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Introduction: In Sub-Saharan Africa, surgical conditions remain neglected in its health care systems. This results in a low surgical output from district hospitals with many patients referred to Referral Hospitals in the region. Therefore surgical camps in district hospitals are often necessary where volunteer surgical teams perform a wide range of mostly elective surgical procedures. These surgical camps are pre-planned activities carried out at no cost to the patients who belong to poor and hard to reach vulnerable communities. The purpose of this surgical camp was to offer free specialised surgical service in a rural hospital and hence improve surgical access to a poor vulnerable community in Northern Uganda. Training basic surgical skills and the provision of continuous medical education to medical officers in the region was also part of the objective of this surgical camp. Methods: A descriptive study using data collected from a one week surgical camp in the year 2011 was performed at St. Joseph’s Maracha Hospital. Data from operating log forms regarding date of procedure, patient gender, clinical diagnosis, operation performed and type of anaesthesia was obtained. Data was analysed for age, sex, type and rate of surgical procedure and type of anaesthesia. The participants’ involved specialist general surgeons, medical officers, clinical officers, theatre nurses and anaesthetists. Results: In total, 105 surgical procedures were performed during the 7-day-long camp. Mean age of the patients was 39.54 years. The male: female ratio was 1:0.38. Adult inguinal herniorrhaphy formed 68.6% of all surgical procedures. Conclusions: The bulk of surgical disease encountered during the camp were inguinal hernias. Surgical camps improve access to surgical care to vulnerable hard to reach populations and should become an integral part of health service delivery in rural Africa.

Introduction: A mother is the foundation of a family and also the very root and foundation of a Nation. Maternal health is a matter of great importance all over the world as it defines the social status of women in a country as well as the quality of health services provided by a Nation to its people. Materials and Methods: The study was performed in a rural tertiary care institute located in central India. After clearance from the ethical committee of the institute and approval from university for thesis synopsis was received, study was initiated on patients meeting the study requirements from a period of January 2016 to September 2017. Result: In this study, amongst all cases of Maternal near Miss 36% were due to haemorrhage, 22.4% due to medical disorders, 21.6% due to hypertensive disorders of pregnancy, 15.2% due to infection, and 4.8% were due to labour related disorders. Investigating MNM cases will help to improve the maternal health system more as women has survived catastrophe. Positive feedback to health worker will do miracles. Keywords: Maternal near miss (MNM), Maternal mortality ratio (MMR).

Background: In full term newborns, the Ductus arteriosus closes functionally within of birth, and it normally closes structurally between 2 to 8 weeks. Complete conclusion of the ductus in untimely babies may not happen until a half year old enough, and in exceptional cases may not happen until adulthood. Is medical term that afterwards birth, the ductus arteriosus fails to close, allowing oxygenated blood to travel back to the lungs from the left heart Changed Word Structural Changes Thesaurus via the pulmonary artery, which has a higher pressure. Increased laboured breathing and failure to gain weight at a normal rate are frequent later in the first year of life. A patent ductus arteriosus (PDA) can lead to pulmonary hypertension and right-sided heart failure if left untreated. Case Report Information: A 2 years 6 months old child brought by the parents in Aacharya Vinoba Bhave Rural Hospital on 22/12/2020. An patients parent’s verbalization, the child was apparently alright at 8 months of age. When he started having fever, cold and cough and decreased feed intake. Then they took the child to local doctor where 2D ECHO was done. Suggestive of patent ductus arteriosus. Patient is referred to Aacharya Vinoba Bhave hospital for further management. Conclusion: The patient was admitted in AVBRH with complaints of fever, cold and cough, decreased feed intake. Then the report mainly focused on surgical management and quality nursing care due to which patient was discharged without any further complication and satisfaction.

Bacterial vaginosis is condition in which abnormal vaginal discharge can cause. Due to this sexually transmitted diseases are causing in the women. In the bacterial vaginosis there is an imbalance in the vaginal acidity the pH becomes more than 5 the bacteria becomes overgrowth and due to this bacterial infection or bacterial vaginosis leads [1]. Objective: 1: To assess the prevalence of bacterial vaginosis among women. 2: To find out the association between prevalence of bacterial vaginosis among women with socio-demographic variable. Materials and Methods: Research Approach- Quantitative research approach. Research Design: Cross sectional survey design. Setting of the Study: The study was conducted at rural hospital and primary health centre. Population: women Sampling technique: non-probability convenient sampling technique. Sample size: 115. Results: The data obtained to describe the sample characteristics including demographic variables (age of women, education, marital status, occupation, age of menarche ,menstrual history, use of contraception, types of contraception), prevalence of bacterial vaginosis women the total participant was 115 women age of 30-50 years. Hence the all findings were describes there was no association between socio demographic variables and prevalence of bacterial vaginosis is 6.1%. Conclusion In this study the finding of the study shows that overall there was n association between bacterial vaginosis and demographic variables. The prevalence of bacterial vaginosis was 6.1% in the present study which was relatively low. However it vaginosis was common among sexually active women. The test was done by pap smear test which gave exact result and interpretation of test.

Diagnosing Acute Myocardial Infarction (AMI) in the setting of the Left Bundle Branch Block (LBBB) proposes a great challenge to the clinician. Despite current therapy recommendations, early reperfusion may not be appropriate for all patients with new or presumed new LBBB because only a minority is caused by acute myocardial infarction with true occluded artery. This is a case of a 47-year-old man presented at a rural hospital emergency with highly suspected acute myocardial infarction, a history of old infarct, and LBBB on ECG. Relying on careful clinical examination and close evaluation of hemodynamic with serial ECG, the patient was decided to be managed conservatively. Thorough clinical judgment is required in diagnosing and managing patients with acute MI and LBBB. Avoiding unnecessary burdens and risks resulting from early reperfusion therapy may have a significant impact especially in the centre with limited modality settings.

