Post cholecystectomy common bile duct dilatation: a study from upper hills of Himachal Pradesh, India

Background: Relationship between cholecystectomy followed by postoperative dilatation of the common bile duct is uncertain. Various studies have shown variable results regarding the dilatation of common bile duct after cholecystectomy.Methods: This study was a 1-year prospective study conducted at IGMC, Shimla with consent and ethical approval from the committee. Total 50 cases of symptomatic cholelithiasis belonging to either sex admitted in Surgical Wards of IGMC Shimla for elective surgery were selected for the present study. Cholecystectomy was done in all cases, after doing all the investigations.Results: The mean preoperative CBD diameter in the study group was 4.2mm, 48 hours postoperatively was 5.58mm and at 1-month interval following cholecystectomy was 6.02mm, so the mean postoperative diameter observed was (6.02+5.58=5.8mm).Conclusions: Significant dilatation does occur in CBD which is purely compensatory as there was no evidence of any pathological dilatation. This dilatation occur only in early post-operative period till the CBD adapts to contain bile equal to the Gall Bladder

Causes, Consequences, and Policy Responses to the Migration of Health Workers: Key Findings from India

Background: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries—Jamaica, India, the Philippines, and South Africa—that have historically been “sources” of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. Methods: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Results: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. Conclusions: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers

Genetic Diversity of Genus \u3cem\u3eAvena\u3c/em\u3e in North Western-Himalayas assessed by Morphological Traits

Oat (Avena sativa L.) is a cool season, annual crop grown mainly in moist areas of temperate climates of the world serving as a food for mankind and forage for cattle. Oat is an important rabi fodder crop in India.In India, oat is also cultivated in Himalayan states like Kashmir, Himachal Pradesh and Uttarakhand. Oat in these regions have a wider adaptability, because of its excellent growing habitat, quick re-growth and better nutritional value (Misri, 2004). Oat breeding programme in Indian regions has not achieved much impetus due to a narrow genetic base of cultivated gene pool within the regionally adapted germplasm. The competition for utilization of land for food grains and fodder necessitates intensified efforts towards more efficient forage research and production, for which it is imperative to characterize and evaluate Avena species in order to identify donors for different traits and diversify primary oat gene pool. Historically, morphological traits have been important in the diversity analysis of crop species. The characterization of germplasm using morphological traits help the plant breeders to select the accessions to be utilized in hybridization programme. Considering the potential forage value of oats and limited genetic information available at morphological level, present study was aimed to assess the genetic diversity of genus Avena using morphological characterization. The information generated from this study will be helpful in characterizing the genus Avena germplasm and in the selection and utilization of diverse genotypes to enhance variability and productivity of commercial oat for future crop improvement endeavors in the Indian North-Western Himalayan region

Correction: Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study

[This corrects the article DOI: 10.2196/31951.]. The corrections will appear in the online version of the paper on the JMIR Publications website on January 18, 2022, with the publication of this correction notice. Because this was made after submission to PubMed, PubMed Central, and other full-text repositories, the corrected article has also been resubmitted to those repositories

Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study.

BACKGROUND: A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community's vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. OBJECTIVE: Our organization is planning an awareness-cum-engagement intervention-door-to-door basic eye checkup and visual acuity screening in VCs coverage areas-to connect with the community and improve the rational use of VCs. METHODS: In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ≤10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. RESULTS: Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. CONCLUSIONS: Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. TRIAL REGISTRATION: ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31951

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Bouveret’s Syndrome: 64-Slice CT Diagnosis and Surgical Management—A Case Report

Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred to as Bouveret’s syndrome. We present a case of gallstone-induced duodenal obstruction in an elderly female patient, diagnosed on a 64-slice MDCT scanner. One-stage surgery, that is, stone removal and cholecystectomy, was performed resulting in relief of obstruction and complete cure. Clinical features, multidetector computed tomography (MDCT) findings, and surgical management are discussed

Estimation of carbon emissions from groundwater pumping in central Punjab

During the past decade, the carbon emission patterns due to groundwater pumping in central Punjab have changed enormously, and today the sector is one of the main contributors of C-emissions. This study identifies the critical blocks of central Punjab that should be aimed for reducing the carbon emissions of the groundwater economy. This study is based on the regional scale and highlights various factors that play crucial role in contributing to these emissions. Overlay analysis of the choropleth maps (tube well density, groundwater draft, groundwater depth and C-emissions) showed that SC-III zone was the most critical zone of central Punjab. Blocks Bhawanigarh, Dharmkot, Malerkotla I, Malerkotla II, Sangrur, Sherpur and Sunam were considered as threat to the environment and should be targeted to reduce C-emissions