Author name: jainhospitals

Rajesh Jain1*, Veeraswamy Seshiah2 N, Guneeta Mehta Jain3, Pikee Saxena4, 5Shaily Agarwal, 6Sadhana Tiwari 2MD, FRCP, Distinguished Professor, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India;3MD, Department of Obstetrics & Gynecology, Med Gynae clinic, Saharanpur, UP, India; 4MD, Department of Obstetrics and Gynecology, Lady Hardinge Medical college, New Delhi; 5MD, Department of Obstetrics & Gynecology, GSVM Medical College, Kanpur, India; 6MD Fellow,  Department of Obstetrics and Gynecology, GSVM Medical College, Kanpur, India Submitted: 28 June 2024; Accepted: 10 July 2024; Published: 20July 2024 1*Corresponding Author, Rajesh Jain MD, PG Diploma Diabetes (UK), Project Manager, Diabetes Prevention Control Project, NHM, Uttar Pradesh, India, 108 B Gandhi gram, Vinobha nagar, Kanpur-208007, India Email:[email protected] Abstract  Gestational diabetes mellitus (GDM) is a state metabolic disorder caused by carbohydrate intolerance during pregnancy for the first time. This disease is very important as it affects the mother and fetus. It is said that GDM disrupts the pregnancy process and causes many diseases, such as recurrent miscarriage, congenital anomalies, preeclampsia, stillbirth, macrosomia, preterm birth, and emergency delivery after pregnancy, pregnancy, and delivery. It also causes long-term complications by inducing type 2 diabetes mellitus in mothers and children. GDM is generally considered a lifestyle disorder, and therefore, its burden varies by race, geographic boundaries, genetics, and reproductive risk. Consequently, it is necessary to investigate the prevalence and risk of GDM to evaluate prevention strategies.  Ist Trimester early management of Dysglycemia with Medical Nutrition Treatment (MNT) and Metformin is promising. It might be advocated in the future for curtailing the epidemic of GDM and Type 2 Diabetes.  Recently, the TOBOGM study and our ongoing trial with early dysglycemia in 8-10 weeks of gestation resulted in better maternal-fetal outcomes and reduced GDM conversion during pregnancy. This publication is important as the final results of our trial will be published soon.  Prevalence  India is one of the countries with diabetes in the world and has one of the highest rates of GDM in women, affecting more than 5 million women in the country each year [1].  India currently has the second highest number of people with type 2 diabetes in the world at 77 million; Almost half of these patients are women. IDF 2019 estimates that 6 million newborns in India alone are affected by some form of hyperglycemia (HIP) during pregnancy, 90% of which are due to GDM [1].  Therefore, all women should be tested for gestational diabetes, even if they are asymptomatic. Unfortunately, the diagnostic criteria are not the same. (Table-1) Table – 1: Diagnostic Criteria used by International/National organizations for estimating gestational diabetes. Organization Fasting Plasma Glucose mmol/dl     or  mg/dl   Glucose Challenge 1 h Plasma Glucose mmol/dl or mg/dl 2 h Plasma Glucose 3 h Plasma Glucose      WHO1999 1   ≥7.0 or 125                75gm OGTT Not required ≥7.8 or 140 mg/dl Not required     WHO2 2013   ≥5.1 or 92   ≥10.0 or 180 ≥8.5 or 153 mg/dl   ADA3/American college     Obstetricians & Gynaecologist4 2018   ≥ 5.3 or 95 100gm OGTT ≥10.0 or 180 ≥8.6 or 155 mg/dl ≥7.8 or 140 mg/dl    ADIPS 5 2014   ≥5.1 or 92   ≥10.0 or 180 ≥8.5 or 153 mg/dl   EASD6, 1991   ≥7.0 or 125     ≥10.0 or 180   FIGO7, 2015   ≥5.1 or 92   ≥10.0 or 180 ≥8.5 or 153 mg/dl                  Diabetes Canada Clinical Practice Guidelines8, 2018   ≥5.3 or 95 75gm OGTT ≥10.6 ≥8.9 or 160 mg/dl Not required IADPSG9   ≥5.1 0r 92 75gm OGTT ≥10.0 0r 180 ≥8.5 or 153 mg/dl Not required DIPSI10 2014 – 75 gm OGTT, non-fasting – ≥7.8 or 140 mg/dl Not required NICE11   ≥5.6 or 100     ≥7.8 or 140 mg/dl Not required Note: 1WHO 1999 Guidelines: World health Organization; 2WHO 2013 Guidelines 3ADA: American Diabetes association; 4ACOG: American College of Obstetrician and Gynecologist; 5ADIPS: Australasian Diabetes in Pregnancy Society; 6EASD: European Association for the Study of Diabetes; 7FIGO: International Federation of Gynaecology and Obstetrics; 8Diabetes Canada clinical Practice Guidelines; 9IADPSG: International Federation of Gynaecology and Obstetrics; 10DIPSI: Diabetes in Pregnancy Study Group in india; 11NICE: National Institute of Clinical Excellence Diabetes in Pregnancy: Global, Regional, and Indian Scenario  The global diabetes epidemic is on the rise. According to IDF Head Professor Andrew Boulton, diabetes has become an epidemic. The global prevalence of diabetes is estimated to rise from 537 million in 2021 to 783 million in 2045, an increase of 46%. [1] Diabetes is common worldwide, and this is a concern; by 2021, there will be 74.1 million diabetics in India.  