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Introduction: A correct histopathological diagnosis is dependent on an array of technical variables. The quality and completeness of a histological section on a slide is extremely prudent for correct interpretation. However, this is mostly done manually and depends largely on the expertise of histotechnician. In this study, we analysed the application of digital image analysis for quality control of histological section as a proof-of-concept., Material and Methods: Images of 1000 histological sections and their corresponding blocks were captured. Area of the section was measured from these digital images of tissue block (Digiblock) and slide (Digislide). The data was analysed to calculate DigislideQC score, dividing the area of tissue on the slide by the tissue area on the block and it was compared with the number of recuts done for incomplete section., Results: Digislide QC score ranged from 0.1 to 0.99. It showed an area under curve (AUC) of 98.8%. A cut-off value of 0.65 had a sensitivity of 99.6% and a specificity of 96.7%., Conclusion: Digiblock and Digislide images can provide information about quality of sections. DigislideQC score can correctly identify the slides which require recuts before it is sent for reporting and potentially reduce histopathologists' slide screening effort and ultimately turnaround time. These can be incorporated in routine histopathology workflows and lab information systems. This simple technology can also improve future digital pathology and telepathology workflows., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Hospital administrators are often challenged with overcrowding at hospitals. The study hospital receives referred patients; however, they have to wait in long queues even for getting registered. This was a cause of concern for hospital administrators. The study was undertaken to find an amicable solution to the queues at registration using Queuing Theory., Method: This observational and interventional study was carried out in a tertiary care ophthalmic hospital. In the first phase, data of service time and arrival rate was collected. The queuing model was built using the coefficient of variation (CoV) of the observed times. Server utilization for new patient registration was found to be 1.21 and was 0.63 for revisit patients. Scenario-based simulation carried out using free software for optimal utilization of both types of servers. Recommendations made to combine the registration process and to increase one server were implemented.In the second phase, after one year, patient registration data were collected and compared for the number of patients registered using SPSS 17., Results: Number of patients registered within the registration timings increased whereas the number of patients registered after the registration timings decreased significantly at 95% CI with a p-value of less than 0.001. Queues finished early and more number of patients were registered in the same time., Conclusion: Using queuing theory, the bottleneck of the systems can be identified. Scenario and software-based simulations provide solutions to the problem of queues. The study is an application of Queuing Theory with a focus on efficient resource utilization. It can be replicated in an organization with limited resources facing the challenge of queues., Competing Interests: The authors have none to declare., (© 2021 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)

Rumex abyssinicus Jacq. is a perennial medicinal herb widely used in traditional medicine to treat many diseases. Phytochemicals of the plant were isolated using column chromatography and thin layer chromatography techniques. Extract, fractions and pure compounds were screened for antimicrobial activity against sensitive and multi-drug resistant microbes and their cytotoxicity was performed on different cancer cell lines. The mechanism of action of purified helminthosporin as well as the potent fraction containing a mixture of two compounds was assessed. Fraction R7C3 was the most potent antibacterial with the lowest MIC value of 0.12 µg/mL. Helminthosporin was the most potent compound with the lowest MIC value of 1.95 µg/mL. The compound was more potent than the antibiotic chloramphenicol against multi-drug resistant (MDR) bacteria with MIC equal to 16 µg/mL. The fraction and helminthosporin were shown to destroy the cell wall of the yeast and bacteria, and DNA fragmentation effect on the genome of Candida albicans and Bacillus cereus. Helminthosporin was the most cytotoxic compound with IC 50  ˂ 10 µM. Fraction R7C3 showed the most potent cytotoxic effects on all cancer cell lines, with IC 50 ranging from ˂1 to 4.35 ng/mL. Our study is the first report on the mechanism of action of helminthosporin, a potent candidate in the development of new drugs against multi-resistant bacteria and cancer cells. In addition, this study uncovered Rumex abyssinicus as a new source of syringic acid and bis(2-ethyloctyl) phthalate., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Leishmaniasis on the Indian subcontinent is thought to have an anthroponotic transmission cycle. There is no direct evidence that a mammalian host other than humans can be infected with Leishmania donovani and transmit infection to the sand fly vector. The aim of the present study was to evaluate the impact of sand fly feeding on other domestic species and provide clinical evidence regarding possible non-human reservoirs through experimental sand fly feeding on cows, water buffalo goats and rodents. We performed xenodiagnosis using colonized Phlebotomus argentipes sand flies to feed on animals residing in villages with active Leishmania transmission based on current human cases. Xenodiagnoses on mammals within the endemic area were performed and blood-fed flies were analyzed for the presence of Leishmania via qPCR 48hrs after feeding. Blood samples were also collected from these mammals for qPCR and serology. Although we found evidence of Leishmania infection within some domestic mammals, they were not infectious to vector sand flies. Monitoring infection in sand flies and non-human blood meal sources in endemic villages leads to scientific proof of exposure and parasitemia in resident mammals. Lack of infectiousness of these domestic mammals to vector sand flies indicates that they likely play no role, or a very limited role in Leishmania donovani transmission to people in Bihar. Therefore, a surveillance system in the peri-/post-elimination phase of visceral leishmaniasis (VL) must monitor absence of transmission. Continued surveillance of domestic mammals in outbreak villages is necessary to ensure that a non-human reservoir is not established, including domestic mammals not present in this study, specifically dogs., Competing Interests: The authors have declared that no competing interests exist.

