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Purpose Globally, spine disorders are the leading cause of disability, affecting more than half a billion individuals. However, less than 50% of G20 countries specifically identify spine health within their public policy priorities. Therefore, it is crucial to raise awareness among policy makers of the disabling effect of spine disorders and their impact on the economic welfare of G20 nations. In 2019, SPINE20 was established as the leading advocacy group to bring global attention to spine disorders. Methods Recommendations were developed through two Delphi methods with international and multi-professional panels. Results In 2022, seven recommendations were delivered to the leaders of G20 countries, urging them to: Develop action plans to provide universal access to evidence-based spine care that incorporates the needs of minorities and vulnerable populations. Invest in the development of sustainable human resource capacity, through multisectoral and inter-professional competency-based education and training to promote evidence-based approaches to spine care, and to build an appropriate healthcare working environment that optimizes the delivery of safe health services. Develop policies using the best available evidence to properly manage spine disorders and to prolong functional healthy life expectancy in the era of an aging population. Create a competent workforce and improve the healthcare infrastructure/facilities including equipment to provide evidence-based inter-professional rehabilitation services to patients with spinal cord injury throughout their continuum of care. Build collaborative and innovative translational research capacity within national, regional, and global healthcare systems for state-of-the-art and cost-effective spine care across the healthcare continuum ensuring equality, diversity, and inclusion of all stakeholders. Develop international consensus statements on patient outcomes and how they can be used to define and develop pathways for value-based care. Recognize that intervening on determinants of health including physical activity, nutrition, physical and psychosocial workplace environment, and smoking-free lifestyle can reduce the burden of spine disabilities and improve the health status and wellness of the population. At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. Conclusion SPINE20 advocacy efforts focus on developing public policy recommendations to improve the health, welfare, and wellness of all who suffer from spinal pain and disability. We propose that focusing on facilitating access to systems that prioritize value-based care delivered by a competent healthcare workforce will reduce disability and improve the productivity of the G20 nations.

Background Various micronutrients are needed in pregnancy for growth of baby, preventionof disorders which affect mother and baby. Thiamineis one such micronutrient. Pregnantwomen have greaterrisk of deficiency. Research continues. Objectives: Study was conducted to know effects of high dose Thiamine ‘Megathiamine’ for prevention of pregnancy specific disorders, better maternal neonatal outcome so as to be able to use knowledge for maternal - neonatal health promotion even with limited resources as Thiamine does not cost much. Material Methods Study subjects were women with 14±2 weeks pregnancy who presented for prenatal care, had no medical, obstetric disorder at inclusion in study, no contraindication to Thiamine. End point was one week beyond birth. Study subjects,1200 women were divided into two Groups A, B. Each arm with 600 women was given Megathiamine or Placebo in triple blinded way. Women who received Megathiamine or Placebo (known only to pharmacologist not part of care providers ) were followed, up to one week post birth till there were 500 births in each arm . Results After completion of study and analysis of results, decoding revealed that anaemia was almost in double numbers in women who received Megathiamine than those who received Placebo(10 vs 5), Oligohydramnios, Fetal Growth Restriction(FGR) and Hypertensive Diseasesof Pregnancy (HDsP) were not different in both groups.In Megathaimine grouppreterm births and LBW were more than placebo 55 (38.4Percentage) vs 44 (33.88Percentage), respectively in Megathaimine, placebo groups. Admissions to Neonatal Intensive Care Unit (NICU) were more is Megathaimine group comparedto Placebo (45 (0.9Percentage) vs 23 (4.6Percentage). Conclusion Present study revealedthat Megathiamine had no benefitto mother or baby. Excessof Thiamine lead to ill effects in mothers, babies

Good health of bones is of the utmost importance to human beings. Smart materials like lead zirconate titanate (PZT) patches are small in size and carry less weight, which makes them most apt for biomedical structural health monitoring (BSHM). In the past, focus on the development of low-cost non-invasive techniques for real-time monitoring of critical bones has been undertaken as an alternative to current diagnosis techniques such as dual x-ray absorptiometry (DEXA), which is not portable and emits radiations. This paper presents a study to evaluate a previously developed non-bonded piezo sensor (NBPS)-based diagnostic technique for non-invasive detection of osteoporosis, in the framework of the electro-mechanical impedance (EMI) technique. As part of the study, the experimental trials in the paper are performed for comparing DEXA and bone electro-mechano gram (BEMG) on healthy subjects as well as those with osteoporosis. It was found that BEMG identified structural system for healthy and osteoporotic subjects were quite different leading to a new technique to identify osteoporosis.

Purpose The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. Methods On September 17–18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. Results In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. Conclusions SPINE20’s initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Ehlers-Danlos is a connective tissue disorder characterized by hypermobile joints, hyperextensible skin, and increased bleeding tendency. We report a case involving endovascular repair of an intussusception of aortic dissection that occurred in an Ehlers-Danlos patient following surgical repair of an intercostal artery bleed. Given the rarity of Ehlers-Danlos, continued reporting of treatment outcomes is important for refining complication management in this population. Our experience lends support for endovascular rescue of failed aortic repair that may arise in Ehlers-Danlos patients and contributes to the otherwise small body of literature concerning endovascular intervention in this population overall.

Background: Postmortem interval estimation is an important tool in forensic medicine. Estimating time since death is extremely important in cases where there is doubt about the period of death. After death, many changes occur in a regular sequence and can be used to arrive at an approximate time since death. When a post-mortem is conducted, doctor conducting the post-mortem examination has to give his opinion about post-mortem interval i.e. the probable time that elapsed between death and post-mortem examination even in cases of decomposed dead bodies. While giving this opinion, we always think we should have some other dependable methods to be more accurate in answering this question. Algor mortis, Rigor mortis, and Livor mortis have been the basis for ascertaining the post-mortem interval collectively. Among them, Rigor Mortis is an important indicator of post-mortem interval. Although it is a dependable tool for estimating post-mortem interval, it is influenced by many endogenous and exogenous factors like nature of death, nature of the body, temperature, humidity etc. Time of death is almost always asked by investigating authorities to connect the crime with criminals. Determining the death time has always been a topic of keen interest amongst forensic pathologists from its inception to date. Many workers in forensic medicine have tried to investigate to determine the time of death based on post mortem findings. To date, it is still an important and fascinating criterion to ascertain the time since death. With this study, we aimed to demonstrate the intricacies of Rigor Mortis with fluctuating temperature and humidity of the local region. We planned to estimate and compare the post-mortem interval based on Rigor Mortis in different body muscles. Materials and Methods: This study was conducted in the Department of Forensic Medicine and Toxicology at G.G.S. Medical College, Faridkot after taking clearance from the institutional ethics committee. Thirty medico-legal autopsy cases were included in the study where the exact time of death was known and included only hospital deaths. The relatives of the deceased were explained the purpose and nature of the study and provided with the patient information sheet and informed consent was taken. The details of the cases were noted from the hospital bed head ticket, relative interview and the police inquest papers. The exact temperature and humidity were noted at the start of autopsy using a digital hygrometer. Results: A total of 30 cases were observed out of which males outnumbered the females by approximately 3:1. Maximum cases consisted of Roadside Accidents (43.3%) followed by poisoning, assault and hanging, in that order. The average temperatures during the study months varied from a maximum of 41.3°C (June) to a minimum of 33.7°C (July). The average humidity varied from a maximum of 62.6% (July) to a minimum of 29.3% (May). The average temperatures during the study months varied from a maximum of 41.3°C (June) and a minimum of 33.7°C (July). The average humidity during the study months varied from a maximum of 62.6 % (July) and a minimum of 29.3% (May). Fully established Rigor Mortis was observed at a minimum of 10 hours and a maximum of 29 hours in May and June.

