Charcot’s Neuroarthropathy: A Case Report and Review of Literature

Charcot’s neuroarthropathy (CN) is a progressive disabling complication of diabetes mellitus, usually seen 10 years after diagnosis of diabetes. There is widespread destruction of affected joint and bones around it leading to severe deformity and loss of function. Its treatment may require multiple corrective surgeries or even amputation apart from application of cast, glycemic control and bisphosphonates. Here, we report such a case of CN, which was treated with multiple strategies aggressively to a good outcome

Technology for Improving Street Dog Welfare and Capturing Data in Digital Format during Street Dog Sterilisation Programmes

Street dogs survive on food handouts provided by individuals, or the wider community yet typically receive limited to no veterinary care. They can also carry a variety of zoonotic diseases such as rabies, posing a significant risk to human and dog population health. Dog sterilization is one of the most humane and effective methods available to control street dog populations. Dog sterilization programs, particularly those operating at a large-scale, often face a variety of challenges including limited resources, staffing, and less-than-ideal facilities. Record keeping is often a challenge as well, which can complicate the return of a sterilized dog to their location of capture. Street dogs are territorial, and the return of a dog to an incorrect location is fraught with various welfare issues, as well as an increased risk of postoperative complications, including death. Humane Society International developed a mobile phone-based application called ‘HSIApps’ drawing on years of field experience and data collection in street dog location recording, as well as clinical and postoperative treatment. HSIApps facilitates the return of dogs back to their exact captured location, which ensures dog welfare, and generates reports of a variety of useful data variables to maximize the efficacy and reliability of sterilization programs

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Design of a Wideband Cylindrically Conformed H-Shaped Slot Antenna for Space Communication

Abstract: A simple and compact wideband cylindrically conformed H-shaped slot antenna is presented in this paper. Proposed antenna is composed of an H-shaped slot on the ground plane which is conformed on a cylindrical surface. Different substrate materials has been analyzed and Rogers RT/duroid 5880 (Ɛr = 2.2) shows better results. Simulation results has been observed for different curvature of conformal antenna. The operating bandwidth of proposed conformal slot antenna exists over Ku and K bands. An impedance BW (S11≤-10db) of 2.75 Ghz (16-18.75 Ghz) and percentage BW of 15.77 % is achieved. Maximum gain of 23.86 dB at Ɵ = 51.34º at resonant frequency is observed. Radiation results has been simulated by using FEM based simulation software Ansoft HFSS Ver 13. Index terms: H-shaped slot antenna, wideband, conforma

KNUCKLE HYPERPIGMENTATION IS A MARKER OF VITAMIN B12 DEFICIENCY IN VEGETARIAN POPULATION

BACKGROUND B12 deficiency is common in India as is Vitamin D, folic acid, or iron deficiency. Megaloblastic Anaemia due to vitamin B12 deficiency is extremely common in the predominantly vegetarian population. The symptoms are modified also by the underlying disorder causing its deficiency. Knuckle hyperpigmentation is one of the essential features of it. In spite of being a common disorder, its recognition is delayed or missed because the manifestations are diverse in nature, and is often subclinical. Laboratory estimations of B12 levels are also not reliable. The ways of picking up those with clinical or subclinical B12 deficiency and the reasons and solutions are very much needed. Here we emphasize the clinical sign of knuckle hyper pigmentation as an important clue towards the aetiology of Megaloblastic Anaemia. The aim of the study is to know the correlation of knuckle hyper pigmentation with serum vitamin B12 deficiency in vegetarian population. MATERIALS AND METHODS 40 patients with knuckle hyperpigmentation, all were vegetarian screened for serum vitamin B12 deficiency. RESULTS Out of 40 patients, 28 females and 12 males, 32(80%) patients showed decreased levels of serum Vitamin B12. CONCLUSION Vitamin B12 deficiency is not uncommon in vegetarian population and knuckle hyperpigmentation is an early marker of this and need larger studies to know it better. Knuckle pad hyperpigmentation is much more frequent than diffuse pigmentation of the palms and/or soles in such patents. Few patients with vitamin B12 deficiencies do present with severe anaemia requiring blood transfusions and often have skin hyperpigmentation

