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Continued advancements in orthopaedics have led to the development of many new implants; many of these are being utilized in clinical practice with little or no evidence base for their safety or effectiveness. Highly publicized failures in orthopaedic technology have led to an increased awareness of this issue in both medical and non‐medical circles. In most cases, the significant harm caused to the public could have been avoided by the appropriately staged implementation of new implants. This review comments on the current literature regarding the optimal practice for the introduction of new orthopaedic technology. The authors’ experience with the failed ESKA Adapter Short‐stem/Modular Hip is described; the methodology used for its evaluation is used as a basis to discuss what was successful about the process and also give warning on what could be improved upon. The ideal practice requires new orthopaedic implants to be evaluated by high‐volume surgeons in specialist orthopaedic hospitals. These studies should include biomechanical studies, radiostereophotometric analysis, implant retrieval and outcome assessment. Results and complications should be reported early to the appropriate joint registry and regulatory body. Once a suitable evidence base has developed, the implant can be distributed into wider clinical practice or withdrawn. These recommendations aim to protect the patient and public from harm while allowing surgical innovation to still continue. [ABSTRACT FROM AUTHOR]

A series of trans-2,3-dihydrofuro[3,2- c]coumarins ( 4) has been synthesized by a one-pot by aromatic aldehydes, 4-hydroxycoumarin, α-tosyloxyketones, and pyridine using triethylamine as catalysts in acetonitrile. The synthesized compounds were then screened for their antioxidant and anthelmintic activities. [ABSTRACT FROM AUTHOR]

The current article reports on providing surface modification of magnetic nanoparticles with gold to provide stability against aggregation. Gold-coated magnetite nanoparticles were synthesised to combine both magnetic as well as surface plasma resonance (SPR) properties in a single moiety. The nanocomposites were produced by reduction (using ascorbic acid) of gold chloride on to the surface of iron oxide nanoparticles. Ascorbic acid not only acts as a reducing agent, but also the oxidised form of ascorbic acid i.e. Dehydro-ascorbic acid acts as a capping agent to impart stability to as synthesised gold-coated iron oxide nanocomposites. The synthesised nanocomposite was monodispersed with a mean particle size of around 16 nm and polydispersity index of 0.190. X-ray diffraction analysis confirms presence of gold on the surface of magnetite nanoparticles. The synthesised nanocomposites had a total organic content of around 3.2% w/w and also showed a shifted SPR peak at 546 nm as compared to gold nanoparticles (528 nm). Both uncoated and gold-coated magnetite exhibited superparamagnetic behaviour at room temperature. Upon coating with gold shell, saturation magnetisation of iron oxide nanoparticles decreases from 42.806 to 3.54 emu/gram. [ABSTRACT FROM PUBLISHER]

The airway compression poses a challenge for the anesthesiologist in airway management during aneurysm repair surgery. [ABSTRACT FROM AUTHOR]

In several ethnic populations including the relatively non-obese Indian population, the android pattern of body fat, typified by more upper body adiposity measured as waist hip ratio (WHR) was found to be a greater risk factor for type 2 diabetes than general obesity which is calculated by BMI. Various studies have shown that central obesity is common in Indians despite low rates of obesity. This is probably one of the reasons for a higher prevalence of diabetes in urban area To study the Anthropometric Indices & their relationship with diabetes in urban population of Rohtak, Haryana. Population based descriptive type of epidemiological study, design adopted was cross-sectional. Urban field practice area with population of 57000, attached to Dept. of Community Medicine PGIMS, Rohtak. 1003 subjects were selected using simple random sampling through random number table. Various anthropometric indices estimated were Weight, Height, Body Mass Index (BMI), Waist Hip Ratio, Waist Height Ratio. Fasting Blood Glucose estimation was done for detection of Diabetes using ADA criteria. ANOVA, chi square test, percentages & proportions. Out of 1003 study subjects, 81 were detected as diabetics & 103 were diagnosed as pre-diabetics. Mean weight of diabetics and pre diabetics was 65.77 ± 12.94 kg and 66 ± 13.64kg, respectively which was significantly higher than that of non-diabetics 59.59 ± 13.64kg (p < 0.001) implying a strong association of obesity with diabetes. Body mass index (BMI) was high in diabetics (26.11 ± 4.31) as well as pre diabetics (25.68 ± 4.98), classifying them as overweight as compared to normal BMI (22.99 ± 4.20) in non-diabetics. (p< 0.001). Waist hip ratio was highest in diabetics (0.95 ± 0.057) followed by in pre diabetics (0.92 ± 0.069) and was least in non-diabetics (0.89 ± 0.079). (p < 0.001) [ABSTRACT FROM AUTHOR]