Background: Cancellation of surgeries is a regular phenomenon in any hospital, and reasons may vary from clinical to managerial ones. The aim of the study is to suggest scheduling to address the problem of time over run related cancellations. This is an observational and descriptive study conducted in a tertiary care hospital with ophthalmology facilities. The sample size is calculated with 95% confidence interval using Epi Info 6 from the total surgeries performed in the last 5 years (n = 380). Simple random sampling technique was used., Methods: Surgical time for all types of ophthalmic surgeries (n = 582) was observed. Allocation of listed cases to the available operating rooms (ORs) was carried out using the observed time using LEKIN software., Results: The time over-run of 2 h and 6 h was noted for two units, whereas idle OR time was observed in other units. An average idle time of 19% was noted on each day. Reallocation of the cases to the ORs was carried out taking all the planned cases (of both the operating units of the day) as the number of jobs and all the available ORs as parallel machines using LEKIN software. All the planned cases could be accommodated; still, an average of 17% of the total available operation theater (OT) time was found idle on each day., Conclusions: Planning of cases using procedure time and scheduling on a daily basis using allocation models with simple algorithms can provide optimal utilization of OTs and can address the time over-run and related cancellations., Competing Interests: The authors have none to declare., (© 2021 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)

Purpose: Leadership skills are vital for efficient delivery of health reforms. India, a low- and middle-income country, is transforming its public health care significantly. The health workforce, particularly doctors, however lacks leadership skills. This study aims to highlight the leadership skills gap and raise concerns about how India might achieve its ambitious health reforms in the lack of formal, prospective leadership training for its workforce., Design/methodology/approach: This study conducted nine management development programmes between 2012 and 2020 and collected data from 416 ( N = 444, 94% response rate) health-care professionals using a questionnaire. Participants were asked to inform leadership challenges that they perceived critical. A total of 47 unique challenges were identified, which were distributed across five domains of American College of Healthcare Executives Competency Assessment Tool (2020). Relevant information was also obtained from review of secondary sources including journal articles from scientific and grey literature and government websites., Findings: Majority of participants (85.36%) had never attended any management training and were from public sector (56.1%). Mean total experience was 18 years. Top 5 challenges were lack of motivation (54.26%), communication (52.38%), contracts management (48.31%), leadership skills (47.26%) and retention of workforce (45.56%). Maximum challenges (29) were in domain of business skills and knowledge, followed by knowledge of health-care environment (9), leadership, professionalism, and communication and relationship management (3 each)., Originality/value: In absence of the leadership training, senior health professionals particularly doctors in India, suffer leadership challenges. Efforts should be made to strengthen leadership capacity in Indian health-care system to advance the country's ongoing national health reforms., (© Emerald Publishing Limited.)

Objective: This study intends to compare the clinical characteristics and the prevalence and spectrum of bacterial pathogens in COVID-19 patients admitted to ICU during the first and second waves at a tertiary care, teaching and referral hospital of eastern India., Method: This is a hospital-based retrospective study which analysed demographic details, clinical profile and bacterial culture results of severe and critically ill COVID-19 patients admitted in intensive care units (ICU) during April -Oct 2020 (1st wave) and April -July 2021 (2nd wave)., Result: The patients admitted during the 2nd wave were comparatively older and had multiple comorbidities compared to the 1st wave. (23.8%) (45/189) and 50% (173/346) of the COVID-19 patients admitted to ICU developed bacterial infection during the 1st and 2nd wave respectively. Overall, there was predominance of multidrug resistant Gram negative bacilli in both the waves. There was increased isolation of intrinsic colistin resistant microorganisms., Conclusion: Multidrug resistant Gram negative bacterial infections, remain a dreaded complication in severe and critically ill hospitalised COVID-19 patients requiring ICU care and high usage of colistin spirals the emergence and spread of pathogens intrinsically resistant to colistin., (© Journal of the Association of Physicians of India 2011.)