Patient management and intervention practices are a crucial component of patient treatment in the hospitals. Increase in inpatient mobilization to improve patient treatment raises a physiotherapist’s physical demands and therefore risk of injury. With the context of a patient mobilization program, better work procedures and decrease in physiotherapist’s injuries while working, SPH program was incorporated. The purpose of this study is to assess the impact of the SPH program and mobilization in the context of efforts to improve health care quality and patient safety, as well as the safety of physical therapists. There will be 2 groups, intervention (SPH) and comparison (no-SPH) each group will consist of 30 patients. The intervention group will be consisting the patients admitted in rehabilitation unit for the first three months of the research and the comparison group will consist the patients admitted in rehabilitation unit in the last 3 months of the research. Intervention group will undergo rehabilitation with SPH program which will include equipment like lifts based on ceiling and floors, sit to stand supports, motorized hospital beds and ambulation aids. In this study we found that the SPH program did not impede rehabilitation but also somewhat sped up the recovery process. Patients who had an SPH program during rehabilitation showed similar but better outcomes than those who did not.

In India, vaginal tuberculosis (FGTB) is a common cause of infertility, but diagnosis is difficult because of the form of the disease of people in need. Traditional diagnostic methods include the detection of rapid bacilli acid in endometrial or peritoneal biopsy, epithelioid granuloma biopsy, or a positive Expert type in biopsy, although this is only available in a small percentage of cases, leaving patients many are not available. Diagnosis of GTB by PCR along with histopathological findings leads to high sensitivity and specificity. So, both diagnostic and operative laparoscopy and hysteroscopy are the modalities essential for management of genital TB in infertile women. This review discusses various diagnostic modalities including endometrial or peritoneal biopsy to detect epithelioid granuloma on microscopy, role of PCR for GTB and correlation of two for early diagnosis of genital tuberculosis so that management will be started at early stage which can prevent patient from getting permanent damage to organs. Tuberculosis being endemic in counties likes India; it is often a leading cause of infertility. Early diagnosis is crucial because, by the time patient reports with infertility, already the damage has started and reverting tubal patency is almost impossible. Early diagnosis typically fails in developing countries, primarily because there are no pathognomonic signs of the disease and either poor sensitivity or procedurally invasive diagnostic methods are in use.

The testicles develop in the abdomen while a male baby is still in the uterus. Before birth, the testicles typically drop from inside the abdomen down into the scrotum. The scrotum is the sack of skin hanging behind the penis where the testicles are housed. Undescended testicles fail to drop into the scrotum before birth or in the first few months of life. The condition is also called cryptorchidism. Here we discussed, A 15 Years old male child was brought to Acharya Vinobha Bhave Rural Hospital with a complaint of undescended testis and is brought for surgical management. The history of previous illness as narrated by the father the child was born with an undescended testis on the right side.

Despite rural hospitals' central role in their communities, they are increasingly in financial distress and may merge with other hospitals or health systems, potentially reducing service lines that are less profitable or duplicative of services that the acquirer also offers. Using hospital discharge data from thirty-two Healthcare Cost and Utilization Project State Inpatient Databases from the period 2007-18, we examined the influence of rural hospital mergers on changes to inpatient service lines at hospitals and within their catchment areas. We found that merged hospitals were more likely than independent hospitals to eliminate maternal/neonatal and surgical care. Whereas the number of mental/substance use disorder-related stays decreased or remained stable at merged hospitals and within their catchment areas, it increased for unaffiliated hospitals and their catchment areas, indicating a potential unmet need in the communities of rural hospitals postmerger. Although a merger could salvage a hospital's sustainability, it also could reduce service lines and responsiveness to community needs.

Background: Many studies were conducted on nebulization therapy with the aim to compare the effectiveness of medication but not many of research are conducted on demonstration skills one the use of nebulization therapy. Aim of the Study: The aim of the study is to assess effectiveness of demonstration skill on use of nebulization therapy among the parents of hospitalized children. Objectives: To assess the existing demonstration skill on use of nebulization therapy among the parents of hospitalized children. To assess the effectiveness of demonstration skill on use nebulization therapy among the parents of hospitalized children. To associate the post-test demonstration skill score on use nebulization therapy among the parents of hospitalized children with selected demographic variables. Methodology: An academic hospital based study will conduct in the Acharya Vinoba Bahave Rural Hospital in Sawangi (Meghe), Wardha, Maharashtra, India. This study will use an interventional approach with a one-group pre-test post-test design and non-probability convenience sampling to select 60 samples. The parents will be select based on criteria for inclusion and exclusion. The data will be collected using a demographic variables and self-Structured Observational Checklist on Nebulization therapy will use to collect the data. Pre-test demonstration skill was carried on day 1 and post-test conducted with same checklist on 7th day which will be filled out by the researcher while observing the parents while they provide nebulization therapy to their children. Conclusion: Conclusion of this research will be drawn from statistical analysis of samples.

The study aim was to determine the association of a one United States dollar (USD) dollar incentive and tuberculosis (TB) treatment outcomes among people with TB receiving treatment at a rural hospital in Uganda under programmatic settings. We conducted a quasi-experiment in which people with TB were randomised (1:1 ratio) to receive either a one USD incentive at months 0, 2, 5 and 6 (Dollar arm) or routine care (Routine arm). A second control group (Retrospective controls) consisted of participants who had a treatment outcome in the preceding 6 months. Treatment outcomes were compared between the intervention and control groups using Pearson’s chi-square and Fisher’s exact tests. The association between the incentive and treatment outcomes was determined using Poisson regression analysis with robust variances. Between November 2018 and October 2019, we enrolled 180 participants (60 in the Dollar arm and 120 in the Control group). TB cure (33.3% vs. 20.8%, p = 0.068) and treatment success (70.0% vs. 59.2% p = 0.156) were higher in the Dollar arm than the Control group, while loss-to-follow-up was lower in the Dollar arm (10.0% vs. 20.8% p = 0.070). Participants in the Dollar arm were more likely to be cured (adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.04–2.44, p = 0.032) and less likely to be lost to follow-up (aIRR: 0.44, 95% CI 0.20–0.96, p = 0.040). A one-dollar incentive was associated with higher TB cure and lower loss-to-follow-up among people with TB in rural Uganda.

