Vijesh Sreedhar Kuttiatt

Background: Morbidity Management and Disability Prevention (MMDP) practices are essential in mitigating the progression of lymphedema and in preventing episodes of adenolymphangitis. Despite their importance, patients’ adherence to these prescribed practices has frequently been found to be suboptimal. Currently, there is a lack of a standardized tool for the objective assessment of patients’ adherence to MMDP practices in patients with filarial lymphedema. This study was undertaken to develop a scoring system for assessing patients’ adherence to MMDP and to validate this among patients attending a filariasis management clinic. Methodology: A scoring tool (VCRC MMDP Adherence Assessment Tool and VAAT score) was developed to evaluate adherence to MMDP practices across eight defined domains. The total score ranges from 0 to 40, reflecting the degree of adherence. This tool was validated through a cross-sectional study involving 90 patients diagnosed with varying grades of filarial lymphedema. Results: Based on the VAAT score, patients were categorizable into three different levels of adherence: optimal adherence (≥ 30), medium adherence (20–29) and poor adherence (< 20). Among the 90 patients assessed, 21 (23%) demonstrated optimal adherence, 47 (52%) showed medium adherence and 22 (25%) were categorized as having poor adherence. Conclusion: This study marks the first development and validation of a scoring system to assess adherence to MMDP practices in patients with filarial lymphedema. The tool proved useful in effectively identifying individuals with suboptimal adherence. However, further validation is required in a greater number of patients in a prospective manner and in different geographical and epidemiological settings.

Public health research often relies on top-down approaches that do not adequately address local needs or engage end-users as active participants. This article narrates the implementation of a bottom-up health research approach at the Model Rural Health Research Unit (MRHRU) in Puducherry, India, aimed at prioritising community participation in health research. The model leverages a participatory approach to integrate local stakeholders into the research process. The study outlines a structured, democratic process for stakeholder engagement, beginning with the identification and network-building of stakeholders and progressing through collaborative brainstorming, priority setting and project development. By aligning research initiatives with these ‘felt needs’, the MRHRU facilitates relevant and impactful health interventions. This approach, while grounded in the local context, provides a model for setting health priorities based on community perceptions, adaptable to other regions and settings, underscoring the benefits of participatory health research in eliminating health disparities and achieving health equity.

Lymphatic filariasis (LF) is a parasitic disease caused by filarial nematode worms, transmitted by mosquitoes. Infection damages the lymphatic system which leads to limb lymphedema and hydrocele. LF continues to remain one of the major neglected tropical diseases. Patients with filarial lymphedema are prone to nutritional deficiencies due to poverty, poor nutrition, old age, and frequent adenolymphangitis. However, studies on micronutrient deficiencies in affected patients remain scarce. In this study, we aimed to assess the levels of vitamin A and D in patients visiting a specialized clinic for filarial lymphedema management. We recruited 40 patients and analyzed their vitamin A and D levels. In parallel, we also evaluated a set of 30 apparently healthy volunteers. Sociodemographic and clinical data were collected through a semi-structured interview using a proforma. Dietary data were recorded using a 24-h dietary recall method. Among 40 patients with filarial lymphedema, three had vitamin A deficiency, and so did six among the 30 healthy volunteers. Twenty patients and equal number of healthy volunteers were deficient in vitamin D. The study highlights vitamin D deficiency among patients with filarial lymphedema and healthy individuals. It is desirable to have nutritional counseling and multivitamin supplementation in the Morbidity Management and Disability Prevention (MMDP) component of the LF elimination program. Creating awareness about vitamin D deficiency among health care workers and public is also essential.