Introduction: Small round cell tumors (SRCT) are difficult to sub categorise on fine-needle aspiration cytology (FNAC) samples as they are rare and it is difficult for cytopathologists to obtain enough experience for rendering reliable diagnoses. Various sub categories of SRCTs are morphologically very similar. Many SRCTs do not have specific antigens which could be demonstrated with immunocytochemistry (ICC) or they lose them when poorly differentiated. Besides, cross-reactivity exists between some SRCTs. Suboptimal FNAC sampling from a heterologous component and unstandardized performance of ICC contributes to the pitfalls., Presentation of the Case: A 40-year-old male presented with a swelling measuring 3 cm in diameter on palmar aspect of right-hand. Magnetic resonance imaging suggested cyst of tendon sheath. However, on cytology in combination with ICC, a diagnosis of non-lymphoid small round cells tumor was suggested, with confirmatory diagnosis on histopathology., Conclusion: FNAC assisted with ICC can be a rapid and economical diagnostic tool in cases of high-grade malignant tumors for which early diagnosis is extremely important., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: The recent Covid-19 pandemic has burdened the healthcare facilities, especially in the presence of limited infrastructure. We aimed at applying a queuing model to the Covid-19 screening area so as to optimize the screening services and ensuring that no patient is refused the service., Methods: The mean arrival time of patients, number of physicians, mean screening time and queue characteristics were observed and entered in the M/M/c/K queuing model using R programming to optimize the number of physicians required in the screening area., Results: Considering the mean arrival of 7 patients in 10 minutes and screening of 3 patients in 10 minutes by 1 physician, 2 physicians were assigned. At this capacity, the probability of saturation of the system was 15% with patient loss rate of 1.05 per 10 minutes. Queuing simulation with 3 physicians reduced the patient loss rate to 0.013 per 10 minutes and a saturation probability of 0.2%. However, an increase of arrival rate from 10 to 20 led to an early saturation of the system., Conclusion: Queuing models offer an opportunity for the healthcare providers and hospital administrators to optimize patient care services, especially in critical areas with an ever-changing situation such as the current pandemic.

Background: In the wake of the novel coronavirus pandemic, the closure of educational institutions has imposed a situation of potential gap in learning. Since training of medical and paramedical students is vital in creation of our army of these frontline health-care workers, this study was aimed at comparing the asynchronous and synchronous methods of online teaching for imparting training to students of medical laboratory technology (MLT)., Materials and Methods: This cross-sectional study included 33 students of the 1 st -year batch of MLT course at a tertiary level hospital. Ten lectures each from the subject of biomedical statistics were delivered through asynchronous (lecture shared on WhatsApp group) and synchronous (online live lecture) methods followed by a brief examination for each topic. A short survey was designed to assess the students' perception of clarity of concepts, confidence of solving the examination, and their preference for one of these methods. Appropriate statistical tests were applied to the data., Results: Synchronous method of online teaching was preferred by majority of the students ( P < 0.001). Students' clarity in understanding of the concepts ( P < 0.001) and confidence of the ability to solve examination questions ( P < 0.05) was higher after synchronous teaching. The examination scores after synchronous online teaching were significantly higher ( P = 0.0156) than those for topics covered through asynchronous method., Conclusion: Online teaching, especially the synchronous method, offers an opportunity of continuum of training during crisis situations such as the ongoing novel coronavirus pandemic. The wide availability of internet services and the ever-changing global situation mandates readiness for this modality of teaching, both for the teachers and the students., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Objectives: Fine-needle aspiration cytology (FNAC) of the salivary gland lesions has diverse and sometimes overlapping features that pose a diagnostic challenge for the cytopathologists. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been introduced to bring uniformity in the reporting of salivary gland FNAC and improve the clinic-pathologic communication resulting in better patient management. The aim of the present study was to assess the application of the MSRSGC on FNAC specimens of salivary gland lesions at a tertiary care hospital., Material and Methods: All salivary gland aspiration cytology cases along with histopathology follow-up of salivary gland lesions, wherever available, over a period of 36 months were analyzed and re-categorized according to MSRSGC into six categories and the risk of malignancy (ROM) was computed., Results: Of the 123 patients, 23 (18.69%) were classified as non-diagnostic, 39 cases (31.7%) as non-neoplastic, one (0.81%) as atypia of undetermined significance (AUS), benign neoplasm in 49 (39.8%) cases, uncertain malignant potential in two cases (1.63%), suspicious of malignancy in two cases, and malignant in seven cases (5.69%). Out of 123 cases, histopathological correlation was available in 34 cases, for which the ROM was calculated. The ROM was 0% for non-neoplastic, 11.1% for benign neoplasm, and 100% each for salivary neoplasm of uncertain neoplastic potential, and 100% for malignant categories., Conclusion: In the present study, the distribution of cases according to MSRSGC was comparable with the previous studies. The proportion of cases classified as AUS was within the goal set by MSRSGC at less than 10%. A risk-based stratification of salivary gland lesions in the form of MSRSGC is essential in the present era to guide and alert the clinician about the subsequent management plan and convey the ROM., Competing Interests: The authors declare that they have no competing interests., (© 2021 Cytopathology Foundation Inc, Published by Scientific Scholar.)

