Objectives:To assess the epidemiological profile of asthma in school going children in Srinagar, Kashmir.Study design:Cross-sectional study.Setting:Thirty-one schools with proportionate representation from both government and private schools as well as from primary, middle, and high schools.Participants:School children aged 10–16 years with equal representation of sex and all ages.Main Outcome Measure:Prevalence of current and past asthma.Methods and Results:After administering a modified pretested questionnaire, peak expiratory flow measurement was carried. Children who had asthma-like symptoms or positive family history of asthma or physician-labeled asthma were subjected to spirometry and bronchodilator reversibility. Out of 806 children, bronchial asthma was seen in 60 (prevalence of 7.4%) which included 34 boys and 26 girls. Majority of asthmatic children (78.3% [n = 47]) had probable asthma; 6.7% (n = 4) had definite asthma; and 15% (n = 9) had physician-diagnosed asthma. Majority of children had intermittent asthma (78.3% [n = 47]). Mild persistent asthma was seen in 12.7% (n = 7) and 10% (n = 6) had moderate persistent asthma. None of the children had severe persistent asthma. The prevalence of current asthma was 3.2% (n = 26). On univariate analysis, the factors found to be statistically significant were family history of asthma (odds ratio [OR] =8.174; confidence interval [CI] =4.403–15.178), seasonal cough (OR = 4.266; CI = 2.336–7.791), allergic rhinitis (OR = 2.877; CI = 1.414–5.852), atopic dermatitis (OR = 6.597; CI = 2.72–16.004), and obesity (OR = 6.074; CI = 2.308–18.034). On multivariate analysis, family history, seasonal cough, allergic rhinitis, atopic dermatitis, and obesity were found to be significant independent risk factors.Conclusions:Srinagar qualifies as a low prevalence area for bronchial asthma in the age group of 10–16 years. Majority of children had mild intermittent asthma resulting in under diagnosis and wrong treatment.

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BackgroundWithin Kashmir, which is one of the topographically distinct areas in the Himalayan belt of India, a total of 2,236 cumulative deaths occurred by the end of the second wave. We aimed to conduct this population-based study in the age group of 7 years and above to estimate the seropositivity and its attributes in Kashmir valley.MethodsWe conducted a community-based household-level cross-sectional study, with a multistage, population-stratified, probability-proportionate-to-size, cluster sampling method to select 400 participants from each of the 10 districts of Kashmir. We also selected a quota of healthcare workers, police personnel, and antenatal women from each of the districts. Households were selected from each cluster and all family members with age 7 years or more were invited to participate. Information was collected through a standardized questionnaire and entered into Epicollect 5 software. Trained healthcare personnel were assigned for collecting venous blood samples from each of the participants which were transferred and processed for immunological testing. Testing was done for the presence of SARS-CoV-2-specific anti-spike IgM, IgG antibodies, and anti-nucleocapsid IgG antibodies. Weighted seropositivity was estimated along with the adjustment done for the sensitivity and specificity of the test used.FindingsThe data were collected from a total of 4,229 participants from the general population within the 10 districts of Kashmir. Our results showed that 84.84% (95% CI 84.51–85.18%) of the participants were seropositive in the weighted imputed data among the general population. In multiple logistic regression, the variables significantly affecting the seroprevalence were the age group 45–59 years (odds ratio of 0.73; 95% CI 0.67–0.78), self-reported history of comorbidity (odds ratio of 1.47; 95% CI 1.33–1.61), and positive vaccination history (odds ratio of 0.85; 95% CI 0.79–0.90) for anti-nucleocapsid IgG antibodies. The entire assessed variables showed a significant role during multiple logistic regression analysis for affecting IgM anti-spike antibodies with an odds ratio of 1.45 (95% CI 1.32–1.57) for age more than 60 years, 1.21 (95% CI 1.15–1.27) for the female gender, 0.87 (95% CI 0.82–0.92) for urban residents, 0.86 (95% CI 0.76–0.92) for self-reported comorbidity, and an odds ratio of 1.16 (95% CI 1.08–1.24) for a positive history of vaccination. The estimated infection fatality ratio was 0.033% (95% CI: 0.034–0.032%) between 22 May and 31 July 2021 against the seropositivity for IgM antibodies.InterpretationDuring the second wave of the SARS-CoV-2 pandemic, 84.84% (95% CI 84.51–85.18%) of participants from this population-based cross-sectional sample were seropositive against SARS-CoV-2. Despite a comparatively lower number of cases reported and lower vaccination coverage in the region, our study found such high seropositivity across all age groups, which indicates the higher number of subclinical and less severe unnoticed caseload in the community.

Background: Pregnancy induced hypertension (PIH) is a significant cause of morbidity among pregnant females and also affects the foetal outcome. Numerous risk factors have been identified. This study was conducted to estimate the prevalence of PIH and the factors associated with PIH. Methods: This was a cross-sectional hospital-based study. Pregnant women admitted for delivery in the gynaecology and obstetrics department of SKIMS Soura formed the study participants. Patients with chronic hypertension were excluded. A minimum sample size of 295 was calculated but finally a sample of 402 was achieved. The data was collected over a 3-month period from July to September 2021 using convenient sampling. Data was entered in Microsoft excel and analysed using IBM SPSS version 23. Results: A total of 402 pregnant women were included. Majority (61%) of the participants were up to 30 years of age, majority (97.8%) were up to para 3 and 89% were literate. The prevalence of PIH was 6.5%. Hypertension was more frequent among the women with age more than 30 years (p=0.041) and women with higher pre-pregnancy BMI (p=0.010). Maternal education, occupation and parity were not associated with hypertension in pregnancy. Conclusions: In our study older women and women with higher body mass index (BMI) were more at risk of having PIH in pregnancy. Therefore, we would recommend earlier age at marriage and lifestyle modification for maintaining normal BMI.

