201.  Prevalence of mild, moderate and severe anemia was observed to be 39-58 %, 7-20 % and 1-3 %, respectively in 4 districts. Coverage of iron folic acid tablets amongst adolescent girls, adolescent boys, pregnant women, lactating mothers, and women of reproductive age groups were 38 %, 16 %, 73 %, 46 %, 11 % respectively. The study has shown that prevalence of severe and moderate anaemia has decreased to a greater extent, however the prevalence of mild anaemia is still very high.

2 illus, 1 table, 24 ref

041179   AGARWAL V, JAIN S, GARG S K, SINGH G, MITTAL C (Community Medicine Dep, Lala Lajpat Rai Memorial Medical Coll, Meerut - 250 004, Uttar Pradesh, Email: drvertika.0620@gmail.com) : Common mental disorders and its socio-demographic correlates among women of reproductive age in urban and rural area of Meerut. Indian J Comm Health 2020, 32(2), 359-64.

Common Mental disorders are distress states manifesting with anxiety, depressive and unexplained somatic symptoms categorized as ‘neurotic, stress-related and somatoform disorders’ in ICD-10. These are 2-3 times more common in women than in men and also more in urban area than rural. Women of reproductive age are at higher risk especially those with social disadvantage, low income and low education. To assess the prevalence of common mental disorders and associated socio-demographic factors among women of reproductive age (15-49 years) residing in urban and rural area of Meerut. This was a cross-sectional study done in urban and rural area of Meerut from June 2018 to October 2019. 267 women in reproductive age (15-49years) were interviewed in urban as well as rural area using a predesigned pretested questionnaire regarding socio-demographic profile. Self- Reporting Questionnaire-20 was used to determine presence of common mental disorders. Overall prevalence of common mental disorders among women of reproductive age group was 19.8 % (106) with 24.2 %(65) in urban and 15.4 %(41) in rural area. Statistical analysis revealed that various socio-demographic variables like belonging to urban area (24.2 %),being widowed/separated (urban-85.7 %;rural-75.0 %), belonging to broken family(urban-54.5 % %; rural-58.3 %), being employed(urban-39.6 %;rural-33.3 %) and lower socio-economic status(urban-54.5 %;rural-40.0 %) were significantly associated with presence of common mental disorders. In urban women increasing age was also associated with common mental disorders. The study revealed a high prevalence of common mental disorders in both urban and rural area and a significant association with various socio-demographic variables.

1 illus, 2 tables, 15 ref

041178   ACHARYA A S, DEBBARMA S, RASANIA S K, TIWARI N, BACHANI D, KHANDEKAR J (Community Medicine Dep, Lady Hardinge Medical Coll, New Delhi - 110 001, Email: darth.24@gmail.com) : Risk assessment of diabetes using the Indian diabetes risk score in an urban resettlement colony of East Delhi. Indian J Comm Health 2020, 32(2), 354-8.

The burden of diabetes in India is expected to worsen in the coming years. Indian Diabetes Risk Score (IDRS) is a validated and cost‑effective tool to identify risk of developing diabetes among population. To assess the risk of Type 2 Diabetes mellitus using the IDRS in adults aged 30 years and above and to study the association of risk of diabetes with other factors. A cross-sectional study was conducted in Kalyanpuri area of East Delhi. Data collection was done from August to December, 2018. 494 residents aged 30 years and above were included in the study. Data was collected using a semi-structured questionnaire. SPSS version 23 was used for data analysis. 43.7 % of the study subjects were aged 50 years or above and majority (65.38 %) were females. More than half (59.31 %) of the subjects were found to have high risk of diabetes. Age and central obesity were found to be significantly associated with risk of diabetes (p<0.05). Risk of developing diabetes was not associated with gender. Conclusion- Early detection of risk of diabetes by periodic screening and appropriate behavioral change communication would be effective in controlling the diabetes crisis.

4 tables, 18 ref

041177   PRABHAKAR V, VIRK A, SINGH P (Community Medicine Dep, Adesh Medical Coll, Kurukshetra, Haryana - 136 135, Email: sainiparmal@gmail.com) : Prevalence of obesity and need for screening using tools like Indian diabetes risk scale in diabetes prevention among medical students. Indian J Comm Health 2020, 32(2), 348-53.

