National Institute of Medical Statistics

Objectives: Oral diseases are among the most prevalent global health problems, disproportionately affecting disadvantaged populations. Essential Oral Health Care (EOHC), endorsed by the World Health Organization, comprises basic promotive, preventive, and curative services that should be universally accessible. Public perceptions and psychological factors, particularly Locus of Control (LOC), strongly influence oral health behaviors and service use. This study assessed adults’ perceptions of Essential Oral Health Care (EOHC) services and examined the association of Locus of Control (LOC) with sociodemographic factors. Methods: A cross-sectional study was conducted among 150 adults residing in Trilokpuri, New Delhi. Data were collected through interviewer-administered questionnaires on six domains: perceived needs, essential services, service adequacy, barriers to utilization, self-rated oral health and LOC. Statistical tests, including Mann- Whitney U test, Spearman correlation test, and multivariable logistic regression, were applied. Results: Most participants (68.0%) recognized oral health as part of general health, yet only 34.0% reported a dental visit in the past year. Pain relief (42.0%) was the most commonly perceived essential service. Cost and waiting time were major barriers. Internal LOC was observed in 38.7% of participants and was positively associated with higher socioeconomic status (SES) (p < 0.05). Conclusions: Adults demonstrated limited awareness and narrow perceptions of EOHC, with substantial access and affordability barriers. Internal LOC was significantly associated with higher SES, underscoring the need for community-based oral health education and systemic strengthening of affordable EOHC services.

Pyomyositis is a rare bacterial infection of skeletal muscle characterised by abscess formation, having significant morbidity. Early diagnosis is often challenging, especially in patients with atypical presentations. We report a case of pyomyositis in an immunocompetent adult male, promptly diagnosed using point-of-care ultrasound (POCUS) in the emergency department. The patient presented with fever, hypotension and confusion, and no source of infection was initially identified. Careful re-examination revealed subtle thigh asymmetry and tenderness. POCUS revealed an intramuscular collection in the left thigh and a diagnosis of pyomyositis was confirmed by ultrasound-guided aspiration and culture. Culture of the purulent fluid grew Escherichia coli, an unusual pathogen in pyomyositis, particularly in immunocompetent individuals. Rapid diagnosis enabled timely drainage and culture-directed antibiotic therapy, leading to complete recovery. This case underscores the importance of repeated clinical assessment and highlights the role of bedside ultrasound in rapidly identifying occult sources of sepsis, particularly when advanced imaging is delayed.

Stigma is a recurring challenge in epidemics, undermining disclosure, testing, and reintegration. During COVID-19 in India, little is known about how community perceptions translated into recovered participant´s experiences of stigma. A multicentric qualitative study was conducted (September 2020–January 2021) across 18 districts in 7 Indian states. In depth telephone interviews were undertaken with 223 participants (136 community members, 87 recovered individuals). Data were analysed thematically using Braun and Clarke’s framework, with NVivo-assisted coding, reflexive journaling, and saturation checks to ensure rigour. Six major-themes were identified: fear and moralisation, institutional labelling, structural inequalities, economic and psychological harms, stigma within health-care interactions, and coping. Community fears of contagion and visible labelling (stickers, barricades, police visits) legitimised gossip and blame, which recovered participant´s described as persistent rejection, job loss, shop boycotts, and psychological distress. Stigma disproportionately affected informal workers, poorer households, and Muslim minorities, which was further fuelled by media portrayals. Coping relied on family support, while community members highlighted the role of health workers and positive media narratives in stigma reduction. Stigma during COVID-19 in India was socially produced and sustained by fear, institutional measures, and social hierarchies. These dynamics directly translated into recovered participant´s lived experiences, undermining both equity and epidemic control. Addressing stigma is therefore central to pandemic preparedness. Risk communication should avoid fear-based messaging, institutional protocols must protect confidentiality, and psychosocial support and equity monitoring should be embedded into preparedness frameworks. What is already known on this topic Stigma is a recurring challenge in epidemics, documented in HIV, TB, and Ebola. Early reports from COVID-19 highlighted stigma against health-care workers, but less is known about community and recovered participant´s experiences. What this study adds First multicentric Indian study to capture both community perceptions and recovered participant´s experiences of COVID-19 stigma. Demonstrates how fear and institutional labelling directly translated into exclusion beyond recovery, economic loss, and psychological distress. How this study might affect research, practice or policy Shows stigma is a structural determinant of epidemic response. Provides evidence for embedding stigma-sensitive communication, equity monitoring, and psychosocial support into preparedness frameworks.