A return to normal surgical practice following the first wave of the COVID-19 pandemic was expected to be limited by extra precautions put in place to mitigate the risks posed by the Sars-Cov2 virus to patients and theatre staff. Rates of COVID-19 infection within the local authority area remained well below national levels from August 2020-February 2021 despite a surge in cases during the second wave. Despite low levels of COVID-19 infection there was a 16.2% reduction in the number of operating lists and a 31.2% reduction in the number of surgical procedures performed. There was a significant increase in the number of cancellations (p=0.011) year on year. The results suggest that the ability of Otolaryngological departments to clear the backlog of cases caused by the postponement of non-urgent surgery during 2020 will be limited as long as the extra precautions remain.

BACKGROUND The tympanic cavity is susceptible to infection by viruses and bacteria through the Eustachian tube, thereby making ear pathologies and particularly middle ear inflammatory conditions a frequent reason to consult an otorhinolaryngologist. With the advent of High-Resolution Computed Tomography, diagnosis of the middle ear anatomy, pathology and its complications if any, could be made out with better precision by providing a direct visual window by providing minute structural details. The aim of the study was to assess temporal bone pathologies that could be evaluated by HRCT study of the temporal bone in a rural hospital based setup and correlate if possible with surgical/histopathological findings. METHODS The study was a retrospective study done in M.V.J Medical College and Research Hospital, Bangalore amongst 50 patients from February 2020 to January 2021 who underwent HRCT of the temporal bone and relevant statistics were drawn from these cases. After local examination, clinical evaluation and consent, CT scan was performed. Follow-up of patients was done for confirmation with operative and/or histopathological findings whenever possible. All the data obtained were recorded in a tabulated form and analysed on MS Excel. RESULTS Amongst 50 patients, infective aetiology was found to be the most common cause, of which chronic otomastoiditis was the most common, followed by chronic Cholesteatoma, otitis media, chronic mastoiditis, and otitis externa. Amongst the congenital aetiology, we had 1 case each of osteoma, facial nerve involvement, microtia and inner ear dysplasia. Amongst the traumatic cases, longitudinal type of fracture was the most common type, followed by transverse and mixed fractures with hemotympanum being the most common HRCT finding. CONCLUSIONS HRCT of the temporal bone helps in accurate assessment of infective, congenital, traumatic and neoplastic aetiologies and helps the otologist understand the disease's extent and aid in surgery. KEYWORDS High-Resolution Computed Tomography, HRCT, Temporal bone, Radiology

PROBLEM The lack of dedicated theatre time for orthopaedic surgeries at a small rural hospital meant that operations were regularly performed after hours as well as on weekends. DESIGN Retrospective observational audit. SETTING Data were collected for 317 patients admitted for trauma surgery between August 2019 and March 2020 at Shoalhaven District Memorial Hospital, which has an orthopaedic service and acts as a referral hospital for a 4561-km2 catchment on the South Coast of New South Wales. KEY MEASURES FOR IMPROVEMENT Decreased time to surgery, length of stay and proportion of after-hours operating. STRATEGIES FOR CHANGE To quantify patient outcomes demonstrating effectiveness of the trauma list in theatre operations at the hospital, providing evidence for adequate provision of care at the rural location A reduction in out-of-hours operations results in a significant financial saving to the hospital, as well as increased safety to patients. EFFECTS OF CHANGE Significantly more operations were performed before 16:00 hours as well as on a weekday. Trauma list patients have a shorter length of stay (4.82 vs 7.8 days). Patients prior to the trauma list waited on average 89 hours for surgery, whereas patients on the trauma list waited only 43 hours. LESSONS LEARNT A dedicated, twice-weekly orthopaedic trauma list is able to significantly reduce after hours and weekend surgeries. Patients placed on the trauma list had a significantly shorter length of stay and time to surgery. We therefore recommend the usage of dedicated trauma lists at small, regional sites not just to achieve cost savings but also to improve the patient journey and keep patients closer and returning to the home sooner.

Background: In inguinal hernia patient post-operative recurrence rate has been decrease due to advancement in prosthetic mesh. The hernia outcome study should concentrate on hernia post-operative quality of life and various complications. Objectives: To study the application of HERQL INSTRUMENT in surgical practice. To study the quality of life pre-operatively & post-operatively. To utilise as HERQL INSTRUMENT in clinical management as a prognostic indicator to improve upon the healthcare system. Methodology: All the patients of inguinal hernia presenting to Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha as an elective/emergency case will be included in the study after obtaining consent. Patient has to go through the HERQL questionnaire pre-operatively and post-operatively or post-operatively only. These patients will be enrolled in the study. Results: We expect a causal relationship between formative symptomatic subscale and the reflective functional status demonstrated by HERQL. The assessment of summative pain in preoperative and immediate postoperative patient shows changes in summative pain and 3 month follow up suggestive of clinical response of HERQL. Conclusion: This study will help to know quality of life in “post-operative” hernia patient with the help of “HERQL instrument”.

Background: Occurrence of elective Caesarean Section (CS) is prevalent in the advanced age group, i.e. 26-30 years while higher incidence of emergency CS is seen in 20-25 years, the younger age group. Emergency caesarean delivery analogous with substantially greater maternal and foetal delivery complications in contrast to elective caesarean sections regardless of its growing acceptance as a preferable alternative to vaginal delivery. The study attempts to determine risk factors for emergency and scheduled caesarean surgeries, along with indications of LSCS and maternal-foetal outcomes. Method: Prospective observational study will be carried out on post-natal care women who have undergone LSCS in the past 1 week in the rural tertiary care hospital, Wardha. Study participants will be approached in the OBGY Post Natal Care Ward 1or 2 days post-delivery after assuring their comfort. A predesigned & pre-structured questionnaire containing socio-demographic profile, maternal details, and reasons for planned/emergency C-section, neonatal details etc. Results: From the baseline study, the average number of caesarean-sections was 55-60 %. Proportion of elective and emergency caesarean was 41.40 % and 58.60% respectively. Emergency group is expected to show all of the complications significantly higher in terms of both maternal and fetal outcome. Conclusion: Previous c-section, foetal distress and misrepresentation of the foetus (Breech and Transverse Lie) were recorded as a most important indicator of caesarean section along with obstructed labour. Higher incidence of emergency CS was 20-25 years, while the incidence of elective C-Section was prevalent. in the age group of 26-30 years; Modifiable risk factors for the Caesarean Section, such as early marriage with its associated inadequate pelvic growth and unnecessary avoidance of hospital delivery due to fear of CS, should be discouraged.