The prevalence of lifestyle diseases in increasing throughout the world. They are increasingly taking over communicable diseases as the major cause of morbidity and mortality. Medical students usually have sedentary lifestyle coupled with high level of stress, owing to academic requirements. Hence, they are at a much higher risk of developing lifestyle diseases. Study subjects were administered a validated questionnaire to collect information related with the components of IDRS. Based on the score, they were divided into high risk, moderate risk and low risk. Data was analysed using the SPSS version 21. Half of all the students were in the moderate risk group. The rest was distributed among low risk (17.33 %) and high risk (27.33 %). Among those with low risk of developing T2DM, 73 % were males, whereas females constituted 70.7 % of those with high risk of developing T2DM. The association of developing T2DM was also highly significant with obesity. Statistically significant association of high T2DM risk were found with gender being female, family history of T2DM and BMI≥23 Kg/m2 IDRS has been shown to be an effective tool for screening populations. Hence, regular programs with IDRS along with blood sugar and lipid profile of moderate and high risk group along with stress management can be effective in supporting medical students to cope with demanding study and work conditions among medical students and doctors.

5 tables, 253 ref

041175   ANBAZHAGAN S, ANBAZHAGAN S, JAYSINGH S (Community Medicine Dep, Shri Balaji Vidyapeeth Univ, Kancheepuram, Chennai - 603 108, Email: surecommed87@gmail.com) : mHealth in comprehensive geriatric service- the way forward. Indian J Comm Health 2020, 32(2), 341-3.

The projected increase in the number of disabled older persons poses a challenge for health care and social services. (1) Multiple health problems of such people will require an integrated approach.(2) While the elderly have unique assessment needs, these are often not addressed adequately. Usually only the presenting illness of the elderly are adequately addressed and the ‘Non-medical’ & ‘Non-presented’ issues are not looked into. Many of these issues are not presented to the treating physician as patients & families presume that these are part of normal aging. The importance of comprehensive geriatric assessment is that, it permits a systematic evaluation & documentation of all the issues that concern this population and identification of problems could lead to implementation of corrective and or preventive measures. There is evidence to suggest that a variety of M health techniques can be applied effectively and safely in geriatric medicine in providing comprehensive geriatric service across a variety of clinical settings.

16 ref

041174   DEVANBU V G C, RAVI H, TANEJA N (Community Medicine Dep, Chettinad Hospital & Research Institute, Chennai, Tamil Nadu, Email: drchellaiyan@gmail.com) : Pradhan mantri jan arogya yojana – ayushman bharat. Indian J Comm Health 2020, 32(2), 337–40.

Ayushman Bharat Initiative” also known as Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in 2018, by Government of India. The core principle of Ayushman Bharat - National health protection mission is co-operative federalism and flexibility to states. PMJAY encapsulates a progression towards promotive, preventive, palliative and rehabilitative aspects of Universal Health coverage through access of Health and Wellness Centre (HWCs) at the primary level and provisioning of financial protection for accessing curative care at the secondary and tertiary levels through engagement with both public and private sector. PMJAY covers 1350 medical packages including surgery and day care treatments, cost of medicines and diagnostics. It involved participation of centre and states, use of technology for administration of the scheme and involved participation of private sector hospitals and insurers to provide accessible and affordable healthcare by a large section of society. The objective of this review is to explore the PMJAY program and to assess how far it could achieve the goal of universal health coverage. It is a major step by Government of India to fulfil the goal of universal health coverage hence if implemented properly it could be a game changer.

16 ref

041173   RASTOGI A, KAPIL U (Epidemiology Dep, Institute of Liver and Biliary Sciences, Delhi - 110 070, Email: rastogiaayushi6@gmail.com) : Non-alcoholic fatty liver disease in children: An emerging public health problem in India. Indian J Comm Health 2020, 32(2), 330–6.