Background: Visceral leishmaniasis, also known on the Indian subcontinent as kala-azar, is a fatal form of leishmaniasis caused by the protozoan parasite Leishmania donovani and transmitted by the bites of the vector sandfly Phlebotomus argentipes . To achieve and sustain elimination of visceral leishmaniasis, the transmission potential of individuals exposed to L donovani from across the infection spectrum needs to be elucidated. The aim of this study was to evaluate the relative infectiousness to the sandfly vector of patients with visceral leishmaniasis or post-kala-azar dermal leishmaniasis, before and after treatment, and individuals with asymptomatic infection., Methods: In this prospective xenodiagnosis study done in Muzaffarpur district of Bihar, India, we included patients with clinically confirmed active visceral leishmaniasis or post-kala-azar dermal leishmaniasis who presented to the Kala-Azar Medical Research Center. These participants received treatment for L donovani infection. We also included asymptomatic individuals identified through a serosurvey of 17 254 people living in 26 high-transmission clusters. Eligible participants were aged 12-64 years, were HIV negative, and had clinically or serologically confirmed L donovani infection. During xenodiagnosis, the forearms or lower legs of participants were exposed to 30-35 female P argentipes sandflies for 30 min. Blood-engorged flies were held in an environmental cabinet at 28°C and 85% humidity for 60-72 h, after which flies were dissected and evaluated for L donovani infection by microscopy and quantitative PCR (qPCR). The primary endpoint was the proportion of participants with visceral leishmaniasis or post-kala-azar dermal leishmaniasis, before and after treatment, as well as asymptomatic individuals, who were infectious to sandflies, with a participant considered infectious if promastigotes were observed in one or more individual flies by microscopy, or if one or more of the pools of flies tested positive by qPCR., Findings: Between July 12, 2016, and March 19, 2019, we recruited 287 individuals, including 77 with active visceral leishmaniasis, 26 with post-kala-azar dermal leishmaniasis, and 184 with asymptomatic infection. Of the patients with active visceral leishmaniasis, 42 (55%) were deemed infectious to sandflies by microscopy and 60 (78%) by qPCR before treatment. No patient with visceral leishmaniasis was found to be infectious by microscopy at 30 days after treatment, although six (8%) were still positive by qPCR. Before treatment, 11 (42%) of 26 patients with post-kala-azar dermal leishmaniasis were deemed infectious to sandflies by microscopy and 23 (88%) by qPCR. Of 23 patients who were available for xenodiagnosis after treatment, one remained infectious to flies by qPCR on the pooled flies, but none remained positive by microscopy. None of the 184 asymptomatic participants were infectious to sandflies., Interpretation: These findings confirm that patients with active visceral leishmaniasis and patients with post-kala-azar dermal leishmaniasis can transmit L donovani to the sandfly vector and suggest that early diagnosis and treatment could effectively remove these individuals as infection reservoirs. An important role for asymptomatic individuals in the maintenance of the transmission cycle is not supported by these data., Funding: Bill & Melinda Gates Foundation., (© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.)