Objectives This study aimed to investigate the impact of newly introduced clinical pharmacy services on the health care of chronic haemodialysis patients attending an outpatient haemodialysis unit in a rural hospital with limited resources in Alexandria, Egypt. Methods A quasi-experimental pre-/post-test study was conducted from November 2016 till June 2018. Clinical pharmacists collected relevant information using a pre-specified form. Patients’ data were reviewed for drug-related problems (DRPs), which were documented using the Pharmaceutical Care Network Europe (PCNE) classification system, version 8.02 and resolved by the clinical pharmacists. Measured values of calcium, phosphorus and haemoglobin were compared with target levels set by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Proportions of patients achieving therapeutic values of each parameter were compared before and after implementing the program using the McNemar test. We also reported the analysis of DRPs identified and addressed by the clinical pharmacy team. Key findings A total of 685 DRPs were identified during the follow-up period. Improper dose and inappropriate drug selection were the most common DRPs (45.8% and 18.9%, respectively). There was a statistically significant increase in the proportion of patients achieving target corrected calcium levels (30% pre-intervention versus 69.6% post-intervention, P = 0.001) and haemoglobin levels (9.1% pre-intervention versus 31.9% post-intervention, P = 0.003), but not in phosphorus levels (18.6% pre-intervention versus 22% post-intervention, P = 0.7). Conclusions Clinical pharmacists were able to resolve frequent DRPs and improve some markers of health care in haemodialysis patients.

BACKGROUND: Rural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities. METHODS: Using a 20% sample of the 2012 Medicare Chronic Condition Warehouse, we studied the overall ED visit rate and the unscheduled care rate by geography using the Dartmouth Atlas’ hospital referral regions (HRR). We calculated HRR urbanicity as the proportion of beneficiaries residing in an urban zip code within each HRR. We report descriptive statistics and utilize K-means clustering based on the ED visit rates and unscheduled care rates. RESULTS: We found rural ED use is more common and disproportionately the site of unscheduled care delivery when compared to urban communities. The ED visit and unscheduled care proportions were negatively correlated with increased urbanicity (r = −0.48, p < 0.001; r = −0.58, p < 0.001). CONCLUSION: he use and role of EDs by Medicare beneficiaries appears to be substantially different between urban and rural areas. This suggests that the ED may play a distinct role within the healthcare delivery system of rural communities that face disproportionate barriers to care access.

The present study has been undertaken to evaluate the pattern of adverse drug reactions (ADRs) of intravenous anticancer (i.v.) drugs with their causality and severity in a tertiary health care set up. The study was an observational cross-sectional survey over a period of 18 months. The indoor patients who were diagnosed to have cancer and receiving i.v. anticancer drugs were included in the study. The details of the patients and ADRs were recorded at the time of visit or within one-month of occurrence of ADRs using case record form and ADR reporting form. A total of 374 patients on cancer chemotherapy were included in the study and ADR was seen in 293(78.34%) patients. Out of total 812 number of ADRs, most ADRs (51.60%) were G.I. system related, followed by skin and appendages related ADRs (23.88%). The association of females in developing haematological ADRs is statistically significant (p

OBJECTIVE: Between January 2005 and July 2020, 171 rural hospitals closed across the United States. Little is known about the extent that other providers step in to fill the potential reduction in access from a rural hospital closure. The objective of this analysis is to evaluate the trends of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in rural areas prior to and following hospital closure. DATA SOURCES/STUDY SETTING: We used publicly available data from Centers for Medicare and Medicaid Provider of Services files, Cecil G. Sheps Center rural hospital closures list, and Small Area Income and Poverty Estimates. STUDY DESIGN: We described the trends over time in the number of hospitals, hospital closures, FQHC sites, and RHCs in rural and urban ZIP codes, 2006–2018. We used two‐way fixed effects and pooled generalized linear models with a logit link to estimate the probabilities of having any RHC and any FQHC within 10 straight‐line miles. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: Compared to hospitals that never closed, the predicted probability of having any FQHC within 10 miles increased post closure by 5.95 and 11.57 percentage points at 1 year and 5 years, respectively (p

Background: Seizures are a common presenting complaint in pediatric patients. There are many underlying causes which may present as seizures in pediatric population, for example: febrile seizures, hypoxic ischemic encephalopathy, congenital malformations, certain neoplasms etc. Magnetic resonance imaging(MRI) plays a fundamental role in evaluation of these causes and is especially of use in identifying the structural lesions presenting as seizures. Objectives: To assess the role of MRI(1.5 Tesla) in evaluation pediatric seizures and to study spectrum of MRI findings associated with various causes. Methodology: A prospective study will be conducted at “Acharya Vinoba Bhave Rural Hospital, Sawangi”, involving 138 pediatric patients coming to Radiology department. Results: After statistical analysis, we expect to find effectiveness of MRI in evaluation of pediatric seizures. Conclusion: In this study we expect to find usefulness of MRI as a diagnostic tool in assessment of pediatric seizures especially in those with structural lesions.

