Comparison of external and endoscopic endonasal dacryocysto-rhinostomy: a hospital based retrospective study

Background: The aim of the study was to compare and analyze the surgical outcome in doing external dacryocystorhinostomy (Ex-DCR) and endoscopic endonasal dacryocystorhinostomy (En-DCR), at our tertiary care referral hospital of this hilly region of northern India. Design was retrospective and comparative.Methods: A retrospective review of total 106 patients with unilateral or bilateral primary nasolacrimal duct obstruction (NLDO), who had undergone either Ex-DCR or En-DCR surgery that included revision surgeries, with or without silicone tube intubation (STI), for a period of two years from October 2013 to September 2015, were enrolled in this study. Consecutive six months follow up was observed, in all. Surgical outcome was evaluated at each follow up, objectively and subjectively. Statistical data was analyzed using IBM SSPS 23.0 version software. P-value <0.05 was considered statistically significant.Results: Total 111 DCR surgeries (55 Ex-DCR, 56 En-DCR), were performed on 106 primary NLDO patients, including 5 bilateral En-DCR. Mean age for Ex-DCR and En-DCR was 52±17years, 36±18years, respectively. Female preponderance was seen in both the groups (F:M=41:14 in Ex-DCR, 32:14 in En-DCR). Overall, the success rate of DCR surgery was 92.80% (n=103 out of 111). Intergroup success rate was found to be almost similar (Ex-DCR 52/55; 94.54%; En-DCR 51/56; 91.07%, P=1.00), whereas, ultimate success rate considering repeat /revision surgeries following failed DCR (n=8, Ex-DCR-3,En-DCR-5) was 100%. Commonest perioperative and late complication in both the groups were, hemorrhage and rhinostomy scarring, respectively.Conclusions: Success and complication rate of both Ex-DCR and En-DCR surgeries are almost similar after primary DCR surgeries. We emphasize the advantage of doing En-DCR in bilateral NLDO, repeat/revision DCR, NLDO associated with additional intranasal disease, other than its esthetic advantage over Ex-DCR. However, further multicentric randomized controlled studies are required to substantiate our findings.

Aseptic-clinical hand hygiene knowledge survey amongst health care workers in a tertiary care hospital in Western India

Background: Maintenance of hand hygiene among health care workers (HCWs) is the cornerstone of infection prevention and control programmes in a health care facility. Poor hand hygiene amongst HCWs is the single most common cause of cross-transmission of infections between patients and HCWs in the hospital. The objective of this study was to identify the risk factors for non-adherence and assess the knowledge regarding maintenance of hand hygiene amongst health care workers at a tertiary health care centre in Western India.Methods: A descriptive, cross-sectional study was conducted on HCWs - doctors, undergraduate students and staff nurses at a tertiary care hospital and post-graduate institute in western India after ethical committee clearance. A self-report questionnaire by the World Health Organisation (WHO) for the Hand Hygiene Knowledge Survey (2009), which consisted of ten questions and “My 5 moments of hand hygiene”, was answered by the study participants after their written/informed consent. Data was analysed using one-way Anova and Student’s t-tests.Results: 317 participants responded to the survey which included 131 doctors, 111 medical students and 75 staff nurses. 90.85% participants routinely used an alcohol-based hand rub (ABHR) but their overall hand hygiene knowledge score was only 61.04%. Prior formal training in hand hygiene significantly improved the knowledge of HCWs (P<0.001). There was a significant difference between the knowledge and actual practice of “My 5 Moments of hand hygiene”.Conclusions: Hand hygiene knowledge remains unsatisfactory till date amongst HCWs. There is a need to educate HCWs through frequent training session’s right from the time of undergraduate medical study