Research Question: What is the prevalence of Anaemia in college going youths in a rural block of Haryana? Objectives: To determine prevalence of Anaemia in college going youths in rural block of Haryana. Methodology: Cross-sectional, descriptive at Government College for women in rural block, Lakhanmajra, Dist. Rohtak among 187 college going young women of age group 15 to 24 years.Results:The overall prevalence of anaemia was 60.96%. 114 out of 187 young women had varying severity of anaemia while anaemia was absent in 39.04% of the girls.Out of the 187 girls, 83 (44.38%) were mildly anaemic, 26(13.9%) were moderately anaemic and 5(2.67%) were severely anaemic. Conclusion: The present study revealed anaemia to be a major health problem among the college going girls in rural areas in Haryana. [ABSTRACT FROM AUTHOR]

Aim: This study evaluated and compared the role of newer dental adhesives to bond composite resin to the resin modified glass ionomer (RMGIC) liner. Materials and Methods: Thirty-six specimens were prepared on acrylic blocks, with wells prepared in it by drilling holes, to retain the RMGIC. The specimens were randomly divided into three groups of 12 specimens each. In group I, a thin layer of an adhesive, which was a Total-etch type (Adper Single bond-2), was applied between RMGIC and the composite resin. Ingroup II, a Self-Etch adhesive (Adper prompt-L pop) was applied, and in group III there was no application of any adhesive between RMGIC and the composite resin. After curing all the specimens, the shear bond strength was measured using an Instron universal testing machine. Results: The results were drawn and tabulated using ANOVA-fishers and Tukey's statistical tests. The maximum shear bond strength values were recorded in group II specimens with the self-etch adhesive (Adper prompt-L pop), showing a mean value of 5.826 when compared to the group I adhesive-Total-etch type with a mean shear bond strength of 4.6380, while group III specimens, where no adhesive was used, showed a minimum mean shear bond strength of 2.8385. There was a great and significant difference between group I and group II (P value 0.003), whereas, both group I and group II showed a vast and significant difference from group III (P value 0 - 001). Conclusion: Hence, this present study concludes that application of Self-Etch adhesive (Adper prompt-L pop) in between RMGIC and composite resin increases the shear bond strength between RMGIC and the resin composites, as compared to the Total-etch type adhesives (Adper Single Bond 2), as well as, without application of the adhesive agent. [ABSTRACT FROM AUTHOR]