This increase may be due to the aging of the Population, physical inactivity, urbanization, and obesity. These conditions increase the risk of diabetes mellitus, but early life is a risk factor. As suggested in David Baker’s “Fetal origins of adult disease” hypothesis, pregnancy planning can significantly impact adult health and disease. Pregnancy can be defined as the process in which stress or stimulus during a sensitive or important period of fetal development permanently changes the structure, body, and metabolism and thus creates a predisposition to a disease in the elderly.  Lifestyle changes and medical interventions have been reported to slow or delay the development of Type-2 diabetes mellitus in people affected by impaired glucose tolerance (IGT), the first line of defense. Maintaining normoglycemia in GDM or other vulnerable individuals is the best option to prevent developing type 2 diabetes (T2DM). Diabetes can be reversed or stopped through primary prevention. For primary prevention of diabetes mellitus, women with gestational diabetes (GDM) are considered an ideal group because their children are more likely to have diabetes, and most of them acquired T2DM. Gestational diabetes may be an important factor in diabetes and obesity. By 2021, the Global prevalence of hyperglycemia in pregnancy (HIP) will be 21.1 million people, accounting for 16.7% of births to women aged 20-49. These individuals may experience some form of hyperglycemia during pregnancy; 80.3% of these were due to GDM [2]. Therefore, all women must be tested for GDM, even if they have

Research Article Dr. Nilanjan Dam1, Dr. Poonam Kushwaha2, Dr. Saket Shekhar3, Dr. S.P. Singh4, Dr. Anju Gahlot5 1. MD Fellow, Department of Community Medicine, RMCHRC, Kanpur, U.P., India; 2 Assistant Prof, Department of Community Medicine, RMCHRC, Kanpur, U.P., India; 4Associate Prof, Department of Community Medicine, RMCHRC, Kanpur, U.P., India; 5 Professor and HOD, Department of Community Medicine, RMCHRC, Kanpur, U.P, India. Submitted: 20 June 2024; Accepted: 28 June 2024; Published: 29 July 5 2024 Corresponding Author: Dr. Nilanjan Dam, MD Fellow, Department of Community Medicine, RMCHRC, Kanpur, U.P., India. Email: [email protected] INTRODUCTION Biomedical waste management is critical to India’s public health and environmental protection. With the rapid growth of the healthcare sector, biomedical waste generation has increased significantly, posing challenges in its proper handling, treatment, and disposal. This comprehensive analysis provides an overview of the current status of biomedical waste management in India, including the regulatory framework, categorization of waste, segregation practices, collection and transportation methods, treatment and disposal technologies, record-keeping requirements, training and awareness programs, monitoring and enforcement mechanisms, and emerging trends. The analysis also explores the challenges healthcare facilities, regulatory authorities, and other stakeholders face in ensuring effective biomedical waste management and proposes strategies to address these challenges. Furthermore, it discusses innovative approaches and future directions to promote sustainable biomedical waste management practices and safeguard public health and the environment. Efforts to combat the Coronavirus disease (COVID-19) pandemic have significantly increased the quantity of bio-medical waste (BMW) generation. Emphasis should be given to awareness and training all HCWs regarding proper BMW management during this pandemic to prevent infection transmission.[1] Bio-medical waste (BMW) management is of utmost importance as its improper management seriously threatens healthcare workers, waste handlers, patients, caregivers, the community, and the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because a lesser BMW amount means a lesser burden on waste disposal work and cost savings.