Background: The Thrombolysis in Myocardial Infarction (TIMI) score is considered a method for early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI). It is composed of seven factors and if present, each factor contributes a value of one point toward the TIMI risk score, making it a simple tool that does not require differential weights for each factor. A higher score implies a higher likelihood of adverse cardiac events and/or risk of mortality. A TIMI risk score ≥3 recommends early invasive management with cardiac angiography and revascularization. As per CDC study in 2014, Americans living in rural areas are more likely to die from leading causes such as cardiovascular diseases. An estimated number 25,000 deaths than their urban counterparts, which coincide with a TIMI risk score of ≥3, potentially limit the utility of the TIMI risk score in risk stratification in rural catherization laboratories. The objective of this study was to assess the reliability of TIMI score as early risk stratification in patients with unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in rural hospital. Methods: A retrospective chart review study in a rural hospital was conducted for subjects that received left heart catheterizations, exercise stress tests, or chemical stress tests for a diagnosis of UA/NSTEMI. A total of 399 subjects who underwent left heart catheterization and/or stress testing were recruited for this study. A total of 153 subjects who were transferred out to a larger facility, transitioned to comfort care, refused intervention, or passed away were excluded from the study. The 246 remaining subjects were classified into two groups, those with TIMI 0–2 compared with those having TIMI ≥ 3. A null hypothesis was postulated that there was no significant difference between the two groups with regard to prevalence of either positive stress test or evidence of obstructive coronary disease following coronary angiography. T-test and Wilcoxon rank-sum analysis were performed through SPSS statistical analysis. Results: Formal statistical analysis using T-test as well as Wilcoxon rank-sum test comparing the two groups showed p = 0.34 for T-test and p = 0.60 for Wilcoxon rank-sum test. This is consistent with the postulated null hypothesis: that there is no significant difference between the two surgery groups with respect to the mean/median TIMI score. Conclusion: There was no statistical difference between high and low TIMI score in the intervention of unstable angina/non-ST elevated myocardial infarctions (UA/NSTEMI) in a rural hospital.

Although plastic surgeons often demonstrate interest and ability in global surgery, it is not always clear how much of the surgical pathology that presents at a typical community hospital in the African bush could be well-treated by a plastic surgeon. This is compounded by the fact that many surgeons in Africa do not recognize the full breadth of disorders that can be treated by a plastic surgeon. We aim to quantify the cases that fall under the purview of plastic surgery at our 158-bed rural hospital in southern Gabon in central Africa. We reviewed the entire operative case log for 2018 for Bongolo Hospital in Lebamba, Gabon, and we filtered for all cases that fell under the purview of plastic surgery. We compared this number to the number of cases that had previously been categorized as plastic surgery cases. Of the 1718 surgical cases in 2018, 27 (1.6%) had originally been classified as plastic surgery cases. Upon our re-review, 186 cases (11%) fell under the purview of plastic surgery, and up to 16% of cases would be adequately treated by a plastic surgeon. At least 1 in 9 surgical cases at this first-level, rural, African hospital can be classified as plastic surgery. This case load testifies to the impact plastic surgeons can have in the sub-Saharan African context, even at smaller, rural hospitals. Level of Evidence: Level IV, risk study.

Background: Globally, it is estimated that unsafe abortions contribute to 8% of maternal deaths. Sub-Saharan Africa has the highest regional estimate of abortion related mortality at 90 per 100, 000 live births. In Zambia the reasons for the termination of pregnancy is enshrined in the Termination of Pregnancy Act of 1972 which states that an abortion may legally take place if the continuation of the pregnancy involves a risk to the pregnant woman's life, physical or mental health; a risk to the physical or mental health of any existing children; or if there is a substantial risk that the child will be born with birth abnormalities. The Termination of Pregnancy Act further specifies that the pregnant woman's actual or reasonably foreseeable environment may be considered. In this study, we set out to assess the reasons women give when requesting for a termination of pregnancy at Mansa General Hospital of Luapula province of Zambia.Methods: We carried out a descriptive cross-sectional study of 66 women’s medical records who requested termination of pregnancy in 2018 January and 2019 December. The records were retrieved from Mansa General Hospital in Luapula province, Zambia. The case notes and consent forms were used to determine the characteristics and the reasons women requested a termination of pregnancy.Results: Out of the 66 retrieved records of women who requested a termination of pregnancy from the registry of the hospital, 58 had their request of a termination of pregnancy successfully done and 8 never went further to terminate their pregnancy while 1 of the 66 records had the information missing on whether their request was met or not for a termination of pregnancy.Mean age was 25 (SD 7.3) with a minimum of 13 and maximum of 44. Average gestation age was 7.5 weeks (SD 2.8). Fifty percent (50%) of women had one living child and 32.7% were married. Forty one percent (41%) were in their first pregnancy. Sixty eight percent (68.2%) of patients had secondary education whereas 27.3% had a tertiary education. Median parity was 2. The commonest reason for termination was the need to advance in education (27.5%). The second was poor economic home situation (20.3%). The third was medical reasons(13.0%).Conclusion: Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Zambia

BACKGROUND Post caesarean section pain requires effective analgesia. Effective analgesia is integral to improvement of quality and patient care among lower segment caesarean section (LSCS) patients. Magnesium, an N-methyl-D-aspartate receptor antagonist along with calcium-channel blocker, has previously been investigated for its analgesic properties. But there is scanty previous literature available for intramuscular magnesium sulphate in the analgesic role in post caesarean mothers. The purpose of this study was to evaluate the effect of existing MgSO4 regimens (among severe pregnancy induced hypertension patients, excluding eclampsia) during early 1st 24 hours’ postoperative analgesic requirements in caesarean section patients comparing to only analgesic group. METHODS It is a retrospective observational study, conducted from January 2019 to June 2020. Patients were randomly selected, normal patients as control = 50 who got post-operative inj. diclofenac 75 mg IM twice a day and rescue analgesia inj. diclofenac 75 mg IM. Test sample comprised of 50 randomly selected severe pregnancy induced hypertension (PIH) patients who got prophylactic inj. magnesium sulphate by Pritchard regimen for 24 hrs. post delivery with 4 gm 20 % inj. magnesium sulphate intravenous with 10 gm 50 % intramuscular in both buttocks as loading dose followed by 5 gm 50 % inj. magnesium sulphate intramuscular 4th hourly for 24 hrs. along with inj. diclofenac 75 mg IM twice a day. Visual analogue scale for pain was noted among both the groups, and were compared for the effect of analgesics in the study groups. RESULTS There was a decrease in analgesic consumption and immediate post-operative pain in the group receiving MgSO4 with analgesic (inj. diclofenac 75 mg), in comparison to control group of inj. diclofenac 75 mg. (P < 0.0001). CONCLUSIONS There was a decrease in analgesic consumption in the group receiving MgSO4 plus analgesic, in comparison to control group (analgesic group). Pain severity assessment 2, 6, 12 and 24 hours post operatively showed that there was a statistically significant decrease in pain scores between the study and the control groups (P < 0.0001). It established the role of magnesium sulphate as an adjuvant analgesic along with diclofenac or other traditionally used pain medications among the post caesarean mothers in early post-operative period. KEYWORDS Analgesia, Pregnancy, Post-Operative Analgesia, Magnesium Sulphate, Lower Segment Caesarean Section (LSCS), Pain Relief, Obstetrics

Introduction: Hospital-acquired malnutrition (HAM) is prevalent among hospitalised children in developing countries. This condition relates to worse clinical outcomes, prolongs length of stay in hospitals, and increases mortality. A multidisciplinary approach should be performed to prevent and manage this problem. However, HAM is often underdiagnosed, especially in rural hospitals with limited human resources. This study aims to delineate the risk factors of HAM among hospitalised children in a rural hospital. Methods: This nested case-control study derived from the implementation of a nutritional screening programme in Parindu Hospital, Sanggau, West Borneo, was conducted from December 2018 to February 2019. HAM was defined as a loss of body weight of >2% after hospitalisation. Independent variables such as the age of patients, fever, gastrointestinal loss, pre-existing malnutrition, length of stay, and grade of disease were analysed in univariate and multivariate analyses using logistic regression. Risk factors were expressed as odds ratio and adjusted odds ratio (aOR) with 95% confidence interval (CI). Results: Thirty-three patients were analysed as cases with 59 controls. Median age was younger in the case group (49 months, IQR 14-72.5) than control group (88 months, IQR 43-116). After adjustment for other covariates, age

BACKGROUND Chronic kidney disease (CKD) is a global health problem which is progressive and asymptomatic until the end stage in recent years which is most common in patients of middle and low socio-economic status. The disease is mostly associated with diabetes or hypertension, young and middle-aged individuals living in agricultural communities and drinking well water. We want to study the clinicopathological profile of chronic kidney disease of unknown aetiology (CKDU) cases admitted in a rural tertiary care hospital. METHODS A retrospective study was conducted among fifty patients who reported with ultrasonography (USG) report showing small shrunken kidneys and / or kidney biopsy suggestive of chronic tubulointerstitial nephritis with absence of immune deposits and admitted in the Medicine department of AVBRH Hospital and JNM College of Medical Sciences, Sawangi (M) Wardha of Central India. RESULTS The mean age was 36.46 ± 10.90 years with majority of the patients between the ages of 35 to 55 years. The body mass index (BMI) of the study group was within 22.52 ± 1.96. CKDU was more commonly seen in males (64 %) as compared to females (36 %). The subjects were predominantly farmers (54 %) who used to drink well water. USG showed small shrunken kidneys in all the study subjects, which was in 100 % cases. Pesticide exposure was seen in 32 % cases. The glomerular filtration rate (GFR) revealed that 30 % of the patients were in grade II. The biochemical report revealed the mean value of haemoglobin to be 8.75 ± 1.39, mean serum urea level to be 64.96 ± 15.19, mean serum creatinine level to be 4.5 ± 2.67, mean serum sodium level to be 132.48 ± 5.83 and mean serum potassium to be 4.43 ± 0.78. The mean random blood sugar (RBS) value was 98.64 ± 19.62, serum calcium level was 8.87 ± 0.43, serum phosphorus level was 5.05±0.39 and urine protein / creatinine ratio was 0.90 ± 0.12. CONCLUSIONS This study highlights the need to review health policies and allocates resources for prevention and treatment of CKDU in Central India, Maharashtra. KEY WORDS Chronic Kidney Disease of Unknown Aetiology (CKDU), Hypertension, Diabetes, Shrunken Kidneys

Objective The aim of the study is to describe the status of perinatal mortality (PM) in an Indian rural hospital. Study design Retrospective analysis of data was compiled from PM meetings (April 2017 to December 2018) following "Making Every Baby Count: audit and review of stillbirths and neonatal deaths (ENAP or Every Newborn Action Plan)." Results The study includes 8,801 livebirths, 105 stillbirths (SBs); 74 antepartum stillbirths [ASBs], 22 intrapartum stillbirths [ISBs], and nine unknown timing stillbirths [USBs]), 39 neonatal deaths or NDs (perinatal death or PDs 144). The higher risks for ASBs were maternal age >34 years, previous history of death, and/or SBs. Almost half of the PDs could be related with antepartum complications. More than half of the ASB were related with preeclampsia/eclampsia and abruptio placentae; one-third of the ISB were related with preeclampsia/eclampsia and gestational hypertension, fetal growth restriction, and placental dysfunction. The main maternal conditions differed between PDs (p = 0.005). The main causes of the ND were infections, congenital malformations, complications of prematurity, intrapartum complications, and unknown. The stillbirth rate was 11.8/1,000 births, neonatal mortality rate 4.4/1,000 livebirths, and perinatal mortality rate 15.8/1,000 births. Conclusion This is the first study of its kind in Andhra Pradesh being the first step for the analysis and prevention of PM. Key points · Many conditions that lead to stillbirths are linked to neonatal deaths and PM has been outside of the global parameters from the last decades.. · This is the first study following International Classification of Disease perinatal mortality codes and the audit of ENAP in Andhra Pradesh.. · Extended PM and mortality are mainly caused by similar preventable and treatable conditions..

The deleterious effects of hypoalbuminaemia in the peri-operative period are well documented. We aimed to review serum albumin levels in a cohort of orthopaedic trauma patients to determine the prevalence of hypoalbuminaemia. Secondarily, we aimed to identify factors associated with an increased risk of hypoalbuminaemia. A retrospective cross-sectional study was performed of data collected prospectively at a regional hospital serving primarily a rural population in South Africa. Two hundred ninety-five patients were included in the study. Twenty-nine per cent of the cohort was found to have hypoalbuminaemia. Femur neck fractures (p < 0.001), intertrochanteric fractures (p = 0.004), tibial plateau fractures (p = 0.034) and polytrauma (p = 0.013) were associated with hypoalbuminaemia. The mean albumin level was lower in HIV-positive patients when compared to HIV-negative patients (35.7 g/L vs 37.5 g/L, p = 0.007). The presence of comorbidities other than HIV, like diabetes mellitus (p = 0.001), previous pulmonary tuberculosis (p = 0.034) and chronic renal failure (p = 0.007) was associated with hypoalbuminaemia. In this cohort of orthopaedic trauma patients from rural South Africa, we found a 29% prevalence of hypoalbuminaemia at the time of presentation. High-risk subgroups include patients with pre-existing comorbidities and increased age, as well as patients presenting with polytrauma, femoral neck, intertrochanteric femur or tibial plateau fractures.

To study epidemiological profile, prevalence, and molecular epidemiology of RVGE in hospitalized under-5 children at a tertiary care teaching rural hospital located in sub-Himalayan belt of Northern India. This was a hospital-based surveillance study done over 4 y (2016–2019) including under-5 children hospitalized with acute gastroenteritis (AGE). Demographic and clinical parameters were recorded in a pre-designed performa. After consent, stool samples were collected and sent to Christian Medical College (CMC), Vellore for RV screening by enzyme immunoassay (EIA). Each EIA-positive sample was further subjected to G and P typing using published methods. Out of total 851 included children, rotavirus gastroenteritis (RVGE) was detected in 23.03% (196/851) cases by EIA. The highest incidence for RVGE-positive cases (40.43%) was observed in 2016 with gradual decline over next 3 y. Maximum cases of diarrhea were observed in 12–23 mo age group along with highest rotavirus detection. G3P[8] was most common genotype (46.94%) found, followed by G1P[8] (13.78%), G2P[4] (4.59%), G1P[6] (8.16%) and G9P[4] (3.57%). Mixed genotype was seen in 13.78% of total cases. This study summarizes the changing trends in the epidemiology of RVGE in Northern India along with the major circulating genotypes postvaccine introduction.

Background: Stress affects U.S. healthcare workers (HCWs) and costs US$191 billion annually. About 30% to 50% of healthcare providers report burnout. Based on an assessment of a U.S. rural hospital system, 94% of workers experienced negative health consequences. We conducted a quality improvement (QI) project for the purpose of implementing a stress management program for HCWs in a hospital system. Methods: A total of 500 HCWs were informed of the program through hospital communication channels. Using the Plan–Do–Study–Act (PDSA) process, we screened workers presenting to the occupational health clinic for care. Project team members recruited other workers for stress screening throughout the organization. Interventions included contacting workers with elevated scores on the Perceived Stress Survey (PSS; N = 213). The nurse practitioner scheduled them for a shared-decision-making (SDM) appointment ( N = 33) where workers were informed of and encouraged to participate in stress reduction activities. Surveys were used to assess effectiveness of SDM appointments and the stress reduction activities. After each 2-week PDSA cycle, interventions were adjusted. Findings: Of the 42% ( N = 213) of workers who were screened for stress, 24% ( n = 52) had elevated scores. Fifty percent ( n = 26) completed an SDM appointment. Participants reported an 86% assurance level that they would use personalized stress management plans. Participants utilizing the interventions ( n = 271) reported 25% to 72% reduced stress levels. Conclusions/Application to Practice: This successful project, in a rural setting, included workers across job classifications. Team engagement, PSS screening, SDM opportunities, and stress management activities were project strengths. This low-cost project can be replicated.

Hypertensive disorders (HD) of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. Although several risk factors for hypertensive disorders of pregnancy have been firmly established, the risk attributable to specific race-ethnicities is less clear. The risk of preeclampsia-eclampsia may differ by maternal ethnicity 30 as also the course, severity and prognosis. This study aimed to compare severe preeclampsia and eclampsia in tribal and nontribal women of Jangalmahal area of West Bengal in terms of incidence, clinical, demographic picture, severity, course of disease, response to treatment, complications and delivery outcome including foetal outcome and maternal outcome.

Introduction: Advances in science and Technology have led to transformation of laboratory diagnostics from manual, cumbersome testing methods to fully automated science, ensuring accuracy and speed. Quality is the core issue for all laboratories and this requires total quality management in the laboratory process in the preanalytical, analytical and post analytical phases. Objectives: To study and evaluate the types, frequency and magnitude of errors in our tertiary health care clinical Biochemistry Laboratory in the preanalytical testing process and its overall impact on Total Quality Management System of our laboratory. Materials and Methods: A prospective observational study, samples received for analysis between Jan 2015 to Dec 2015 in the clinical biochemistry section was evaluated for various preanalytical errors. We evaluated the frequency and types of preanalytical errors found in our laboratory by monitoring specimes requested for laboratory analyses from both inpatient and outpatient divisions and statistically analyzed. Results and Discussion: Of the total 1,38,275 analytical requests, 6446 (4.66%) samples were rejected due to various errors in preanalytical variables. For the inpatient samples, preanalytical error rate was 4.20% (4107 samples), the preanalytical variable with highest frequency of occurrence was specimen hemolysis/ Lipemic sample (1.00%) 980 samples. For the outpatient sample preanalytical error rate was 5.75% (2339). The variable with highest frequency was requisitions with incomplete patient treating physician information 1.37% (559). Preanalytical errors in laboratories are very common and play a very important role in patient care and treatment. Lipemic/hemolytic samples are known to affect the parameter to be analysed and incomplete patient information leads to error in reporting the patient’s results, which means the post analytical error becomes unavoidable and incomplete treating physician information leads to delayed reporting

Background: Identification and intervention are pivotal in improving outcomes in cases of early childhood developmental delays (DDs). Mothers, as primary caregivers, are at a vantage point to recognize these delays early and seek prompt care. Objective: The objective of the study was to assess the awareness of early childhood developmental milestones (ECDMs) and identify factors that influence awareness among mothers of young children at a maternity hospital in rural South India. Materials and Methods: This was a cross-sectional study among mothers with a child under the age of 3 years, availing of health and immunization services at the rural hospital. The interview schedule included 4 items pertaining to risk factors associated with delayed milestones and 32 items regarding awareness of ECDM across four domains: Gross motor, fine motor, social, and language. Each correct answer was awarded 1 point. Results: Among 156 mothers, the mean ECDM awareness score was only 12.4 (±3.6), out of a maximum of 36. Awareness of some of the first milestones to be achieved in infancy was found to below. ECDM awareness score was significantly higher among mothers with higher levels of education (p=0.014) and among mothers who received health education on ECDM from community-level workers (p=0.038). Conclusion: Awareness among rural mothers regarding ECDM across all four developmental domains was found to be inadequate. Poor maternal awareness, of milestones that are the first to be achieved, is likely to result in delayed recognition and intervention for DD. Community-level workers must educate mothers regarding ECDM during immunization sessions and home visits, using the Mother and Child Protection Card as an educational tool.

