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Papers by Ronnie Thomas

Asian Cardiovascular and Thoracic Annals

Background Hyperhomocysteinemia is associated with an increased risk for cardiovascular diseases.... more Background Hyperhomocysteinemia is associated with an increased risk for cardiovascular diseases. The influence of hyperhomocysteinemia on post-operative events, after coronary artery bypass surgery graft, is less studied. Methods This cross-sectional study aimed to determine if hyperhomocysteinemia was associated with post-operative complications in patients < 50 years who underwent off-pump coronary artery bypass graft for coronary artery disease. A set of major post-operative complications were considered as primary outcome measures. The independent effect of hyperhomocysteinemia and other risk factors in the incidence of post-operative complications was determined by multivariate analysis. Results The mean homocysteine levels among the study participants who had post-operative complications were significantly higher than those without post-operative complications (17.37 mmol/L vs. 12.84 mmol/L). On multivariate analysis, hyperhomocysteinemia, diabetes mellitus, and higher bod...

IntroductionCatastrophic health expenditure during COVID-19 hospitalization has altered the econo... more IntroductionCatastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the Out of Pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditures due to COVID-19 hospitalisation in Kerala, South India.Materials and MethodsA cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalised patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participant during hospitalisation and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of effective household income.ResultsFrom the study, median and mean Out of Pocket (OOP) expenditures...

Indian Journal of Public Health Research & Development, 2020

Context: Hospital sanitation workers are at the frontlines of the global crisis caused by COVID-1... more Context: Hospital sanitation workers are at the frontlines of the global crisis caused by COVID-19 and face the challenge of lack of awareness about the disease and methods of protecting themselves and others from getting infected. A targeted health education intervention was conducted among them on knowledge and practice regarding basic epidemiology, clinical features and prevention of COVID-19. Aim: To evaluate effectiveness of targeted health education intervention with focus on knowledge and practice regarding COVID-19 pandemic among hospital sanitation workers Settings and Design: Quasi-experimental one group pre test, post test design Methods and Material: Study was done among 46 hospital sanitation workers using structured questionnaire covering demographic variables, knowledge on the basic epidemiological characteristics, clinical features and practice on the prevention of COVID-19. After obtaining informed consent, pre-test was conducted and a targeted health education was given. On the 3 rd day, post-test was conducted using same questionnaire. The mean pre and post test scores were calculated and difference between the scores was analyzed. Statistical analysis used: Data was analyzed using SPSS version 25. Demographic information was tabulated using descriptive statistics. The difference between the mean pre test and post test scores was analyzed using paired t test. Results: The mean pre test score was 9.39±1.5, with 35(76%) having good and 11(24%) poor pre test scores. Those in the age group 36-45 years had significantly higher pre test scores compared to other age groups (p=0.03). The mean post test score was 10.6±1.13. There was a statistically significant improvement in the post test scores of the study subjects (p=0.001). Hence, the targeted health education intervention was effective in improving the knowledge and practice of hospital sanitation workers regarding basic epidemiology, clinical features and prevention of COVID-19. Conclusions: Given the heightened vulnerability of hospital sanitation workers to nosocomial infections, all health care institutions should integrate targeted health education intervention into their epidemic response plan.

Indian Journal of Public Health Research & Development, 2021

Background: In Kerala, an Indian State, COVID-19 treatment was restricted to government hospitals... more Background: In Kerala, an Indian State, COVID-19 treatment was restricted to government hospitals till the first week of August 2020. There was a suggestion to involve private hospitals if the disease spreads fast and wide. Three quarters of the healthcare delivery in the state is by private health care providers. Methods: The hospital administration decided to train different levels of health care workers (HCW) in caring COVID-19 patients along with measures to remain safe from the disease. This was a mandatory two hours online training session covering the necessary topics as per the Guidelines of World Health Organisation (WHO) and Indian Council of Medical Research (ICMR). Post test was conducted based on the knowledge acquired during the programme, general awareness as a medical professional and media reports that a medical personal should follow. Conclusion: The response from doctors was 73.7% (out of 559).More response was from the interns (96.4%). All the respondents appeared for the post test and 93.4% secured marks above the cut off level of 75%. The participation and high percentage of success rate shows the interest of medical professionals to step up their skill, especially when they face a new challenge.

