India's public health system - how well does it function at the National level?

India has relatively poor health outcomes, despite having a well-developed administrative system, good technical skills in many fields, and an extensive network of public health institutions for research, training, and diagnostics. This suggests that the health system may be misdirecting its efforts, or may be poorly designed. To explore this, the authors use instruments developed to assess the performance of public health systems in the United States and Latin America based on the framework of the Essential Public Health Functions, identified as the basic functions that an effective public health system must fulfill. The authors focus on the federal level in India, using data obtained from senior health officials in the central government. The data indicate that the reported strengths of the system lie in having the capacity to carry out most of the public health functions. Its reported weaknesses lie in three broad areas. First, it has overlooked some fundamental public health functions such as public health regulations and their enforcement. Second, deep management flaws hinder effective use of resources-including inadequate focus on evaluation, on assessing quality of services, on dissemination and use of information, and on openness to learning and innovation. Resources could also be much better usedwith small changes, such as the use of incentives and challenge funds, and greater flexibility to reassign resources as priorities and needs change. Third, the central government functions too much in isolation and needs to work more closely with other key actors, especially with sub-national governments, as well as with the private sector and with communities. The authors conclude that with some reassessment of priorities and better management practices, health outcomes could be substantially improved.Public Health Promotion,Agricultural Knowledge&Information Systems,Health Monitoring&Evaluation,Health Systems Development&Reform,Disease Control&Prevention,Agricultural Knowledge&Information Systems,Health Systems Development&Reform,Health Economics&Finance,Housing&Human Habitats,Health Monitoring&Evaluation

Relation of serum 25(OH) D with variables of thyroid and lipid profile in perimenopausal women

Background: Deficiency of vitamin D is quite prevalent among elderly population or postmenopausal women worldwide and may affect various function of the body. The status of its deficiency with their relation with other variables are not well explored in perimenopausal women.Methods: 100 perimenopausal women from the department of obstetrics and gynaecology were selected without having known risk of thyroid disorder and cardiovascular disease. The age group criteria for these women were 40 to 50 years. Thyroid profile including TSH, T3, and T4 were estimated by using enzyme linked immunesorbent assay. Serum levels of 25(OH) D3 was estimated by using spectrophotometric method. Lipid profile including TC, TG and HDL-C were estimated CHOD-POD method, GPO-PAP method, and CHOD-POD/Phosphotungustate method. LDL-C was calculated by friedewald formula.Results: There 58 women were presented with insufficient amount of vitamin D. They were characterised with increased BMI, elevated thyrotropin alongwith lower concentrations of T3 and T4. Increased levels of TC, TG and LDL-cholesterol alongwith lower concentration of HDL-C were also observed in women with vitamin d deficiency. Women having vitamin D deficiency were presented with overweight (OR-18.0, p-value=<0.001) and dyslipidemia (OR-12.13, p-value≤0.001). Vitamin D was negatively correlated with variable i.e. BMI, TSH, TC, TG and LDL-C. This negative association was significant (<0.001) while HDL-C and T4 were positively correlated with vitamin D levels in this study population.Conclusions: Vitamin D deficiency frequently occurs in middle aged perimenopausal women. Negative correlation of it with BMI, TSH and lipid variables may suggest the development of cardiovascular disease and hypothyroidism in coming years. Vitamin D supplements or vitamin D containing diet and regular exposure to sun is highly recommended to perimenopausal women

A case of perforation of rectum due to self-administered enema in a pregnant woman

A 23 year old primigravida at 35 weeks gestation presented with pain abdomen, fever and dissension of abdomen. Initially patient was managed conservatively at peripheral centre for two days and then reported to our hospital. An ultrasound done which shows collection inside peritoneal cavity and perforation was suspected. Decision of laparotomy was done. First caesarean section was done and a single live male baby born weighing 2.4 kg born. Then on exploration a small perforation in rectum was found and it was repaired by surgeon. But they found two more perforations and colostomy was done. On taking detailed history patient told that she-herself administered enema because of constipation. In post op period patient expired because of septicemia and ARDS

Ontology-based Classification and Analysis of non- emergency Smart-city Events

Several challenges are faced by citizens of urban centers while dealing with day-to-day events, and the absence of a centralised reporting mechanism makes event-reporting and redressal a daunting task. With the push on information technology to adapt to the needs of smart-cities and integrate urban civic services, the use of Open311 architecture presents an interesting solution. In this paper, we present a novel approach that uses an existing Open311 ontology to classify and report non-emergency city-events, as well as to guide the citizen to the points of redressal. The use of linked open data and the semantic model serves to provide contextual meaning and make vast amounts of content hyper-connected and easily-searchable. Such a one-size-fits-all model also ensures reusability and effective visualisation and analysis of data across several cities. By integrating urban services across various civic bodies, the proposed approach provides a single endpoint to the citizen, which is imperative for smooth functioning of smart cities