There is an arising need for effective wound dressings that retain the bioactivity of a cellular treatment, but without the high costs and complexities associated with manufacturing, storing, and applying cell-based products. As skin wound recovery is a dynamic and complicated process, a significant obstacle to the healing of skin wounds is the lack of an appropriate wound dressing that can imitate the microenvironment of healthy skin and prevent bacterial infection. It requires the well-orchestrated integration of biological and molecular events. In this study, we have fabricated full-thickness skin graft biocomposite membranes to target full-thickness skin excision wounds. We reinforced human amniotic membrane (hAM) with electrospun polycaprolactone (PCL) to develop composite membranes, namely, PCL/hAM and PCL/hAM/PCL. Composite membranes were compared for physical, biological, and mechanical properties with the native counterpart. PCL/hAM and PCL/hAM/PCL displayed improved stability and delayed degradation, which further synergically improved the rapid wound healing property of hAM, driven primarily by wound closure analysis and histological assessment. Moreover, PCL/hAM displayed a comparable cellular interaction to hAM. On application as a wound dressing, histological analysis demonstrated that hAM and PCL/hAM promoted early epidermis and dermis formation. Studies on in vivo wound healing revealed that although hAM accelerates cell development, the overall wound healing process is similar in PCL/hAM. This finding is further supported by the immunohistochemical analysis of COL-1/COL-3, CD-31, and TGF-β. Overall, this conjugated PCL and hAM-based membrane has considerable potential to be applied in skin wound healing. The facile fabrication of the PCL/hAM composite membrane provided the self-regenerating wound dressing with the desired mechanical strength as an ideal regenerative property for skin tissue regeneration.

Background: Medical complications during pregnancy, including anaemia, gestational diabetes mellitus and hypertensive disorders of pregnancy place women are at higher risk of long-term complications. Scalable and low-cost strategies to integrate non-communicable disease screening into pregnancy care are needed. We aim to determine the effectiveness and implementation components of a community-based, digitally enabled approach, "SMARThealth Pregnancy," to improve health during pregnancy and the first year after birth., Methods: A pragmatic, parallel-group, cluster randomised, type 2 hybrid effectiveness-implementation trial of a community-based, complex intervention in rural India to decrease anaemia (primary outcome, defined as haemoglobin < 12g/dL) and increase testing for haemoglobin, glucose and blood pressure (secondary outcomes) in the first year after birth. Primary Health Centres (PHCs) are the unit of randomisation. PHCs are eligible with (1) > 1 medical officer and > 2 community health workers; and (2) capability to administer intravenous iron sucrose. Thirty PHCs in Telangana and Haryana will be randomised 1:1 using a matched-pair design accounting for cluster size and distance from the regional centre. The intervention comprises (i) an education programme for community health workers and PHC doctors; (ii) the SMARThealth Pregnancy app for health workers to support community-based screening, referral and follow-up of high-risk cases; (iii) a dashboard for PHC doctors to monitor high-risk women in the community; (iv) supply chain monitoring for consumables and medications and (v) stakeholder engagement to co-develop implementation and sustainability pathways. The comparator is usual care with additional health worker education. Secondary outcomes include implementation outcomes assessed by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), clinical endpoints (anaemia, diabetes, hypertension), clinical service delivery indicators (quality of care score), mental health and lactation practice (PHQ9, GAD7, EuroQoL-5D, WHO IYCF questionnaire)., Discussion: Engaging women with screening after a high-risk pregnancy is a challenge and has been highlighted as a missed opportunity for the prevention of non-communicable diseases. The SMARThealth Pregnancy trial is powered for the primary outcome and will address gaps in the evidence around how pregnancy can be used as an opportunity to improve women's lifelong health. If successful, this approach could improve the health of women living in resource-limited settings around the world., Trial Registration: ClinicalTrials.gov NCT05752955. Date of registration 3 March 2023., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population., Methods/design: This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health ( n  = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers ( n  = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health., Discussion: The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Votruba, Praveen, Mellers, Rajan, Thout, Arora, Malik, Kashyap, Majumdar, Hirst and Maulik.)

This paper explores the causal link between the likelihood of re-migration to cities and the perceived threat of contracting COVID-19 using novel data on male reverse migrant workers in India. We find that reverse-migrants who believe there is a significant chance of contracting COVID-19 display a significantly lower likelihood of returning to their urban workplaces, regardless of their duration of migration. On the other hand, longer-duration migrants display a lower perceived chance of contracting COVID-19 than shorter-duration migrants. We also contribute to the migration literature by linking behavioural attributes to the decision to migrate. We find that more impatient individuals display a heightened belief regarding contracting COVID-19 and a higher projected likelihood of returning to work. Finally, we find that while both loss and risk-averse individuals have a lower projected likelihood of returning to urban workplaces, only loss-averse individuals perceive that their chance of contracting COVID-19 is lower., Competing Interests: None, (© 2023 Elsevier B.V. All rights reserved.)

