Impact of electronic vaccine intelligence network application used in immunization sessions in Pune city

Background: Millions of deaths due to various diseases have been reduced globally as well as in India since inception of vaccination programme. In order to avoid the instances of cold chain failure and ensure constant monitoring of temperature of cold chain equipment’s Electronic vaccine intelligence network (eVIN) technology was adopted by Government of India.Methods: A mixed methodology design with both qualitative as well as quantitative components were studied. This study was conducted in 16 immunization centres spread across the metropolitan Pune city in western Maharashtra.Results: Vaccine beneficiaries increased for polio 814 (3.25%), DPT1643 (21.79%), MR 9615 (23.02%) and IPV 2297 (23.58) vaccine after execution of eVIN app. Vaccine availability of BCG (6.04%), Polio (20.02%), MR (64.24%), IPV (11.38%) and hep B had increased as compared to the other vaccines. The vaccine wastage decreased for penta (8.64%), IPV (123.98%), TT (32.63%) and hep B (47%) vaccines post eVIN application compared to the pre eVIN. The qualitative study included in depth interviews, key informants’ interview and focus group discussions. Various themes and subthemes emerged like the user-friendliness of app, difficulties faced by health care workers, their suggestions for improvements in the app.Conclusions: The eVIN system is playing a pivotal role in effective and efficient management of vaccine supply, maintaining stock availability and monitoring. To reduce vaccine wastage usage of small dose vials in immunization sessions would be helpful.

Correlation of Liver Stiffness Measurements with AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) Scores in Pediatric Patients with Hepatitis B or Liver Transplantation

Background and Objective: Current standard for assessing liver fibrosis is biopsy. However, its invasive nature, cost, and limited sampling are problematic for many patients. Fibroscan is a technology that utilizes transient elastography (TE) to measure liver stiffness (LSM) quickly and non-invasively. TE is a novel method in children and has shown to be a measure of fibrosis. Biomarkers for hepatic fibrosis include the APRI and FIB-4 scores, which are not well-studied in children. Our goal is to correlate APRI and FIB-4 with LSM in children who have hepatitis B (hep B) or have received liver transplants (LT). Methods: LSM scores of 26 children with hep B and 41 children with LT were retrieved from a research database at Riley Hospital for Children. We then obtained laboratory results closest to the date (+/- 1 year) of their TE. Those results were used to determine APRI and FIB-4 scores. Spearman correlation (rs) was determined between LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in each disease. Results: Table 1. Spearman Correlations for LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in Hep B and LT Disease Comparison Spearman Correlation (rs) Hep B LSM APRI 0.321 LSM FIB-4 0.376 APRI FIB-4 0.731* LT LSM APRI 0.303 LSM FIB-4 0.526* APRI FIB-4 0.632* *p < 0.05 Conclusion and Potential Impact: The moderate correlation of LSM with FIB-4 in LT shows potential for future clinical use, but the correlations of LSM with APRI in both conditions and the correlation of LSM with FIB-4 in Hep B are weaker. APRI and FIB-4 are strongly correlated in these children. However, additional studies with larger sample sizes should be completed. Because patients with LT and chronic hep B regularly need longitudinal evaluation, finding non-invasive tools are important to ensure compliance and ease.

Seropositivity of Hepatitis B & C Virus in Surgical Patients Undergoing Elective & Emergency General Surgery

Aim: To assess the seropositive cases of hepatitis B & C in surgical patients admitted for both emergency & elective surgery. Methodology: This study was conducted in the surgery department of Pak Red Crescent Teaching Hospital. The design of the study was descriptive observational. All the 1238 patients undergoing emergency and elective surgery were enrolled in this study by convenient sampling. Demographic data of all the patients were recorded. Along with routine preoperative tests, all the patients were screened for hepatitis B & C virus infection. Immunochromatography (ICT) method was adopted for both HBsAg and Anti-HCV screening. In patients with week positive results further test of enzyme-linked immunosorbent assay (ELISA) was performed. Operation theater staff and surgeon were informed about seropositive patients to take special precautionary measures during handling of the sharp objects. Biological waste of such patients is disposed of by using Biosafety protocols. Demographic data along with risk factors, HbsAg & Anti-HCV status were collected and analyzed with Microsoft Excel 2019. Results: A total number of 1238 patients were enrolled in our study, out of them 708 were male and 530 were female. Average age of the patients was 40.05±16 years. Out of 1238 patients, HBV was found in 14(1.13%) patients and HCV was found in 121 (9.77%) patients both hepatitis B & C was found in 3(0.24%) patients. Conclusion: Preoperatively screening of hepatitis B and C should be performed mandatory in all patients regardless of the nature of surgery. Before operating seropositive patients, surgeon and operation theater staff should be informed to take precautionary measures while handling the sharp objects. Used infected material of such patients should be disposed of by using Biosafety protocols. All the health works must be vaccinated against hepatitis B virus. Keywords: Hep B infection, Hep C Infection, Seropositive.

