Comparative study between Blair’s procedure of ankle fusion and arthroscopic ankle arthrodesis

Background: Our objective was to perform a comparative study in terms of functional outcome of Blair’s procedure of ankle fusion versus arthroscopic methods of ankle fusion.Methods: 25 patients that underwent arthroscopic ankle arthrodesis versus Blair’s procedure of ankle fusion were taken for study at government medical college, Srinagar (VCSGGIMS and R) from the duration 2015-2021. Clinical assessment was done foot and ankle disability index and visual analog scale score for pain. Radiological assessment was done by serial X-rays. Regular follow-ups were taken till one year.Results: Both modalities proved to be equally effective in terms of patient’s functional outcome. Our analysis showed that Blair’s procedure ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, p=0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, p<0.00001), and longer length of stay (MD 1.60,95% CI 1.10-2.10, p<0.00001) compared to arthroscopic ankle fusion; however, there was no significant difference between two groups in terms of infection rate (OR 2.41, 95% CI 0.76-7.64, p=0.14), overall complication rate (OR: 1.54, 95% CI 0.80-2.96, p=0.20), and operation time (MD 4.09, 95% CI 2.4910.66, p=0.22).Conclusions: We found no significant difference between two groups in terms of infection rate, overall complication rate, and operation time. Further high quality randomized controlled trials that are adequately powered are required

Awareness and Pattern of Tobacco Use among the Medical Students of Government Medical College

Introduction: Nearly 6 million people die due to tobacco every year and this figure will increase to 8 million tobacco-attributed deaths per year by 2030 with 80% of them occurring in developing countries. Objective: To study the awareness and pattern of tobacco use among the undergraduate medical students of Government Medical College, Haldwani. Material and Methods: A Cross-sectional study was conducted among 303 medical students using a predesigned and pretested, semi-structured self-administered anonymous questionnaire. Data was analyzed by using SPSS v 16. Results: Among 303 participants, 44(14.5%) were smokers.  Majority of the students (97.73%) were more than 20 years of age at the time of initiation of tobacco use. Cigarette smoking was most common form (79.55%) of abuse. Male students were using tobacco significantly higher than that of females (?2=36.68). The effect of parental tobacco use on tobacco consumption habits of the users were significantly higher than non-tobacco users (?2=180.75). The tobacco consumption was significantly increased among the senior students as compared to that among the juniors (?2=15.29). Awareness about harmful effects of tobacco abuse was very high (90.76%) and mainly they got knowledge from media. 84.16% students support ban on tobacco use in public places. Conclusion: We can conclude that though the awareness among medical students regarding harmful effects of tobacco use was very high but they got this knowledge mainly from the electronic media, so it is necessary to introduce teaching on tobacco dependence and cessation early in the courses of the medical colleges

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Public health cadre in India: The need of the hour

India has made considerable progress in public health since independence including eradication of small pox, poliomyelitis, guinea worm, and elimination of yaws, leprosy and neonatal tetanus from the country. The strategies of the National Rural Health Mission have resulted in significant improvements in key health indicators like institutional deliveries, full immunization, and availability of diagnostic and family welfare services in many states of the country. However, the country’s health system continues to faces many challenges. Population of India as per census 2011 stood 1210 million.1 The demographic transition of the country has been relatively slow, so the population ages slowly. Because of epidemiological transition, the county is facing double burden of communicable as well as non-communicable diseases. The rates of coronary heart disease (CHD) have increased rapidly in India recently which is also attributed partly to a demographic transition. The country is facing other several public health problems. In 2012, the infant mortality rate (IMR) was 42/1000 live births and there was a huge gap between IMR of rural (46/1000 live births) and urban (28/1000 live births), while the maternal mortality ratio was 178/100,000 live births.2 According to National Family Health Survey (NFHS-3), nearly 50 % of children under 5 years age have protein energy malnutrition of various grades

Effect of supportive supervision on the process of indenting and stock management by senior nursing ward in-charges at a tertiary care hospital in Garhwal region of Uttarakhand, India

Introduction: The duties of nursing administration include tasks such as placing orders, conducting regular checks on ward supplies, and ensuring regular updation of the stock register. This study assesses the effect of a supportive supervision strategy on the process of indenting and stock management by senior nursing ward in-charges and the barriers faced by them during the discharge of this duty. Methods: A cross-sectional study with mixed-method approach was conducted. Senior nursing officers were administered structured questionnaires and in-depth interviews for the quantitative and qualitative approaches, respectively. Quantitative analysis was done using statistical software and qualitative content analysis was done manually for the audio recorded and transcribed in-depth interviews. Results: The availability, legibility, accuracy, completeness, chronology, continuity, timeliness, safety, etc., of records, saw improvements on successive follow-up visits. On analyzing the in-depth interviews, administrative and management issues such as constantly changing personnel, unsystematic handover process, and problems related to supply chain and disposal came up. Work-related issues, such as lack of training, workload pressure, as well as staff-related and personal issues, were also identified. Conclusion: Transfers of designated senior nursing ward in-charges should be avoided if possible. In case done, the process of proper charge transfer should be followed. Issues such as the lengthy process of indenting and lack of training of nursing staff should be addressed. Incentivizing such work should be encouraged along with increasing autonomy for handling wards by senior nursing officers. Communication with all the stakeholders should be improved