Purpose: The search for an ideal Hypospadias repair dressing continues. We aimed to develop a hypoallergenic optimized biocompatible dressing (BD)., Method: BD with a multi-layered structure of hydrophilic treated Polypropylene with three-layered technologies; Absorbent-spunlaced hydroentangled polyester/viscose blend, outer Polypropylene, Polyester, Acrylic, and Spandex, with super Absorbent Polymer and Acrylic adhesive. Wistar rat abdominal wound model was divided into two groups: control (normal gauze dressing with adhesive) and Study (BD). The physical properties and wound characteristics were compared., Results: Average mass: thickness of BD was 626.7 ± 5.6 g m -2 : 2.6 ± 0.015 mm. Absorption was 1425.2 ± 127.6%. Percentage desorption of solution A from dressings at 24:40 h was 1249 ± 150%:1417 ± 230%. BD was hydrophilic with no particles/residue after immersion and pH neutral. The average air permeability was 11.6 ± 1.6 cm 3 /cm 2 /sec. The tensile force was 200N-220N with an extension on the breaking point at 24 mm. BD was superior for ease of removability on Day 6 (p = 0.012) and sticking quality (p = 0.036), absorption (p = 0.036), ease of removability(p = 0.036), and sustenance (p = 0.030) on Day 10. BD dressing demonstrated better wound healing (p = 0.015) and decreased redness (p = 0.002) on Day 10. Histopathological healing was better with BD on Day 14(p = 0.025) and Day 20 (p = 0.034)., Conclusion: BD demonstrated better desirable physical and wound healing qualities with less inflammation compared with control normal dressing., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Hygiene is the foundation of health. This communication proposes the concept of glycaemic hygiene, defined as "conditions and practices that help to maintain health, and prevent the development of diabetes mellitus and its complications". Glycaemic hygiene is relevant at the level of the person, the physician and the community. Aspects such as personal hygiene, food hygiene, physical activity hygiene, mental/ emotional hygiene and dental hygiene must be optimized to ensure good health individuals. Skin hygiene, vaccine hygiene and environmental hygiene are equally important in diabetes care. Physicians should ensure pharmacological hygiene, language hygiene and information hygiene to foster good diabetes self-care and management.

In this contribution, we report the fabrication of multifunctional nanoparticles with gold shell over an iron oxide nanoparticles (INPs) core. The fabricated system combines the magnetic property of INPs and the surface plasmon resonance of gold. The developed nanoparticles are coated with thiolated pectin (TPGINs), which provides stability to the nanoparticles dispersion and allows the loading of hydrophobic anticancer drugs. Curcumin (Cur) is used as the model drug and an encapsulation efficiency of approximately 80% in TPGINs is observed. Cytotoxicity study with HeLa cells shows that Cur-loaded TPGINs have better viability percent (~30%) than Cur alone (~40%) at a dose of 30 μg of TPGINs. Further, annexin V-PI assay demonstrated the enhanced anticancer activity of Cur-loaded TPGINs via induction of apoptosis. The use of TPGINs leads to a significant enhancement in generating reactive oxygen species (ROS) in HeLa cells through improved radiosensitization by gamma irradiation (0.5 Gy). TPGINs are further evaluated for imparting contrast in magnetic resonance imaging (MRI) with the r 2 relaxivity in the range of 11.06-13.94 s -1  μg -1  mL when measured at 7 Tesla. These experimental results indicate the potential of TPGINs for drug delivery and MR imaging., (Copyright © 2021. Published by Elsevier B.V.)