Successful outcome in a patient with glioma of brain with twin pregnancy

We present a case of glioma in pregnant female with twin pregnancy. Gliomas during pregnancy are rare. Gliomas during pregnancy pose a risk to maternal and fetal life. The benefit-to-risk ratio should be carefully evaluated and discussed prior to get marriage and pregnancy. In present case, patient had non-specific symptom like seizure and no any focal neurological deficit, Caesarean Section (CS) was done at term with multidisciplinary group, including a neurosurgeon, obstetrician, anesthesiologist and neonatologist. She has been followed up to the present date and remains in good health

Successful outcome of pregnancy in RHD with severe MS, severe pulmonary artery hypertension, moderate MR/TR/AR and mild AR

Rheumatic heart disease with severe Pulmonary Arterial Hypertension (PAH) in pregnancy is a grave situation, present with high maternal morbidity and mortality. In this case report, we describe our successful management of such a case which was even more difficult in combination with sever mitral stenosis, severe pulmonary artery hypertension and mild to moderate MR/TR. This patient got her diagnosis late in pregnancy, beyond the time at which a therapeutic termination could not have been performed

Knowledge, attitude, beliefs and use of over the counter drug products among medical undergraduates

Background: Over the counter (OTC) drug products are available without prescription and considered safe, effective, affordable and easily accessible. Among medical students use of OTCs and even prescription drugs available as OTCs is increasing day by day. The objective of the study was carried out to assess the knowledge, attitude and beliefs about OTCs, their use, safety and regulatory issues of OTCs among medical undergraduates.Methods: A questionnaire-based study was conducted and 151 medical students participated in this study. A preformed and validated questionnaire consisting of 2 parts was used. Part 1 consisted of general information regarding OTCs and Part 2 consisted information about knowledge, attitude, beliefs and use of OTCs. Data were analyzed and the results were expressed as percentages.Results: 100% participating students were aware about OTCs. 70% used them a lot because of availability and belief on safety. Chemist was a good source of advice over minor medical problems according to 38% of students. Information to be read on drug label was known to 62.5% of them. Affordability and accessibility (84%) was the main reason for OTCs use. Common medications bought without prescription were antibiotics, antihistaminics (100%) and cough syrups (90%). Headache and fever (100%), acidity (91%) were common indications for OTC use. Common OTCs stored at home were painkiller, antacids and skin care products.Conclusions: All students though were aware of OTCs but had little knowledge of regulation and usage. Many prescription drugs were also available as OTCs. Medical students need to be educated and trained about OTCs and the related issues.

Kimura’s disease: a diagnostic and therapeutic enigma

Kimura’s disease is a rare chronic inflammatory disorder present in 2nd and 3rd decade. It has a predilection for head and neck region presenting as a slowly growing painless swelling. It is usually accompanied by peripheral eosinophilia and elevated serum IgE and hence it was initially thought to be of allergic origin. Histologically the lesions are characterized by reactive hyperplasia of lymph nodes, eosinophilic infiltration and increase in postcapillary venules. Authors have reported a male patient with a slowly growing right sided neck swelling which is recurring even after course of steroids and excision done twice at an interval of 6 months. Kimura’s disease although a benign Lymphoid disorder but the incidence of recurrence despite taking treatment is a cause of much concern for the patient

A prospective randomized trial to compare side effects of early versus late removal of Foley’s catheter and vaginal pack following vaginal hysterectomy

Background: There is a controversy about the ideal time for removal of catheter and vaginal pack following vaginal hysterectomy. The present study was undertaken to compare post-operative morbidity in early and late removal of Foley’s catheter and vaginal pack.  The aim of this study is to compare post-operative morbidity in early and late removal of Foley’s catheter and vaginal pack following vaginal hysterectomy.Methods: This was a prospective randomized study with n=100 of those women who were undergoing vaginal hysterectomy with or without pelvic floor repair and fulfilled the inclusion criteria. After informed written consent, they were assigned to Foley’s catheter and vaginal pack removal group in 6 hours (group I, n=50) or 24 hours removal group (group II, n=50). Primary parameters used to assess were urine routine and microscopy, urine culture and sensitivity on post-operative day 2, need for re-catheterization and repacking, febrile morbidity, ambulation, vault infection and post-operative hospital stay duration were analyzed in both groups.Results: Febrile morbidity was found in 6% and 8%, Positive urine culture was found in 10% and 20%, Rate of re-catheterization was 10% in group I and group II respectively. Vaginal bleeding after pack removal and repacking was in 6% in group I whilst none had in group II.Conclusions: Early removal was associated with less incidence of urinary tract infection, and increased rate of re-catheterization and repacking. Needs larger comparative studies to support the practice of early removal