Background The comparative efficacy of epidural bupivacaine with Magnesium sulphate and bupivacaine combined with Tramadol in providing postoperative analgesia remains controversial.This study aims to assess the efficacy of epidural postoperative analgesia using a combination of 0.125%of Bupivacaine with 50mg MgSO4, compared to 0.125%of Bupivacaine with 50mg tramadol in patients undergoing surgeries for the lower limbs. Method 60 patients classified as ASA grade I and II were randomly divided into two groups, Group I and Group II, each containing 30 patients. Group I received a total of 9 ml of 0.125% bupivacaine (8 ml) combined with 50mg tramadol (1 ml), while Group II was given 9 ml of 0.125% bupivacaine (8 ml) with 50mg MgSO4 (1 ml). The analgesic effectiveness was evaluated by the onset of analgesia, duration of analgesia, quality of analgesia, and the time taken to administer the first rescue analgesic. Results The onset of analgesia in Group I was recorded as 6.67±0.80 minutes, while Group II had an onset time of 7.67±0.80 minutes (p=0.001). The duration of analgesia for Group I was 5.16±0.72 hours, compared to 4.51±0.62 hours in Group II (p=0.001). The time until the first rescue analgesia was 5.260±0.716 hours for Group I, whereas Group II required 4.617±0.622 hours (p=0.001). Over a 24-hour period, Group I needed an average of 3.47±0.51 rescue doses, while Group II required 3.97±0.49 doses. The quality of analgesia was evaluated in both groups, showing no statistically significant differences. Adverse effects included nausea and vomiting in 4 patients and pruritus in 1 patient in Group I, while Group II experienced hypotension in 4 patients and bradycardia in 2 patients. Mean systolic and diastolic blood pressures were comparable across both groups, with significant differences only at 5, 10, and 15 minutes. The mean heart rates at 5, 10, and 15 minutes were 94.67±4.15, 89.73±3.85, and 85.40±4.40 in Group I, and 97.00±4.09, 92.20±3.46, and 87.53±3.27 in Group II, indicating statistical significance. The mean post-operative VAS scores recorded upto 24hrs. The mean VAS score was 0.40±0.498 and 0.47±0.507 at 2hrs, 2.87±0.730 and 2.93±0.691 at 4 hrs, 1.60±0.621 and 1.87±0.730 at 6hrs, 2.60±0.621 and 2.87±0.507 at 8hrs, 1.87±0.629 and 2.07±0.691 at 12hrs, 2.60±0.621 and 2.67±0.479 at 24hrs respectively. Conclusion Tramadol proved to be more effective than magnesium when combined with bupivacaine, as it led to a faster onset of pain relief, prolonged the duration of analgesia, and decreased the requirement for extra rescue epidural top-up doses within a 24-hour timeframe.

AimsResistance to the artemisinins and the artemisinin‐based combination therapy (ACT) partner drugs has developed in Southeast Asia, and artemisinin resistance has also emerged in eastern Africa. Triple ACTs (triple artemisinin‐based combination therapies, TACT), consisting of two partner drugs with different mechanisms of action and similar pharmacokinetic profiles, combined with an artemisinin derivative can help to delay or prevent artemisinin resistance and prolong the useful lifetime of the partner drugs. This study aims to characterize the pharmacokinetic properties of a recommended TACT, artemether‐lumefantrine plus amodiaquine, using data from two large clinical trials.MethodsWe analysed data from two randomized, controlled intervention trials conducted between 2015 and 2020 in one African country and two Southeast Asian countries, in which artemether‐lumefantrine was administered alone (n = 443) or together with amodiaquine (n = 442) to patients with uncomplicated P. falciparum malaria. Both studies included a sub‐cohort with dense pharmacokinetic sampling, combined with sparse data in the other patients. Concentration–time data of artemether, dihydroartemisinin, lumefantrine, desbutyllumefantrine, amodiaquine and desethylamodiaquine were analysed using nonlinear mixed‐effects modelling.ResultsPharmacokinetic models were developed for all drugs and demonstrated good predictive performance and goodness‐of‐fit diagnostics. Coadministered amodiaquine was not a significant covariate on pharmacokinetic properties of artemether‐lumefantrine. Model‐predicted Cmax and AUC (median [95% confidence interval, CI]) for artemether were 256 (159–407) ng/mL and 2850 (1820‐4920) h·ng/mL for artemether‐lumefantrine alone, and 230 (123–391) ng/mL and 2800 (1570‐4570) h·ng/mL for artemether‐lumefantrine‐amodiaquine. For dihydroartemisinin, values were 135 (54.5–214) ng/mL and 1870 (813–3015) h·ng/mL for artemether‐lumefantrine alone, and 116 (40.8–186) ng/mL and 1580 (547–2680) h·ng/mL for artemether‐lumefantrine‐amodiaquine. For lumefantrine, values were 15.2 (2.90–31.3) μg/mL and 600 (275–1230) h·μg/mL for artemether‐lumefantrine alone, and 14.1 (2.72–31.4) μg/mL and 586 (269–1070) h·μg/mL for artemether‐lumefantrine‐amodiaquine. Day 7 concentrations of lumefantrine were 452 (215–1240) and 438 (204–1030) μg/mL for artemether‐lumefantrine alone and artemether‐lumefantrine‐amodiaquine, respectively. All geometric mean ratios (GMRs) for the drug–drug interaction (DDI) effect on key pharmacokinetic parameters of artemether, dihydroartemisinin and lumefantrine fell within the 0.80–1.25 range, with the majority of the corresponding 90% CI also contained within this range. This indicates no clinically relevant DDIs between artemether‐lumefantrine and amodiaquine.ConclusionsThe DDI effect of amodiaquine on the pharmacokinetics of artemether‐lumefantrine is expected to be minimal, the based on the current analysis. However, further large‐scale clinical trials are needed to confirm this finding.