International Journal Of Community Medicine And Public Health

Kerala state in India was known for its early response to the Covid-19 pandemic by public health ... more Kerala state in India was known for its early response to the Covid-19 pandemic by public health mitigation measures through science-based advocacy. The objective of this study was to analyze epidemiological and clinical characteristics of COVID-19 patients admitted to a tertiary care center in central Kerala. This retrospective case series was undertaken by reviewing the medical records and extracting the epidemiological data, clinical symptoms and laboratory findings of consecutive patients admitted between April 1st and September 31, 2020. Clinical and demographic parameters of hospitalized patients were analyzed regarding their association with the severity of disease. The mean age of the patients was 35.8 years with significant male predominance. Shopkeepers represented 15.6% of the patients and healthcare workers represented 12.5%. Primary contact with a known case was documented in 62.5% of the patients. Asymptomatic patients constituted 25% of the patients and the most commo...

Journal of Family Medicine and Primary Care, 2020

Background: The distribution of body fat and its variation is of great importance in determining ... more Background: The distribution of body fat and its variation is of great importance in determining the pathogenesis of insulin resistance. Central obesity has been recognized as an independent risk factor for diabetes. The objective of the study was to evaluate the predictive accuracy of various anthropometric measures of body fat in determining impaired glucose tolerance (IGT) or prediabetes among South Indian population. Methodology: This was a community-based comparative cross-sectional study where the anthropometric measures of a representative sample of 171 individuals with glycosylated hemoglobin (HbA1c) in the range for IGT were compared with age- and gender-matched controls with HbA1c in the normal range. The predictive accuracy of the various anthropometric measures of obesity to identify individuals with IGT was estimated using the area under the receiver operating characteristic (ROC) curve. Results: Patients with IGT in both genders had significantly higher BMI, waist circumference (WC), neck circumference (NC), and waist-to-height ratio (WHtR). ROC analysis revealed WHtR in females and NC among males to have the largest area under the curve for predicting IGT. In both genders, WC, WHtR, and NC had better predictive accuracy for prediabetes as compared to BMI and waist-to-hip ratio (WHR). Conclusion: It is suggested that the WHtR and WC are better screening tools for prediabetes in comparison to BMI and WHR among the South Indian population.

Background. Kerala was the first state to have the confirmed case of COVID 19 in the country and ... more Background. Kerala was the first state to have the confirmed case of COVID 19 in the country and it was first confirmed in Thrissur district on 30 January 2020.Our institute being in the heart of the city had to take adequate measures to mitigate the spread and treat the required patients by keeping its staff safe & healthy. The hallmark of COVID 19 infection is high infectivity, pre symptomatic transmission and asymptomatic prevalence which could result in high cumulative numbers of infections, hospitalizations, and deaths. Kerala was the first state to confirm community transmission in July 2020.Health care workers being in the forefront in the war against COVID19 are very prone in acquiring the infection and are possible to be asymptomatic sources for cluster formation. Knowing the development of immunity as shown by the presence of anti COV2 antibodies in the population contributes to the epidemiological understanding of the disease. The intent of the study is to do an antibody ...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021

Introduction: The hallmark of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infect... more Introduction: The hallmark of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is high infectivity, pre symptomatic transmission and asymptomatic prevalence which could result in high cumulative numbers of infections, hospitalisations, and deaths. Kerala was the first state to confirm community transmission in July 2020. Healthcare Workers (HCWs) being in the forefront in the war against Coronavirus Disease-2019 (COVID-19) are more prone to acquire the infection and could possibly be asymptomatic sources for cluster formation. Knowing the development of immunity as shown by the presence of anti COV-2 antibodies in the population contributes to the epidemiological understanding of the disease. Aim: To determine the pattern of seropositivity of SARS-CoV-2 among the HCWs at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, six months after revoking the lockdown. Materials and Methods: This cross-sectional study was carried out among ...

Kerala Journal of Psychiatry, 2020

Background: The COVID-19 pandemic has made an unprecedented psychological impact on healthcare wo... more Background: The COVID-19 pandemic has made an unprecedented psychological impact on healthcare workers. The objective of this study was to appraise the willingness, attitudes and psychological preparedness of the frontline healthcare workers to respond to the COVID-19 pandemic. Methodology: This was a mixed-method study combining a web-based cross-sectional survey, focus group discussions and semi-structured interviews. The crosssectional survey covered 202 healthcare workers, and the qualitative assessment was done on 16 frontline healthcare workers. Results: The willingness to respond to the pandemic was found to be significantly higher among doctors and nurses compared to medical interns. Among demographic factors increasing age and female gender were the key factors in determining willingness and positive emotional response. While anxiety was the most common emotional response, the fear of infecting family members was found to be the most common risk perceived in qualitative analysis. The study highlights the altruistic attitude of frontline health workers to be the most important contributing factor for psychological preparedness. Conclusion: This study outlines the fact that willingness to respond in a pandemic is an innate response in healthcare workers. Considering the risks, workload and socioeconomic stressors, proactive psychosocial support should be given to frontline healthcare workers by the institutions, governments, and society.

International Journal Of Community Medicine And Public Health, 2020

Background: The world’s third largest risk factor for disease and disability is alcohol consumpti... more Background: The world’s third largest risk factor for disease and disability is alcohol consumption. This is associated with many serious socio-economic issues, including violence, child neglect and abuse, and absenteeism at the workplace.Methods: In this study the socio demographic details of the patients admitted from 1st January 2016 to 31st December 2016 were collected directly from the medical records of a de-addiction centre situated at Thrissur, Kerala. The data was entered to excel and statistical analysis was done by using SPSS 21. A total of 571 cases were included in the study.Results: This study shows that more than half of the patients (52.42%) seeking de-addiction comes under middle age group with the mean age of 42 years. Based on educational category of the patients of this study only 10.4% had graduation and above. The majority of the subjects had either high school certificate or below (84.4%). The educational status of patients was comparable with the pattern amon...

International Journal of Research in Medical Sciences, 2020

Coronavirus disease 2019 (COVID-19) pneumonia usually presents as an unilateral or bilateral lowe... more Coronavirus disease 2019 (COVID-19) pneumonia usually presents as an unilateral or bilateral lower zone opacities. We wish to highlight a case of COVID 19 presenting as upper lobe consolidation with pre-existing co morbidities and unknown primary source of infection.

Journal of Thyroid Research, 2020

Background. Perchlorate is an anion that occurs as a contaminant in groundwater. It originates fr... more Background. Perchlorate is an anion that occurs as a contaminant in groundwater. It originates from the improper disposal of ammonium perchlorate, a component of rocket fuel. The objective of this study was to explore whether the exposure to perchlorate in drinking water had an impact on the thyroid function of the population residing near an ammonium perchlorate plant in Kerala. Methodology. Using an ecological study design, we compared the serum levels of thyroid-stimulating hormone, thyroxine, and thyroid peroxidase antibodies among a representative sample of 289 study subjects from the area surrounding the ammonium perchlorate enrichment plant to 281 study subjects in a control area. Results. The perchlorate concentration in the groundwater varied from 1600 ppb to 57,000 ppb in the 10 samples from the contaminated area and was below 24 ppb in all locations in the control area. No significant differences were found in the mean serum TSH concentration and mean T4 levels between th...

Indian Journal of Pathology and Oncology, 2020

The incidence of colorectal cancers is rising in the young adult population. To understand its pa... more The incidence of colorectal cancers is rising in the young adult population. To understand its pathogenesis we compared the clinical and pathological characteristics of early and late onset colorectal cancers. Materials and Methods: Sixty seven consecutive histopathologically confirmed cases who were diagnosed at the centre from April 2018 and M arch 2019 were studied. The study subjects were divided into two age-groups, the early onset group with subjects younger than 45 years and the late onset group with subjects older than 45 years. The clinico-pathological characteristics of colorectal carcinoma cases were compared using an analytical cross-sectional design. Results: Majority of patients in both groups presented with bleeding rectum followed by pain abdomen and constipation. Weight loss was significantly higher among early onset group(p value <0.041). A significantly higher proportion of subjects with type 2 diabetes mellitus were observed in the late onset group (p value = 0.008). A predominance of distal colon and rectal site cancers were seen in both groups. Early onset patients had a significantly higher frequency of mucinous tumours (p=0.018). A statistically significant difference was observed between the two groups in the stage wise comparison with majority of early onset subjects presenting in Stage I and II (p value=0.015). Analysis of CEA and Heamoglobin levels also revealed key distinctions. Conclusion: This study emphasizes the existence of some salient differences between early and late onset colorectal carcinomas with regard to the clinicopathological profile. Further studies are warranted to uncover the molecular features of early onset colorectal cancer.

Indian Journal of Community Medicine, 2019

A 30-year-old male working in an abattoir in UAE returned home to Kerala, South India, after gett... more A 30-year-old male working in an abattoir in UAE returned home to Kerala, South India, after getting diagnosed with Crimean–Congo hemorrhagic fever infection. He was admitted to a tertiary care center on the day of arrival and was placed under isolation. Due to the risk of spread of infection among health-care workers, contact-tracing and symptom-monitoring activities were undertaken. As strict standard contact precautions, isolation, contact identification and listing, quarantine, and sensitization of health-care workers were implemented, no secondary cases occurred.

ClinicoEconomics and Outcomes Research

Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture ... more Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households, especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the out of pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditure due to COVID-19 hospitalization in Kerala, South India. Materials and Methods: A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalized patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participants during hospitalization and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of the household's capacity to pay. Results: From the study, median and mean OOP expenditure was obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had catastrophic health expenditure, with 32.9% having incurred distress financing. Multivariate analysis revealed being below poverty line, hospitalization in private healthcare facility, and presence of co-morbid conditions as significant determinants of catastrophic health expenditure. Conclusion: High levels of catastrophic health expenditure and distress financing revealed by the study have unveiled major unaddressed challenges in the road to universal health coverage.

IP innovative publication pvt ltd, 2020

Introduction: The incidence of colorectal cancers is rising in the young adult population. To und... more Introduction: The incidence of colorectal cancers is rising in the young adult population. To understand
its pathogenesis we compared the clinical and pathological characteristics of early and late onset colorectal
cancers.
Materials and Methods: Sixty seven consecutive histopathologically confirmed cases who were
diagnosed at the centre from April 2018 and M arch 2019 were studied. The study subjects were divided
into two age-groups, the early onset group with subjects younger than 45 years and the late onset group
with subjects older than 45 years. The clinico-pathological characteristics of colorectal carcinoma cases
were compared using an analytical cross -sectional design.
Results: Majority of patients in both groups presented with bleeding rectum followed by pain abdomen
and constipation. Weight loss was significantly higher among early onset group(p value <0.041). A
significantly higher proportion of subjects with type 2 diabetes mellitus were observed in the late onset
group (p value = 0.008). A predominance of distal colon and rectal site cancers were seen in both groups.
Early onset patients had a significantly higher frequency of mucinous tumours (p=0.018). A statistically
significant difference was observed between the two groups in the stage wise comparison with majority of
early onset subjects presenting in Stage I and II (p value=0.015). Analysis of CEA and Heamoglobin levels
also revealed key distinctions.
Conclusion: This study emphasizes the existence of some salient differences between early and late
onset colorectal carcinomas with regard to the clinicopathological profile. Further studies are warranted
to uncover the molecular features of early onset colorectal cancer.