Brogen Singh Akoijam

Spatial distribution and characteristics of injecting drug users (IDU) in five Northeastern states of India

BackgroundInjecting drugs is the major driving force of human immunodeficiency virus (HIV) epidemic in Northeastern India. We have assessed the spatial distribution of locations where injecting drug users (IDU) congregate, as well as the risk behaviour and key characteristics of IDUs to develop new strategies strengthening intervention measures for HIV prevention in this region.MethodsLocations of IDUs congregation for buying and injecting drugs were identified through Key Informants (KI). Verification of the location and its characteristics were confirmed through field visits. We also conducted semi-structured and structured interviews with IDUs to learn more about their injecting behaviour and other characteristics.ResultsAltogether, 2462 IDU locations were identified in 5 states. The number of IDU locations was found to be greater in the states bordering Myanmar. Private houses, parks, abandoned buildings, pharmacies, graveyards, and isolated places were the most frequently chosen place for injecting drugs. Many injecting locations were visited by IDUs of varying ages, of which about 10-20% of locations were for females. In some locations, female IDUs were also involved in sex work. Sharing of needle and syringes was reported in all the states by large proportion of IDUs, mainly with close friends. However, even sharing with strangers was not uncommon. Needle and syringes were mainly procured from pharmacies, drug peddlers and friends. Lack of access to free sterile needles and syringes, and inconsistent supplies from intervention programs, were often given as the cause of sharing or re-use of needles and syringes by IDUs. Most of the IDUs described a negative attitude of the community towards them.ConclusionWe highlight the injection of drugs as a problem in 5 Northeastern India states where this is the major driving force of an HIV epidemic. Also highlighted are the large numbers of females that are unrecognized as IDUs and the association between drug use and sex work. Understanding of risk behaviours and other key charecteristics of IDUs in the region will help in strengthening harm reduction efforts that can prevent HIV transmission.

Size estimation of injecting drug users (IDU) using multiplier method in five Districts of India

The HIV epidemic in Manipur, the highest HIV prevalence state of India, is primarily driven by injecting drug use. Reliable estimate of population size of injecting drug users (IDU) is critical for aiding HIV prevention program in the state to combat drug driven HIV epidemic. The study described multiplier method, an indirect technique of estimation of IDU size in five districts of Manipur, India making use of existing records of rapid intervention and care (RIAC) programs. Number of IDUs who accessed RIAC services during the past 12 months was taken as the benchmark data for the size estimation. The benchmark data were then multiplied by the inverse of the proportion of the IDUs who reported having accessed RIAC services during the same period to derive the sizes of IDU population in each study districts. The estimated sizes of IDU population in five districts were: 7353 (95% CI: 6759-8123) in Imphal West, 5806 (95% CI: 5635-6054) in Imphal East, 3816 (95% CI: 3571-4139) in Thoubal, 2615 (95% CI: 2528-2731) in Churachandpur and 2137 (95% CI: 1979-2343) in Bishenpur district. Multiplier method seems to be a feasible indirect technique which can be applied to estimate of IDU population using existing data from intervention programs in settings like Manipur where reliable size estimation of IDU population is lacking.

High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India

Background & objectives: It is well documented that the Northeast State of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection. Methods: Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection. Results: HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection. Interpretation & conclusions: The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.

Characteristics of primigravid women seeking abortion services at a referral center, Manipur

Objective: To explore the characteristics of primigravid women seeking abortion services and find out the reasons for undergoing abortion. Materials and Methods: A cross-sectional study based on data collected in 5 years was carried out. All primigravid women who came to avail of the abortion services were included and their characteristics were recorded. Reasons for undergoing abortion in their first pregnancy were ascertained. The information was gathered by personal interview conducted by a trained person. Results: There were 11,141 MTP cases in the 5 years, with 740 (6.6%) women coming for abortion in their first pregnancy. There was a decrease in these cases during the years under study. Most of the women belonged to the 15-24 years age group. The majority of the women were from rural areas. Abortion services were less sought by women who were educated up to graduation or above. The majority of the women were unmarried. A little more than half of the women sought abortion services with 12 weeks of gestation or more. Parents referred these women for abortion services more than their partners. Sociocultural factor was the commonest reason for undergoing abortion among these women. Conclusion: Pregnancy in unwed girls was the main reason for seeking abortion services. They lack adequate knowledge of contraceptive methods. There is a need for encouraging adolescent health services including sex education.