NAFLD was earlier believed to be the disease of adults only however in 1983, the existence of this disease was seen in paediatric population. Nearly four decades have passed since the first description of the Paediatric NAFLD (P-NAFLD), yet it is one of the areas which is given least priority in the country. The P-NAFLD is reversible and can be prevented by lifestyle and behaviour modification and hence there is a need to this review highlights the importance of P-NAFLD in the country and need for formulating strategies for prevention and control of P-NAFLD in the country. All published articles in the MEDLINE database on P-NAFLD in India were included. The important findings were summarized and critically analysed. The existing review suggests, the prevalence of P-NAFLD is uncertain in the country. NAFLD is a phenotypic product of complex interaction of heredity (nature) and environment (nurture). This review summarizes the importance of P-NAFLD in India and discusses the predisposition of these risk factors in Indian children. Further population-based studies on prevalence and incidence are required on general paediatric population to quantify the magnitude of the disease in India for better management of the condition.

2 illus, 49 ref

041172   TIWARI A, MANAR M K, SINGH S K, MOHAN U, PANDAY K, MOHAN U (Community Medicine & Public Health Dep, King George’s Medical Univ, Lucknow, Uttar Pradesh - 226 003, Email: manar.781@gmail.com) : Traditions & customs of ancient indian culture and their role in COVID 19 pandemic prevention and control. Indian J Comm Health 2020, 32(2), 317–23.

The truth of COVID 19 Pandemic is that it has already changed the demography of many countries, still changing the Climate & Environment and will continue to change the Global Economy for quite some time. The simple good personal hygiene and physical distancing measures were identified as one of the most effective protections against COVID 19. The Indian way of living has many scientific principles inherited in it to combat infectious diseases. We follow the Sanatan Sanskriti concepts traditionally, sometimes not even realizing the rationale behind it. This article tries to explore the correlation between the preventive measures and our traditional Sanatan practices. The pandemic has shaken the globe and time has come to rethink and move back to basics of our ancient traditions for a sustainable future. There is a need to promote our cultural practices and avoid running behind the ultra-modern ways of living so that the world learns to combat and live with the COVID 19.

2 illus, 2 tables, 32 ref

046399   SAM S P, GEO J, LEKSHMI G I, KALLIVAYALIL R A (Psychiatry Dep, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla- 689 101, Email: roykalli@gmail.com) : Post stroke depression and lesion location: A hospital based cross-sectional study. Kerala J Psychiatry 2020, 33(2), 0.30834/KJP.33.2.2020.223.

Depression is seen in about 40 % of patients with stroke and is a common neuropsychiatric consequence. Post-stroke depression (PSD) can be related to the site and side of infarct and psychological stressors. There are conflicting results in this area of research and dearth of studies from India. Thus the study aims to assess the prevalence of PSD in stroke patients and the relation between site and side of stroke with PSD. A cross-sectional study was done among 40 stroke patients recruited by consecutive non-random sampling in Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla. A semi-structured proforma was used to collect the socio-demographic, illness-related and neuroimaging details. Hamilton depression rating scale was used to assess the severity of depression. SPSS 20.0 was used for statistical analysis. 64 % of the patients with left-sided lesion had PSD, whereas only 20 % had PSD among the right-sided group which was significant with a p-value of 0.005.PSD was seen in 64 % (N=9) of patients with subcortical lesions which were significantly high (p=0.006) when compared to 14 % (N=2) of the patients with PSD among the cortical group. This study showed a high prevalence of PSD and its correlation with left-sided cortical and subcortical lesions. Eliciting the relationship between the lesion and depressive symptoms may help shed light on the neurobiology of depressive disorders.

2 tables, 7 ref

041171   JOSHI V, JOSHI N K, BAJAJ K, BHARDWAJ P (All India Institute of Medical Sciences, Jodhpur, Rajasthan - 342 005, Email: drjoshinitin30@gmail.com) : HIV/AIDS awareness and related health education needs among slum dwellers of Jodhpur city. Indian J Comm Health 2020, 32(1), 167-9.

