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Contribution: The main contribution is to provide practitioners and researchers with an insight in efficiently and effectively employing multi-attribute decision making (MADM) methods in e-learning website selection problems. Background: Advances in information systems and the Internet have resulted in e-learning websites becoming an important interface for learners. The selection of a particular website directly affects the end users' performance, with the objectives and expected outcomes of e-learning being largely dependent on the quality of the teaching processes and the effectiveness of online access. Evaluation and selection of these websites has thus become a decisive issue for learners and developers. Intended Outcomes: This paper is expected to provide decision support to leaders in education and educational organizations in effectively analyzing and managing their e-learning system. A knowledge-based system may be developed to develop and assess e-learning websites in a meaningful way. Application Design: A hybrid MADM method, fuzzy complex proportional assessment (COPRAS) is used to evaluate, rank, and select e-learning websites of "C" programming language. The fuzzy COPRAS method is validated by comparison with the technique for order preference by similarity to ideal solution, on an existing selection problem of 12 websites available in the open literature. Findings: Fuzzy COPRAS provides a comprehensive ranking of e-learning websites based on fitness degree values. The case study results rated tutorialspoint.com as the best of the e-learning websites considered, and howstuffworks.com was rated lowest. This paper shows that fuzzy COPRAS could be useful for e-learning practitioners, developers, and the researchers.

Aim and background: High-quality cardiopulmonary resuscitation (CPR) is associated with improved patient outcomes, but healthcare workers (HCWs) may be frequently undertrained. This study aimed to assess baseline knowledge and skills among HCWs about basic and advanced life support and the effect of simulation-based training on it. Methods: It was a single-center prospective quasi-interventional study among resident doctors and nurses at a Tertiary Center in New Delhi, India. A questionnaire-based assessment was done to assess baseline knowledge. The participants then underwent simulation-based training followed by questionnaire-based knowledge assessment and skill assessment. A repeat questionnaire-based assessment was done 6 months post-training to assess knowledge retention. Results: A total of 82 HCWs (54 doctors and 28 nurses) were enrolled. The participants scored 22.28 ± 6.06 out of 35 (63.65%) in the pre-training knowledge assessment, with low scores in post-cardiac arrest care, advanced life support, and defibrillation. After the training, there was a significant rise in scores to 28.32 ± 4.08 out of 35 (80.9%) (p < 0.01). The retention of knowledge at 6 months was 68.87% (p < 0.01). The participants scored 92.61 ± 4.75% marks in skill assessment with lower scores in chest compressions and team leadership roles. There was a positive correlation (r = 0.35) between knowledge and skills scores (p < 0.01). Conclusion: There is a progressive decrease in baseline knowledge of HCWs with the further steps in the adult chain of survival. The simulation training program had a positive impact on the knowledge of HCWs. The training programs should focus on defibrillation, advanced life support, post-cardiac arrest care, and leadership roles. [ABSTRACT FROM AUTHOR]

Background: An unwavering availability of opioids is crucial for effective pain and palliative care and for managing opioid dependence. This study aims to study the pattern of morphine consumption and the use of safety protocols for prescribing opioids in a tertiary cancer hospital in India. Patients and methods: The medical and pharmacy records were studied retrospectively to investigate the pattern of oral Morphine consumption and distribution from 2008 to 2020. Results: The number of new cancer patients visiting the hospital, the number of re-visits of these patients, and inpatient admissions to palliative care services increased unswervingly from 2008 to 2019 with a sharp fall in 2020 owing to the COVID pandemic. Annual oral morphine consumption showed a steady increase from 4.89 kg in 2008 to 11.53 kg in 2019 with a fall to 5.68 kg in 2020. However, the trend for oral morphine dispensed per patient per visit showed a mild increase from 1.1 grams in 2008 to 2.06 grams in 2012, followed by a gradual decline to 0.89 grams in 2020. Opioid diversion incidence was found to be zero. Conclusions: Comprehensive interventions alongside safety protocols for prescriptions of opioids and effective integration of palliative care can help prevent opioid use disorders. [ABSTRACT FROM AUTHOR]