Background: Doxycycline is widely used to treat various bacterial infections and has significant global implications, especially as the preferred medication for scrub typhus and leptospirosis. However, its use is limited in children below 8 years of age due to potential adverse effects on teeth and bones. This study aims to assess the risk of dental adverse events associated with doxycycline, a tetracycline-class antibiotic, in children under 8 years of age.Methods: In this review, we searched PubMed, the Cochrane Library, and Google Scholar for studies published until November 2023. We included studies administering doxycycline to children under 8 years, focusing on dose, duration, and dental adverse events to assess the safety of doxycycline.Result: A total of 325 articles were initially retrieved, of which 5 studies were available for analysis. This review included information on 162 children who were treated with doxycycline between the ages of 0 and 8 years. The median age at doxycycline administration was 4.25 years and interquartile range (IQR) of 2.065–5.563 years. The oral dosage, based on weight, had a median of 2.3 mg/kg/day, with an IQR of 1.525–5.438 mg/kg/day. The median duration of drug administration was 8.5 days and the IQR of 6–12.5 days. We found a pooled proportion of adverse events of 0.21 (95% CI: 0.13–0.28).Conclusion: This review suggests that the occurrence of teeth-related adverse events with short-term doxycycline use is minimal, with a low incidence reported. While these findings offer a preliminary basis for the use of doxycycline in children under 8 years of age, the limited number of studies underscore the need for further research to evaluate its therapeutic use and implication for paediatric guidelines.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/myprospero, Identifier CRD42023494713.

Background: Filarial lymphedema, caused by lymphatic filariasis, is characterized by chronic swelling and recurrent skin infections. Acute adenolymphangitis (ADL) episodes significantly exacerbate morbidity. Diabetes mellitus (DM) increases susceptibility to infections; however, the relationship between diabetes and ADL frequency and severity in filarial lymphedema patients remains unclear. This study investigated the influence of diabetes on ADL attacks and identified predictors influencing ADL episodes in patients with filarial lymphedema. Methodology/Principal findings: This case-control study analyzed data from 166 patients (79 diabetic, 87 non-diabetic) attending a filariasis management clinic in Puducherry, India. Sociodemographic data, clinical characteristics, ADL frequency, severity, and adherence to morbidity management and disability prevention (MMDP) practices were collected. Univariate and multivariate logistic regression analyses examined the association between diabetes mellitus and ADL episodes. Diabetes status did not significantly influence ADL frequency or severity. However, lymphedema severity and intertrigo presence emerged as significant predictors of increased ADL attack risk. Home-based care was associated with increased ADL frequency, suggesting potential inadequacies in current self-care practices. Integration of filarial lymphedema care into existing non-communicable disease (NCD) clinics at primary healthcare centers (PHCs) and subcenters could streamline care delivery, enhance patient management, and optimize healthcare resource utilization. Conclusions: This study emphasizes the importance of integrated care approaches addressing both diabetes and lymphedema management. Lymphedema severity and intertrigo management should be prioritized in patient care to mitigate ADL risks. Strengthening home-care education and protocols is essential for improving ADL outcomes. Future research should explore structured community-based and prospective studies to clarify diabetes management’s potential protective role and further enhance the quality of care for affected individuals.

Introduction: This study analyzed the age and sex distribution of COVID-19 patients during the initial three COVID-19 waves in Puducherry, India, from August 2020 to March 2022, to understand the distribution of infection across different demographic groups. Methods: The disease surveillance program conducted at ICMR-Vector Control Research Centre processed 79,705 Throat Swab/Nasal Swab (TSNS) samples received from various institutions in Puducherry through the Integrated Disease Surveillance Program (IDSP). Real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) was performed following approved protocols. Results: Test positivity rates during the second (14.6%) and third waves (25.1%) were significantly higher than the first wave (11.4%). In the first wave, children (p < 0.001) and elderly individuals (p = 0.017) had a lower risk of testing positive than adults. However, in the second wave, elderly individuals had a 1.12 (95% CI: 1.03 – 1.23) times greater risk of contracting COVID-19 (p = 0.013). Children had a lower risk of testing positive across all waves (p < 0.001). A significant sex difference was noted only in the first wave, with males having a 1.27 (1.18-1.37) times greater chance of being COVID-19 positive. The mean age of female patients was significantly younger than male patients in the third wave (p = 0.008). The third wave showed an increasing trend of infection across all age groups and sexes, especially among younger individuals. Conclusions: The study highlights an increasing trend of infections across all age groups and sexes during the third wave. Micro-epidemiological analyses are crucial for developing targeted intervention strategies that address age and sex demographics effectively.