Stability indicating high performance liquid chromatography (HPLC) method was developed for the assay of Tenofovir in bulk and solid dose formulation. The HPLC separation was achieved on kromasil C18 (100mm × 4.6mm, 5 μm) column using a mobile phase of Methanol: Potassium dihydrogen orthophosphate buffer (30:70,v/v) at a flow rate of 1 ml min-1 and UV detection at 260 nm. Peak elutes at 7.33 appropriate. The method was validated for linearity, repeatability, accuracy, precision, robustness, limit of detection and limit of quantification. The accuracy was between 99.14 - 99.97%. The highest R.S.D. amongst interday and Intraday precision was found 0.808 and 0.473 respectively.The assay was linear over the concentration range of 10-50 μg/ml (R≈0. 999). The method was robust as no significant change in chromatographic parameters. LOD and LOQ was found to be 0.90 and 2.71 respectively. The stress studies were performed per ICH guidelines to confirm its Stress testing was carried out in presence of acid, base, hydrogen peroxide, heat and light to demonstrate specificity of the method as per ICH guidelines. The developed method could separate the potential degradation products from the Tenofovir peak. It was concluded that highest degradation occurs in basic condition. This proposed method was suitable and practical for analysis the content of Tenofovir in pharmaceutical products and could be of benefit for the prediction shelf life of Tenofovir in marketed formulations.

Study Design: A cross-sectional design. Objectives:This is an exploratory study to better understand how individuals with SCI in these diverse countries are managing and coping with bladder and bowel dysfunction. Setting: Our project is a collaboration between two centers: the International Collaboration on Repair Discoveries (ICORD)/Blusson Spinal Cord Center in Vancouver, Canada and the Indian Spinal Injuries Centre in New Delhi, India. Methods: Data from thirty-three participants was analyzed. Participants completed an online questionnaire that included demographic information and assessed bowel and bladder functioning using the Neurogenic Bowel Dysfunction (NBD) score, Wexner Incontinence score (WIS), Neurogenic Bladder Symptom Score (NBSS) and the Incontinence QOL (I-QOL). Continuous data were compared using t-tests; for not normally distributed data Mann-Whitney U tests used. For evaluation of association between categorical variables, Fisher’s exact test or Chi-square was used. Results: The Canadian sample reported higher NBD total scores indicating more severe bowel dysfunction, less daily bowel movements, and was more likely to experience uneasiness, headaches, and perspiration during bowel movements. The NBSS indicated a higher proportion of the Indian sample was unsatisfied or unhappy with their bladder function. The distribution of the WIS and I-QOL scores were the same across both countries. Conclusion: Potential explanations for differences include diet, methods of management, financial resources, as well as patient and caregiver education. These variables are heavily influenced by cultural, geographical, and economic circumstances.

Background: Ultrasonography (USG) has become part of everyday care of pregnant women in most of the countries of the globe. However like any other technology, it has potential to raise social, ethical, economic dilemmas about benefits, challenges for health providers, beneficiaries of the services. Awareness, utilization of USG by rural tribal women who live in extreme poverty with access problems is not well known. Objective: Community based study was carried out to know awareness of USG amongst rural, tribal, preconception, pregnant women and use of USG during pregnancy. Material methods: Study was conducted in tribal communities of 100 villages where community based mother child care services were initiated after having developed a health facility in one of 100 villages. Total 2400 preconception, 1040 pregnant women of 15-45 years, were interviewed in villages for knowing their awareness about USG, whether pregnant women had USG during pregnancy. Results: Of 2400 preconception women, 626 (26.08%) were not aware of sonography. Of those who knew, 694 (39.1%) said sonography helped in confirmation of pregnancy, 1080 (60.88%) said it helped in knowing fetal age and position. Of 1040 pregnant women also 271 (26.1%) were not aware of USG. Those who knew, sources of information, were Accredited Social Health Activists (ASHAs) in 208 (27%), nurse midwives in 170 (22.1%), family members in 311 (40.4%), doctors in 80 (10.4%). Only 258 (33.5%) of 769 women who knew about USG had got USG done. Of them 82 (31.8%) were told that something was wrong without any details. Conclusion: Study revealed that many rural tribal women did not even know about USG. Community health workers, ASHAs did create awareness of USG in some. Only 25% pregnant women had USG done but without knowing any details of findings.