Introduction: Providing cardiopulmonary resuscitation (CPR) to a coronavirus disease-2019 (COVID-19) patient is challenging for the healthcare providers (HCP). COVID-19 cases have specific CPR requirements, which differ from standard resuscitation efforts. Objective: This paper aims to evaluate whether online learning can be an effective methodology for imparting information on the management of cardiopulmonary arrest in COVID-19 patients due to a novel virus unknown to HCP based on evaluation of knowledge acquisition and satisfaction of the nurses in the new area of medicine and virology. Methodology: In a single-arm, one group before and after design, from a cohort of 160 nurses trained in comprehensive cardiac life support (CCLS) formulated by the Indian Resuscitation Council (IRC), 73 nurses participated in the study. After obtaining informed consent through the email from the nurses, baseline data including demographic profile and knowledge related to CPR in COVID-19 patients were collected. An online intervention spread over 1 week was given using a validated e-learning module. The online intervention was found to be effective (pre- and post-intervention knowledge score 13.65 ± 3.01 vs 19.92 ± 1.94, p = 0.001). The majority of nurses were highly satisfied with the content and the training methodology (37.23 ± 4.70). Conclusion: A well-structured, online study material can be used in imparting knowledge and demonstrating the basic and essential skills to nurses, required for giving CPR to COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: The "second wave" of the COVID-19 pandemic hit India from early April 2021 to June 2021. We describe the clinical features, treatment trends, and baseline laboratory parameters of a cohort of patients with SARS-CoV-2 infection and their association with the outcome. Methods: This was a retrospective cohort study. Multivariate logistic regression models were fitted to identify clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay, and death. Results: A total of 2080 patients were included. The case fatality rate was 19.5%. Among the survivors, the median duration of hospital stay was 8 (5-11) days. Out of 853 (42.3%%) of patients who had COVID-19 acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged >45 years had higher odds of death as compared to the 18-44 years age group. Vaccination reduced the odds of death by 40% (odds ratio [OR] [95% confidence interval [CI]]: 0.6 [0.4-0.9], P = 0.032). Patients with hyper inflammation at baseline as suggested by leukocytosis (OR [95% CI]: 2.1 [1.5-3.1], P < 0.001), raised d-dimer >500 mg/dL (OR [95% CI]: 3.2 [2.2-4.7], P < 0.001), and raised C-reactive peptide >0.5 mg/L (OR [95% CI]: 3.7 [2.2-13], P = 0.037) had higher odds of death. Patients who were admitted in the 2nd week had lower odds and those admitted in the 3rd week had higher odds of death. Conclusion: This study shows that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Improving vaccination rates and early admission of patients with moderate and severe COVID-19 can improve the outcomes. [ABSTRACT FROM AUTHOR]

Purpose - This study examines the effect of housing environment on residents' satisfaction and happiness using the data collected fromselected residents of Gurugram, an urban locality in India. Design/methodology/approach - Using the convenience-cum-judgmental sampling technique, data was collected from 321 residents of 17 gated private housing estates and tested by performing factor analysis and partial least squares - structural equation modeling. Findings - The results revealed that maintenance service at housing estates significantly influences residents' satisfaction followed by social infrastructure, dwelling attributes and residential amenities, whereas the accessibility aspect has no significant impact on residents' satisfaction and happiness. Results also show a significant impact of social infrastructure on residents' happiness, and most notably, residents' satisfaction has a significant influence on their happiness. Research limitations/implications - The findings of this study are likely to provide valuable insight into housing stakeholders (government officials; real estate developers; property and construction professionals, i.e. planners, architects and maintenance managers) to improve the attributes in urban housing setting and neighborhood facilities to upsurge the residents' satisfaction and happiness level toward the housing estates and townships, which leads to quality and happiness in residents' life. Originality/value - According to the authors' knowledge, the present study is the first to provide an inclusive way toward showcasing the key antecedents of residents' satisfaction and happiness in the Indian urban housing context. Authors anticipate that future researchers will find present research as a valuable contribution to the residents' satisfaction and happiness in urban housing planning and revitalization of urban locations. [ABSTRACT FROM AUTHOR]

The success of any enterprise will depend on two major factors: one is the environment of working and another is commitment, through which reliability and creditability increase among the various stakeholders. In India, most of the enterprises in public sector are suffering from heavy losses, continuously, and disinvesting is taking the place speedily. The main focus of this paper is concentrated on power sector, as the next era is related to digitalization, the challenges will also increase and these may also be converted into opportunities by implementing proper policies and practices. The parameter of human resources has also been changed in this changing environment, the researcher tried to cover maximum parameters applicable in public sector enterprises, leveraging HRM policies and critically analyse their impact on working environment and commitment. Further, this study includes the applicability of HRM policies with theoretical and in practice methods. This paper will also describe the various problems facing by the enterprise in public sectors in India and their remedies with respect to the current scenario of global market at competitive age, and providing facts and details to examine how HRM Policies has affected and is affecting the growth and market share of the business. [ABSTRACT FROM AUTHOR]