INTRODUCTION: Urinary tract infections are the most common infections seen in the hospital setting and take the second lead after respiratory tract infection in community acquired infections. Nitrofurantoin and Fosfomycin are older drugs that are being revived and recommended as first-line agents in treating uncomplicated UTI. AIMS AND OBJECTIVES: To assess the comparative efficacy of 5day nitrofurantoin versus single dose fosfomycin for clinical resolution in uncomplicated UTI. MATERIALS AND METHODS: This randomized clinical trial was conducted from January 2019 to September 2019 at the Department of Obstetrics and Gynaecology, AIMS, B G Nagara, Mandya, Karnataka. Patients were randomized to either oral nitrofurantoin 100mg twice daily for 5 days or single dose of oral fosfomycin 3g. Baseline urine routine was done. They were followed up at 14(+/-2) and 28(+/-7) days after completion of antibiotic therapy which was considered at day 5 as fosfomycin has long half-life. The data was entered in Microsoft Excel and outcomes were analysed using Epi Info software. RESULTS: Out of total 92 patients screened,63 were enrolled and randomized. Thirty-two (50.7%) were given nitrofurantoin and 31 (49.2%) received fosfomycin. Of total enrolled after screening 3 (4.7%) patients were lost to follow-up, so only 60 patients (n=92, 65.2%) comprised the study population. CONCLUSION: Five-day nitrofurantoin is superior to single dose fosfomycin in treatment of acute uncomplicated UTI.

The article describes the barriers rural surgeons face when attempting to measure, analyze, and benchmark the quality and value of the care they provide for their patients. Examples of suboptimal care are presented as well as special geographic and resource-related circumstances for many of these disparities of care. The article includes in-depth descriptions of the American College of Surgeons (ACS) Optimal Resources for Surgical Quality and Safety Program and the ACS Rural Hospital Surgical Verification and Quality Improvement Program. The article concludes by discussing several documented clinical, economic, and social advantages of keeping surgical care local.

Nearly 60 million people live in a rural area across the United States. Since 2005, 162 rural hospitals have closed, and the rate of rural hospital closures seems to be accelerating. Major drivers of rural hospital closures are poor financial health, aging facilities, and low occupancy rates. Rural hospitals are particularly vulnerable to policy and market changes, and even small changes can have a disproportionate effect on rural hospital financial viability. Surgery can be safely performed in rural hospitals; however, hospital closures may be putting the rural population at increased risk of morbidity and mortality from surgical disease.

Civilian and military guidelines recommend balanced transfusion to patients with life-threatening bleeding. Early start of transfusion has shown improved survival. Thus, a balanced blood inventory must be available in all levels of health care to ensure early stabilization and damage control resuscitation of patients with bleeding. Whole blood has been reintroduced as a blood product for massive bleeding situations because it affords plasma, red blood cells, and platelets in a balanced ratio in a logistically advantageous way. In this article, we describe how to establish a whole blood-based blood preparedness program in a small rural hospital with limited resources. We present an implementation tool kit, which includes discussions on whole blood program strategies and the process of developing detailed procedures on donor selection, collection, storage, and transfusion management of whole blood. The importance of training and audit of the routines is highlighted, and establishment of an emergency walking blood bank is discussed. We conclude that implementation of a whole blood program is achievable in small rural hospitals and recommend that rural health care facilities at all treatment levels enable early balanced transfusion for patients with life-threatening bleeding by establishing protocols for whole blood-based preparedness.

INTRODUCTION: Preeclampsia and eclampsia are a multisystem disorder occurring during pregnancy, complicating 3-8% of pregnancies accounting 10-15% of maternal and neonatal mortality and morbidity. AIMS AND OBJECTIVES: The aim is to study severe preeclampsia and eclampsia and associated maternal and foetal outcomes at a rural tertiary health care centre. MATERIALS AND METHODS: This is a prospective cohort study conducted at Sri Adichunchanagiri Institute of Health Sciences and Research Centre, B.G Nagara, Karnataka from July 2018 to December 2019. Patients included in the study will be as per inclusion and exclusion criteria. Patients with severe preeclampsia and eclampsia will be included by thorough history taking and data will be entered in Microsoft Excel and outcomes will be analysed using Epi Info software. RESULTS: Out of 3068 deliveries conducted, 157 cases were diagnosed with severe preeclampsia and eclampsia. Incidence of severe preeclampsia being 4.7%(n=146), and that of eclampsia (n=11, 0.3%). Majority belonged to age group 21-25years (47.1%), 90(57.3%) were Primigravida. Preterm deliveries before 32 weeks accounted 21.6%(n=34), while before 34 weeks were 29.9%(n=47). A total of 29.4% preterm deliveries (n=109) were observed. Onset of eclampsia was noted mostly in antepartum period accounting 54.54%(n=6) of total eclampsia case report, 47.13% (n=74) were started on Pritchard’s regimen. Caesarean section was undertaken in 36.9%(n=58) patients with IUGR being common indication (n=19, 32.7%). IUD was noted in 7.6%, LBW in 75.15% CONCLUSION: The importance of continued efforts in monitoring and reviewing the line of treatment with better antenatal care, early recognition and hospital treatment of patients can decrease the incidence rate of severe preeclampsia and eclampsia.