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INTRODUCTION: In the prevailing COVID-19 pandemic, the Indian healthcare system has worked hard towards restricting the adverse outcomes to the least possible figures. The present study aims to share the experience of a COVID-dedicated tertiary care government hospital in Northern India of managing COVID-19 patients with comorbidities. METHODOLOGY: A retrospective, observational study was conducted in a COVID-dedicated tertiary health care government hospital in Northern India. Details on sociodemographic data, hospital admission data, and drug utilization pattern of all laboratory-confirmed COVID-19 patients of all age groups, either gender, having comorbidity (s), and admitted between April and September, 2020 were noted and evaluated. RESULTS: Among the total study participants (N = 406), 2868 drugs were prescribed. Out of these, 2336 were used for the management of symptoms of COVID-19 and 532 were used for the management of coexistent comorbidity (s). For COVID-19 symptoms, the most commonly prescribed class of drugs were antimicrobials (853, 36.52%), followed by nonsteroidal antiinflammatory drugs (374, 16.01%), proton pump inhibitors (299, 12.80%), antihistamines (232, 9.93%), immunosuppressant drugs (103, 4.41%), and others. For comorbidities most commonly prescribed were antihypertensive (310, 58.60%) drugs, followed by antidiabetic drugs (166, 31.38%), bronchodilators (34, 6.43%), thyroid hormones (11, 2.08%), immunosuppressant drugs (7, 1.32%). CONCLUSION: The most frequently prescribed antihypertensives were calcium channel blockers (CCBs) and least prescribed was beta blocker+CCB. Among the antidiabetic drugs, most frequently prescribed was insulin and least prescribed was DPP-4 inhibitors and Biguanide+DPP-4 inhibitor both.

ABSTRACTThis study examined the oral hygiene levels and periodontal status in a group of children and adults with hearing impairment attending a special school in Udaipur, India. Oral hygiene status was assessed by the Simplified Oral Hygiene Index (OHI‐S) of Greene and Vermillion and periodontal status by the Community Periodontal Index. An analysis using a bivariate analysis revealed that all the oral hygiene variables varied significantly with age, economic status, and education of the parents. A multiple regression analysis showed that the education of the mother was the single best predictor for oral hygiene status and explained 92% of the variance. These findings show that children with hearing impairment have poor oral hygiene and high levels of periodontal disease. This may be due to a lack of communication; hence, appropriate oral health education should be tailored to the needs of these students with the support of their teachers and their parents.

This article attempts to understand how youth in contemporary India perceives, experiences and engages with the contestations around the ideas of citizenship and nation against the backdrop of the new citizenship policies. In December 2019, the majoritarian Hindu nationalist government in India enacted a Citizenship Amendment Act (CAA) that purported to give citizenship to persecuted religious minorities from India's neighbouring countries. But the Act crucially did not include Muslims in the list of oppressed minorities and created widespread anxieties about the possible loss of citizenship through the CAA and the National Register of Citizens. Millions of young people across Indian university campuses and neighbourhoods took to the streets to protest against the legislation. Drawing on the narratives of the young people who participated in these protests, this article highlights the youth's conceptions of and negotiations with their identity and the use of different modes of resistance deployed in the anti-CAA movement. The article concludes by laying out the implications of these youth protests as a mode of 'public pedagogy' for citizenship education as an alternative to the statist models of citizenship education.

The private healthcare sector in low- and middle-income countries is increasingly seen as of public health importance, with widespread interest in improving private provider engagement. However, there is relatively little literature providing an in-depth understanding of the operation of private providers. We conducted a mixed methods analysis of the nature of competition faced by private delivery providers in Uttar Pradesh, India, where maternal mortality remains very high. We mapped health facilities in five contrasting districts, surveyed private facilities providing deliveries and conducted in-depth interviews with facility staff, allied providers (e.g. ambulance drivers, pathology laboratories) and other key informants. Over 3800 private facilities were mapped, of which 8% reported providing deliveries, mostly clustered in cities and larger towns. 89% of delivery facilities provided C-sections, but over half were not registered. Facilities were generally small, and the majority were independently owned, mostly by medical doctors and, to a lesser extent, AYUSH (non-biomedical) providers and others without formal qualifications. Recent growth in facility numbers had led to intense competition, particularly among mid-level facilities where customers were more price sensitive. In all facilities, nearly all payment was out-of-pocket, with very low-insurance coverage. Non-price competition was a key feature of the market and included location (preferably on highways or close to government facilities), medical infrastructure, hotel features, staff qualifications and reputation, and marketing. There was heavy reliance on visiting consultants such as obstetricians, surgeons and anaesthetists, and payment of hefty commission payments to agents who brought clients to the facility, for both new patients and those transferring from public facilities. Building on these insights, strategies for private sector engagement could include a foundation of universal facility registration, adaptation of accreditation schemes to lower-level facilities, improved third-party payment mechanisms and strategic purchasing, and enhanced patient information on facility availability, costs and quality.