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has recently emerged as a viable management option for peritoneal surface malignancy (PSM). CRS and HIPEC is a complex, multidisciplinary and resource-intensive surgical procedure. It has a steep learning curve and is associated with significant morbidity and mortality. The expertise is mostly limited to few dedicated high-volume centers located in developed countries. We present a single institutional experience of 232 cases of CRS and HIPEC performed at a tertiary care cancer center in a low- and middle-income country (LMIC). Methods: A multidisciplinary PSM program was initiated in 2015 at a high-volume public-sector tertiary care cancer center in North India catering largely to patients belonging to low- and middle-income groups. Perioperative protocols were developed, and a prospective structured database was created to capture data. All patients undergoing CRS and HIPEC between January 2015 and December 2020 were identified, and the data was retrospectively analyzed for clinical spectrum, surgical details, and perioperative morbidity and mortality. Results: Two hundred and thirty-two patients underwent CRS and HIPEC during the study period. Epithelial ovarian carcinoma (56.5%) was the most common malignancy treated, followed by pseudomyxoma peritonei (18.5%), colorectal carcinoma (13.4%), and malignant mesothelioma (5.6%). Optimal CRS could be achieved in 94.4% of patients. Cisplatin and mitomycin were the most common drugs used for HIPEC. A total of 28.0% of patients had morbidity including deep vein thrombosis, subacute intestinal obstruction, sepsis, burst abdomen, lymphocele, urinoma, acute renal failure, and enterocutaneous fistula. The overall treatment-related mortality was 3.5%. Conclusions: Results of the current study indicate that it is feasible to establish a successful CRS and HIPEC program for PSM in government-funded hospitals in LMIC facing resource constraints. The most common indication for CRS and HIPEC were carcinoma of the ovary followed by pseudomyxoma peritonei and colorectal carcinoma. Overall morbidity and mortality in the current series are comparable to global standards, reported from high-income countries. A protocol-based multidisciplinary team approach, optimal patient selection, and surgical expertise can help achieve optimal outcomes in government-funded hospitals in LMIC. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has awakened the need for telemedicine and teleconsultation to continue medical care while maintaining social distancing for safety against infection. The concept of the electronic intensive care unit (e-ICU) is evolving rapidly in developed nations.-ICU in developing countries like India not only has great potential but also has many roadblocks. This article showcases the concept, advantages, and challenges of e-ICU in India, with a glimpse of the future. [ABSTRACT FROM AUTHOR]

Background: Ongoing pandemic because of COVID-19 has spread across countries, with varied clinical features and severity. Awareness of clinical course among asymptomatic and symptomatology in symptomatic cases is essential for patients' management as well as optimal utilization of health services (in resource limited settings) based on clinical status and risk factors. This study aimed to describe the clinical characteristics and outcomes of patients admitted with COVID-19 illness in the initial phase of the pandemic in India. Methods: It was an observational study. Patients aged 18 years or more, with confirmed SARS-CoV-2 infection, asymptomatic or mildly ill, were included. Patients with moderate-severe disease at admission or incomplete clinical symptomatology records were excluded. Data regarding demography, comorbidities, clinical features and course, treatment, results of SARS-CoV-2 RT-PCR, chest radiographs, and laboratory parameters were obtained retrospectively from hospital records. The outcome was noted in terms of course, patients discharged, still admitted (at the time of the study), or death. Results: Out of 231 cases, most were males (78.3%) with a mean age of 39.8 years. Comorbidities were present in 21.2% of patients, diabetes mellitus and hypertension being the most common. The most common symptoms were dry cough (81, 35%), fever (64, 27.7%), sore throat (36, 15.6%); asymptomatic infection noted in 108 (46.8%) patients. The presence of comorbidities was an independent predictor of symptomatic disease (OR-2.66; 95%CI 1.08–6.53, P = 0·03). None of the patients progressed to moderate-severe COVID-19, and there were no deaths. Conclusions: A large proportion of patients remained asymptomatic whereas those with comorbidities were more likely to be symptomatic. Most with mild disease had a stable disease course, barring few complication in those with comorbidities. The pandemic continues to grow as large number of asymptomatic cases may go undiagnosed. [ABSTRACT FROM AUTHOR]

