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Both human respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) cause immune-mediated under-five acute respiratory infections (ARIs), but differences in their disease pathogenesis, if any, are not well-known. This study was undertaken to analyze the epidemiological and immunological features of RSV and hMPV infections. Nasopharyngeal aspirates from children (aged 2 months to 5 years) with ARI, presenting to our tertiary care center between December 2013 and March 2016, were subjected to real-time polymerase chain reaction for the detection of RSV and hMPV. Positive samples were analyzed for co-infection and cytokine levels. Of the 349 nasopharyngeal aspirates, RSV was detected in 40.68% (142/349), hMPV in 6.59% (23/349), and both in 1.4% (5/349). Co-infections were common, with rhinovirus being the most common co-offender. The demographic and clinical parameters of RSV- and hMPV-infected children were comparable. The MMP-9/TIMP-1 ratio was significantly higher in RSV-mediated ARI and IFN-γ in hMPV-mediated ARI. Both RSV and hMPV are common among North Indian children with ARI, and coinfections are common. Their clinical features are non-discriminatory, and molecular diagnosis should be utilized to ascertain their individual epidemiology. The differences in their immune-pathogenesis (MMP-9/TIMP-1 ratio in RSV and IFN-γ in hMPV) could serve as useful tools for developing newer drugs.

Synovial chondromatosis of the shoulder is a rare entity that is generally mono-articular and uncommon in diarthrodial joints. Treatment of synovial chondromatosis of the shoulder includes open arthrotomy retrieval of loose bodies and synovectomy. With advances in arthroscopy, the same could be achieved using arthroscopic techniques. This case report describes a case report of a 35-year-old male patient who presented with complaints of pain and restriction of movement for 6 months. The MRI of the patient was suggestive of multiple loose bodies in the shoulder joint, in the subdeltoid region, and subscapularis muscle with subacromial bursitis. Arthroscopically more than 100 loose bodies were retrieved with subacromial decompression. Shoulder synovial chondromatosis has been rarely reported in the literature. The malignant transformation although rare, but it is still a possibility. The recurrence rate varies from 3.2% to 22.3%. Open arthrotomy, synovectomy, and retrieval of loose bodies cause delayed recovery and more morbidity with high chances of subscapularis insufficiency due to the need of subscapularis tenotomy. Arthroscopic treatment although have limitations such as limited visualization, limited synovectomy, and difficult interventions around the axillary recess or biceps sheath, but provides with the advantage of lesser morbidity and early rehabilitation. Synovial chondromatosis can be successfully treated arthroscopically as it provides intra-articular and extra articular access with early rehabilitation, lesser morbidity, and early recovery.

Introduction: Pregnancy brings about many changes in mothers' body which continue even after the baby is born. After a vaginal delivery, taking good care of the mother is an essential part of postpartum care and to maintain overall fitness. Objective: The purpose of this research was to evaluate the effect of a physiotherapeutic intervention to improve the maternity fitness of Indian women. Methodology: It was a three-group RCT (randomized controlled trial). The target population consisted of women in ante and postnatal stage, 50 participants (58 were included in the end) in each group, randomly selected from Obstetrics and Gynecology OPD of a tertiary care hospital in North India. The study was carried out in the department of PRM (Physiotherapy). A total of 174 participants was included in the study and was divided into three groups, two intervention groups, and one control group. The target population consisted of women in ante and postnatal stage, randomly selected from ANC (Antenatal clinic) and PNC (Post-natal clinic). The study was conducted over a period of 4 years (2014–2018). They were advised to do exercise, postural correction, regular walking, and electrotherapy modalities and six follow-ups throughout their pregnancy. Outcome measures like (Visual Analogue Scale = VAS): Low and upper back pain relief (n = 158), Leg cramps (n = 41), Coccyx pain (n = 36), Sacro-iliac joint pain (n = 26) was considered. Results: The impact of the intervention package on both ante-natal and post-natal women with fitness-related health problems showed significant improvement. Conclusion: Pain, leg cramp and heaviness in the lower limb, coccyx pain, etc., during pregnancy are common complaints that start early in pregnancy and may persist throughout life if treatment does not start early in the pregnancy.

The current study was done to compare the effectiveness, safety and clinical outcome between Laparoscopic and Open Appendectomy in terms of operating time, complications and length of hospital stay. Patients undergoing Appendectomy by Laparoscopic and Open technique from November 2016 to October 2017 were enrolled in the study after fulfilling eligibility criteria. According to surgical approach patients were randomly divided into two groups Laparoscopic Appendectomy Group (LA group) & Open Appendectomy Group (OA group) respectively. The following parameters were assessed primarily in terms of operating time, resumption of oral diet, length of hospital stay, no. of analgesic doses, conversion rate, post-operative pain, Intraoperative and post operative complications like wound infection, prolong ileus, intraabdominal abscess, diarrhea and urinary tract infection. Results: We found that operating time was comparable in both groups, resumption of oral diet was earlier in LA Group as compare to OA Group (with p value of

Teaching and learning has existence from the earliest times of human civilization. Socrates in 300 BC involved his learners by dialectic method which has inspired philosophers for more than two thousand years. The argumentative dialogue based on oral questioning and answering process to stimulate critical thinking in the dialectic method allowed others to learn by self-generated deeper understanding.(1) The Gurukul teaching in the ancient vedic time encourages the students to stay in guru’s place (termed as Gurukul) where the education was delivered through scriptures describing vedas, rules of sacrifice, understanding secrets of nature and correlating them with their real life. In these times, the education was more organized and disciplined focusing upon memory retention and concentration(2). The learning through script and writing started in 3500BC where Egyptians developed alphabets from hieroglyphs prototype which was used either on stone monuments or on papyrus, a flexible paper like material.(3)The script was later adopted by Greeks (Phoenician writing system)(4) in 11th century and thereafter by China in 1400-2100BC (oracle bone script)