Assessment of body composition and body mass index of adolescent school children in Imphal-West district, Manipur

Objective: The aim of this study is to avoid psychological distress to the mother and baby by avoiding General Anaesthesia and overnight hospital stay which will be required, if the abscess is to be drained by incision drainage and to avoid leaving an ugly scar on the breast. Materials and Methods: In our prospective study, 50 patients with breast abscesses were treated by needle aspiration of pus, oral antibiotics, and repeat aspiration, if necessary. All were outpatients, and treated in Department of Surgery, Regional Institute of Medical Sciences, Imphal. Ultrasonography was not used. Out of 50 patients, 31 were lactating mothers. Results: The mean age of the patient was 32 years (19-80 years). Staphylococcus aureus was the most common organism isolated in both lactating and non lactating cases. Of the 50 cases, 39 (78%) resolved well without recurrence. Eight (16%) cases failed to respond to repeated aspiration and underwent incision and drainage. Three (6%) cases had recurrent abscess occurring 1 month after the last aspiration. Conclusion: Needle aspiration with antibiotic is an effective treatment for breast abscesses.Objectives: Abdominal wound dehiscence occurs in 0.5-3% of the patients following laparotomies. As the vacuum assisted closure technique is now well established to manage chronic wounds, we hereby describe an innovative approach to apply negative pressure to acute wounds. Materials and Methods: The innovative negative pressure device was applied in 5 patients, three with wound dehiscence after cesarean section and two after hysterectomy. A commercially available closed suction apparatus 14 gauge in size and 5 cm thick sponge were used. The sponge was covered with an adhesive transparent sheet. The dressing was changed every 48-72 hours depending on the amount of secretion present in the chamber. The suction device was charged as and when it got deflated. Results: All the wounds had gradually decreasing area of undermining and the discharge from the second dressing change onwards. Whereas three of them underwent a two-layered closure, the other two healed with 100% take of the skin graft. Discussion: Healing by secondary intention is a time consuming process that leads to prolonged hospital stay. The negative pressure wound therapy (NPWT) has been used to treat chronic wounds and pressure ulcers, It evacuates the drainage from the wounds and thereby decreases edema of wound margins and the adjacent areas. It also improves the blood flow to the wounds and decreases bacterial burden. The innovative device used by us is easily available, affordable, and simple to use with good outcome. Conclusion: NPWT is a valuable alternative in selected cases when a surgical closure is not indicated or not desired by the patient. The innovative device was well accepted by our patients as it did not add to their postpartum or post-operative stress. It can be used in any set-up in any patient, meeting the criteria of NPWT.A man sustained firearm injury in the abdomen and later on died due to bronchopneumonia following postoperative complications. This case is being reported to establish the importance of Medical Audit Sessions to improve patient care service in the hospital.Gastrointestinal mucormycosis is an uncommon disease most often occurring in immunocompromised individuals, patients with diabetes, and patients suffering from hematologic and solid malignancy. Rarely, it may occur in normal persons without any contributory factor. We report a rare case of gastric mucormycosis in an immunocompetent individual who recovered with Amphotericin-B treatment.We report a case of axillary vein thrombosis in a 45-year-old-man, sustained after fall of heavy object over the right upper limb. Three days later, a diagnosis of right distal axillary vein thrombosis was made. Patient was given subcutaneous low molecular weight heparin followed by oral warfarin. His symptoms disappeared after 3 months of treatment. It is important to be aware of this unusual but potentially serious complication, as early diagnosis and treatment may limit morbidity and mortality.Background : Childhood obesity is a precursor for later disease risk and it is important to obtain a