Introduction: Cancer-related fatigue (CRF) is one of the adverse outcomes of cancer and its treatment. Despite its high prevalence; the data are scarce from the Indian population on the prevalence of CRF and its predictors in advanced cancer patients. Hence, we aim to find the prevalence of the fatigue, its impact of fatigue on quality of life (QOL), and possible predictors. Methods: This study was conducted after approval of the ethical committee in adult patients of advanced cancer receiving palliative care. The data collected included demographic details, nutritional status, any comorbidities involving cardiorespiratory, renal, pulmonary, and neurological system, type and stage of cancer, site of metastasis, any previous or ongoing chemotherapy or radiotherapy, history of drug intake, hemoglobin, and albumin. The study parameters included assessment of fatigue, QOL, and symptom assessment as per the validated tools. The primary objective of the study was to find the prevalence of fatigue in advanced cancer patients receiving palliative care. The secondary objectives were to find predictive factors of fatigue, its impact on QOL of patients, and the relation between the fatigue and QOL receiving palliative care. The correlation between fatigue score and QOL was analyzed using Pearson's correlation coefficient. Multiple linear regression analysis was performed for identifying the predictors of CRF. Results: The fatigue was observed in all 110 patients in this study. Of these, severe fatigue was seen in 97 patients (Functional Assessment of Chronic Illness Therapy [FACIT]-F < 30). The median (interquartile range [IQR]) FACIT-F score was 14 (8-23). The median (IQR) of the overall QOL was 16.66 (16.6-50).The correlation between the fatigue (FACIT-F) and QOL was + 0.64 (P < 0.001). The predictors of fatigue included pain, physical functioning, Eastern Cooperative Oncology Group, tiredness, and the level of albumin. Conclusion: We conclude that the prevalence of fatigue in Indian patients with advanced cancer receiving palliative care was high and it has a negative impact on QOL. Pain, physical functioning, performance status, and albumin were found to be independent predictors of CRF. [ABSTRACT FROM AUTHOR]

Introduction: During the current COVID-19 crisis, striking a balance between adequate pain relief in advanced malignancy patients and avoiding hospitals due to fear of contracting the infection has been the biggest challenge for patients as well as palliative care physicians. This study explored the trends in opioid dispensing for cancer pain before and during the lockdown. Methods: The trends were calculated based on an analysis of quantity of all opioids dispensed. March 24, 2020, was considered as a cutoff for analyzing before and during lockdown period dispensing trends. No information regarding individual patients was retrieved in the current study. Results: There was a decrease in total morphine, tramadol, and fentanyl patch dispensing parallel to decrease in total number of patients visiting the outpatient department. However, there was a statistically significant increase in per capita opioid dispensing during the lockdown period. There was also an increase in the proportion of cancer pain patients that were dispensed morphine during the lockdown. Conclusion: Despite the lockdown, the palliative care team at Institute Rotary Cancer Hospital has continued to provide adequate pain relief to patients that could manage to reach the center. Policy-makers need to be cognizant of the pain relief needs of cancer patients in times when accessing hospitals is becoming increasingly difficult. Cancer-related pain and mortality could well be the next pandemic once the current COVID-19 begins to reduce. [ABSTRACT FROM AUTHOR]

Background and Aims: With the COVID-19 pandemic, lockdown, and fear from contagion, the advantages of telemedicine are clearly outweighing the setbacks by minimizing the need for individuals to visit health-care facilities. Our study aims to assess how palliative medicine physicians could follow up on cancer patients and barriers they faced, discuss their results, and evaluate their treatment response with the help of telemedicine. Materials and Methods: We conducted a prospective analysis of the smartphone-based telemedicine service at our palliative care (PC) unit from March 25, 2020, to May 13, 2020. We recorded the patient's reason for call, main barriers to a hospital visit, and the assistance given to them by the physician on call. Each caller was asked to measure his/her satisfaction with the service on a 4-point scale. Results: Out of 314 patients, 143 (45.54%) belonged to Delhi and 171 (54.46%) belonged to other states. 157 patients sought help for symptom management; 86 patients needed to restock their opioid medications. Seventy-one patients required information regarding their oncological treatments requiring consultation from other departments. Titration of oral opioids and medication prescription (n = 129), contact details of other PC units at their native state for opioid procurement (n = 55), and attachment to our community-based PC service (n = 22) were main modes of management. Fifty-six patients were very satisfied and 152 patients were satisfied with the service. Conclusion: Telemedicine is the future of health-care delivery systems. In PC, we deal with immunocompromised debilitated cancer patients and telemedicine is immensely helpful for us to provide holistic integrated care to these patients who are unable to visit hospitals regularly. [ABSTRACT FROM AUTHOR]