Background: An outreach (OR) health-care facility providing broad specialty outpatient services was started by All India Institute of Medical Sciences (AIIMS), New Delhi, in rural area of district Jhajjar, Haryana., Objectives: This study aimed to ascertain the resource requirement for establishing an OR health-care facility and patient satisfaction with regard to the services being provided., Methods: A cross-sectional study was conducted in 2017 at an OR Outpatient Department (OPD) of AIIMS, New Delhi, at Jhajjar. Service delivery model adopted for health-care delivery was hub and spoke. Traditional method of costing was used for economic evaluation. Feedback pro forma of 400 patients who attended OPD services was analyzed to measure health service accessibility., Results: Capital expenditure to set up the facility was calculated to be approximately INR 17,57,49,074/- ($ 2,703,832) and operational cost per year was approximately INR 8,73,86,370/- ($ 1,344,406). Approximate per-patient cost for single OPD consultation was calculated to be INR 874 ($13.45) which included medicines and investigations. High scores for all domains of accessibility of health care were observed., Conclusion: The study provides a preliminary evidence that OR health-care facilities can be instrumental in increasing access to health-care delivery with lesser capital outlays, however, large-scale multicentric studies are needed to arrive at any conclusion. The services have been very well accepted by the local community members being quality medical care with highly subsidized health-care services., Competing Interests: None

Aims: There is limited literature on the outcome of care in intensive care units (ICUs), especially when it comes to neonatal surgical units. Hence, this study was aimed to observe the outcome of care provided in the neonatal surgery ICU (NSICU) at an apex tertiary care teaching institute of North India., Methods: A descriptive, observational study was carried out through retrospective medical record analysis of all the patients admitted in NSICU from January to June 2011., Results: In NSICU, from January to June 2011, 85 patients were admitted. More than two-third (69.9%) patients were admitted through the emergency department. Of the total admitted patients, 69.9% were male. Mean and median age of the admitted patients were 6.31 and 2 days (range 0-153 days), respectively. The most common diagnosis was esophageal atresia with tracheoesophageal fistula (36.1%). Within a day of admission at NSICU, 88% patients underwent surgical intervention. Of the total admitted patients, 56.6% required mechanical ventilation with 3.57 days (range 0-31 days) of mean duration of mechanical ventilation. Reintubation rate (within 48 h of extubation) was observed to be 15.7%, and 27.7% (23) of the patients required vasopressor support during their NSICU stay. Patients who developed postoperative complications were 34.25%, with the most common being wound infection/discharge/dehiscence. Two patients were readmitted within 72 h of their discharge/transfer out from the NSICU., Conclusion: NSICU survival rate was 85.5% and net death rate was observed to be 14.5%. Sepsis was the major reason for mortality in NSICU., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Indian Association of Pediatric Surgeons.)

Purpose: Indian health care system comprising of public and private sectors needs enhancement of medical leadership capacity to face the growing challenges. Hence, this study was designed to evaluate medical leadership competencies of public and private sector doctors., Findings: A survey questionnaire was developed to assess "self-assessed proficiency levels" as well as "perceived importance of competency levels," to which 532 doctors responded-290 (54.5%) from private sector and 242 (45.5%) from public sector hospitals. Statistically significant "leadership competency gap" was observed for all 30 leadership competencies in both sectors, more so in public sector. The 10 most deficient competencies were mainly in the NHS-MLCF domains of "working with others," "managing services," and "setting direction." The most low-rated competency among public sector doctors was "knowledge of HR, procurement, financial, and contract management" while "ability to influence key decision makers who determine future government policies" was most deficient among private sector physicians. Further, deficiencies related to "time and stress management" and "conducting need analysis, identifying and prioritizing requirements" were confined to public and private sector doctors, respectively., Conclusions: This study, first from India, highlights a critical need for medical leadership development programs in both sectors for enhancement of medical leadership capacity in the country., (© 2018 John Wiley & Sons, Ltd.)