The people living in slums lack the basic civic amenities. Due to deprivation of socioeconomic resources and health care facilities these groups of people are more vulnerable to infectious diseases like HIV/AIDS. To assess the knowledge and awareness about HIV/AIDS and to identify related health education needs in urban slums of Jodhpur. A cross sectional study was conducted during July – Nov 2018 in slums of Jodhpur city.  Two stage cluster sampling strategy was used to collect data from 1200 participants regarding HIV/ AIDS knowledge and awareness to identify health education needs in urban slums. Descriptive statistics, chi-square test and multivariate logistics analysis were used. A total of 1200 participants were surveyed, out of which 48.5 % were males.   Among the study population 58 % (n=697) has heard about HIV/AIDS and only 17.5 % (n=211) have knowledge that the HIV and AIDS are different. Only 17.8 % (n=214) have undergone HIV testing. Females were less likely aware about preventive measures of HIV than males (OR=0.09, 95 %CI=0.05-0.14, P value<0.05). The younger population (15-45years) were less likely aware about preventive measures for HIV than older population (>45 years). Only 13.9 % (n=110) of tobacco consumers and 11.5 % (n=78) alcohol consumers have undergone HIV testing. The comprehensive health education program should be designed with focus on different education needs according to age and gender of urban slums.

2 tables, 15 ref

046398   VENUGOPALAN V, SHARADHA NAVEEN R, ESKIN M (Psychiatry Dep, Government Medical Coll, Palakkad, Kerala, Email: vinuprasadvgm2000@yahoo.com) : Change in attitude towards suicide with current undergraduate training in psychiatry: A cross-sectional study. Kerala J Psychiatry 2020, 33(2), 153-7.

Teachers in the field of psychiatry has the responsibility to impart changes in students' attitude towards important areas of the subject. Suicide is the psychiatric emergency that a primary care practitioner is most likely to encounter in day to day practice. In this cross-sectional study, we looked into the change in the attitude of an undergraduate student towards suicide with his/her training in psychiatry with the present undergraduate curriculum. We recruited undergraduate medical students doing their MBBS course from a medical college of South India. Their responses to Eskin's Attitudes towards Suicide Scale (E-ATSS) and Eskin's Social Reactions to Suicidal Persons Scale (E-SRSPS) were collected. The students were divided into groups of students completed undergraduate training in Psychiatry and those who are yet to get exposed to it.  Responses in E-ATSS and E-SRSPS from both groups were compared. The overall attitude of students towards suicide and suicidal person were favourable compared to many previous studies. There was a significant difference in the factor ' suicide as a sign of mental illness' when responses from both groups were compared. 2.72 ± 1.11 in the exposed group compared to 3.16 ± 1.11 of unexposed group. p-value<0.001). Also, there was a significant difference in responses to the disapproval of suicidal disclosure. 2.83 ± 0.65 in the exposed group and 2.67 ± 0.67 in the unexposed group. (p-value - 0.01). The current undergraduate medical curriculum by Medical Council of India is successful in bringing attitude change in some important domains of the subject of suicide. Domains remain under-covered by the curriculum should be looked into in the future curriculum revisions.

2 tables, 20 ref

041170   KUMAR D, KISHORE S, KHAPRE M, SINGH M, JAIN B, BHADORIA A S (Community and Family Medicine Dep, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, Email: deepakkumar1786@gmail.com) : Prevalence and risk factors of tobacco abuse in Rishikesh. Indian J Comm Health 2020, 32(1), 164-6.

Tobacco is the most common form of substance abuse. Commonest evil of modern society is use of tobacco, though alcohol is equally harmful as tobacco but the accessibility of tobacco and its product are far easier for any individua. To determine the prevalence of tobacco abuse in the community and its association with sociodemographic factors of study participants. A community based cross-sectional study was conducted among 804 study participants of age group 15 – 60 years in Rishikesh, Uttarakhand. Since the population of urban and rural area is almost equal, so to get equal representative 402 study participants were selected from each area. Data was collected in MS Excel and analyzed using SPSS version 23 using appropriate statistical techniques like percentage, chi-square test and p-value. Overall prevalence of substance abuse was found to be 37.4 % out of which the prevalence of current users was 31.34 %. Present study revealed that in spite of having strict law for prohibition of substance abuse, people are still addicted. There is a need to change either in law or in behavior of people at large.

