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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 9 | Issue 2
Page Nos. 105-145

Online since Tuesday, December 20, 2022

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COMMENTARY  

SARS-CoV-2-related multisystem inflammatory syndrome in children and adolescents p. 105
Arpita Gupta
DOI:10.4103/cjhr.cjhr_71_21  
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REVIEW ARTICLES Top

Lock to unlock: A multidimensional impact of COVID-19 in India p. 107
Murugan Mageshwari, Abhijit Boratne Vinodrao
DOI:10.4103/cjhr.cjhr_82_21  
The COVID-19 pandemic forced for first lockdown in India in March 2020. Resurgence of COVID-19 cases has forced many states in India to reintroduce the movement restrictions in March 2021. With four times increase in number of cases, many hospitals are swamped with patients, shortage of doctors and healthcare workers, shortage of personal protective equipment (PPEs), medications, and oxygen. The second wave led to out of pocket expenditures, hike in health care budget, burnouts among the health care workers (HCWs), migration, and hampered education system. The crisis was due to insufficient oxygen and beds, repeated changes in the treatment protocol and testing strategies, violence against HCWs and front line workers (FLWs), vaccination hesitancy to vaccination shortage, and increased morbidity to mortality. The quarantine and isolation of HCWs and FLWs become difficult due to the insufficient workforce. This formed as an opportunity leading to public–private partnership for patient care and successful vaccination. The pandemic brought the concept of advanced technologies and inventions such as use of Robotics, Apps such as Arogyasetu and CoWin, Ventilators, and O2 plants (O2 concentrator), and self-testing kits (COVISELF). Apart from the COVID appropriate behaviors, mass vaccination and newly approved treatments, the policymakers can stabilize the country with helping hand from industries, development of workforce, adequate production, and supply of medicines-vaccine and PPEs to rejuvenate the healthcare industry at the earliest.
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Strengthening of health care and local production of medicines and other health technologies to improve access and affordability p. 112
Abhijit Vinod Rao Boratne, Mageshwari Murugan, Senkadhirdasan Dakshinamurthy
DOI:10.4103/cjhr.cjhr_83_21  
A lot of discussion happened regarding the required World Health Organization's support to strengthen local production of drugs in this pandemic. During the COVID-19 pandemic, the world has struggled for everything starting from the availability of masks, personal protective equipment's, medicines, equipment, ventilators, and even basic oxygen. All these needs have exposed the existing condition of our health-care system that has called for improving the infrastructure and workforce at the earliest. Health-care spending and its impact on economic performance are vital to be seen leading to an increase in gross domestic product and vice versa. A recent estimate states that our country which was told as world's pharmacy is now facing a shortage of vaccines doses. A recent estimate states that our country which was told as world's pharmacy is now facing a shortage of vaccines doses creating the necessary research and development to discover or develop innovative way of strengthening the local production of medicines. The Ministry of Health and Family Welfare in India has initiated several measures to ensure the quality of drugs available in India. Lower- and middle-income countries face macroeconomic vulnerabilities, high levels of poverty and are lagging behind the universal health coverage. Hence, necessary recommendations were arrived for these issues in this article.
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Experiential teaching learning of humanities in health professions education p. 118
Anushi Mahajan, Purvi Bhagat, Sudhir Babu, Anuj Singhal, Dinesh Badyal, Rajiv Mahajan
DOI:10.4103/cjhr.cjhr_161_20  
Humanities are an integral part of health professions. However, with educational focus shifting gradually toward knowledge, information, evidence-based medicine, and technology, it has taken a back seat and become a part of the “hidden curriculum.” Humanities are hardly ever taught upfront to students of the health profession, let alone its assessment. With the need of its inclusion in health professional education now recognized and established through competency-based education, we need to be aware of the tools and strategies which can be used to teach and assess it. In this article, we share selected tools with relevant readily usable examples for teaching humanities to students of the health profession. Faculty may find it useful to plan sessions around related competencies. Incorporation of such experiential teaching and learning methods can help us achieve the transition from “high-tech” to “high touch” health professions education.
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ORIGINAL ARTICLES Top