The private healthcare sector in low- and middle-income countries is increasingly seen as of public health importance, with widespread interest in improving private provider engagement. However, there is relatively little literature providing an in-depth understanding of the operation of private providers. We conducted a mixed methods analysis of the nature of competition faced by private delivery providers in Uttar Pradesh, India, where maternal mortality remains very high. We mapped health facilities in five contrasting districts, surveyed private facilities providing deliveries and conducted in-depth interviews with facility staff, allied providers (e.g. ambulance drivers, pathology laboratories) and other key informants. Over 3800 private facilities were mapped, of which 8% reported providing deliveries, mostly clustered in cities and larger towns. 89% of delivery facilities provided C-sections, but over half were not registered. Facilities were generally small, and the majority were independently owned, mostly by medical doctors and, to a lesser extent, AYUSH (non-biomedical) providers and others without formal qualifications. Recent growth in facility numbers had led to intense competition, particularly among mid-level facilities where customers were more price sensitive. In all facilities, nearly all payment was out-of-pocket, with very low-insurance coverage. Non-price competition was a key feature of the market and included location (preferably on highways or close to government facilities), medical infrastructure, hotel features, staff qualifications and reputation, and marketing. There was heavy reliance on visiting consultants such as obstetricians, surgeons and anaesthetists, and payment of hefty commission payments to agents who brought clients to the facility, for both new patients and those transferring from public facilities. Building on these insights, strategies for private sector engagement could include a foundation of universal facility registration, adaptation of accreditation schemes to ...

Newborn Vaccination is identified as a critical parameter for evaluating the overall performance of immunization programs with guidelines clearly advocating for administration of BCG, OPV zero dose and Hepatitis B birth dose to newborns. However in spite of sustained improvement in full immunization coverage in India, coverage of newborn vaccines has remained traditionally low. The USAID supported Maternal and Child Health Integrated Program (MCHIP), operational in India from 2009 – 2014 provided technical support to the Universal Immunization Program (UIP) at the National level and in the states of Jharkhand and Uttar Pradesh. During the project period, MCHIP undertook an assessment in 46 selected health facilities across 5 districts of the two states to study the implementation of the newborn vaccination program. Key findings from the assessment included a lack of knowledge among staff about the benefits of newborn vaccination, absence of written guidelines, unavailability of one vaccine compromising the administration of the remaining two and poor documentation practices. Following the assessment technical support was provided to strengthen implementation at these selected facilities which included providing on-the-job orientations to staff members posted in delivery rooms, establishing a sound supply chain mechanism to ensure round the clock availability of vaccines in labour rooms, strengthening documentation by incorporating separate columns in the delivery registers for recording vaccine administration and improved Supportive Supervision mechanisms. The intervention produced favorable results with a progressive increase in coverage of not only BCG and OPV zero dose but also Hepatitis B birth dose which was introduced in the UIP during the course of the intervention. Overall this intervention, which focused on operationalizing an already existing strategy, clearly indicated that the practice of vaccinating newborns delivered at health facilities is easily implementable and replicable, and that its ...

RS Kumar,1 Manish Kumar Jain,2 Jitendra Singh Kushwaha,3 Santosh Patil,4 Vasanti Patil,5 Soumya Ghatak,6 Jayesh Sanmukhani,7 Ravindra Mittal7 1Department of Pulmonary Medicine, Government Medical College & Government General Hospital, Srikakulam, India; 2Department of Pulmonary Medicine, Maharaja Agrasen Superspeciality Hospital, Jaipur, India; 3Department of Medicine, Prakhar Hospital Pvt. Ltd, Kanpur, India; 4Department of ENT, Jeevan Rekha Hospital, Belgavi, India; 5Department of ENT, Rajarshi Chhatrapati Shahu Maharaj Government Medical College and CPR Hospital, Kolhapur, India; 6Department of ENT, College of Medicine and Sagore Dutta Hospital, Kolkata, India; 7Department of Clinical Research and Regulatory Affairs, Cadila Healthcare Limited, Ahmedabad, IndiaCorrespondence: Jayesh Sanmukhani, Department of Clinical Research and Regulatory Affairs, Cadila Healthcare Ltd, Ahmedabad, India, Tel +91 76000 12192, Email Jayesh_sanmukhani@yahoo.co.in; jayeshsanmukhani@zyduscadila.comObjective: To compare the efficacy and safety of a fixed dose combination of Fluticasone Furoate and Oxymetazoline Hydrochloride Nasal Spray 27.5/50 mcg (FDC) with Fluticasone Furoate Nasal Spray 27.5 mcg (Fluticasone) in the management of allergic rhinitis.Patients and Methods: A prospective, randomized, double-blind, two-arm, active-controlled, parallel, multicenter, comparative clinical study was conducted in patients with allergic rhinitis aged 18 years and above having moderate-to-severe nasal congestion.Results: A total of 250 patients were randomized (1:1) to receive either the FDC or Fluticasone alone in a dose of two sprays in each nostril once daily at night. There was a significantly (P< 0.001) greater reduction in night-time Total Nasal Symptom Score with the FDC as compared to Fluticasone at all the time points starting from as early as day 3 and sustained till the end of treatment (Day 28) (Day 3: − 3.1 vs − 2.2; Day 7: − 4.0 vs − 3.4; Day 14: − 5.7 vs − 5.0; Day 28: − 7.0 vs − 6.4). A significantly ...