2 tables, 10 ref

046397   CHERIAN V, PHILIP J, JOHN A (Community Medicine Dep, Sree Narayana Institute of Medical Sciences, Ernakulam- 683 594, Email: alexanderjohn.snims@gmail.com) : Prevalence and factors associated with post-traumatic stress disorder among flood-affected adults in a panchayat in Ernakulam District in Kerala. Kerala J Psychiatry 2020, 33(2), 10.30834/KJP.33.2.2020.222.

Floods affected the state of Kerala following unusually heavy rainfall during the monsoon season in August 2018. Post-Traumatic Stress Disorder (PTSD) is the most common and debilitating psychological disorder among victims of floods or any other massive disaster. This study aimed to determine the prevalence and the factors associated with Post-Traumatic Stress Disorder (PTSD) among flood-affected adults in a panchayat in Kerala. In light of the looming threat of climate change, and with Kerala being especially prone to recurring floods due to its geographical location, there is an urgent need to assess the impact of floods on the psychological wellbeing of the residents of the state. To the best of our knowledge, this is the first study to investigate the occurrence of PTSD among the residents of Kerala following exposure to floods. This was a cross-sectional study undertaken in 100 households in a flood-affected community in Kerala. The PTSD Checklist for DSM-5 (PCL-5) was administered to diagnose PTSD. The intensity of flood exposure was measured using a checklist of ten factors. The prevalence of PTSD was 22 %. Loss of a relative, physical injury, and affliction with a physical illness were significantly associated with PTSD. A higher intensity of flood exposure was associated with a greater prevalence of PTSD.  Our study demonstrates the high prevalence of PTSD following floods in Kerala and the need to conduct post-disaster mental health screening. It highlights those factors that may predict the occurrence of PTSD in the affected population. Recommendations are also put forward to mitigate the psychological impact of floods on the inhabitants of the state in the coming years.

2 tables, 20ref

041168   GUPTA D, KUMAR S, CHAKRABORTTY S (Wayne State Univ, Michigan, United States, Email: dgupta@med.wayne.edu) : SOHAM: SEARCHING OUR-OWN HEALTH AFTER MEDICINE by understanding physician mortality data from the United States. Indian J Comm Health 2020, 32(1), 154-60.

While SEARCHING OUR-OWN HEALTH AFTER MEDICINE (SOHAM), we as aging physicians have to first explore and expose our mortality with underlying uniqueness of causes for physician mortality. Herein, publicly available data at Centers for Disease Control and Prevention from National Occupational Mortality Surveillance program of the National Institute for Occupational Safety and Health comes in handy. As compared to all occupational workers in the United States, intentional self-harm, Parkinson’s disease, Alzheimer’s and other degenerative disease were more likely causes of death while chronic obstructive pulmonary disease, diseases of the respiratory system, ischemic heart disease and diseases of the heart were less likely causes of death among physicians in the United States. Summarily, we as physicians may have somewhat overcome sufferings of our lungs and hearts but surrendered to sufferings of our brains and minds and therefore must envisage devising physical, psychological, socioeconomic and spiritual interventions for constantly bettering our living.

5 tables, 12 ref

046396   SUKESH G, NAIR I V (Health Services Dep, District Hospital, Kozhencherry, Pathanamthitta, Email: sukeshgopi@gmail.com) : Pathways to care and duration of untreated illness in patients attending a State Psychiatric Hospital. Kerala J Psychiatry 2020, 33(2), 10.30834/KJP.33.2.2020.218.