[2] Evolution of Biomedical Waste Management Rules in India The management of biomedical waste in India has evolved over the years in response to growing concerns about its impact on public health and the environment. The journey of regulatory development in this area can be summarized as follows: Waste management has become critical, posing potential health risks and environmental damage. It has taken a central place in the national health policy and is attracting considerable international interest. India participated in the United Nations Conference on the Human Environment held in Stockholm in June 1972, where decisions were taken to take appropriate steps to protect and improve the human environment.[4] The safe & sustainable management of BMWs is a legal and social responsibility of everyone involved in providing or utilizing healthcare services (i.e., patients, families, HCWs, hospital administration, and health system). The BMW Rules, 2016 (further amended in 2018 & 2019) is a joint product of research made by agencies such as the Centre for Chronic Disease Control, Health Care Without Harm, and the Centre for Environmental Health under the Public Health Foundation of India. This guideline was introduced to create a stringent and elaborate set of rules and change how BMWs are managed in India. Monitoring the activities in health facilities and their compliance with the standard guidelines is important, as proper compliance with BMW practices ensures the safety of patients and HCWs.[5] Healthcare waste (HCW) includes all the waste medical facilities generate. It comprises waste produced during testing, treatment, or vaccination of humans or animals. The quantity of general (non-hazardous) waste is 70–80% of total waste generated by health care facilities (HCFs).[6] Pathology, microbiology, blood bank, and other diagnostic laboratories generate a sizable amount of biomedical waste (BMW). BMW’s audit is required to plan proper strategies. The audit in our laboratory revealed 8 kgs of anatomical waste, 600 kgs of microbiology waste, 220 kgs waste sharps, 15 kgs of soiled waste, 111 kgs of solid waste, 480 liters of liquid waste along with 33,000 liters per month of liquid waste generated from labware washing and laboratory cleaning and 162 liters of chemical waste per month.[7] Devoted healthcare workers and facilities are also significant. Further, the proper and continuous monitoring of BMW is a vital necessity. Therefore, developing environmentally friendly methods and the right plan and protocols for the disposal of BMW is very important to achieve the goal of a green and clean environment. This review article aims to provide systematic, evidence-based information and an organized, comprehensive study of BMW[8]. BACKGROUND In healthcare facilities, a significant amount of infectious material and biomedical waste (BMW) is produced during patient care, and healthcare professionals regularly handle these materials. Therefore, healthcare professionals must have the necessary knowledge, attitude, and practice regarding managing BMW. AIMS AND OBJECTIVES This study is, therefore, conducted to assess the knowledge, attitude, and practices of BMW management among healthcare workers in our institution.  MATERIAL AND METHOD The Institution, cross-sectional study will be conducted among all health care workers (paramedical staff, nursing staff, lab technicians, attendants, GNM and other trainees) of either sex, any age, involved in various procedures done during diagnostic, therapeutic, and vaccination etc. outpatient departments (OPD), indoor patient departments (IPD) and emergency/ causality of Rama Medical College Hospital and Research Centre, Mandhana, Kanpur, those who will give consent, with total enumerative sampling from August 2023 onwards. Subjects will be recruited after informed consent. Data collection and entry will be done using Google Forms. Collected data will be tabulated, analyzed, and interpreted by Jamovi 2.2.5.0. Continuous data will be presented as frequency, percentage, and Mean and SD. Categorical variables will be presented as frequency & percentages. Appropriate statistical tests will be applied accordingly. 95% confidence intervals (CI) and p-value (<0.05) will be considered significant. Confidentiality of the given information will be maintained. Ethical approval will be obtained from the Institutional Ethical and Research Advisory Committee, Rama Medical College Hospital and Research Centre, Mandhana, Kanpur. RESULTS Profile of study subjects- In the study, females 159 (78.3%) outnumbered males 44 (21.7%). The mean age of