Background and Aims: The coronavirus disease 2019 (COVID-19) is spreading at an unprecedented speed. Lack of resources to test every patient scheduled for surgery and false negative test results contribute to considerable stress to anesthesiologists, along with health risks to both caregivers and other patients. The study aimed to develop an early warning screening tool to rapidly detect 'highly suspect' among the patients scheduled for surgery. Methods: Review of literature was conducted using terms 'coronavirus' OR 'nCoV 2019' OR 'SARS-CoV-2' OR 'COVID-19' AND 'clinical characteristics' in PUBMED and MedRxiv. Suitable articles were analysed for symptoms and investigations commonly found in COVID-19 patients. Additionally, COVID-19 patient's symptomatology and investigation profiles were obtained through a survey from 20 COVID-19 facilities in India. Based on literature evidence and the survey information, an Early Warning Scoring System was developed. Results: Literature search yielded 3737 publications, of which 195 were considered relevant. Of these 195 studies, those already included in the meta-analyses were not considered for independent assessment. Based on the combined data from meta-analyses and survey, risk factors of COVID-19 disease identified were as follows: history of exposure, fever, cough, myalgias, lymphocytopaenia, elevated C-reactive protein (CRP)/lactate dehydrogenase (LDH) and radiographic infiltrates. Conclusion: Development of this Early Warning Scoring System for preoperative screening of patients may help in identifying 'highly suspect' COVID-19 patients, alerting the physician and other healthcare workers on the need for adequate personal protection and also to implement necessary measures to prevent cross infection and contamination during the perioperative period. [ABSTRACT FROM AUTHOR]

Introduction: End-of-life care (EOLC) is an increasingly important concern in the management of terminally ill patients. Effective EOLC depends significantly on the physicians working in the critical care units. Thus, adequate knowledge of critical care professionals regarding EOLC is important. We conducted this study to evaluate the awareness and knowledge of doctors working in critical care units toward EOLC. Materials and methods: Doctors working in critical care units were invited to fill paper-based questionnaire. The validated questionnaire was constructed based on the existing literature on EOLC and expert opinion. The questionnaire comprised four sections: demographic details, experience with EOLC situations, general awareness of EOLC, and specific awareness of EOLC in clinical practice. The collected data were analyzed by descriptive analysis. Results: Most respondents had not counseled more than five families regarding EOLC over 1 month. Majority of the respondents (81.7%) had heard of EOLC; the major source of information being their work in the concerned specialty. Only 29.2% of the respondents applied EOLC principles in their clinical practice. Main barriers were lack of information and training. Only 20.3% of the respondents were aware of Indian guidelines about EOLC. Majority of the respondents disagree regarding the usage of critical care units and resuscitation of terminally ill patients and were in favor of home care. One-third respondents felt uncomfortable in discussing EOLC issues with the families. Half of the respondents felt that they were only somewhat competent in managing EOLC issues. Most respondents opined that training and education in medical curriculum for terminally ill patients are lacking and were in strong favor of inclusion of specific training for the same. Conclusion: The EOLC needs to be an integral part of critical care management and teaching curriculum. An integral referral system may also be an option for various advance disease patients getting treatment from critical care specialists for EOLC decision. [ABSTRACT FROM AUTHOR]

Background and Aims: Perioperative fasting guidelines have been published and updated to standardise practices. Hence, Indian Society of Anaesthesiologists decided to conduct a survey to assess the fasting practices and the food habits across India, which would be subsequently used for developing preoperative fasting guidelines for the Indian population. We detail and discuss herewith the content validity of the questionnaire developed for the survey. Methods: Thirty-six questions related to perioperative fasting practices were framed based on the collected evidence and relevance to regional diet and concerns. Subsequently, an information sheet was prepared and sent to 10 experts to grade each question. The responses were tabulated, and item-wise content validity index (I-CVI), scale-wise content validity index (S-CVI) and modified kappa statistic were calculated in Microsoft Excel™ sheet. Results: Seven of the 10 experts completed the assessment and grading as per the instructions provided and submitted a completed proforma. S-CVI for relevance, simplicity, clarity and ambiguity was 0.72, 0.86, 0.72 and 0.72, respectively. S-CVI/average or average congruency percentagewas 0.95, 0.97, 0.95 and 0.95 for relevance, simplicity, clarity and ambiguity, respectively. Question 2 received an I-CVI of 0.71 in terms of clarity and question 23 received an I-CVI of 0.71. They were modified as persuggestions of the experts. Conclusion: We conclude that our questionnaire designed to ascertain the preoperative fasting practices for a surveymet the content validity criteria both by qualitative and quantitative analyses. [ABSTRACT FROM AUTHOR]

Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic has affected all the aspects of life of mankind, posing unique challenges for health-care services. In order to contain the spread of the virus, a countrywide mass lockdown has been imposed in India. Although the lockdown has modified the epidemic trajectory, it has affected the lives of many non-COVID patients. Patients in need of care could not approach hospitals. Methods: This retrospective observational study was conducted in the Department of Onco-Anaesthesia and Palliative Medicine at a tertiary care center in India. The yearly data of patient flow for the year 2019 was compared with that during the lockdown. Results: The single-day average of out-patients, in-patients, and other department consultation requests requiring palliative care decreased drastically during the lockdown in comparison to the previous year. The single-day average of teleconsultations increased more than double during the lockdown. Conclusion: Although lockdown decreases the spread of the epidemic, it increases the suffering of other patients who require medical care. Various steps have to be adopted in the regular working pattern of hospitals to cater to the needs of the patients requiring care, without increasing the risk of contracting COVID-19. [ABSTRACT FROM AUTHOR]

Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60-70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful. [ABSTRACT FROM AUTHOR]

Background: Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by deposition of lipoproteinaceous material within alveoli, with a variable clinical course. Here, we report an experience of management of PAP at our center. A systematic review of previously reported cases from India is also included in the article. Materials and Methods: This study included patients with primary PAP managed at our center from 2009 to 2015. Diagnosis of primary PAP was based on histopathologic diagnosis on bronchoalveolar lavage or transbronchial lung biopsy and absence of causes of secondary PAP. For systematic review of Indian publications, the literature search was performed using PubMed and EMBASE databases using the terms “pulmonary alveolar proteinosis’” or “alveolar proteinosis” and “India” or “Indian.” Results: During the above‑specified period, five patients with diagnosis of PAP were admitted at our center. Median age of patients was 32 years (interquartile range [IQR] 30.5–59); 80% were female. Mean duration (± standard deviation) of symptoms was 6.2 (±1.79) months. Anti‑granulocyte‑macrophage colony stimulating factor (GM‑CSF) antibodies were elevated in 4 out of 5 patients (80%). For management, whole lung lavage (WLL) was done for four patients with median volume of 32.5 (IQR 18–74) L per patient. All the patients showed significant symptomatic as well as improvement in physiological parameters. Subcutaneous GM‑CSF and ambroxol were given to 3 patients and 1 patient, respectively. The median follow‑up of all patients was 18 (IQR 5–44) months. A systematic review of all Indian studies of PAP revealed thirty publications. Conclusions: WLL is the most common, effective, and safe therapy in patients with PAP. GM‑CSF administration is an efficacious treatment for patients with incomplete response after WLL. [ABSTRACT FROM AUTHOR]

Stature is a significant parameter in establishing identity of an unknown. Conventionally, researchers derive regression formula separately for males and females. Sex, however, may not always be determined accurately, particularly in dismembered remains and thus the need for a universal regression formula for stature estimation irrespective of sex of an individual. The study was carried out in an endogamous group of North India to compare the accuracy of sex-specific regression models for stature estimation from foot length with the models derived when the sex was presumed as unknown. The study reveals that regression equation derived for the latter can estimate stature with reasonable accuracy. Thus, stature can be estimated accurately from foot length by regression analysis even when sex remains unknown. [ABSTRACT FROM AUTHOR]

The article discusses questionnaire-based study related to ultrasound guided regional anaesthesia (UGRA) among anaesthesia residents in India. Topics discussed include role of study in understanding the impact of UGRA procedures on the residents' understanding of the sonoanatomy of blocks, a table depicting relation between number of blocks performed per week and other using ultrasound guidance, and role of ultrasound in improving ratio of successful blocks and reduced complications.