Prevalence of hypertension and its risk factors among individuals attending outpatient department of rural health training centre, Haldwani

Introduction: Hypertension is one of the major health and development challenges of the 21st century, which, for most countries, has developed together with rapid cultural and social changes, ageing populations, increasing urbanization, dietary changes, reduced physical activity, and other unhealthy behaviours. Objectives: 1) To find out the prevalence of Hypertension in study subjects 2) To identify the risk factors associated with Hypertension. Materials and Methods: A Cross-sectional study was carried out among 369 individuals of 30 years and above attending Out Patient Department (OPD) in Rural Health Training Centre (RHTC) under the Department of Community Medicine, Government Medical College, Haldwani during June 2013-August 2013. A pretested predesigned questionnaire was used to collect demographic data by interview technique .The blood pressure was recorded and classified using JNC VII criteria to grade hypertension. Data was compiled, entered & analyzed using SPSS version 20. Results: Among 369 patients, the prevalence of hypertension was 41.7%; out of this, 28.7% were aware of their hypertensive status while 13% were newly diagnosed cases. The association between hypertension with increase in age, family history of hypertension, increase salt intake, consuming mixed diet, increase waist circumference, waist hip ratio and body mass index was found significant. Physical inactivity, gender, tobacco and alcohol consumption were not significantly associated with hypertension. Conclusions: The prevalence of hypertension in rural area is relatively high. Extensive efforts are required for raising the awareness level & regular screening of high-risk population is recommended for preventing the complications & disability

Awareness and Pattern of Tobacco Use among the Medical Students of Government Medical College

Introduction: Nearly 6 million people die due to tobacco every year and this figure will increase to 8 million tobacco-attributed deaths per year by 2030 with 80% of them occurring in developing countries. Objective: To study the awareness and pattern of tobacco use among the undergraduate medical students of Government Medical College, Haldwani. Material and Methods: A Cross-sectional study was conducted among 303 medical students using a predesigned and pretested, semi-structured self-administered anonymous questionnaire. Data was analyzed by using SPSS v 16. Results: Among 303 participants, 44(14.5%) were smokers.  Majority of the students (97.73%) were more than 20 years of age at the time of initiation of tobacco use. Cigarette smoking was most common form (79.55%) of abuse. Male students were using tobacco significantly higher than that of females (ᵡ2=36.68). The effect of parental tobacco use on tobacco consumption habits of the users were significantly higher than non-tobacco users (ᵡ2=180.75). The tobacco consumption was significantly increased among the senior students as compared to that among the juniors (ᵡ2=15.29). Awareness about harmful effects of tobacco abuse was very high (90.76%) and mainly they got knowledge from media. 84.16% students support ban on tobacco use in public places. Conclusion: We can conclude that though the awareness among medical students regarding harmful effects of tobacco use was very high but they got this knowledge mainly from the electronic media, so it is necessary to introduce teaching on tobacco dependence and cessation early in the courses of the medical colleges

A new pyrrolyl-pyranone based AIEgen with solution solid dual emissive property

192-199The design and synthesis of organic molecules having aggregation induced emission (AIE) property has been a prime area of research in recent years. In this regard, we have synthesized new pyranone based AIEgens with interesting photophysical properties. The synthesized donor-acceptor based pyranones 3 and 4a-d show multicolour emission in the range of 476-585 nm in solid state. The compound 3 also showed blue emission (485 nm) in DMSO solution and surprisingly exhibits orange emission (572 nm) with remarkable bathochromic shift in 99% water in DMSO due to AIE characteristics. The detailed study of AIE behaviour of 3 was carried out in increasing fraction of water (0-99%) in THF, the intensity of emission at 485 nm gradually increased upto 80% of water and then decreased at 90% water. Interestingly, the THF solution of 3 in 99% water showed remarkable bathochromic shift (~100 nm) of emission maximum from blue (λmax 485 nm) to orange region (λmax 585 nm) due to formation of nano-aggregates leading to restriction in intramolecular rotation (RIR). The time-correlated single photon counting (TCSPC) analysis of 3 in the water−THF (99:1) mixture showed an average lifetime of 4.8 ns for these nano-aggregates. The pyrrolyl-pyranone 3 having Solution-Solid Dual Emissive (SSDE) characteristics may be utilized in exploring its application in both biomedical and material research fields