Development and Pilot Testing of a Smartphone-Based Self-Care Program for Patients with Chronic Hepatitis B

The purpose of this study is to develop a smartphone-based self-care program (Hep B Care®) for patients with the chronic hepatitis B virus (HBV). To pilot test the feasibility of Hep B Care®, 63 participants with chronic HBV were recruited from an outpatient clinic at S hospital, Seoul, South Korea (experimental group [EG]: n = 30, control group [CG]: n = 33) between February and July 2016. Hep B Care® was developed based on the theory of self-care whilst having a chronic illness. During the 12-week intervention period, the application: (1) provided information about the disease, medication, nutrition, and exercise; (2) encouraged taking medication and exercise using alarms; and (3) enabled the exchange of messages between healthcare providers and patients. Salivary cortisol, fatigue, depression, anxiety, knowledge of the HBV, quality of life, and medication adherence were all measured as outcomes. Cortisol levels were significantly increased, knowledge of the HBV was improved, and the mean anxiety score was significantly decreased in the EG. Thus, Hep B Care ® partially improved health outcomes in the EG. We recommend that large trials be conducted among patients with the HBV. The smartphone-based self-care program for providing education and coaching is effective for improving knowledge and reducing anxiety among patients with the HBV.

HBV, HCV, HIV & TB Prevalence in Injection Drug Users in Major Cities of Punjab, Pakistan- a Survey-Based Research Report

Hepatitis-B,C,HIV and TB among intravenous drug users continues to be a serious explanation for disease and death, this study was conducted to survey the prevalence of Hepatitis-B,C,HIV and TB in rehabilitation center of Punjab, Pakistan. A telephonic and visited survey of 78 rehabilitation centers in Punjab Pakistan to assess their treatment. An analysis of 21 responded that returned useable data revealed that only 7.2% patients of responded rehabilitation centers are positive for HEP-B. 33.23% patients are positive for HEP-C, 8.74% patients are positive for HIV and 0.87% patients are positive for TB. Majority of the respondent of whom doctors, psychologists believe that the patient, partner of the patient and their children should be offered for HEP-B,C,HIV and TB screening regularly.

AST to platelets ratio (APRI) as a Biomarker of liver fibrosis status in patients of chronic Hepatitis B and Hepatitis C in comparison with Fibroscan

Objective: The aim of the study is to correlate the AST to platelets ratio (APRI) with different stages of liver fibrosis measured by the fibroscan. Methods: The study included 40 patients. The study was conducted in outpatient clinic of Lahore General Hospital. The study duration was from November-2020 to January-2021. Their fibroscan data was collected from hepatic clinic of general hospital OPD and their AST and Platelets values were obtained retrogradely from the PACS system of hospital. Correlation between the APRI and fibroscan values was done by linear Pearson correlation test. Results: APRI values showed moderately positive correlation with increased kpa values and different stages of fibrosis (r=0.55). Similarly, the correlation coefficient of AST also shown to be moderately positive correlated with kpa values and stages of fibrosis however this correlation was slightly weak as compared to APRI values (r=0.49). The correlation coefficient (r) for platelets showed moderately negative correlation with liver fibrosis stages (r=-0.43). Conclusions: APRI levels increased as the degree of fibrosis and inflammation increased in patients suffering from chronic hep B and hep C. So, our data showed the clinical significance of APRI levels in diagnosing extent of liver fibrosis and cirrhosis. Keywords: AST, Platelets, APRI, fibroscan, chronic hepatitis

Evaluation of immune response to hepatitis B vaccine among health care workers at a tertiary care hospital in south India: a retrospective record based study

Seroprevalence of hepatitis B virus (HBV) among healthcare workers (HCWs) is two to four times higher than that of the general population due to repeated exposure. To determine the hepatitis B (hep B) vaccination status, non-response rate to (hep B) and its determinants among HCWs at a tertiary care teaching hospital in south India. A secondary analysis of the medical records of a group of HCWs who joined the hospital from 1st January 2015 to 31st December 2016 was done. A total of 451 HCWs received the vaccine at the study hospital. Mean age of the HCWs was 25.3±6.1 years, majority 374 (82.1%) of them were females and joined as staff nurses 213 (47.2%). Only 164 (36.3%) had received all 3 doses of hep B vaccination. Complete vaccination with (hep B) among HCWs was poor. Health education and suitable administrative controls must be instituted to ensure protection.

Effectiveness of Wellbeing Intervention for Chronic Kidney Disease (WICKD): results of a randomised controlled trial

Background End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing. Few studies have investigated the efficacy of psychosocial interventions for people with ESKD and none exist for Indigenous people, a population in which the ESKD burden is especially high. Methods This three-arm, waitlist, single-blind randomised controlled trial examined efficacy of the Stay Strong App in improving psychological distress (Kessler distress scale; K10), depressive symptoms (adapted Patient Health Questionnaire; PHQ-9), quality of life (EuroQoL; EQ. 5D) and dialysis adherence among Indigenous Australians undergoing haemodialysis in central and northern Australia (Alice Springs and Darwin), with follow up over two 3-month periods. Effects of immediate AIMhi Stay Strong App treatment were compared with those from a contact control app (The Hep B Story) and treatment as usual (TAU). Control conditions received the Stay Strong intervention after 3 months. Results Primary analyses of the full sample (N = 156) showed statistically significant decreases in K10 and PHQ-9 scores at 3 months for the Hep B Story but not for the Stay Strong app or TAU. Restricting the sample to those with moderate to severe symptoms of distress or depression (K10 > =25 or PHQ-9 > =10) showed significant decreases in K10 and PHQ-9 scores for both Stay Strong and Hep B Story. No significant differences were observed for the EQ-5D or dialysis attendance. Conclusions Findings suggest that talking to people about their wellbeing and providing information relevant to kidney health using culturally adapted, locally relevant apps improve the wellbeing of people on dialysis. Further research is required to replicate these findings and identify active intervention components. Trial registration ACTRN12617000249358; 17/02/2017.