Background: Ultrasound appears to be a suitable diagnostic technology for use in primary care and community settings. It plays a pivotal role in evaluation of patients and helps in making timely diagnosis and more widely on referral pathways into secondary care.Methods: The study was conducted at the primary health centre Hazratbal, which is one of the primary health centre of field practice area of the Department of community medicine, Government Medical College, Srinagar. This observational study was conducted over a period of three months where 255 patients were scanned by a primary care physician (sonologist). For each patient scanned, the ultrasound performing physician completed a standardized data collection form including patient demographics, clinical details, indications for ultrasound and ultrasound findings.Results: A total of 255 patients were scanned during the study period. Males were 43 (17%) and females were 212 (83%). Maximum number of patients were in the age range of 25-34 years, n=96 (38%). Among the patients scanned 66 (24.44%) were obstetric cases. Acute diffuse abdominal pain n=32 (11.85%) was the most common clinical presentation followed by pain upper abdomen n=28 (10.37%) among non-obstetric patients. Ovarian cyst was the most common finding, followed by fatty liver and bilateral nephrolithiasis.Conclusions: The utility of ultrasonography in the hands of primary care physician is of great value. It is cost effective option, especially in this part of the world. We need to give expertise to primary care physicians in order to provide better health care at primary health care settings, which will lessen the burden of referrals.

Background: Rabies, a neglected tropical disease, is vaccine preventable and occurs in more than 150 countries. It is almost always fatal. About 40% of deaths due to rabies occur in children under the age of 15 years. Objectives were to study the pattern of injury following exposure to canine bite, bear maul and rabid cow among the attendees of Antirabies clinic of SMHS hospital, Srinagar and to classify the type of exposure using WHO guidelines for initiation of post exposure prophylaxis.Methods: The study was conducted over a period of three months from 1st June 2016 to 31st August 2016, in Anti Rabies Clinic of Department of Community Medicine, Government Medical College, Srinagar. It was a descriptive Study and included all victims of canine bite and rabid cow. A total of 134 patients were received.Results: Most [83 (61.9%)] of the patients were males with mean age of 36.63 years. Legs were the most common [57 (43.2%)] site of exposure followed by hands [15 (11.2%)] and thigh [13 (9.7%)]. Contact with a rabid cow was present in 5 (3.7%). Class II exposure was most frequently encountered [83 (61.9%)]. Class III exposure was seen in 49 (36.6%). All patients who attended anti rabies clinic for post exposure prophylaxis received free Antirabies Vaccine. Combined Antirabies vaccine and immunoglobulin was received by 49 (36.6%).Conclusions: Dog bite related injuries happen frequently in Srinagar. There is proper post exposure prophylaxis in place in SMHS hospital. There is need for curbing the ever increasing dog population and enforcing rabies vaccination in dogs.

Background: Post-exposure prophylaxis (PEP) is the mainstay of prevention in suspected exposure to rabies virus. Exposed patients are able to obtain anti-rabies vaccine in the anti-rabies clinic pro bono but they have to pay for passive immunization and cover other associated costs. Aim: To estimate and analyze the direct and indirect costs of rabies PEP. Methods: This study was conducted on 429 patients, who were exposed to bites from various animals and reported to Shri Mahraja Hari Singh Hospital (SMHS), an associated tertiary hospital of Government Medical College, Srinagar, Kashmir. Patient socio-demographic profile, details of animal bite exposure, the cost incurred for PEP was collected. The data were analyzed using a descriptive statistic. Results: The study revealed a total median cost incurred on patients for receiving a PEP as 29.3 USD (United States Dollar), with an Inter-quartile Range (IQR) of 0.2 USD to 43.1USD. The direct median cost was 20.5 USD with an IQR of 6.2 USD to 29.4USD, while the indirect median cost was 20.3USD with an IQR of 13.5USD to 24.4USD. Conclusion: Post-exposure prophylaxis imposes a significant economic burden to bite victims especially those of low socio-economic strata for whom the cost is substantial.

Purpose: Late onset neonatal hypocalcemia (LNH) is defined as hypocalcemia detected after day 3 of life. Its occurrence in babies fed with cow’s milk is well understood. Since the advent of modern-day formulas, the incidence has however decreased. Methods: A prospective descriptive study (January 2017 to December 2017) of LNH seizures in neonates was conducted. LNH was defined as the total serum calcium of less than 7 mg/dL in preterm or less than 8 mg/dL in term newborns after 72 h of life. Results: 14 neonates were presented with myoclonic and focal seizures due to late hypocalcemia. All were formula fed. Their mean serum calcium, phosphorus, alkaline phosphatase, magnesium, 25-OH vitamin D, intact PTH levels were 4.93 mg/dL, 9.19 mg/dL, 244 U/L, 1.2 mg/dL, 30 nmol/L, 38.6 pg/mL, respectively. Mean maternal vitamin D levels were 43 nmol/L. Mean hospital stay was 4 days. Clinical response to treatment was brisk in those who were able to shift to total breast feeding early. Conclusions: LNH in formula-fed and vitamin D deficient babies is not uncommon. Emphasis should be laid on exclusive breast feeding even in vitamin D deplete mothers. However, mothers at risk should be supplemented with vitamin D during pregnancy.