Quality by design (QbD) is utilized in the event of pharmaceutical processes to create certain predefined product quality. QbD ideas unit of measurement explained in International Conference on Harmonization (ICH) pointers Q8 (R1) (Pharmaceutical development), Q9 (Quality risk management [QRM]), and Q10 (Pharmaceutical quality system). ICH Q8 (R1) guideline defines QbD as “a systematic approach to develop that begins with predefined objectives and emphasizes product and methodology, understanding, and methodology management, supported sound science and QRM.” QbD approach studied the implications of various input variables (e.g. methodology parameters, and materials) of the merchandise development methodology, on the final word product (active pharmaceutical ingredient or drug product). The late QbD approach integrates the principles of QRM, and methodology analytical technology (PAT). QbD combined with methodology analytical technology (PAT) tools modify methodology management and increase assurance that the merchandise quality attributes unit of measurement achieved consistently. An integrated and risk-based approach for review of the merchandise development methodology is also a future need of the QbD plan. Although implementing the QbD approach is not a restrictive demand, restrictive agencies to supply flexibility in their pointers for producing that unit of measurement developed by the QbD approach. Rising trends embody the growing interest in quantifying and managing the impact of raw materials’ attributes variability of methodology and product, what is more, as a result of the event of retrospective QbD approaches in complement to simple QbD. Thus, the QbD approach is also a tool for developing worth effective and quality pharmaceutical products.

Together, SARS-CoV-2 and M. tuberculosis have killed approximately 5.7 million people worldwide over the past 2 years. The COVID-19 pandemic, and the non-pharmaceutical interventions to mitigate COVID-19 transmission (including social distancing regulations, partial lockdowns and quarantines), have disrupted healthcare services and led to a reallocation of resources to COVID-19 care. There has also been a tragic loss of healthcare workers who succumbed to the disease. This has had consequences for TB services, and the fear of contracting COVID-19 may also have contributed to reduced access to TB services. Altogether, this is projected to have resulted in a 5-year setback in terms of mortality from TB and a 9-year setback in terms of TB detection. In addition, past and present TB disease has been reported to increase both COVID-19 fatality and incidence. Similarly, COVID-19 may adversely affect TB outcomes. From a more positive perspective, the pandemic has also created opportunities to improve TB care. In this review, we highlight similarities and differences between these two infectious diseases, describe gaps in our knowledge and discuss solutions and priorities for future research.

This review article covers a combination of aspects of the sole entity which defines the quality of products in the pharmaceutical sector. Quality audit is one of the essential elements of ISO 9001 quality system standards. It assures that an organization has distinctly defined a quality system to manufacture the quality products and work according to it. Concession or negotiation in quality of pharmaceutical products would directly impact the health of patients so audits are performed at specified time interval to ensure the quality as it is benefaction for the companies towards gaining loyalty from customers, maintain regulatory standards, long term revenue and profit. Regulatory bodies have their standard assessment tools termed Audits and Inspection, which reviews and evaluates various records, systems, and procedures followed in an organization. Most of the articles glorify that the quality audits mainly involve documented examinations and verification of all the processes and activities routinely performed, leading to ensure the required quality standards. The article is a result of a collection of data about the principles and objectives of quality audit and the benefits it provides to the respective firm by following the proper audit plan, procedures, corrective actions, and follow up making us aware of methods of gathering information for an audit, a brief knowledge of audit closure meetings, reports and basic criteria for selecting the auditor. Auditors play an important role to guarantee their organization’s consistency with pharmaceutical United States Food and Drug Administration and current Good Manufacturing Practices guidelines and other quality standards like ICH Q10. The article also describes the deficiencies occurring during and after the audit and a case study regarding the audit. The figures represented in the given article comprises the basic principles of audit, types of audits, steps of conducting an audit efficiently, audit management, and flow cycle of audit which gives an overall idea of the running of audit in a consistent manner to check the product meets the regulatory requirements, expected results and patient’s compliance.