better understanding of the body composition and body mass index (BMI) in children. Objective: To determine the body composition and its relation with BMI of adolescents. Materials and Methods: A cross sectional study of 3356 school children in age group 12 to 19 years residing in Imphal-West District, Manipur was conducted during May 2005 to May 2008. BMI and Body composition were determined using the TANITA Body Composition Analyzer (TBF-300, JAPAN). Results: The mean (Standard Deviation) BMI among boys and girls were 18.7 (2.6) and 19.2 (2.8) respectively and the difference was statistically significant (P = 0.000). Multiple linear regression analysis shows that BMI was significantly associated with waist circumference, weight, fat%, total body water (P = 0.000) and fat free mass (P = 0.041) among the boys and inversely associated with height, hip circumference and waist-hip ratio (WHR) (P = 0.000). Among girls, BMI was positively associated with hip circumference (P = 0.035), weight (P = 0.000), fat% (P = 0.000) and total body water (P = 0.000) and inversely associated with height (P = 0.04). Conclusion: Though fat percentage was found to be significantly correlated with BMI, it could explain little of the variation in BMI.Objective: To study, the effect of prophylactic ketamine (K) gargle in reduction of post-operative sore throat (POST) following endotracheal intubation. Materials and Methods: 90 adult patients between 18 years and 60 years with American Society of Anesthesiologists I and II, scheduled for elective open cholecystectomy surgery under general anesthesia were randomly assigned into 2 groups of 45 patients each. Group S-received 30 ml of normal saline (NS) and Group K-received 40 mg of K in 30 ml of NS. Then the patients were asked to gargle with the preparation for 30 s after their arrival in the operation room. Anesthesia was induced 5 min later. On arrival in the post-anesthesia care unit (0 h), and at 2 h, 4 h, and 24 h thereafter, the patients were questioned by a blinded investigator whether he/she had experienced sore throat or any other side- effects. POST was graded on a four-point scale (0-3). Results: The incidence of POST was higher in NS group compared with K group at 0 h, 2 h, 4 h, and 24 h. In addition, there is reduced incidence of hoarseness of voice in K group compared to NS group at 0 h, 2 h, 4 h, and 24 h after extubation. Conclusion: In conclusion, gargling with K decreases the incidence and severity of POST and hoarseness of voice.Introduction: Dengue is a major public health problem in tropical and sub-tropical regions of the world. Detection of specific Immunoglobulin M [IgM] antibodies forms the mainstay for diagnosis of dengue infection. However, IgM antibodies develop after 4-5 days of infection and there is an urgent need for an alternative diagnostic tool that can detect dengue infection during this phase. Materials and Methods: We carried out a prospective study with the aim to analyze the utility of a commercial non-structural protein 1 antigen (NS1 Ag) based rapid immunochromatographic test for detection of dengue infection in anti-dengue IgM seronegative serum samples. Results: A total of randomly selected 86 IgM negative samples were tested for the presence of dengue NS1 Ag. Of these, 59.30% (51/86) were positive for NS1 Ag. Conclusions: Our findings, therefore, supplement the findings of other similar studies suggesting NS1 Ag as an early diagnostic marker that is feasible to look for in a routine diagnostic laboratory. Furthermore, NS1 Ag assay may be a useful tool for detecting dengue infection during acute phase of infection when IgM antibodies are not formed to the detectable levels.Background: Hemodynamic instability is one of the most imminent conditions during general anesthesia (GA), especially, during laryngoscopy and intubation. The aim of the study was to study the perioperative hemodynamic effect of clonidine in normotensive patients undergoing elective surgery under GA. Materials and Methods: A randomized double blinded placebo controlled study was conducted in the department of Anesthesiology, Regional Institute of Medical Sciences, Imphal on 150 normotensive adult patients of either sex aged 18-60 years (American Society of Anesthesiologist I and II) undergoing elective surgery under GA. The patients