Background & objectives: In December 2019, a novel coronavirus (SARS-CoV-2) emerged in China and rapidly spread globally including India. The characteristic clinical observations and outcomes of this disease (COVID-19) have been reported from different countries. The present study was aimed to describe the clinico-demographic characteristics and in-hospital outcomes of a group of COVID-19 patients in north India. Methods: This was a prospective, single-centre collection of data regarding epidemiological, demographic, clinical and laboratory parameters, management and outcome of COVID-19 patients admitted in a tertiary care facility in north India. Patient outcomes were recorded as death, discharge and still admitted. Results: Data of 144 patients with COVID-19 were recorded and analyzed. The mean age of the patients was 40.1±13.1 yr, with 93.1 per cent males, and included 10 (6.9%) foreign nationals. Domestic travel to or from affected States (77.1%) and close contact with COVID-19 patients in congregations (82.6%) constituted the most commonly documented exposure. Nine (6.3%) patients were smokers, with a median smoking index of 200. Comorbidities were present in 23 (15.9%) patients, of which diabetes mellitus (n=16; 11.1%) was the most common. A significant proportion of patients had no symptoms (n=64; 44.4%); among the symptomatic, cough (34.7%) was the most common symptom followed by fever (17.4%) and nasal symptoms (2.15%). Majority of the patients were managed with supportive treatment with hydroxychloroquine and azithromycin given on a case-to-case basis. Only five (3.5%) patients required oxygen supplementation, four (2.8%) patients had severe disease requiring intensive care, one required mechanical ventilation and mortality occurred in two (1.4%) patients. The time to reverse transcription-polymerase chain reaction (RT-PCR) negativity was 16-18 days. Interpretation & conclusions: In this single-centre study of 144 hospitalized patients with confirmed COVID-19 in north India, the characteristic findings included younger age, high proportion of asymptomatic patients, long time to PCR negativity and low need for intensive care unit care. [ABSTRACT FROM AUTHOR]