Fosfomycin susceptibility among multidrug resistant and extended spectrum β-Lactamase producing uropathogenic Escherichia coli isolates at a tertiary care hospital of Western India p. 125
Ruchi Jain, Nita Pal, Saroj Hooja
DOI:10.4103/cjhr.cjhr_21_21  
Introduction: Urinary tract infections are mostly treated empirically with broad-spectrum antibiotics which have resulted in development of multi-drug resistant strains. Limited options of newer antibiotics have necessitated the reintroduction of some old antimicrobial agents such as fosfomycin. Aim: To evaluate the in-vitro activity of fosfomycin against uropathogenic E.coli. Method: A total of 145 E.coli isolates were identified by conventional microbiological procedures and antimicrobial susceptibility performed by Kirby-Bauer disk diffusion method. They were screened for extended spectrum β-lactamase (ESBL) production and screen positives were confirmed by phenotypic confirmatory test (CLSI). Results: Out of 145 isolates, 91 (62.76 %) were found in males and 54 (37.24%) from females. Majority of the isolates were detected in the age group of 21-30 years 48.96%. A very high susceptibility of 94.48% was observed with fosfomycin. Suceptibility to tigecycline and nitrofurantoin was 87.58 % and 77.24 % respectively. Multi-drug resistance was observed in 85.51% isolates and 45.51% were ESBL producers. Conclusion: Fosfomycin showed an excellent in vitro activity against MDR and ESBL producing E.coli, therefore it should be considered as a potential therapeutic alternative in the treatment of UTI.
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A randomized controlled trial of lidocaine versus ropivacaine for pain relief after episiotomy p. 130
Asis Adhikary, Papiya Biswas, Tanushree Mondal, Subir Kumar Bhattacharyya
DOI:10.4103/cjhr.cjhr_88_20  
Introduction: Episiotomy is the most common surgical procedure for parturient. Analgesia after episiotomy has received less attention, though the postepisiotomy pain may hamper the day-to-day activities such as sitting, sleeping, urinating, and walking of the parturient. It is desirable to reduce the postepisiotomy pain as early as possible. Therefore, we planned to carry out a randomized controlled trial to compare the safety and efficacy of lidocaine versus ropivacaine perineal infiltration for pain relief after episiotomy. Materials and Methods: The prospective randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology of R. G. Kar Medical College and Hospital, Kolkata. One hundred women were enrolled and randomized into the two groups: Lidocaine infiltration group and ropivacaine infiltration group. Primary objective was to evaluate the efficacy of postepisiotomy pain control by the visual analog scale (VAS) score at 24 h after the episiotomy. Secondary objectives were to evaluate the efficacy of postepisiotomy pain control by VAS score during suturing, at 2 h and 48 h or any adverse effects and maternal satisfaction at 48 h. Results: The postepisiotomy pain relief at 2 h and 24 h was significantly lower in ropivacaine in comparison to lidocaine infiltration. Mean VAS Score 24 h after suturing in lidocaine group was 6.38, and in ropivacaine group, it was 5.64. Maternal pain perception at the time of suturing and at 48 h was also less in ropivacaine than in lidocaine infiltration. Mothers were more satisfied with ropivacaine drug. Conclusion: The present study showed that there was definite improvement of postepisiotomy pain relief at 2 h and 24 h in ropivacaine local infiltration of the episiotomy wound in comparison to lidocaine infiltration and mothers were more satisfied with ropivacaine use.
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Duties, responsibilities, and challenges of community health workers: Evidence from a health block of northern Indian province p. 135
Ramesh Kumar Rattu, Manoj Kumar, Kavita Sekhri, Ankit Chaudhary
DOI:10.4103/cjhr.cjhr_35_21  
Introduction: Accredited Social Health Activist (ASHA) worker is a significant frontline health worker that acts as a link between community and health services and helps delivering quality health services to vulnerable section of the society. The present study was conducted with an objective to explore the duties and responsibilities of the ASHA worker along with obstacles faced by them while discharging their duties. Methods: It was a cross-sectional study including 150 ASHA workers of a health block in Himachal Pradesh. Data were collected using a semi-structured questionnaire consisting of six subsections dedicated to different dimensions related to ASHA workers. Results: Majority of ASHAs stated that their job had a positive effect on their social relationships, confidence as well as their physical and mental health. About two-thirds workers failed to fulfill targets due to many activities running simultaneously. About 43.3% felt mental stress during the job and 20.7% workers experienced harassment by hospital staff. About 40% stated that they had received unsatisfactory training. Toilet facility was available for only 59.3% workers and safe drinking water for 64.7% ASHAs. Only 4.7% of ASHAs were satisfied with their monthly income. Conclusion: While ASHAs are working with dedication in the field, still they are experiencing many problems associated with their personal life, community norms, terrain of the workplace, transportation, and organizational issues. The study recommends few amendments as ASHAs being an integral part of Indian health system must be given their due consideration so that the vision of universal health coverage and sustained development can be attained effectively.
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CASE REPORTS Top

Leishmanial lymphadenopathy in a native patient from the nonendemic region of Himachal Pradesh, India p. 140
Rashmi Kaul Raina, Shubham Sharma, Neha Verma, Meghavath Haritha Bai, Ritika Kashyap, Sujeet Raina
DOI:10.4103/cjhr.cjhr_87_21  
A case of leishmanial lymphadenopathy in an immunocompetent native from a nonendemic area of the Ravi River valley area (altitude 996 m above the mean sea level) of Chamba, Himachal Pradesh, India, is reported. Diagnosis of visceral leishmaniasis by demonstration of Leishman–Donovan bodies in lymph nodes by fine-needle aspiration cytology has been rarely reported.
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Malaria and dengue coinfection p. 143
Amandeep Kaur, Monika Sharma
DOI:10.4103/cjhr.cjhr_62_21  
Concurrent infection of malaria and dengue may be difficult to diagnose because of overlapping signs and symptoms. An 11-year-old boy presenting in the causality with blanching rash, respiratory distress, and hypotension was initially managed as dengue shock syndrome. Due to high-grade fever and hepatosplenomegaly, peripheral blood film for malarial parasite was sent, which came out to be positive for vivax malaria. This case report emphasizes the need to consider about the possibility of dengue–malaria coinfection in the endemic areas and highlights the challenges related to management among these patients.
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