Background Induced abortions are globally sought, whether permitted, or not permitted. Community based information about abortion seeking by rural tribal women is scarce. Objectives Community based study was carried out to know the magnitude, profile, reasons, places, persons performing IA for rural tribal women. Material Methods Study was conducted in 118 villages to get the study subjects . Women from every fourth house were interviewed for desired information. Results and Conclusion Of all abortions, 2.17% in Melghat and 24.38 %in Sewagram were IA. Most women who had IA were young and 19% in Melghat region, 2.6% in Sewagram region were illiterate. Majority of Sewagram region, were housewives of low middle class, in Melghat unskilled workers of low economic class. In Melghat region all women reported seeking IA at health facilities,63% Private hospitals (PH), 18.5% Sub centres (SC), 7.4% Medical College (MC), 7.4% District hospital(DH), 3.7% Primary Health Centres (PHCs) and In Sewagram region 58% PH, 23% MC, 6.7% PHCs, 3.9% DH, 3.9% SCs and 3.9% at home. Most women said they had IA for spacing with no contraceptive use or contraceptive failure, poor health, poverty, IA were done medically in 76.2%, surgically 23%. No sex–selective IA were reported and there was no evidence Many women lacked awareness and had misconceptions, more so in Melghat region. In focus group discussions, common reasons for disfavoring IA were personal beliefs (34%), practice restrictions (19%). There was extreme poverty, still PH were used. Lot of awareness is required.

A recent design paradigm seeks to overcome the challenges associated with broadly exploring a design space requiring computationally expensive model evaluations by formally viewing design as a sequential decision process (SDP). With the SDP, a set of computational models of increasing fidelity are used to sequentially evaluate and systematically eliminate inefficient design alternatives from further consideration. Key to the SDP are concept models that are of lower fidelity than the true function and are constructed in such a way that when used to evaluate a given design, they return two-sided limits that bound the precise value of the decision criteria, hence referred to as bounding models. Efficiency in the SDP is achieved by using such low-fidelity, inexpensive models, early in the design process to eliminate inefficient design alternatives from consideration after which a higher fidelity, more computationally expensive model, is executed, but only on those design alternatives that appear promising. In general, low-fidelity models trade off discriminatory power for computational complexity; however, it can be demonstrated that knowledge of the underlying physics and/or mathematics can be used to increase the discriminatory power of the lower fidelity models for a given computational cost. Increasing the discriminatory power of the bounding models directly translates into an increase in the efficiency of the SDP. This paper discusses and demonstrates how knowledge of the underlying physics and/or mathematics, otherwise referred to as “problem-specific knowledge,” such as monotonicity and concavity can be used to increase the discriminatory power of the bounding models in the context of the SDP and for engineering designs characterized by demand and capacity relationships. Furthermore, the concept of constructing the bounding models to systematically defer decisions on a subset of design variables, for example for a subsystem, is demonstrated, while retaining the desirable convergence guarantees to the optimal set. The utility of leveraging knowledge to increase discriminatory power and systematically deferring decisions through bounding models in the context of the SDP is demonstrated through two design problems: (1) the notional design of an engine-propeller combination to minimize takeoff distance for a light civil aircraft, and (2) the design of a building’s seismic force resisting structural-foundation system where the performance is evaluated on the basis of minimizing drift and total system cost.

We measured ambient submicron aerosol at an urban background site in Austin, Texas in June 2018 (summer) and October–November 2014 (fall). We report the NR-PM1 (non-refractory particulate matter wi...

This case series looks at the role of intraoperative ultrasound in spine surgery for extradural pathologies.Ten cases of different pathologies were included. Following posterior laminectomy, intraoperative ultrasound was used to determine the adequacy of decompression. The surgical approach and extent of surgery was then determined on the basis of ultrasound observations. Postoperative magnetic resonance imaging was done to correlate the ultrasound findings.We found intraoperative ultrasound to be a useful tool that is easy to use and interpret in spine surgery. The adequacy of decompression was well visualized. The finding also correlated with the decompression achieved on a postsurgery magnetic resonance imaging scan.Intraoperative ultrasound is a useful tool in routine spine surgery. It is effective and easy to read to determine decompression for various pathologies including disk herniation, epidural abscess, tumors, and deformity and reconstructive surgeries. This simple tool can help plan surgeries.