Background: The implementation of hospital infection prevention and control (IPC) in south Asia is not well described. We aimed to assess IPC programmes in hospitals in this region and explore opportunities for improvement., Methods: Attendees from hospitals in the South Asian Association for Regional Cooperation (SAARC) region who were at one of four National Initiative for Patient Safety workshops organised by All India Institute of Medical Sciences (New Delhi) from 2009 to 2012 were invited to complete a semi-structured questionnaire. The survey addressed six main components of IPC programmes., Results: We received responses from 306 participants from 82 hospitals. Five key opportunities for improvement emerged: (1) lack of healthcare epidemiologists, (2) relative infrequency of antibiotic guidelines (53%) and prescribing audits (33%) (3) lack of awareness of needle stick injury rates (84%) (4) only 47% of hospitals were prepared for surge capacity for patients with infectious diseases, and (5) limited coordination of hospital infection control personnel with other support services (55%-66%)., Conclusion: These results outline IPC challenges in the SAARC region and may be useful to guide future quality improvement initiatives., Competing Interests: None

This pilot project was preliminary and essential to a larger effort to define the ability of certain human-subject groups across the infection spectrum to serve as reservoirs of Leishmania donovani infection to sand flies in areas of anthroponotic transmission such as in Bihar state, India. This is possible only via xenodiagnosis of well-defined subject groups using live vector sand flies. The objective was to establish at the Kala Azar Medical Research Center (KAMRC), Muzaffarpur, Bihar, India, a self-sustaining colony of Phlebotomus argentipes (Annandale & Brunneti), closed to infusion with wild-caught material and certified safe for human xenodiagnosis. Prior to this endeavor, no laboratory colony of this vector existed in India meeting the stringent biosafety requirements of this human-use study. From March through mid-December, 2015, over 68,000 sand flies were collected in human dwellings and cattle sheds using CDC-type light traps over 254 nights. Blood-fed and gravid P. argentipes females were selected and placed individually in isoline-rearing vials for oviposition, and >2,500 egg clutches were harvested. Progeny were reared according to standard methods, providing a continuous critical mass of F1 males and females to stimulate social feeding behavior. With construction of a large feeding cage and use of a custom-made rabbit restrainer, the desired level of blood-feeding on restrained rabbits was achieved to make the colony self-sustaining and expand it to working level. Once self-sustaining, the colony was closed to infusion with wild-caught material and certified free of specific human pathogens., (© The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Two new species of genus Bactrocera Macquart, namely B. (Sinodacus) brevipunctata David and Hancock, sp. nov. and B. (Bactrocera) furcata David and Hancock, sp. nov., are described from India. B. (B.) aethriobasis Hardy, B. (B.) rubigina Wang & Zhao, B. (B.) syzygii Tsuruta & White and B. (B.) tuberculata (Bezzi) are recorded for the first time from India. Updated keys to twelve subgenera of Bactrocera and Indian species of Bactrocera (Bactrocera) are also provided.

Operating room services are one of the major cost and revenue-generating centres of a hospital. The cost associated with the provisioning of operating department services depends on the resources consumed and the unit costs of those resources. The objective of this study was to calculate the cost of operation theatre services at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. The study was carried out at the operation theatre department of Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS from April 2010 to March 2011 after obtaining approval from concerned authorities. This study was observational and descriptive in nature. Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of operation theatre (OT) services. Cost was calculated under two heads; as capital and operating cost. Annualised cost of capital assets was calculated according to the methodology prescribed by the World Health Organization and operating costs were taken on actual basis; thereafter, per day cost of OT services was obtained. The average number of surgeries performed in the trauma centre per day is 13. The annual cost of providing operating room services at JPNATC, New Delhi was calculated to be 197,298,704 Indian rupees (INR) (US$ 3,653,679), while the per hour cost was calculated to be INR 22,626.92 (US$ 419). Majority of the expenditures were for human resource (33.63 %) followed by OT capital cost (31.90 %), consumables (29.97 %), engineering maintenance cost (2.55 %), support services operating cost (1.22 %) and support services capital cost (0.73 %). Of the total cost towards the provisioning of OT services, 32.63 % was capital cost while 67.37 % is operating cost. The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 54).

Investigations were carried out to assess the generation and disposal of biomedical waste in the various medical establishments in the urban and rural areas of the U.T. Chandigarh. It was found that there were 474 medical establishments in the U.T., Chandigarh including Nursing Homes, Clinics, Dispensaries, Pathological labs., Hospitals, Veterinary Institutions and Animal houses. The total quantity of bio-medical waste generated in Chandigarh is 811.35 kg/day and the rate of generation of bio-medical waste varies from 0.06 kg/day/bed to 0.25 kg/day/bed. Though the major hospitals are equipped with incinerators, proper bio-medical waste management system is yet to be implemented. The medical establishments in the rural area and smaller ones in the urban area dispose off their bio-medical waste along with municipal solid waste and no waste management system exists. It is recommended that an integrated waste management plan using the three incinerators installed at the major hospitals can safely dispose off the total bio-medical waste generated in the city.