were allocated into three groups viz.: Group 1-2 μg/kg clonidine; group II-3 μg/kg clonidine; and group III - placebo/normal saline. The test drug was administered 30 min before the induction of anesthesia. Upon arrival at theatre, the following data were recorded viz.: (1) Visual analogue score of anxiety, (2) loss of consciousness, and (3) dryness of mouth. Pre-induction heart rate (HR) and blood pressure (BP) were recorded 5 min after resting on the operating table. HR and BP were recorded during the time of intubation every 8 min and ½ h after intubation during the intraoperative period (post-intubation). Postoperative BP and HR on arrival at the post-anesthetic care unit and then every ½ h for 3 h were recorded. Any episodes of nausea and vomiting, shivering and analgesic requirements were noted. Results: Clonidine 2 μg/kg and 3 μg/kg both significantly controlled the perioperative hemodynamics. The hemodynamic changes were statistically significant at all times intervals except at preoperative, at 8 min post-intubation to 1 h post-intubation period. Conclusion: Clonidine is useful as a premedicant in controlling the perioperative hemodynamics changes in normotensive patients undergoing operative procedures under GA.Objective: To test sympathetic division of autonomic nervous system and observe any dysfunction in patients of bronchial asthma. Materials and Methods: Fifty four patients, 18 males, 36 females, and 30 healthy control subjects attending Respiratory Medicine out-patient department Regional Institute of Medical Sciences, Imphal were included in the study. Age ranging from 15 to 60 years were recruited for the study. Spirometry values of forced vital capacity (FVC), forced expiratory volume in first second (FEV 1 ) , FEV 1 /FVC, peak expiratory flow rate (PEFR), forced expiratory flow (FEF 25-75% ) recorded by using HELIOS 702 (Recorders and Medicare System, Chandigarh). Predicted values were taken as values for normal subjects. Sympathetic nervous system tested by measuring diastolic blood pressure response to sustained hand-grip for 2 min and from supine to standing for 3 min. Results: FVC, FEV 1 , PEFR, FEF 25-75% were significantly lower in asthmatics as compared to controls. Diastolic blood pressure response to sustained hand-grip for 2 min and from supine to standing for 3 min was higher in asthmatics as compared to controls. Conclusion: Sympathetic nervous function assessment of the patients shows that sympathetic abnormalities occur in patients of bronchial asthma.Objectives: To study the pattern of diseashe in palpable supraclavicular lymph node using fine needle aspiration cytology (FNAC) in Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur. Materials and Methods: A retrospective study was done by critically analyzing the FNAC reports of palpaple supraclavicular lymph node in last 5 years (January 2006-December 2010) at the Department of Pathology, RIMS Hospital, Imphal, Manipur. Review of all the reports were done and diagnosis was made according to standard guidelines and correlated with patients age, sex, and side of involvement to explore the disease pattern. Results: Out of 255 cases, 48.28% were metastatic tumors, 27.5% were tuberculous lymphadenitis, 15.3% were of non-specific reactive lymphadenitis, 4.3% were non-caseating granulomatous lymphadenitis, 2.7% were of lymphoma and 1.96% was of acute suppurative lymphadenitis. Mean age of presentation of metastatic tumor was 57 years, whereas in case of tuberculous (Tb) lymphadenitis it was 34.5 years. Females were more commonly affected than males with male female ratio of 1:1.4. Left sided involvement was seen in 50%, right sided involvement in 46% and bilateral involvement in 4% of patients. Conclusion: Enlarged supraclavicular lymph node often has some serious underlying pathology both in young adults and old patients. Further, our study highlights the importance of FNAC in the initial evaluation of enlarged supraclavicular lymph nodes.A case of recurrent painless swelling of the gingiva which was clinically diagnosed as pyogenic granuloma in an 18-years-old female is reported to highlight the prevalence of recurrent peripheral ossifying fibroma, the need for a thorough curettage up to the deepest possible tissue at the time of excision and strict postoperative follow-up.

