Impact of Government Schemes on Society An Analytical Study with Special Reference to Madhya Pradesh

For the development of human society, it is necessary that it should have basic facilities, as talking about ancient times, due to the lack of basic facilities at that time, development happened slowly, which we can also call gradual development. But if seen at present, the industrial revolution came from one side and on the other side, there has also been developed in technology. Due to technological development, there was a new revolution in society, in which the distance between people has also reduced on one hand through the internet and other electronic means, while on the other hand, the joint family has moved towards the nuclear family, this is one of its biggest side effects. If we look at the new generation, they seem to be busy with the electronic gazette the most. In the last several decades, all the families were seen eating together and smiling together, now it is becoming extinct somewhere. That is why every person is now feeling lonely and if they fall in some trouble or fall ill, they cannot find their loved ones with them, as a result, they become victims of unnecessary expenses in hospitals. Due to this people have to earn more money and have to work harder to earn more money, this is a big reason that people have a big shortage of time. On the other hand, increasing population and limiting resources can also be said to push society towards inflation. And more money is needed in mobilizing basic facilities and these facilities go away from the reach of common people. In view of all these problems, many announcements are made by the governments keeping in mind the development and development in society, in which human life can be made convenient and comfortable. But many times the plans remain as mere announcements, and sometimes bring a new revolution in society. Today, through a research paper, I would like to consider all these things and try to do a critical study of what is the status of government schemes in society

Role of aspiration cytology in splenic lesions

Background: Splenic fine needle aspiration cytology (FNAC) as a diagnostic procedure has been used since beginning of last century and was first reported in 1916. The objective of the study was to evaluate the diagnostic role of aspiration cytology in splenic lesions.Methods: In our retrospective study Fine needle aspiration cytology (FNAC) of spleen was done in a total 34 cases, out of which 28 cases were aspirated under ultrasonological guidance and 6 cases were aspirated blindly. There were 23 male and 11 female patients and the age range of the patients was from 2 to 69 years with 8 patients from paediatric group. Before commencing the procedure all the necessary precautions and investigations including coagulation profile were done.Results: Out of 34 FNAC cases, 5 were bloody aspirate while 2 cases showed normal splenic aspirate. In 27 cases definite diagnostic opinion was possible. Amongst non-neoplastic group maximum patients (8 cases) were showing features of extra medullary hematopoeisis followed by 4 cases of tuberculosis, then 3 cases each of kala azar and storage disorder and 2 cases showed granulomas. In the neoplastic group, we had 2 cases of non-Hodgkins lymphoma, one case of Hodgkin lympoma with 2 cases of hairy cell leukemia and one case of histiocytosis. No major difference in the cellularity noticed when the aspiration done blindly or under ultrasound guidance No procedural complications were seen in our study.Conclusion: Hence when done with full precautions FNAC spleen is a safe, cheap, rapid and highly diagnostic procedure as a primary investigation.

Genetic analysis of yield and heat stress related traits in wheat (Triticum aestivum L. em. Thell) using microsatellite markers

Microsatellite markers were used for genetic analysis of terminal heat tolerance in F2 (PBW373 × WH1081) population of wheat (Triticum aestivum L. em. Thell). Two parents were evaluated in field under normal sown and late sown conditions. For genotyping DNA from both parents PBW373 and WH1081 was amplified using 200 SSRs. Only 22 SSRs produced polymorphic bands, of size between 100 to 300 bp and an average of 1.45 alleles. The single marker analysis identified 19 markers indicating the putative QTLs for yield, its components and heat stress related physiological traits. The number of markers on these 16 linkage groups varied from one to four. On A genome 13 QTLs on B genome 5 QTLs and on D genome 9 QTLs were identified, respectively. The A, B and D genomes had 1360.3 cM, 272.4 cM and 919.5 cM of linkage coverage with average interval distances of 104.63 cM, 54.48 cM and 102.16 cM/Marker. A total of nine QTLs were resolved following composite interval mapping, one QTL was detected at a LOD score equal to threshold value of 2.5 while eight at LOD scores above the threshold value. All the nine QTLs were shown to be on definitive location on chromosome 3A (QDh.CCSHAU-3A, QDa.CCSHAU-3A and QPm.CCSHAU-3A), chromosome (QBm.CCSHAU-5A, QCtd.CCSHAU-5A and QCl.fl.CCSHAU-5A), chromosome6A (QPh.CCSHAU-6A) and chromosome3B (QTgw.CCSHAU and QMts.CCSHAU-3B). Use of these markers save times, resources and energy that are needed not only for raising large segregating populations for sveral generations, but also for estimating the parameters used for selection

