Supply Chain Management and Restart of Economy in Post COVID-19

The increase in World Trade has led to significant growth in world GDP over last 100 years particularly. Supply chains have become the major enablers of world trade and the world is connected through supply chains. Any disruptions in any part of the world has led to disruptions in supply chains and economic recessions. Crisis like Tsunamis, earthquakes, 911 terror attacks, epidemics/pandemics like COVID-19 etc. have affected the businesses worldwide. COVID-19 pandemic has precipitated economic crisis due to disruption of supply chains and suppressed demand for many products and services worldwide. International Monetary Fund (IMF) has projected global economic growth to be negative 4.9%. This economic crisis has resulted in substantial erosion of market capitalization across the globe. The impact of COVID-19 is very significant on both health of the people and economy worldwide. Almost all businesses and governments are trying its best to save people from health and economic crisis. This requires rebuilding of supply chains through appropriate configuration with reliable sources of supply, collaboration, manufacturing and distribution of goods and services. Sectors like essential items, pharmaceutical, e-commerce have started early recovery of economy. However, other sectors require suitable interventions from government, business organizations in their policies and practices and use of digital technologies for economic recovery

Neutrophil-lymphocyte ratio as a predictor of outcome following traumatic brain injury: Systematic review and meta-analysis

Objetivos: El cociente neutrófilo-linfocito (NLR) es un parámetro hematológico sencillo y de realización rutinaria; sin embargo, los estudios sobre el NLR como herramienta pronóstica en el traumatismo craneoencefálico (TCE) han arrojado resultados contradictorios. Materiales y métodos: Esta revisión sistemática y meta-análisis se llevó a cabo de acuerdo con las Preferred Reporting Items in the Systematic Review and Meta-Analysis guidelines 2020. Se realizaron búsquedas en las bases de datos electrónicas de PubMed, Cochrane Library, Web of Science y Scopus. La población consistió en pacientes con TCE en ausencia de lesión extracraneal moderada y grave. Para el análisis se tomó el RNL del día 1. Los resultados evaluados fueron la mortalidad y la escala de resultados de Glasgow (GOS). No se impusieron restricciones en cuanto al idioma, el año y el país de publicación, y la duración del seguimiento. Se excluyeron del estudio los estudios con animales. Los estudios en los que se comunicaron datos inadecuados para los resultados se incluyeron en la síntesis cualitativa, pero se excluyeron de la síntesis cuantitativa. La calidad de los estudios se evaluó mediante la escala Newcastle-Ottawa (NOS). El riesgo de sesgo se estimó mediante la herramienta de riesgo de sesgo Cochrane RoBANS. Resultados: Se recuperaron 7213 citas mediante la estrategia de búsqueda y se excluyeron 2097 citas en función del cribado del título y el resumen. Se recuperó el texto completo de 40 artículos y se sometió a los criterios de elegibilidad, de los cuales 28 fueron excluidos del estudio. Doce estudios fueron elegibles para la síntesis de la revisión sistemática, mientras que siete estudios cumplieron los requisitos para el metanálisis. La puntuación media de los artículos fue de 8/9 según NOS. El riesgo de sesgo de selección fue bajo en todos los estudios, mientras que el riesgo de sesgo de detección fue alto en todos excepto en un estudio. Diez estudios se realizaron en pacientes adultos, mientras que dos estudios informaron sobre LCT pediátrica. Un metanálisis para GOS mostró que un NLR alto predijo resultados desfavorables en ≥6 meses con una diferencia media de -5,18 (intervalo de confianza del 95%: -10,04, -0,32); P = 0,04; heterogeneidad (I2), siendo del 98%. Las estimaciones del efecto para NLR y mortalidad fueron una diferencia media de -3,22 (intervalo de confianza del 95%: -7,12, 0,68), P = 0,11, y una I2 del 85%. El metanálisis de las características operativas del receptor del área bajo la curva (AUC) de los estudios incluidos mostró un buen poder predictivo del NLR para predecir los resultados tras una LCT, con un AUC de 0,706 (IC del 95%: 0,582-0,829). Conclusiones: Un NLR al ingreso más alto predice un mayor riesgo de mortalidad y resultados desfavorables después de una LCT. Sin embargo, es probable que futuras investigaciones aborden las lagunas existentes. 2022, Scientific Scholar LLC. Todos los derechos reservados.Objectives: The neutrophil-to-lymphocyte ratio (NLR) is a simple and routinely performed hematological parameter; however, studies on NLR as a prognostic tool in traumatic brain injury (TBI) have yielded contradictory results. Materials and Methods: This systematic review and meta-analysis was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-Analysis guidelines 2020. Electronic databases of PubMed, Cochrane Library, Web of Science, and Scopus were searched. The population consisted of TBI patients in the absence of moderate and severe extracranial injury. Day 1 NLR was taken for the analysis. The outcomes evaluated were mortality and the Glasgow Outcome Scale (GOS). No restrictions were placed on the language, year and country of publication, and duration of follow-up. Animal studies were excluded from the study. Studies, where inadequate data were reported for the outcomes, were included in the qualitative synthesis but excluded from the quantitative synthesis. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). The risk of bias was estimated using the Cochrane RoBANS risk of bias tool. Results: We retrieved 7213 citations using the search strategy and 2097 citations were excluded based on the screening of the title and abstract. Full text was retrieved for 40 articles and subjected to the eligibility criteria, of which 28 were excluded from the study. Twelve studies were eligible for the synthesis of the systematic review while seven studies qualified for the meta-analysis. The median score of the articles was 8/9 as per NOS. The risk of selection bias was low in all the studies while the risk of detection bias was high in all except one study. Ten studies were conducted on adult patients, while two studies reported pediatric TBI. A meta-analysis for GOS showed that high NLR predicted unfavorable outcomes at ≥6 months with a mean difference of −5.18 (95% confidence interval: −10.04, −0.32); P = 0.04; heterogeneity (I2), being 98%. The effect estimates for NLR and mortality were a mean difference of −3.22 (95% confidence interval: −7.12, 0.68), P = 0.11, and an I2 of 85%. Meta-analysis for Area under the curve (AUC) receiver operating characteristic of the included studies showed good predictive power of NLR in predicting outcomes following TBI with AUC 0.706 (95% CI: 0.582–0.829). Conclusion: A higher admission NLR predicts an increased mortality risk and unfavorable outcomes following TBI. However, future research will likely address the existing gaps. © 2022, Scientific Scholar LLC. All rights reserved