Objectives: 1. To assess satisfaction of patients with nursing care admitted in NABH accredited hospital and non NABH accredited hospitals. 2. To compare satisfaction of patients regarding nursing care admitted in selected NABH accredited and non NABH accredited hospital. 3. To nd out association of satisfaction of patients with selected demographic variables. BACKGROUND OF THE STUDY NABH is a hospital accreditation process which is not an easy task, to adopted and achieve the highest standards of healthcare it is essential to practice it forever. This process requires continuous hard work and full determination health care worker. Manpower is the most important and the most valuable asset of any organization and success or failure of every organization strongly depends on the performance of manpower. Nurses are back bone of any hospital care provided to patients create good or bad reputation about the hospitals, patient satisfaction is a key factor which attract the health care seekers and uphold the standard of nursing services that play an important role in improvement of health status of society. Sindhu Joseph (2018) conducted a comparative study on “The Effect of Accreditation on Patient Satisfaction in Public Healthcare Delivery: To make accreditation a useful regulatory instrument, there is a need to assess quality based on patient outcome indicators at regular intervals. Research Approach A quantitative research approach is used Research Design Descriptive research design is used Settings Of The Study NABH accredited and non NABH accredited hospitals ptients, data is collected through self reporting check list which has cover 20 points about satisfaction of patients with nursing care . Conclusion: Statistical analysis of the independent t-test there was highly signicant difference between with satisfaction of patients regarding nursing care admitted in selected NABH and NON-NABH accredited hospital. Scores shows there is signicant difference between both groups. The study conrmed that the effect of the score of patients satisfaction in group NABH is more effective rather than group Non-NABH group. Result: Statistical analysis of the data revealed that, according to independent t-test there was highly signicant difference between with nature of work in NABH and Non-NABH accredited hospitals groups. Conclusions: There is consistent evidence that shows that accreditation programs improve the process of care and satisfaction among patients.

INTRODUCTION: Despite knowing, that tourniquet induces ischemia and soft tissue damage surgeons still use it. The purpose of this study is to compare post operative pain and quadriceps function in patients undergoing arthroscopy assisted ACL reconstruction with tourniquet and without tourniquet. METHODS: A blinded randomized prospective trial conducted at Orthopaedic department of a tertiary institute in India from Feb 2019 to June 2019. 45 patients undergoing Arthroscopic ACL reconstruction aged between 18 and 60 years were recruited in the study according to selection criteria. Patients were distributed in 2 groups randomly, namely, tourniquet and non-tourniquet. Preoperatively serum CPK measurement and thigh girth measurement was done. Following standard arthroscopic procedure VAS score monitoring for pain was done for 5 days. Serum CPK levels were performed on postoperative day 1. Thigh girth was measured on postoperative day 21. RESULT: Pain was significantly high in patients in whom tourniquet was used. VAS scores were significantly high in tourniquet group. Tourniquet group patients required more amount of additional analgesics in postoperative period (p

In the changing global socio-economic and epidemiological landscapes, non communicable diseases (NCDs) are affecting the health and wellbeing of populations. The burden is worse among people in low- and middle-income countries with more than 32 million deaths attributable to NCDs each year. This scenario can be explained through the concept of collateral damage, where intentional actions often lead to adverse consequences alongside the primary outcomes. Thus, NCDs can be viewed as collateral damage of unplanned urbanization, rapid globalization, fast pace of life etc., In addition, a lack of appropriate public health approaches has aggravated the situation. It is essential to build a collaborative approach engaging public health agencies to ensure that the developmental initiatives are without the threat of collateral damages and are people-friendly. This will help in reducing the burden of NCDs in primary care settings.

To protect our masses, primary care institutes were developed in many countries, all over the globe. In the previous era, labour was valuable to produce crops and protect native countries from enemies as no substitute for raw labour was available to do these jobs. The scenario has changed after the era of automation. After the agricultural revolution, technological revolution took place. Hence, most of the manual jobs in agriculture sector and industry sector were automated. As a result, “new” type of jobs has emerged which was based, so far, on mainly of cognitive skills, e.g., learning, analysing, communication, and understanding human emotions. As the technology is advancing day by day, the role of humans as individual is becoming less and less except for some extraordinary persons or elite groups. Now the important question is, will elites and governments will go on valuing every human being even when it pays no economic dividends? Will the development of mass medicine/primary care will continue? Will governments/bureaucrats fund adequately for the protection of the health of these useless classes merely on the humanitarian ground? We assume that due to technological advancement and greater role of elite classes, the norm of shifting non-normal people to normality may not require any more, the previous practice of treatment (health for all concept) may not repeat in future and it is quite natural. Experiences from Japan highlight that society may prefer theses elites to the useless average class. The gap between the two classes regarding availing health facilities may widen further. This is because the government may focus more on the health of elites than common masses. One step further the government/ bureaucrat may try for immortality/divinity for this elite class, at any cost for maintaining supremacy over the poor masses.

Background Owing to the coronavirus disease 2019 (COVID-19) pandemic, a nationwide lockdown was imposed in India, with strict confinement measures imposed on the elderly. Because mobility and regular physical activity are considered to be the key determinants of musculoskeletal health, this study aimed to investigate the effect of lockdown and confinement measures on the musculoskeletal health and activities of daily living of the urban geriatric population. Methodology A cross-sectional survey was conducted among the elderly aged ≥60 years. The survey instrument consisted of a questionnaire, a modified Nordic Musculoskeletal Questionnaire (mNMQ), and the Barthel activities of daily living (ADL) index. The net mNMQ score and Barthel ADL index were compared before and during the lockdown. Univariate and multivariate analyses were performed to determine which factors could result in the worsening of the net mNMQ score. In addition, floor and ceiling effects of the net mNMQ score were determined. Results In this study, a total of 105 out of 150 eligible participants were enrolled. A significant decline in physical activity status was noted during the lockdown. Overall, 54.3% of the respondents reported that their medical services were impacted during the lockdown. The net mNMQ score showed a significant worsening during the lockdown (P < 0.0001). A statistically significant increase in the modified NMQ score was noted for the lower limb (P < 0.0001) and spine (P = 0.002), but not for the upper limb (P = 0.052). Elderly whose medical services were impacted during lockdown had significantly worse net mNMQ scores than those whose services were not impacted (odds ratio = 6.16; 95% confidence interval = 2.51-15.08; P = 0.0001). Age, gender, ambulatory status, increase in body weight, and indulgence in exercise before and during lockdown had no effect on the change in the net mNMQ score. A significant ceiling effect was noted in the mNMQ score; however, no floor effect was noted. Conclusions Lockdown and confinement measures resulted in a significant decline in physical activity as well as the overall musculoskeletal health of the urban geriatric population in the present study. Hence, policymakers should ensure uninterrupted medical care to the elderly during extended periods of confinement and develop optimal home-based physical activity programs to counter the problems associated with sedentarism.

Background and Aims: Diabetic retinopathy is the most common diabetes-associated microvascular complication and is among the leading causes of vision loss or blindness in the adult population. The present study is a retrospective study that reported the natural history of diabetic retinopathy.Methods: Retrospective medical records of 170 patients aged > 20 years with a confirmed complication of diabetic retinopathy were recruited into the present study. A questionnaire was also sent to each subject for gathering their experiences, and verification was done by the attending medical physicians. The questionnaire was answered by all recruited patients.Results: The results showed that 23 (13.5%) subjects have a family history of diabetic retinopathy with 10 (5.9%) having mild NPDR, 63 (37.1%) with moderate NPDR, 60 (25.3%) have severe NPDR while 37 (21.8%) have PDR complications. The presence of co-morbidities was found in 139 (81.8%) subjects. Patients with PDR reported a significantly longer duration of diabetes mellitus with worse glycemic control.Conclusions: The study revealed and concluded that adherence to the prescribed management regimen is important, for which patient education was the key which was lacking.

Understanding the demographic and clinical characteristics cases and deaths is essential for better clinical and public health management of coronavirus disease-2019 (COVID-19) in resource-limited settings. We analyzed the COVID-19 deaths reported from India, to describe the demographic and clinical characteristics and identify the factors associated with early hospital deaths (within one day of hospitalization) and survival duration. We conducted a record review of the publicly available data on COVID-19 deaths reported between January 30th and November 30th, 2020. After imputation for missing data, we calculated unadjusted and adjusted prevalence ratio, and regression coefficient for factors associated with early hospital death and survival duration. Of the 20,641 COVID-19 deaths analyzed, a) 14,684 (71.1%) were males; b) 10,134 (50.9%) were aged < 65 years; c) 9,722 (47.1%) treated at public hospitals and d) 5405 (27.1%) were early hospital deaths. Breathlessness was the most common presenting complaint. Diabetes (11,075,53.7%), hypertension (95,77,46.5%) and coronary artery disease (2,821,13.7%) were the common comorbidities. After adjustment, early hospital death was significantly higher among patients aged 10% of India's COVID-19 deaths, providing essential information regarding the COVID-19 epidemiology. The characteristics associated with early hospital death and survival duration among the COVID-19 fatalities may be deliberated as markers for prognosis and compared with survivors.

Infectious diseases are one of the major global health concerns affecting innumerable individuals worldwide Lately, in December 2019, a novel coronavirus (2019-nCoV), now COVID-19 has emerged in Wuhan, China and spread its wing over the whole globe The fact, that there is no vaccine and medicine available to treat and prevent the COVID infection, has forced everyone to avoid physical contacts followed by an advice to stay safe at home As a part of its health promotion activity, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh had started a new drive "From handshake to hands-free greetings", christened as "SALAAM NAMASTE" Campaign from February 5, 2019, long time before the onset of novel COVID-19 pandemic The aim of this awareness initiative was to promote hands-free way of greetings to reduce the transmission of pathogens and infections from one another This practice has been recommended by many specialists worldwide calling it a "modern-day" health hazard as handshaking is responsible for transmission of around 90% of bacteria

Introduction: Psoriasis is a common, chronic, inflammatory skin disease that can have a significant impact on the quality of life of those who are afflicted due to chronicity of the disease and frequent remissions and relapse. There is a vast array of drugs for the treatment. Methotrexate, cyclosporine and retinoids are the most commonly used conventional systemic drugs. Newer studies provide insight into their more effective and safer use and as combination therapy with biologics. Apremilast is an orally administered, small molecule inhibitor of phosphodiesterase 4 (PDE4). Apremilast 30 mg twice daily reduced the severity of moderate to severe plaque psoriasis, palmoplantar psoriasis and guttate psoriasis. Objective: To evaluate efficacy, tolerability and adverse effects of apremilast. Materials and Methods: A clinical trail was conducted in department of Skin & VD of Saraswathi institute of medical college on 80 patients. Apremilast was started after initial titration and followed for 8 weeks. Results: Out of 80 patients 73 patients completed the study of which 69% patients have responded well and 14% patient did not show satisfactory result. No major side effect encountered during the study. Conclusion: Apremilast was effective in plaque psoriasis, palmo plantar psoriasis and guttate psoriasis and is well tolerated with mild adverse effects. Also the regular lab investigations as required in others systemic treatment modalities are avoided. Keywords: Apremilast, Plaque psoriasis, Phosphodiesterase 4 (PDE4), Guttate psoriasis, Palmo plantar psoriasis.

Introduction: A complete Anterior Cruciate Ligament (ACL) injury can result in a progressively increasing symptomatic knee instability, which can cause recurrent intra articular damage and eventually results in osteoarthritis if not treated on time. Aim: To analyse the effects of delaying ACL reconstruction beyond a period of 12 weeks and compared the results with cases managed before that time period. Materials and Methods: A prospective cohort study was conducted between July 2017 to October 2019 in Government Medical College, Jammu on two groups of patients divided into early (12 weeks) on the basis of interval between the injury and definitive surgery. ACL reconstruction was done using a quadrupled semitendinosus-gracilis graft. A standard rehabilitation protocol was followed and the results were compared. Patients were followed-up till one year postsurgery. Software used for statistical analysis was EpiInfo Version 3.0 and SPSS. Results: A total of 72 patients were included in the study. Forty patients were in the early group and 32 in delayed. Male patients outnumbered the females in both the groups and the incidence of injury was more on the right side. Sports injuries were the most common mode of injury, followed by falls and road traffic accidents in both the groups. The incidence of grade 3/4 medial and Lateral Meniscal (LM) tears was more in the delayed group and the association was statistically significant (p

Airplane ear or ear discomfort during flight is common irrespective of ticket price we pay for our flights according to class. Whether we get extra leg space or extra facilities during flying in business class, air travelers often face this problem of airplane ear (Figure 1). Airplane ear is also known as ear barotrauma, barotitis media or aerotitis media [1]–[5]. Severe earache affects individuals of varying levels of social determinants of health as it is entirely a physiological phenomenon [3]. Airplane ear is commonly experienced when the airplane is ascending or descending, which makes it one of the commonest health problems for people travelling in air routes. Open in a separate window Figure 1. Airplane ear. 2. Etiology Generally, airplane ear occurs due to quick changes in altitude and quick changes in air pressure [4]. In normal physiological conditions, the air pressure in our middle ear cavity is nearly equivalent to that of the external ear canal. This equalization of air pressure is maintained physiologically and contributes to regular auditory function and maintenance of normal balance among individuals. However, the eustachian tube dysfunction may occur with any changes in pressure and failure to ventilate through the middle ear space. This may result in outward bulging of the tympanic membrane causing moderate to severe earache. This phenomenon can be compared with a bread expanding while baking [3],[5]. Conversely, due to the vacuum effect, if the air pressure inside the middle ear space reduces rapidly compared to the external ear pressure, the tympanic membrane may be pulled inside due to the pressure gradient. The eustachian tube becomes flattened during the pressure changes and it necessitates bringing air into the middle ear (Figure 2). During sudden ascend or descend of an aeroplane, ear cavity pressure is often decreased complemented by an increase in the cabin compared to the outside air pressure. In such a scenario, the unusual stretching of the eardrum or tympanic membrane may precipitate pain in the ear. At the same time, individuals may also experience decreased hearing abilities and muffled sounds as the eardrum as it becomes unable to vibrate normally [2]–[4]. Open in a separate window Figure 2. Imbalance of air pressure in the middle ear. The pathophysiology remains the same in cases of scuba diving, in hyperbaric oxygen chambers, and during explosions happening nearby [2].

Health information technology (HIT) refers to the comprehensive management of health information across computerized systems and its secure exchange between patients, health care providers, government, and others [1],[2]. A broad and consistent use of HIT can potentially improve the quality of primary health care, reduce medical errors, reduce basic health care costs, decrease paperwork, increase administrative efficiency, and expand access to affordable care. The World Health Organization has identified HIT as a tool with which to address health problems and transform quality of life [3]. India is a hub of IT-enabled service industries. Despite this tremendous potential, there is limited use of HIT in the public health sector as compared with other sectors such as banking, railway, tourism, and entertainment, which have embraced IT on a considerable scale [1]. According to the technology acceptance model [4], the speed of acceptance and dissemination of a particular technology depends primarily on its perceived usefulness and ease of use (Figure 1). England et al. [5] conducted a study which revealed that the complexity of health care organizations and their fragmented internal structure constrained their ability to adopt organization-wide IT. The authors concluded that both organizational and technological factors lead to the slow adoption of strategic IT. Open in a separate window Figure 1. Technology acceptance model [4]. Another important contributing factor to the limited use of IT in health care is the comparatively less revenue generation in the public health sector. For most governments, primary health care is an investment with no immediate return though there are obvious long-term benefits. Such myopic perception at the policy level may function as a barrier to the adoption of any technology [6]. Other reasons of low use of technology in health sector include language barriers, use of outdated technology, and lackluster appeal for the general public [1]. With use of the smart phones by general public increasing day by day, an important way of use of HIT is popularization of emojis, images, and icons are pictorial methods of expression as health-related communication. India is now considered a major mobile technology consumer [7], and communication through mobile phones is no longer limited to text messages. We communicate more with each other using emojis, images, and icons in chats or on social media. The inclination toward this pictorial mode of expression is quite natural. If we consider paleo-anthropology and the history of linguistic development, we can clearly see that Homo Sapiens have always used symbolic languages and wall paintings to communicate with each other (Figure 2). Even the earliest traces of language, dating back to the age of the caveman and woman, were also strikingly similar to icons, paintings, and symbols. These are still observed in tribal hamlets. The symbol/icon is thus a connecting link between our past and the present. Open in a separate window Figure 2. Similarity in symbolic communication earlier and now (Source-https://www.freepik.com/free-photos-vectors/design). Emojis, images, and icons help break the barriers of languages. Meanings of symbols are easily understood across the globe. Furthermore, images tend to have more appeal than text. As the saying indicates, “A picture speaks more than a thousand words.” Interestingly, the written language (script) of some Asian countries (e.g., China, Korea, and Japan) are symbol-based. Apart from being linked with human emotions, Emojis, images, and icons can also be developed or tailor-made to appeal to the cultural norms prevalent in a society. One cannot ignore the strong influence of culture [6].

BACKGROUND The increase in proportion of elderly implies that their problems demand more attention of the administrators. The current study was carried out to assess the functional status of the elderly and to explore the extent and pattern of routine daily life problems faced by them. METHODS An integrated qualitative and quantitative research design was employed. A stratified multistage random sampling technique was used to select the respondents from various areas of Chandigarh. The houses were selected randomly from where elderly persons (> 60 years) were identified. Katz Index of Independence in activities of daily living (ADL) was used to evaluate functional ability of the respondents. Instrumental ADLs (IADLs) were assessed using Lawton and Brody scale. Focus group discussions and in-depth interviews were conducted among the elderly to explore their problems using an interview guide. RESULTS One thousand and eighty elderly were enrolled in the study. Their mean age was 67.22 ± 7.54 years. (range 60-102 years). The majority (70%) were independent in carrying out their daily life activities. Financially, around one-third were completely dependent and around half were partially dependent. Major dependence was in food preparation, housekeeping and laundry. From the qualitative data, four main themes were formulated, that is general personal problems of elderly; family problems; problems faced by elderly in hospitals and at public places. A feeling of purposelessness, financial insecurity, physical dependency, problems in hospitals and so on, emerged as the main problems. CONCLUSIONS Majority of the elderly considered their lives as problematic because they were dependent physically as well as financially. The main domains of dependency were problems related to bowel continence, food preparation, housekeeping and laundry.

In medical schools across the globe, students are taught about the “THE NORMAL CURVE” as a part of statistics unit of Public Health, Community, and Family Medicine. However, its potentials for explaining the subject of health education and behavior change are grossly underutilized. Through this article, we attempt to demonstrate that this can be sorted out by integrating theories of Positive Deviance and Diffusion of Innovation through extrapolation of the concepts of “THE NORMAL CURVE” for explaining or planning things and events in Public Health, Community, and Family Medicine.

Background:Safe Surgery Saves Lives. Patient safety is a fundamental of good quality health care, and complications due to the health-care system are well-documented and constitute an important public health problem. Implementation of the checklist in medicine and surgery can help to decrease the risk of adverse events thus can improve patient safety.Materials and Methods:After the Institutional Ethical Committee clearance, a total of 500 patients were enrolled and divided into two equal groups. In Group 1 (n= 250), patients underwent surgery before regular implementation of the World Health Organization (WHO) surgical safety checklist (SSC), whereas in Group 2 (n= 250), patients underwent surgery after the WHO SSC was regularly implemented. All the patients were followed up after the surgery, and patients were looked for and compared for the postoperative complications.Results:We found that 27 patients (10.8%) in Group 1 and 13 patients (5.2%) in Group 2 developed major wound disruption (P< 0.05). There were 73 patients (29.2%) in Group 1 and 34 patients (13.6%) in the Group 2 who developed an infection of the surgical site (P< 0.05). There were five patients (2%) in Group 1 while none of the patients in Group 2 developed sepsis during the study (P< 0.05).Conclusions:We found that implementation of the WHO SSC significantly reduces surgical site infections, major disruptions of the wound, and sepsis.

Background: Pressure ulcer (PU) is one of the common, neglected and avoidable complications among bedridden patients. Despite the potential to reduce PU incidence, the evidence on the effect of patient/caregiver education is low. This pragmatic randomized controlled trial (CTRI/2011/07/001862) compared the impact of two structured educational interventions to patients and caregivers on prevention of PU in immobile orthopaedic patients. Methodology: Ninety-two orthopedically immobile patients (Braden score ≤12 or stage I PU) and their caregivers were (block) randomized into two equal groups. One group was offered Prevention Package 1 (PP1), i.e., self-instruction manual (SIM), one to one training and counselling on PU care practices. The second group (PP2) was given SIM only. Patients were followed equally at the hospital and home after discharge. Intention to treat analysis was conducted. Results: The cumulative incidence of PU was 8.7% in PP1 and 21.7% in PP2 for the entire study period. PU incidence rate in PP1 and PP2 was 0.9 and 2.41 per 1000 person-days, respectively. Incidence rate ratio was 2.67 (95% CI: 0.89, 8.02, p-0.04). The Kaplan-Meier survival curves of PP1 and PP2 were statistically significantly different (p-0.043). PP1 also showed statistically significant improvement in knowledge on the prevention and management of PU compared to PP2 at post-intervention (p < 0.001). Conclusion: Individualized, structured education of patients and caregiver is effective in improving the knowledge and preventing the PU in immobile orthopaedic patients. A comprehensive approach involving hospital administrators, health care professionals, patients and caregivers may be further researched upon for a sustainable reduction in PU.

INTRODUCTION: We know that risk communication is equally important as risk identification, which is usually not communicated properly to the patients and resulting in poor outcomes, especially in hypertensive patients. OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based public health approach to educate the community to deal with problem of hypertension. METHODOLOGY: This cross-sectional pilot study was done in March 2020 among purposively approached in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the study and their demographic information was noted. They were given colour coded cards as per the current blood pressure level and previous history of hypertension. On each colour coded card, specific advice was written for that category. For all the participants, blood pressure and treatment seeking behaviour was noted. For hypertensive patients, adherence to medication and non-pharmacological measures was noted. RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42 mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension. Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive incidentally. DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive disorders in the community level. We merely bother about making their risk profiling, even in the digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front of them and we missed the “Golden Hour” for the treatment by searching patients' medical details. CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of chronic patients by colour coded OPD/Health cards.

Introduction: Polycystic ovarian syndrome affects 4% to 23% women, worldwide. Obesity, insulin resistance and uncontrolled eating are usually reported in PCOS. However, there is paucity of data describing associations between eating disorder and PCOS. Aim: To compare the anthropometric profile and eating behavior polycystic ovarian syndrome cases with those of healthy age-matched women. Method: Eighty-five PCOS cases and 85 controls were selected for the study from Gyne OPD of PGIMER, Chandigarh. Anthropometric assessments were performed on the cases and controls. Three-Factor Eating Questionnaire (TFEQ-R21) was used for determining the eating behavior. In addition, the frequency of eating processed food from outside was recorded. Results: The average weight of the cases and controls was 65.16 kg and 57.07 kg, respectively. The average frequency of eating processed food in a month was 15 in cases and 4.41 among controls. The average raw score of uncontrolled eating was 23.26 (cases) in comparison to 18.97 (controls). Average raw scores of emotional eating were 12.67 in cases and 10.76 in controls. The cognitive restraint average raw scores were 11.34 (cases) and 13.62 (controls). The cases had higher BMI than the controls. Monthly consumption of processed food was three times higher than the controls in cases. Uncontrolled eating and emotional eating scores were significantly higher in cases. Conclusion: More of PCOS cases were overweight/ obese with higher BMI, and higher emotional eating and uncontrolled eating scores in comparison to the healthy controls.

Background: Infertility is a neglected service component in the public health-care system in India. Objectives: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. Methodology: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods. Interviewed staff included 26 gynecologists; 91 medical officers; 91 auxiliary nurse midwife; 67 laboratory technicians; and 84 accredited social health activist workers. Results: The findings indicate that adequate staff was in place at more than 70% of health facilities, but none of the staff had received any in-service training on infertility management. Most of the DHs had basic infrastructural and diagnostic facilities. However, the majority of the CHCs and PHCs had inadequate physical and diagnostic facilities related to infertility management. Semen examination service was not available at 94% of PHCs and 79% of CHCs. Advanced laboratory services were available in

Background This study was undertaken to explore the treatment-seeking pathways traversed by women with PCOS and elicit their behavior, experiences and perspectives regarding it. Methods This concurrent mixed-method study was conducted on 18–40 years old women diagnosed with PCOS at the Gynecology outpatient department, PGIMER, Chandigarh, India. Of the 275 women, who were administered a questionnaire to elicit their treatment-seeking behavior, 62 willing participants were subjected to in-depth interviews. Quantitative responses were descriptively analyzed and presented as count, proportion, mean or median. Framework analysis was performed for the qualitative data. The findings of both types of data were triangulated to construct the pathways to treatment traversed by PCOS patients. Findings Many (~45%) respondents had no information regarding PCOS. Only 9.1% received some information from their doctors. Though the internet was the primary source of information for 37.5% of respondents, they expressed dissatisfaction with the quality of information. Multiple health care agencies were consulted by most (85.8%) of the respondents. Allopathy was the preferred choice of treatment. The average delay in initiating the treatment was 3 months. The major reasons for this were ignorance, the concept of ‘normality’ and ‘endurance’. Deviations from the normal self (like irregular-menstruation, obesity, hirsutism, infertility) were the concern that led them to consult a doctor. They were also dissatisfied with the treatment due to a late diagnosis, lack of relief, taboo, side-effects, expenses involved and the need for repeated laboratory tests. Participants’ course of treatment was influenced by the interplay of individual, distress, health-system, and social-economic factors. Conclusions Women with PCOS were dissatisfied with the quality of the information and treatment received. There were treatment delays. The patients consulted multiple health agencies, including indigenous therapies, in the hope of relief. The findings provide an empirical basis on points to focus on for building better coping strategies for managing the condition.

Good hand hygiene practices include cleaning of hands either by handwash or by hand rub In healthcare settings, it is not easy to wash hands with soap after seeing each patient and is time-consuming as doctors are already working overtime Hence, in hospital settings, it is also recommended to use alcohol-based hand sanitizers that can rapidly kill microorganisms, which spread various contagious diseases Amidst the COVID-19 outbreak, the demand for essential commodities such as hand sanitizer, masks, etc , increased and hampered the hospital supplies To address the shortage and limited supply of hand sanitizers to the various medical and paramedical departments of a tertiary hospital, the Department of Community Medicine and School of Public Health in coordination with the Pharmacology and Medical Microbiology Department prepared hands sanitizers following the World Health Organization (WHO) guidelines The paper discusses the procedure that was followed for the preparation of hand sanitizer to meet the institutional demand and motivate others in similar settings to address the issue of restricted supply during the COVID-19 pandemic

Background: Ideal mode of treatment is always debatable for Schatzker type 5 and type 6 fractures in proximal tibia. The aim of the study was management in tibial plateau fracture are to obtain anatomic reduction of the articular surface, restoration of axial alignment, and achieve stable fixation which can be done by open reduction and internal fixation (ORIF) using bicolumnar plating.Methods: 26 patients with Schatzker type 5 and type 6 fractures were managed by bicolumnar plating. They were followed up to six months in terms of radiological union, functional outcomes and complications. Functional outcome at the end of follow up was assessed using knee society scoring system.Results: Good to excellent results were obtained in almost all the patients using knee society scoring system, mean knee ROM achieved was 114.5 degree. Average time to achieve radiological union was 14.4 weeks. These results were in comparison with the studies done earlier.Conclusions: Bicolumnar plating is an effective method of treatment of Schatzker type 5 and type 6 fractures and provide excellent result in expert hands. Rehabilitation using early CPM (continuous passive movement) is very effective in reducing the post-operative complications like knee stiffness.

Childhood blindness due to corneal ulceration has historically been prevalent among poor Indian children. To tackle this situation the National Institute of Nutrition (NIN), Hyderabad, India, launched (after field-testing) massive dose based national vitamin A (Vit-A) prophylaxis program. Over a period of time reduction in childhood mortality was also hailed as a beneficial effect of the program. Data from the Indian Council for Medical Research (ICMR) indicate that in most Indian states there has been a gradual reduction in the prevalence of Bitot's spots. However, it was not attributed to the prophylaxis program because of its low and patchy coverage. It was, rather, attributed to the control of malnutrition, along with measles vaccination and improvement in healthcare access. Various studies have concluded that massive dose vitamin A prophylaxis does not reduce childhood mortality; this may have been due to the Hawthorne effect; whereby beneficial effects arose from frequent contact of health workers with community members. Paradoxically, harmful effects of massive doses of Vit-A are documented, e.g. acute toxicity in certain groups of children, ranging from increased intracranial pressure, mental retardation (postnatal period), and even death. Vit-A also intensifies bone demineralization, and increased levels can lead to calcium deficiency and, hence, growth retardation in vulnerable children. According to the present authors, for children who have Bitot's spots or who have just recovered from an attack of measles, the best approach is to give Vit-A in therapeutic doses along with adequate daily intake of vegetables and fruits. Public-spirited citizens, along with the scientific community, must ensure the scrapping of the universal massive dose Vit-A prophylaxis approach, to avoid Vit-A toxicity and reduce economic burden to the health system.

Background: Acne is a common skin disorder that affects both adolescents and adults. Epidemiological data on acne are limited from developing countries. Objective: The objective of this study is to estimate the prevalence and pattern of acne vulgaris among adolescent students of Chandigarh (India), and to study the impact of acne on quality of life. Materials and Methods: Children from three schools were enrolled to investigate the demographic profile, severity and causative factors of acne and its impact on quality of life using a predesigned questionnaire and followed by examination for presence, site and severity of acne. Results: Acne was present in 72.3% of 1032 children included in this study. Mild acne was present in 81.9% students, moderate in 17.1%, and severe in 0.9%. There was a significant association of acne with stress (P = 0.001) and premenstrual flare (P = 0.000). No association was found between acne and diet, hygiene, weather, family history, and smoking. The quality of life was affected in 29% of children and was directly related to the severity of acne (P = 0.000). No difference of impact on quality of life was seen between boys and girls. Conclusions: This study presents the demographic features and clinical characteristics of acne in school children. This large-scale analysis reveals that acne is a very common dermatosis among Indian school children having a significant impact on their quality of life.

Background Food-borne illnesses have been a recognized hazard for decades. Recent promulgation of Food Safety and Standards Act (FSSA), 2006, indicates the concern of our Govt. for food safety. Research on effectiveness of food safety interventions in our country is remarkably scarce. Hence, the present study was conducted in a tertiary care hospital of north India to create evidence-based results for food safety interventions. Methods The study was before and after intervention trial which was registered with CTRI. Data collection was paperless using a software. All food handlers (n = 280) working inside the hospital were recruited. Intervention package comprised Self-Instructional Manual in Hindi for food handlers, short film for sensitization of food handlers on food safety titled ‘Gravy Extra’, and a documentary titled ‘Food Safety from farm to Fork’. Chi square test, paired t test, and Wilcoxon sign rank test were used. Results The mean age of food handlers was 35 ± 2 years. Majority (61.7%) of food handlers were educated less than 10th standard. Nearly 60% of them had up to five years of experience. At base line majority (68.9%) had a fair knowledge about food safety issues. There was a significant improvement in food safety knowledge and practice score of food handlers after the intervention (p