Purpose: Hematopoietic stem cell transplant (HSCT) is an intense form of treatment, resulting in major symptom burden but can prove curative. The quality of life (QOL) is a major endpoint for these patients as the survival rate in them has improved over time. The aim of the study is to assess the QOL and symptom burden of hematological malignancy patients at admission to hospital for HSCT, at 1 month and at 3 months following HSCT., Methods: This prospective observational study was done on hematological malignancy patients who were admitted for HSCT in a regional cancer center. The study subjects were assessed by the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT Scale), Edmonton Symptom Assessment Scale-revised (r-ESAS), and Depression, Anxiety and Stress Scale-21 Items (DASS-21) at the time of hospital admission for transplantation, on day 30 (~ 1 month) and day100 (~ 3 months) of transplantation., Results: A total of 68 patients were included in this study. FACT-BMT scores have decreased from baseline (F0) to the first follow-up (F1) and then increased in the third follow-up (F2). The maximum r-ESAS mean score was for tiredness among all other symptoms at F0 as well as at F1 and at F2. The DASS 21 scores for depression, anxiety, and stress were maximum during F1 and minimum during F2., Conclusion: Symptom burden is maximum during the first month of BMT, which improves later and QOL becomes improved with time., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Aims: Reinfection is gradually being recognised after symptomatic or asymptomatic COVID-19 infection. We try to elucidate various explanations behind COVID-19 reinfection and suggest possible strategies to counteract this threat., Methods: We carried out a comprehensive review of the literature using suitable keywords such as 'COVID-19', 'Pandemics', 'Reinfection', 'Vaccines' and 'India' on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in March 2021 and first half of April 2021 during the current COVID-19 pandemic. Epidemiology, risk factors and trends of reinfection were assessed., Results: A multitude of factors have been associated with rising incidence of COVID-19 reinfection in India and across the world. Emergence of 'Variants of Concern (VOC)', pandemic fatigue and disregard of infection prevention strategies appear to be the most obvious reasons., Conclusions: COVID-19 reinfection is an emerging concern amongst the worldwide population with newer mutant strains demonstrating increasing transmissibility and responsible for continuing waves of the pandemic. COVID Appropriate Behaviour (CAB), improvised vaccines and enhanced vaccination drives are necessary to mitigate global threat., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: Previous studies suggest that body composition and handgrip strength are significantly altered in individuals with type 2 diabetes mellitus. Only few studies are available in prediabetic individuals. The aim is to study the change in body composition in adult individuals with prediabetes and compare it with age and sex-matched normoglycemic individuals., Methods: 100 diagnosed cases of prediabetes and 100 age and sex-matched normoglycemic controls were recruited in the study. Body composition was assessed with Omron HBF 510w and Slim guide skinfold caliper. Handgrip strength was assessed with Camry digital dynamometer., Results: Out of 100 subjects with prediabetes; 53 were female and 47 were male. In this study, there was higher mean body fat percentage (29.37 ± 5.65 vs 25.46 ± 5.27) and visceral fat (11.21 ± 1.92 vs 7.27 ± 2.82) in individuals with prediabetes compared to normoglycemic individuals. Also, there was a lower mean of skeletal muscle percentage (27.21 ± 4.32 vs 31.19 ± 4.63) and handgrip strength (29.61 ± 6.38 vs 33.75 ± 6.8) in individuals with prediabetes compared to normoglycemic individuals. In this study, body fat percentage was positively correlated (r = 0.3385) with prediabetes. The skeletal muscle percentage (r = -0.40721) and handgrip strength (r = -0.301) were negatively correlated with prediabetes., Conclusions: It can be concluded that there is a significant change in body composition and handgrip strength in the individuals with prediabetes, and changes in body composition and handgrip strength can be included as a primary care strategy to motivate lifestyle modifications., (Copyright © 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Study Objective: To evaluate the analgesic efficacy of ultrasound guided combined pectoral nerve blocks I and II in patients scheduled for surgery for breast cancer., Design: Prospective, randomized, control trial., Setting: Operating rooms in a tertiary care hospital of Northern India., Patients: Sixty American Society of Anesthesiologists status I to II adult women, aged 18-70years were enrolled in this study., Interventions: Patients were randomized into two groups (30 patients in each group), PECS (P) group and control (C) group. In group P, patients received both general anesthesia and ultrasound guided combined pectoral nerve blocks (PECS I and II). In group C, patients received only general anesthesia., Measurements: We noted pain intensity at rest and during abduction of the ipsilateral upper limb, incidence of postoperative nausea and vomiting; patient's satisfaction with postoperative analgesia and maximal painless abduction at different time intervals in both groups., Main Results: There was significant decrease in the total amount of fentanyl requirement in the in P group {(140.66±31.80μg) and (438±71.74μg)} in comparison to C group {(218.33±23.93μg) and (609±53.00μg)} during intraoperative and post-operative period upto 24h respectively. The time to first analgesic requirement was also more in P group (44.33±17.65min) in comparison to C group (10.36±4.97min) during post-operative period. There was less limitation of shoulder movement (pain free mobilization) on the operative site at 4h and 5h after surgery in P group in comparison to C group. However there was no difference in the incidence of post-operative nausea and vomiting (22 out of 30 patients in group P and 20 out of 30 patients in group C) but patients in group P had a better satisfaction score with postoperative analgesia than C group having a p value of <0.001(Score 1; 5 VS 20; Score 2; 12 VS 9; Score 3; 13 VS 1)., Conclusions: Ultrasound guided combined pectoral nerve blocks are an effective modality of analgesia for patients undergoing breast surgeries during perioperative period., Clinical Trial Registration: CTRI/2015/12/006457., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Identification of an individual is the mainstay in forensic investigations. The dimensions of the foot have been used for the determination of sex, age, and stature of an individual. The present study examines the relationship between stature and foot dimensions among Gujjars, a North Indian endogamous group. Stature, foot length and foot breadth of 200 subjects comprising 100 males and 100 females were measured. Statistical analyses indicated that the bilateral variation was insignificant for all the measurements except foot breadth in males (p<0.01). Sex differences were found to be highly significant for all the measurements (p<0.01). Linear and multiple regression equations for stature estimation were calculated using the aforementioned variables and multiplication factors were computed. The correlation coefficients between stature and foot dimensions were found to be positive and statistically highly significant. The highest correlation coefficient between stature and foot length in males and foot breadth in females indicates that the foot length provides the highest reliability and accuracy in estimating stature of an unknown male and foot breadth in a female. Prediction of stature was found to be most accurate by multiple regression analysis.

Identification of an individual is of paramount importance in forensic investigations. The dimensions of the foot can be used for the determination of sex and stature of an individual in forensic investigations. No systematic studies are available on the determination of sex from foot measurements of North Indians. Therefore, foot index is derived to determine the sex of an individual in a single community of North India. The foot index for both genders is derived by dividing the foot breadth by foot length and multiplying it by hundred. In the present investigation, the foot index is found to be slightly higher in females in the right foot and males in the left foot. The study suggests that although foot length and foot breadth show significant sex differences, sex determination cannot be made conclusively from the foot index.