Removing barriers to emergency medicine point-of-care ultrasound: Illustrated by a roadmap for emergency medicine point-of-care ultrasound expansion in India

Point-of-care ultrasound (PoCUS) has a potentially vital role to play in emergency medicine (EM), whether it be in high-, medium-, or low-resourced settings. However, numerous barriers are present which impede EM PoCUS implementation nationally and globally: (i) lack of a national practice guideline or scope of practice for EM PoCUS, (ii) resistance from non-PoCUS users of ultrasound imaging (USI) and lack of awareness from those who undertake parallel or post-EM patient care, and (iii) heterogeneous pattern of resources available in different institutes and settings. When combined with the Indian Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, this has led to the majority of India’s 1.4 billion citizens being unable to access EM PoCUS. In order to address these barriers (globally as well as with specific application to India), this article outlines the three core principles of EM PoCUS: (i) the remit of the EM PoCUS USI must be well defined a priori, (ii) the standard of EM PoCUS USI must be the same as that of non-PoCUS users of USI, and (iii) the imaging performed should align with subsequent clinical decision-making and resource availability. These principles are contextualized using an integrated PoCUS framework approach which is designed to provide a robust foundation for consolidation and expansion across different PoCUS specialisms and health-care settings. Thus, a range of mechanisms (from optimization of clinical practice through to PoCUS educational reform) are presented to address such barriers. For India, these are combined with specific mechanisms to address the PCPNDT Act, to provide the basis for influencing national legislation and instigating an addendum to the Act. By mapping to the recent Lancet Commission publication on transforming access to diagnostics, this provides a global and cross-discipline perspective for the recommendations

Rural Indian tribal communities: an emerging high-risk group for HIV/AIDS

BACKGROUND: Rural Indian tribes are anthropologically distinct with unique cultures, traditions and practices. Over the years, displacement and rapid acculturation of this population has led to dramatic changes in their socio-cultural and value systems. Due to a poor health infrastructure, high levels of poverty and ignorance, these communities are highly vulnerable to various health problems, especially, communicable diseases including HIV/AIDS. Our study sought to assess knowledge, attitudes and practices regarding sexuality, and the risk factors associated with the spread of HIV/AIDS and STDs among these communities. METHODS: A nested cross sectional study was undertaken as part of the on going Reproductive and Child Health Survey. A total of 5,690 participants age 18–44 were recruited for this study. Data were obtained through home interviews, and focused on socio-demographics, knowledge, attitudes and behaviors regarding sexuality, HIV/AIDS and other STDs. RESULTS: The study revealed that only 22% of adults had even heard of AIDS, and 18 % knew how it is transmitted. In addition, only 5% knew that STDs and AIDS were related to each other. AIDS awareness among women was lower compared to men (14% vs.30 %). Regarding sexual practices, 35% of the respondents reported having had extramarital sexual encounters, with more males than females reporting extramarital affairs. CONCLUSION: Lack of awareness, permissiveness of tribal societies for premarital or extra-marital sexual relationships, and sexual mixing patterns predispose these communities to HIV/AIDS and STD infections. There is a dire need for targeted interventions in order to curtail the increasing threat of HIV and other STDs among these vulnerable populations

International Health Security: A Summative Assessment by ACAIM Consensus Group

International health security (IHS) encompasses any natural or anthropogenic occurrence that can threaten the safety of human health and well-being. The American College of Academic International Medicine IHS Consensus Group (ACAIM-CG) developed a summative assessment highlighting the main issues that can impact IHS including emerging infectious diseases; chronic health conditions; bioterrorism; planetary changes (volcanic eruptions, earthquakes, wildfires, and climate change); nuclear incidents; information and cyber health; industrialization; globalization; pharmaceutical production; and communication platforms (social media). These concerns can directly and indirectly impact IHS both in the long and short term. When considering IHS, we aim to emphasize the utility of applying a predefined framework to effectively approach health security threats. This framework comprises of prevention, detection, assessment, reporting, response, addressing needs, and the perpetual repetition of the above cycle (inclusive of appropriate mitigation measures). It is hoped that this collective work will provide a foundation for further research within the redefined, expanded scope of IHS