In India, due to various factors, mentally ill often turn to a variety of carers for treatment. It results in a longer duration of untreated illness (DUI) with poor long term prognosis. Studies on pathways to care, seek to find out predictors of mentally ill person’s help-seeking behaviour. There is a dearth of literature in this subject in Kerala setting. Cross-sectional study was conducted on 250 consecutive first-time outpatients. The diagnosis was made according to DSM 5. A pilot-tested, semi-structured proforma was used for socio-demographic details and Encounter form by WHO for pathways to care. The analysis was done using Epi Info software. Four gateways to care identified: Psychiatrist- 71.2 %, faith healers – 14.8 %, non-psychiatrist modern medicine doctors- 9.2 %, alternate systems of medicine- 4.8 %. Median DUI was seven months. Faith healers as first carers were more in BPL compared to APL families (p=0.004). Substance use disorders had longer median DUI than psychotic and anxiety disorders and mental retardation. Major neurocognitive disorder had more delays than the schizophrenia spectrum and other psychotic disorders and mental retardation (p=0.000). Among first carers, longer DUI was with faith healers and alternate systems of medicine when compared to psychiatrists. (p=0.000). Those from higher socioeconomic status and a diagnosis of substance use disorder more often have a psychiatrist as the first carer. Being male was associated with lengthier pathways. Faith healers & alternate systems of medicine practitioners form the first portal of psychiatric care for a small yet significant proportion of the patients. Reduction in DUI in case of psychiatric disorders needs attention to this aspect also.

3 tables, 44 ref

041167   SINGH A (Indira Gandhi National Open Univ, New Delhi - 110 068, Email: meet.aartisingh@gmail.com) : The state of healthcare facilities in the field of cardiovascular diseases: Reflections from a public cardiac hospital, Uttar Pradesh. Indian J Comm Health 2020, 32(1), 151-3.

Literature suggest that majority of Indians belonging to lower socio-economic status (SES) are dependent on public health sector but still there is higher rate of deaths among them due to cardiac diseases. The aims of this paper are twofold: (i) To depict the ground realities of a public cardiac hospital, and (ii) To identify the key challenges for the effective policy implementation and control of CVD. Using direct field based observation, experiences and field notes. India’s public healthcare sector for cardiac patients suffers from problem of accessibility and affordability. Further, prevalence of prohibited practices makes things worse for the poor patients.

11 ref

046395   RADHAKRISHNAN P, ARATHIL P, NARAYANAN D (Psychiatry Dep, Amrita Institute of Medical Sciences, Kochi- 682 041, Email: praveen.arathil@gmail.com) : Association of tobacco smoking with bipolar affective disorder- A comparative cross-sectional study at a tertiary care centre in South India. Kerala J Psychiatry 2020, 33(2), 131-6.

Smokers with psychiatric disorders, most notably those with serious mental illness and substance use disorders tend to present with more severe nicotine dependence and nicotine withdrawal than smokers without these illnesses. The following study aims to explore the correlation of smoking with bipolar affective disorder. The comparative cross-sectional study was done in Amrita Institute of Medical Sciences & Research Centre, Kochi, a 1,450-bed hospital for a period of 2 years. Seventy subjects with Bipolar affective Disorder who were in remission for at least two months and Seventy subjects who were relatives of paediatric outpatients were included in the study and control group, respectively. Clinical variables were assessed, and Hamilton depression rating scale, Young mania rating scale and Fagerstorm nicotine rating scale were administered to the subjects. In this study, 52.9 % of subjects with bipolar disorder were found to be smokers, and 51.4 % of the normal population were smokers. No significant association was observed between bipolar affective disorder, and smoking tobacco, however, a significant correlation was found between smoking status and the total number of episodes of the disorder, psychotic episodes and suicide attempts. There appears to be a relationship between smoking tobacco and certain clinical features of bipolar affective disorder. It is possibly a bidirectional relation between these two disorders. 

5 tables, 22 ref

041165   KOHLI S, CHADHA R (Food and Nutrition Dep, Delhi Univ, Delhi - 110 021, Email: sahibakohli27@gmail.com) : Counselling skills of accredited social health activists for promotion of optimal infant and young child feeding practices. Indian J Comm Health 2020, 32(1), 137-44.