Direct Measurement of Pyroelectric and Electrocaloric Effects in Thin Films

An understanding of polarization-heat interactions in pyroelectric and electrocaloric thin-film materials requires that the electrothermal response is reliably characterized. While most work, particularly in electrocalorics, has relied on indirect measurement protocols, here we report a direct technique for measuring both pyroelectric and electrocaloric effects in epitaxial ferroelectric thin films. We demonstrate an electrothermal test platform where localized high-frequency (approximately 1 kHz) periodic heating and highly sensitive thin-film resistance thermometry allow the direct measurement of pyrocurrents (<10 pA) and electrocaloric temperature changes (<2 mK) using the “2-omega” and an adapted “3-omega” technique, respectively. Frequency-domain, phase-sensitive detection permits the extraction of the pyrocurrent from the total current, which is often convoluted by thermally-stimulated currents. The wide-frequency-range measurements employed in this study further show the effect of secondary contributions to pyroelectricity due to the mechanical constraints of the substrate. Similarly, measurement of the electrocaloric effect on the same device in the frequency domain (at approximately 100 kHz) allows for the decoupling of Joule heating from the electrocaloric effect. Using one-dimensional, analytical heat-transport models, the transient temperature profile of the heterostructure is characterized to extract pyroelectric and electrocaloric coefficients

The power of narrative persuasion: how an entertainment-education serial drama tackled open defecation and promoted contraceptive use in India

Television and radio serial dramas have been used as an effective entertainment-education (EE) strategy to address complex health and social issues around the world. In this article, we analyse India’s experience with the EE television serial, Main Kuch Bhi Kar Sakti HoonSeason 3 (I, A Woman, Can Achieve Anything, hereafter MKBKSH-3), broadcasted in 2019. Produced by Population Foundation of India, MKBKSH-3purposely employed principles of narrative persuasion to tackle open defecation, promote contraceptive use, and advocate for gender equality in a deeply entrenched patriarchal system. As part of a larger programme evaluation, we conducted data collection using two complementary methods: (1) field experiments in Uttar Pradesh’s Kanpur Dehat district with repeated measures among viewers and non-viewers; and (2) viewer surveys through the popular interactive voice response system with callers from across 28 states and union territories. Wherever possible, we kept questions consistent to help triangulate research findings. Our results indicate a significant increase in toilet ownership and decrease in open defecation among MKBKSH-3viewers. Further, MKBKSH-3’scharacters and storylines helped raise awareness of injectable contraceptives, and viewers—both male and female—displayed an increased likelihood of moving toward adopting contraceptives that were promoted. These empirical findings add to the growing literature on the value of entertainment-education serial dramas as enabling media for social and behaviour change.publishedVersio

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register.

OBJECTIVES: To describe the baseline characteristics of SLE patients requiring biologic therapy in the UK and to explore short term efficacy and infection rates associated with rituximab (RTX) use. METHODS: Patients commencing biologic therapy for refractory SLE and who consented to join BILAG-BR were analysed. Baseline characteristics, disease activity (BILAG 2004/SLEDAI-2K) and rates of infection over follow-up were analysed. Response was defined as loss of all A and B BILAG scores to ⩽ 1 B score with no new A/B scores in other organ systems at 6 months. RESULTS: Two hundred and seventy SLE patients commenced biologic therapy from September 2010 to September 2015, most commonly RTX (n = 261). Two hundred and fifty (93%) patients were taking glucocorticoids at baseline at a median [interquartile range (IQR)] oral dose of 10 mg (5-20 mg) daily. Response rates at 6 months were available for 68% of patients. The median (IQR) BILAG score was 15 (10-23) at baseline and 3 (2-12) at 6 months (P < 0.0001). The median (IQR) SLEDAI-2K reduced from 8 (5-12) to 4 (0-7) (P < 0.001). Response was achieved in 49% of patients. There was also a reduction in glucocorticoid use to a median (IQR) dose of 7.5 mg (5-12 mg) at 6 months (P < 0.001). Serious infections occurred in 26 (10%) patients, being more frequent in the first 3 months post-RTX therapy. A higher proportion of early infections were non-respiratory (odds ratio = 1.98, 95% CI: 0.99, 3.9; P = 0.049). CONCLUSION: RTX is safe and is associated with improvement in disease activity in refractory SLE patients with concomitant reductions in glucocorticoid use. Early vigilance for infection post-infusion is important to further improve treatment risks and benefits

A Multicenter, Randomized, Placebo‐Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods: A randomized, double‐blind, placebo‐controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P 50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results: A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient‐years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low‐density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C‐reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion: Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists’ Collaboration meta‐analysis of statin effects in other populations