Knowledge, attitude and perceived barriers towards conducting research among students in a medical college, India

Research is a neglected but extremely important component in the development of medical science including health care. It would be almost impossible to catch up with the changes occurring in diseases and their determinants without research. It is essential that health care providers, especially doctors, possess adequate knowledge and skill of conducting research. Research activity of medical students is important as it promises better clinical care, critical reasoning, lifelong learning and future research activity. 1 Research methodology is a process of deciding study design, making questionnaire, data collection, analysis, interpretation, and assessment procedures conducted in a planned manner in order to find solutions to a problem.

Depression, anxiety and stress among higher secondary school students of Imphal, Manipur

Introduction: Adolescence is a stressful period due to physical, psychological, sexual changes, and the presence of psychiatric disorders such as depression, anxiety, and stress at this stage of life is a matter of concern. Objectives: The objectives of the study were to determine the prevalences of depression, anxiety, and stress among higher secondary school students of Imphal and to determine the association between depression, anxiety, and stress and selected variables such as gender, standard, and religion. Materials and methods: From September 2014 to October 2014, a cross-sectional study was conducted among higher secondary school students of Imphal. The sample size was calculated to be 750. Seven schools were randomly selected, and all the students in that school were enrolled in the study. The study tool used was a questionnaire containing DASS (Depression Anxiety Stress Scale) and sociodemographic characteristics. Results: The prevalences of depression, anxiety, and stress among 830 valid respondents were 19.5%, 24.4%, and 21.1%, respectively. In total, 81.6% of the respondents had at least one of the studied disorders and 34.7% of the respondents had all the three negative states. The prevalences of depression, anxiety, and stress were high among females and were significant for anxiety (P = 0.00) and stress (P = 0.04). The prevalences of depression and stress were significantly higher among 12th standard students with P-values of 0.00 and 0.02. Conclusion: The prevalences of depression, anxiety, and stress were high with anxiety and stress significantly higher among females, whereas prevalences of depression and stress were significantly higher among 12th standard students. More studies are recommended to determine the factors leading to these mental disorders.

Assessment of Knowledge andSkills of CPRamong Internsof two Medical Colleges in North-East India

Introduction: Cardiopulmonary Resuscitation (CPR) is an important life-saving first aid skill, practiced throughout the world.Over time, resuscitation skills have evolved into a proper protocol, which involves CPR commonly known as BLS. Invented in 1960, CPR is a simple but effective procedure that allows almost anyone to sustain life in the early critical minutes after cardiac and respiratory arrest. BLS includes both prompt recognition and immediate support of ventilation and circulation in case of respiratory or cardiac arrest..CPR provided immediately after sudden cardiac arrest can effectively increase the victim’s chances of survival.So, keeping this in mind, the study was undertaken to determine the knowledge and skills about cardiopulmonary resuscitation among interns. Methods: A cross sectional study was conducted at RIMS and JNIMS, Imphalbetween 19 th Jul-10 th Aug 2015. Eighty interns posted at the Community Medicine Department were included in the study. A self-administered questionnaire and assessment of skills were used for data collection. Data were analyzed using descriptive statistics such as frequencies and percentages. Chi-square test was used for analysis. P value of < 0.05 was considered as statistically significant. Results: More than half of them knew when to start CPR but didn’t know when to put a victim in a recovery position or how to open the airway. Nearly three fourth of them didn’t know when they were suppose tostop CPR. Majority of them didn’t know the correct site for chest compression. Very few of them checked for response and breathing and most of the participants had incorrect positioning while performing it. None of the participants knew how to give rescue breaths Conclusions: Most of the interns were found to have inadequate knowledge and skills regarding CPR . Training programmes will be needed to maximize knowledge/skills so as to save more lives with this valuable maneuver.

Prevalence of refractive error among school-going children of Imphal, Manipur

Background: Uncorrected refractive error is the leading cause of eye problem and the second cause of blindness worldwide. Among children aged 5–15 years, 12.8 million are visually impaired because of refractive errors. Objective: To assess the magnitude of refractive error among school-going children of Imphal, Manipur, India, and to determine the association between refractive error and variables such as sex, dietary habits, family history, and daily activities such as watching television and using computers. Materials and Methods: This was a cross-sectional study conducted among upper primary school students (students of classes six and seven) of Imphal from June 21, 2014 to July 8, 2014. Sample size was calculated to be 267. Cluster sampling method was used to select the study participants. Snellen chart, Roman test type chart, and pinhole were used to detect refractive error. Analysis was done using χ2-test and Fisher’s exact test. P value of