An Observational study about the levels of bifurcations in Common Carotid Artery among male & female cadavers

Introduction: The carotid arterial system which begins from the common carotid arteries (CCAs) is the main arterial supply of the head and neck. The knowledge of point of bifurcation of CCA is very important in surgeries of head and neck region to prevent vascular accidents, during catheterization of carotid arteries and intra-arterial administration of chemotherapeutic agents. The carotid arteries lying anterolaterally in the neck are the major structures commonly injured in penetrating wounds of the neck Hence this study to evaluate the variations, levels of divisions among both male and female cadavers in Local Medical Teaching Institutes. Methods: This Observational based descriptive study design was conducted to describe the CCA bifurcation. Study was undertaken in 30 adult formalin fixed cadavers The dissections were carried out according to the instructions given in Cunningham’s manual of practical anatomy . The level of bifurcation of common carotid artery was noted and correlated with the upper border of thyroid cartilage. The age of death ranged from 24 to 78 years and all specimens were fixed in 10% formaldehyde solution. Result: A total of thirty unclaimed adult cadavers of 3 females and 27 males or 60 specimens (30 cadavers, left and right sides). The height of cadavers ranges from 154 cm – 180 cm.The level of bifurcation of the common carotid artery was at the level of upper border of thyroid cartilage in 78.33%. Only 11.66%) showed the higher level . 10 % showed the lower level of bifurcation in the range of 2 mm to 10 mm below the level of upper border of thyroid cartilage. The bifurcation levels were symmetrical on both sides. Conclusion: The present study finds the incidence of bifurcation of common carotid was more or less constant at the level of upper border of thyroid cartilage. Clinicians / Surgeons need to take the standard and variable heights of the carotid bifurcation into consideration; to avoid unnecessary complications

A study to estimate the gestational age by measuring bi-parietal diameter of the foetuses in Gravid Females

Introduction: Monitoring of intra-uterine growth has remained a very important fetal surveillance tool in the care of pregnant women. In wide variety of circumstances of feticide the fetal age determination is important for identification. There are many parameters to determine the age of the fetus during autopsy, which includes measurement of BPD and head circumference in the skull. if during autopsy of a decomposed or mutilated body only skull is present then BPD is useful criteria for estimating age. Biometric values or curves of one population may overestimate or underestimate the fetal age if used for other population with different demographic characteristics. Therefore, this study was undertaken to assess GA with the help of measurement of BPD by ultrasonography. Methods: This Prospective Cross Sectional study involved Prior Consent & was found to be within ethical standards. Study was carried out to measure BPD of the fetus in a total of 100 gravid females by using a grey scale real time Sonography Machine employing a 6-3 MHz convex transducer.The fetal head was imaged in an axial section with the fetus in direct occiput transverse position. The instrument was set so that parietal bones measure approximately 3 mm in thickness. The BPD was measured from the outer surface of skull table to the inner margin of the opposite skull table in a transverse plane.Results: The study was conducted among 100 Gravid Females. Cubic polynomial regression model was fitted to measure BPD as a function of GA. The models were chosen based on the correlation coefficient, R2 To illustrate the variability in measurement, the Standard Deviations of each week were computed and regressed on GA using a simple linear equation. In this study, fetal mean BPD showed linear increase from 13 to 36 weeks and statistically significant correlation was found between GA and BPD. Average growth rate of BPD was found to be 0.31 cm/week from 13 to 28 weeks. Conclusions: This study substantiates the fact that BPD is one of the useful criteria to predict GA and determine EDD and it was found to be statistically significant. We have been able to generate growth charts and an equation for monitoring growth and estimating GA based on a large sample in an area where many mothers are unsure of the date of their last menses and might be at risk of intra-uterine growth restriction. This we believe will guide antenatal caregivers from under-estimation or over-estimation of GA. Accuracy in measurement and resolution in these parameters are of immense importance