Background: Radial head arthroplasty is the preferred surgical management for complex, unreconstructable radial head fractures. There has been increasing use of pyrocarbon prostheses, with potential tribology and modulus advantages over metallic counterparts. This study aims to assess clinical and radiological outcomes for radial head replacement after trauma using a modular, uncemented pyrocarbon prosthesis., Materials and Methods: Between September 2009 and March 2020, a consecutive series of 22 trauma cases were available for review. Patients underwent radial head arthroplasty using a pyrocarbon prosthesis (Ascension Modular Radial Head System, Austin, TX). Recorded outcomes included clinical assessment, radiological evaluation, and patient-reported outcome measures specific to elbow function., Results: Twenty-two patients (7 male, 15 female) with an average age of 51 years (range 21-64) were analyzed with a minimum 12 months of follow-up. All patients had complex radial head fractures, categorized as a Mason 3 or 4 injury. At follow-up, mean elbow range of motion included flexion 130° (range 100°-150°), extension 19° (0-50°), pronation 73° (30°-90°), and supination 70° (10°-90°). The mean Mayo Elbow Performance Index score was 83 (55-100), and Disabilities of the Arm, Shoulder and Hand score was 22 (2.5-60). Radiological evaluation showed 14 patients with asymptomatic proximal neck resorption and two patients with radiological stem loosening. In total, 3 of 22 implants were revised-2 were excised, and 1 revised to a long stem for traumatic implant fracture., Conclusion: Pyrocarbon radial head arthroplasty provided reliable functional results for patients after unreconstructable radial head fracture. The unique potential for fracture of the prosthesis should be considered in long-term follow-up, with appropriate activity advice to patients., (© 2021 Published by Elsevier Inc. on behalf of American Shoulder & Elbow Surgeons.)

Diabetes mellitus has reached pandemic proportions throughout the globe. Though hyperglycaemia is the hall mark feature of diabetes, there are several variations in its etiology, clinical presentation, and associated complications. Some of these variations have been distinctly described in specific regions and ethnicities across India and other regions in the world. In this commentary we describe these endemic syndromes associated with diabetes to improve their awareness, recognition and management. A focused attention on these relatively neglected clinical challenges would encourage future discussion and research to address these conditions.

Background: Diabetic foot ulcer (DFU) is one of the most dreaded complications of Type 2 Diabetes Mellitus (T2DM). Preventive podiatry is most efficient way of minimising DFU. The main aim of the study was to assess the knowledge and foot care practices among patients living with T2DM concerning the DFU., Materials and Methods: We conducted a cross-sectional study in a rural-area of Haryana, India between January to March 2019 amongst 416 people living with T2DM after using multistage random sampling. A pre-tested, structured survey instrument prepared from the recommendation of the American College of Foot and Ankle Surgeons and the Diabetes UK was used after Hindi translation as per standard protocol. The knowledge and practices were classified as good, satisfactory and poor if the total score was between 8-11, 6-7 and <6., Results: 14.2% had a previous history of DFU. The prevalence of good, satisfactory and poor knowledge was 63.5%, 12.5% and 24.0%. Further, 46.7%, 32.7% and 20.6% respondents depicted good, satisfactory and poor practices regarding foot care. On multivariate binary logistic regression analysis, younger age group, higher education, Per capita family income in INR, Blood glucose levels, HbA1c Levels, physical activity and previous history of DFU emerged as significant predictors of good foot-care knowledge and practices., Conclusion: There is an evident gap between foot-care knowledge and practices that should be addressed through comprehensive behaviour change strategies. Comprehensive risk-assessments for diabetes associated complications needs to be piloted at community level to assess the feasibility., (© Journal of the Association of Physicians of India 2011.)

This opinion piece discusses the concept of social insulin resistance, and helps create a comprehensive biopsychosocial model of insulin resistance. Social insulin resistance is defined as a negative attitude, present in some social groups, directed towards avoidance or rejection of insulin therapy. The various aspects of social insulin resistance are described in detail. This important construct has both clinical and public health relevance, and will help plan strategies to improve the acceptance and usage of insulin in diabetes care.