A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study

Background: Laryngeal mask airway (LMA) is an accepted airway device for spontaneous and modest positive pressure ventilation. Propofol is widely used Induction agent. Sevoflurane is a newer pleasant volatile anaesthetic with rapid induction and recovery with stable haemodynamics. The aim of this study was to compare propofol and sevoflurane with respect of haemodynamic changes and conditions for LMA insertion.Methods: This study was done on 60 female patients of ASA I, II grade between 20-60 years of age. Patients were randomized into two groups (n=30). All patients were preoxygenated and received inj. fentanyl 2µg/kg. Induction agent was propofol 2.5mg/kg (group P) or sevoflurane 8% with vital capacity breath (group S). Loss of eyelash reflex was the end point of induction. Induction time, conditions for LMA insertion, number of attempts, time of successful LMA insertion and haemodynamic parameters were noted.Results: time for induction and LMA insertion was significantly faster in propofol group than group S (p<0.05). Successful LMA insertion in first attempt was 100% in group P with excellent conditions (score 18) while in group S, it was 86.7% with excellent to satisfactory conditions (score 16-17). A significant fall in mean arterial pressure (p<0.05) was noted in group P while pulse rates were comparable in both groups.  Conclusions: Sevoflurane vital capacity breath inhalational induction can be used as an effective alternative to propofol though it requires greater time for LMA insertion but with better haemodynamic stability.

A prospective randomized study for comparison of haemodynamic changes and recovery characteristics with propofol and sevoflurane anaesthesia during laparoscopic cholecystectomies

Background: Day care laparoscopic surgical procedures are rapidly increasing nowadays. Rapid emergence and early recovery from anaesthesia with minimal complications are desired. Both propofol and sevoflurane meet above criteria and established as agents of choice in laparoscopic surgeries for induction and maintenance of anaesthesia. So this study aimed to compare sevoflurane with propofol for intraoperative haemodynamic changes with postoperative recovery profile in patient’s undergone laparoscopic cholecystectomies under general anaesthesia.Methods: In this prospective randomized study, sixty patients of either sex, 18-60 years with ASA grade 1 and 2 scheduled for laparoscopic cholecystectomies under general anaesthesia were randomly allocated into two groups. In Group S, patients were maintained on sevoflurane anaesthesia (0.5-2.5%) while in Group P, patients were maintained with propofol infusion (75-125 µg/kg/min) along with O2 (50%) and N2O (50%).The intraoperative haemodynamic parameters, recovery characteristics and postoperative nausea and vomiting (PONV) were observed in both groups.Results: The mean baseline haemodynamic parameters (HR, SBP, DBP, MBP, SpO2 and EtCO2) were comparable in both groups, (P>0.05). No significant difference in HR was at observed any time interval, P>0.05, however, SBP, DBP and MBP were significantly lower in propofol group at different time intervals, P<0.05, but clinically not significant and patients remained haemodynamically stable in both groups. The mean time for all recovery characteristics were significantly shorter in sevoflurane group as compared to propofol group, (P<0.01). However the incidence of PONV was significantly more in sevoflurane group.Conclusions: Sevoflurane can be used as an effective alternative to propofol for maintenance of anaesthesia in day care laparoscopic procedures as it has better recovery profile with stable haemodynamic parameters

Modelling small-scale storage interventions in semi-arid India at the basin scale

There has been renewed interest in the performance, functionality, and sustainability of traditional small-scale storage interventions (check dams, farm bunds and tanks) used within semi-arid regions for the improvement of local water security and landscape preservation. The Central Groundwater Board of India is encouraging the construction of such interventions for the alleviation of water scarcity and to improve groundwater recharge. It is important for water resource management to understand the hydrological effect of these interventions at the basin scale. The quantification of small-scale interventions in hydrological modelling is often neglected, especially in large-scale modelling activities, as data availability is low and their hydrological functioning is uncertain. A version of the Global Water Availability Assessment (GWAVA) water resources model was developed to assess the impact of interventions on the water balance of the Cauvery Basin and two smaller sub-catchments. Model results demonstrate that farm bunds appear to have a negligible effect on the average annual simulated streamflow at the outlets of the two sub-catchments and the basin, whereas tanks and check dams have a more significant and time varying effect. The open water surface of the interventions contributed to an increase in evaporation losses across the catchment. The change in simulated groundwater storage with the inclusion of interventions was not as significant as catchment-scale literature and field studies suggest. The model adaption used in this study provides a step-change in the conceptualisation and quantification of the consequences of small-scale storage interventions in large- or basin-scale hydrological models

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Background: Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods: TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings: Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation: Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding: Cancer Research UK

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme