Mainstreaming menstrual hygiene management: lessons from a decade of programme and policy work

Proper menstrual hygiene management is integral to the dignity and health of women and girls. However, it is a neglected issue both in the WASH and health sectors, leading to a crisis of knowledge, facilities and hygienic practice. This briefing paper describes the initiatives taken by the Bangladesh country programme of the international non-governmental organisation WaterAid. As one of the pioneers of Menstrual Hygiene Management (MHM) in Bangladesh, WaterAid’s experiences hold important lessons for those currently working on the issue, and looking to take it forward to make sustainable impact

A study on correlation between arthroscopy and MRI in internal derangement of knee

Background: The knee joint is a common site of injury, mainly due to trauma, repetitive activities and sports activities. Multiple imaging modalities are currently used to evaluate pathologic conditions of the knee. Magnetic resonance imaging has a better soft tissue contrast and multi planar slice capability, which has revolutionized and has become the ideal modality for imaging complex anatomy of the knee joint. Another advanced modality in the management of IDK is arthroscopy, which can be used in its dual mode, either as diagnostic and/or as therapeutic tool.Methods: Cases were taken according to inclusion and exclusion criteria i.e., patients with knee problems more than 6weeks old, with symptoms of locking of knee, patients with undiagnosed knee pain and knee injury. Only patients between 15-50 years are included in the study. Patients with signs of infection, with osteoarthritis, ankylosis, and patients on ATT were excluded from the study.Results: In our study of 25 cases, there were 20 male and 5 female patients with age ranging from 15 years to 50 years with most patients in between 21-30 years. 11 cases admitted were sport injuries, 14 had motor vehicle accidents. Right side being more common side affected.Conclusions: In conclusion the present study supports that clinical diagnosis is of primary necessity and MRI is additional diagnosing tool for IDK.

Clinical profile of patients with intertrochanteric fractures of hip attending tertiary care hospital

Background: The hip joint is ball and socket joint. In weight bearing the pressure forces are transmitted to the head and neck of the femur at an angle of 165 degrees to 170 degrees regardless of position of pelvis. The plane of the force coincides with strongly developed trabeculae that lie in the medial portion of the femoral neck and extend upwards through the supero-medial aspect of the femoral head. These trabeculae are in line with similar pressure trabeculae that start at acetabulum and run upwards and medial to sacro-iliac joint.Methods: After the patient with intertrochanteric fracture was admitted to our hospital, all the necessary clinical details were recorded in the proforma prepared for this study. After the completion of the hospital treatment patients were discharged and called for follow-up to outpatient department at regular intervals (6 weeks, 12 weeks, 6 months, 12 months) for clinical and radiological evaluation.Results: The most common age group was in the range of 60 to 70 yrs. Most common mode of injury was trivial fall in this series. 56% of the patients having type II BOYD and GRIFFIN fracture.Conclusions: Most common mode of injury in young patients is the road traffic accident while most common mode of injury in older patients is the simple fall (domestic fall).

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Supernumerary Tooth: A Common Odontostomatologic Anomaly Of Number Of Teeth

Supernumerary tooth (ST) is a developmental disturbance of number of teeth characterized by teeth present in excess of normal dental formula of deciduous or permanent dentition.1,2,3,4 It may occur in either dental arch, maxillary or mandibular.5 Literature has shown marked predilection in maxilla over mandible.6,7 The first documented report of supernumerary teeth has been revealed in human fossils that are approximately 11,000 years old.8</jats:p

Clinical profile of patients with intertrochanteric fractures of hip attending tertiary care hospital

Background: The hip joint is ball and socket joint. In weight bearing the pressure forces are transmitted to the head and neck of the femur at an angle of 165 degrees to 170 degrees regardless of position of pelvis. The plane of the force coincides with strongly developed trabeculae that lie in the medial portion of the femoral neck and extend upwards through the supero-medial aspect of the femoral head. These trabeculae are in line with similar pressure trabeculae that start at acetabulum and run upwards and medial to sacro-iliac joint.Methods: After the patient with intertrochanteric fracture was admitted to our hospital, all the necessary clinical details were recorded in the proforma prepared for this study. After the completion of the hospital treatment patients were discharged and called for follow-up to outpatient department at regular intervals (6 weeks, 12 weeks, 6 months, 12 months) for clinical and radiological evaluation.Results: The most common age group was in the range of 60 to 70 yrs. Most common mode of injury was trivial fall in this series. 56% of the patients having type II BOYD and GRIFFIN fracture.Conclusions: Most common mode of injury in young patients is the road traffic accident while most common mode of injury in older patients is the simple fall (domestic fall).

Comparison of Llevel of improvement in serum albumin after protein supplementation verses standard treatment in patients on maintenance hemodialysis.

Background: Hemodialysis has been shown to increase protein catabolism and led to significant loss of proteins during hemodialysis. Hypoalbuminemia has been associated with adverse outcomes. Therefore, the main aim of this study is to determine the effect of intradialytic protein supplementation on serum albumin in hemodialysis patients.&#x0D; Methods: 116 hypoalbuminemic patients, as defined by the operational definition, on twice per week hemodialysis, from 15.09.15 to 15.03.16, were enrolled after obtaining informed consent. A non-randomized control trial was conducted after dividing the study population was divided into 2 groups; the study group which received 20g oral protein supplementation and the control group which have not received any supplementation. Outcome in terms of improvement in serum albumin was recorded on a predesigned proforma. SPSS version 17 was used for analysis. Effect modifiers were controlled by stratification. Chi square test was used to compare improvement in serum albumin between two groups and also after post stratification.&#x0D; Results: There were total 49 male and 67 female patients. Mean age of total patients was 57.25 years. 94.1% of the patients showed improvement in serum albumin in the intervention group and 56.9% in the control group. Patients of both genders between 46 to 75years, and those dialyzed for a shorter duration showed significant improvement in serum albumin levels.&#x0D; Conclusion: As intradialytic oral protein supplementation significantly improved serum albumin levels, specifically in elderly patients, it is therefore recommended to routinely administer nutritional supplements in hypoalbuminemic hemodialysis patients in order to reduce the overall mortality associated with hypoalbuminemia.</jats:p

Width-Based Cell Transmission Model for Heterogeneous and Undisciplined Traffic Streams

Traffic streams in many developing countries consist of various modes of transport, with high heterogeneity in driver behavior. Modeling these types of traffic streams, in which traffic rules (speed limit, lane discipline, etc.) are not strictly followed, is a complex task. A review of the existing literature shows that there is a lack of traffic flow models that model the behavior of heterogeneous and undisciplined traffic streams. Like other undisciplined traffic streams, there are no speed limits (hence no speed enforcement) on most of the roads in Karachi, Pakistan. Lane discipline is also not observed by drivers, which results in a varying number of traffic lanes on a road. Therefore, most of the existing traffic flow models/simulation packages developed for disciplined traffic streams cannot appropriately model traffic streams without lane discipline. This research proposes a width-based cell transmission model (WCTM) by developing a fundamental flow-density diagram whose parameters are a function of the road width. Extensive field data have been collected from a selected arterial in Karachi for development of the fundamental traffic flow diagram. The values of the computed parameters are significantly different than the values reported in the literature. The piecewise-linear flow-density relation is developed by optimally estimating the breakpoints. Results show that the quadrilateral and pentagonal-shaped fundamental diagrams fit better with the collected data in comparison with the triangular-shaped fundamental diagram. The proposed WCTM is applied to selected segments of an arterial and results show that the WCTM was able to accurately model different traffic conditions. </jats:p