Background/Hypothesis: Creeping monotony in the treatment provides minimal motivation for children with beta-thalassemia major, leading to noncompliance for adequate blood transfusions and iron chelation therapy. This study was envisaged to formulate a clinical compliance score and correlate the score with their linear growth velocity and weight gain. Materials and Methods: A prospective longitudinal study among 30 thalassemia children aged between 1 and 18 years was conducted in the Department of Pediatrics, Tata Main Hospital (TMH), Jamshedpur, from July 2012 to January 2014. Relevant clinical information and investigations were recorded using a predesigned pro forma. Compliance score was calculated using pre-, post-transfusion hemoglobin and serum ferritin levels. The height velocity and weight gain were calculated. The same patients were re-assessed in January 2015. Results and Discussion: Mean age of children was 10.18 ± 4.98 years. Forty percent were females. Using the scoring table, 33% were in good category of compliance while 4% had poor compliance. The mean height velocity was significantly higher in good compliance category as compared to average or poor score category in 2014 (P = 0.017). Good compliance score children continued to maintain higher height velocity during the 1-year follow-up (P = 0.02). Average weight gain was higher in good compliance category. Conclusion: This paper brings out a simple, regularly monitored scoring system to promote growth in thalassemia children through improved compliance to treatment, which incentivized them to maintain or improve their scores for better height velocity and weight gain. No such compliance score has been tabulated for thalassemia patients as of date.

Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study: To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of physical, emotional, cognitive, behavioral, and social problems, which may result in difficulties for both patients and their family caregivers. Provision of mechanism of prioritized follow-up care to the operated bedridden neurosurgery patients should be made.

Background The state of disarray from unhygienic conditions and excessive litter throughout urban highways, alleyways, and byways across rural and urban localities of India is abysmal. Such unsanitary conditions impinge upon the future health and welfare of its citizens, tourists and economic development. Purpose The NRL volunteered PGIMER's campus hygiene initiative" is a pioneering effort spearheaded in compliance with Indian Prime Minister's call that citizens of India work together to establish a cleaner and healthier environment. Methods A group of 15 highly motivated students in the Neuroscience Division of the PGIMER, worked together vigorously 2 hours a week to affect a cleaner urban environment in the city. Result The results were national Kayakalp and Skoch award to PGIMER as the cleanest hospital in the country, the vendors or patients no longer litter around the campus, the pot holes have been converted into greener patches, signs board adorn the campus. Conclusion To inspire citizens through faculty- student led sanitation programs.

INTRODUCTION: Food handlers with poor personal hygiene and lack of awareness in preventing foodborne diseases working in hospitality sectors or hospitals could spread foodborne infections. OBJECTIVE: Our study objective was to ascertain the impact of a video-based educational intervention program and administrative measures on improvement in personal hygiene of food handlers in hospital. METHODOLOGY: We conducted this pilot study among all 103 food handlers who were working in a tertiary care hospital. A checklist-based scoring and physical examination were conducted by the investigator for the food handlers. After baseline scoring S1, intervention 1 and 2 was implemented, and score was obtained as S2 and S3, respectively. Descriptive statistics was calculated, and score was compared by repeated measures ANOVA test using SPSS-22 software. RESULTS: Our study revealed that a total of 19.2% of food handlers had health complaints. More than half (54.8%) admitted that they had suffered from any kind of illness since last 6 months. Common illness was viral fever (40.3%) followed by typhoid (5.7%), dengue (4.8%) and urinary tract infection (3.8%). Most of the food handlers had long hair (62.5%) followed by long nail (57.69%). Nearly, one-fifth (20.1%) of food handlers nail was infected with fungus. Worm was found in 14.4% cases by stool examination. Statistically significant (P < 0.05) improvement in score was observed after each intervention. DISCUSSION: Poor hygiene (Score-1 = 23.76) was observed at baseline study although there was a mechanism in place for a yearly health checkup and regular (6 monthly) hygiene training. After interventions (video-based training and administrative measures), the score was improved to Score-3 (42.57). Statistically significant (P < 0.05) differences in hygiene score were observed for variables such as state of residence, education level, and working experiences (inside or outside the hospital). CONCLUSION: It is possible to improve personal hygiene among food handlers using video-based interactive training methods and administrative measures with no extra or minimal cost. RECOMMENDATIONS: This “piggyback” approach of training can be imparted in addition to routine training measures among the food handlers for improving their personal hygiene in the hospital setting.

INTRODUCTION: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. MATERIAL AND METHODS: This study was carried out using institution based cross section study. The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. RESULTS: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days ( Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. CONCLUSION: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

“Texting neck” or “iNeck pain” syndrome is emerging as a public health threat globally because of our adjustment to a NEW NORMAL existence (work-from-home culture) because of the COVID-19 pandemic. This term coined by Dr. Dean L. Fishman, “text neck,” refers to overuse syndrome or a repetitive stress injury, in which we have our head hung forward and down looking at our cellular electronic device for prolonged durations. In our normal anatomical position, neck muscle groups are designed to endure the load of our head, which is about 10–12 pounds and when we bend our head ahead for an inch, we double the weight on these neck muscle groups. The signs and symptoms vary from continual nagging ache to muscle fatigue and limited variety of neck movements. For handling “Texting neck” or “iNeck ache” syndrome, nonpharmacological and pharmacological treatment alternatives are available. The burden of neck pain is already high in countries such as Norway, Finland, and Denmark. It is emerging as a public health problem in other countries also, thanks to work-from-home culture in the COVID-19 era. Few studies have revealed that the awareness for texting neck is poor among poor countries, and increasing population awareness about the risk factors and preventive measures for neck pain is the only way to tackle this emerging threat.