Accredited Social Health Activists (ASHAs) play an important role in communicating messages related to infant and young child feeding (IYCF) practices. Adequate knowledge and counselling skills are crucial for effective behavior change among mothers. To assess counselling skills of ASHAs for promotion of optimal IYCF practices among mothers of young children. ASHAs (n=190) were selected randomly from 21 primary health centres in Delhi. Their knowledge and counselling skills for promotion of optimal IYCF practices were assessed using a questionnaire and simulated counselling sessions based on WHO IYCF counselling course (2006) and IYCF guidelines by WHO (2009), GOI (2006) and IAP (2016). Mean scores of ASHAs on optimal IYCF knowledge and counselling skills were 65.2±11.8 % (n=190) and 41.8±9.4 % (n=182) respectively. Less than half (45 %) of the appropriate key messages were correctly communicated by ASHAs during the simulated counselling sessions. Majority of ASHAs (>75 %) used helpful non-verbal communication, simple language and tried solving problems while counselling. Inability to empathise with caregivers, praising good practices and assessing their understanding were the communication skills which most ASHAs (>95 %) lacked. There is need to focus on improving their counselling skills for effective promotion of optimal IYCF practices.

3 tables, 13 ref

046394   SIVASUBRAMONEY K, KOTHANDARAMAN L, PRABHAKARAN A, BHARATHADAS S, KUMARI J (Psychiatry Dep, Government Medical Coll, Thiruvananthapuram- 695 011, Email: dranilprabhakaran@gmail.com) : Self-reported emotional experience among police personnel before and after attending a mindfulness-based intervention (mindful life management-MLM) –An observational study. Kerala J Psychiatry 2020, 33(2), 125-30.

Stress has been proven to be hazardous, resulting in significant physical, emotional, social and cognitive disturbances which are unpleasant. Police officers have elevated rates of cardiovascular diseases, sleep disorders, anxiety disorders, depression and PRSD. Kerala Police has implemented several programs for management of stress among its members. Mindfulness-Based Interventions (MBIs) have been shown to enhance emotional intelligence, reduce negative emotions and health outcomes in police officers. The objective of the current study is to study the effectiveness of an MBI in reducing the negative emotions among police officers. The present study is an observational study which attempts to assess and compare the subjectively reported emotion and Mindfulness level among police personnel before and six weeks after attending the Mindful Life Management (MLM) workshop. Results of the present study suggests a statistically significant association between subjective emotional experience and the MBIs. Five Facet Mindfulness Questionnaire (FFMQ) scores also were found to be significant statistically.  FFMQ scores before and after the MLM workshop were found to be statistically significant. Results of the present study points to the fact that MLM can be thought of as a method of intervention to manage emotional turmoil among police personnel of our state. The relationship between the change in emotion and change in FFMQ score has to be further explored with adequate sample size. This ongoing study comparing the stress and emotional levels of the police force in the State of Kerala before and after MLM course will help to strengthen further the effects of MBIs in recognizing their emotional state.

3 tables, 21 ref

046393   GEO J, JOSEPH C, GEORGE C S, KALLIVAYALIL R A (Plastic and Reconstructive Surgery Dep, Pushpagiri Medical Coll, Kerala- 689 101, Email: drcyrilplastic@gmail.com) : Self-inflicted upper limb injuries in a tertiary care semi-rural plastic surgery unit–A psychiatric evaluation. Kerala J Psychiatry 2020, 33(2), 121-4.

Deliberate self-harm patients (DSH) with upper limb injuries are commonly admitted in the plastic surgery units. Psychiatric comorbidities are risk factors for these patients with self-inflicted injuries. A multidisciplinary team approach is needed. Patients who presented with self-inflicted upper limb injuries in the plastic surgery department were referred for psychiatric liaison services. Socio-demographic data, mode of injury, plastic surgical procedures, and psychiatry diagnosis were noted. Out of 48 patients, 20 (41.6 %) belong to the 21-30 age group, 30 (62.5 %) were males. 43 (89.6 %) patients needed major plastic surgery procedures. The major psychiatric comorbidities were depressive disorder (27.1 %), adjustment disorder (16.6 %), alcohol dependence syndrome (14.6 %), and bipolar mood disorder (12.5 %). High psychiatric morbidity among self-inflicted hand injuries suggests the need for a multidisciplinary approach and long term follow-up. Psychiatric liaison services are important in the treatment of self-inflicted upper limb injuries.

5 tables, 13 ref