Rotator cuff repair: what questions are patients asking online and where are they getting their answers?

Background@#This study analyzed questions entered online by rotator cuff patients and determined types and quality of websites providing information at the top of queries. @*Methods@#Three strings related to rotator cuff repair were explored in Google Search. The result pages were manually collected under the “People also ask” function for frequent questions and associated webpages. Questions were categorized using Rothwell’s classification with further topical subcategorization. Webpages were evaluated by Journal of American Medical Association (JAMA) benchmark criteria for source quality. @*Results@#One hundred twenty “People also ask” questions were collected with their associated webpages. Based on the Rothwell classification of questions, queries were thematically organized into fact (41.7%), value (31.7%), and policy (26.7%) categories. The most common webpage categories were academic (28.3%) and medical practice (27.5%). The most common question subcategories were timeline of recovery (21.7%), indications/management (21.7%), and pain (18.3%). The average JAMA score for all 120 webpages was 1.50. Journal articles had the highest average JAMA score (3.77), while commercial websites had the lowest JAMA score (0.91). The most common suggested question for rotator cuff repair/surgery was, “Is rotator cuff surgery worth having?,” while the most common suggested question for rotator cuff repair pain was, “What happens if a rotator cuff is not repaired?” @*Conclusions@#The most common questions asked on Google pertaining to rotator cuff repair evaluate management options and relate to the timeline of recovery and pain management. Most information is provided by medical practice, academic, and medical information websites, which have highly variable reliability. By understanding the questions that rotator cuff repair patients are asking online, surgeons can tailor preoperative education to common patient concerns and improve postoperative outcomes.Level of evidence: IV.

Internet search analytics for shoulder arthroplasty: what questions are patients asking?

Background@#Common questions about shoulder arthroplasty (SA) searched online by patients and the quality of this content are unknown. The purpose of this study is to uncover questions SA patients search online and determine types and quality of webpages encountered. @*Methods@#The “People also ask” section of Google Search was queried to return 900 questions and associated webpages for general, anatomic, and reverse SA. Questions and webpages were categorized using the Rothwell classification of questions and assessed for quality using the Journal of the American Medical Association (JAMA) benchmark criteria. @*Results@#According to Rothwell classification, the composition of questions was fact (54.0%), value (24.7%), and policy (21.3%). The most common webpage categories were medical practice (24.6%), academic (23.2%), and medical information sites (14.4%). Journal articles represented 8.9% of results. The average JAMA score for all webpages was 1.69. Journals had the highest average JAMA score (3.91), while medical practice sites had the lowest (0.89). The most common question was, “How long does it take to recover from shoulder replacement?” @*Conclusions@#The most common questions SA patients ask online involve specific postoperative activities and the timeline of recovery. Most information is from low-quality, non-peer-reviewed websites, highlighting the need for improvement in online resources. By understanding the questions patients are asking online, surgeons can tailor preoperative education to common patient concerns and improve postoperative outcomes.

National guidelines for data quality in surveys: An overview

Good quality health, nutrition and demographic survey data are vital for evidence-based decision-making. Existing literature indicates system specific, data collection and reporting gaps that affect quality of health, nutrition and demographic survey data, thereby affecting its usability and relevance. To mitigate these, the National Data Quality Forum (NDQF), under the Indian Council of Medical Research (ICMR) - National Institute of Medical Statistics (NIMS) developed the National Guidelines for Data Quality in Surveys delineating assurance mechanisms to generate standard quality data in surveys. The present article highlights the principles from the guidelines for informing survey researchers/organizations in generating good quality survey data. It describes the process of development of the national guidelines, principles for each of the survey phases listed in the document and applicability of them to data user for ensuring data quality. The guidelines may be useful to a broad-spectrum of audience such as data producers from government and non-government organizations, policy makers, research institutions, as well as individual researchers, thereby playing a vital role in improving quality of health, nutrition and demographic data ecosystem.

Characterizing the third wave of COVID-19: An analysis from the National Clinical Registry of COVID-19

Background & objectives: Data from the National Clinical Registry for COVID-19 (NCRC) were analyzed with an aim to describe the clinical characteristics, course and outcomes of patients hospitalized with COVID-19 in the third wave of the pandemic and compare them with patients admitted earlier. Methods: The NCRC, launched in September 2020, is a multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized COVID-19 patients were captured in an electronic data portal from 38 hospitals across India. Patients enrolled during December 16, 2021 to January 17, 2022 were considered representative of the third wave of COVID-19 and compared with those registered during November 15 to December 15, 2021, representative of the tail end of the second wave. Results: Between November 15, 2021 and January 17, 2022, 3230 patients were recruited in NCRC. Patients admitted in the third wave were significantly younger than those admitted earlier (46.7±20.5 vs. 54.6±18 yr). The patients admitted in the third wave had a lower requirement of drugs including steroids, interleukin (IL)-6 inhibitors and remdesivir as well as lower oxygen supplementation and mechanical ventilation. They had improved hospital outcomes with significantly lower in-hospital mortality (11.2 vs. 15.1%). The outcomes were better among the fully vaccinated when compared to the unvaccinated or partially vaccinated.Interpretation & conclusions: The pattern of illness and outcomes were observed to be different in the third wave compared to the last wave. Hospitalized patients were younger with fewer comorbidities, decreased symptoms and improved outcomes, with fully vaccinated patients faring better than the unvaccinated and partially vaccinated ones.

Correlation of Limnological Features with Ichthyofauna in Hatnur Reservoir in Jalgaon, Maharashtra, India

Background: Limnologycovers the study of all inland waters including running and standing waters, fresh and saline, natural or man-made reservoirs. Unplanned urbanization, rapid industrialization and indiscriminate use of artificial chemicals lead to heavy and varied pollution in aquatic environments causing to deterioration of Limnological features and depletion of aquatic fauna including fish. Scarcity of research related to limnological features and ichthyofauna diversity in Hatnur reservoir stimulated to undertake the present work. Methods: River Tapi (or Tapti) is arising in Madhya Pradesh and flows westward between two spurs of the Satpuda Rangeacross Maharashtra state, and through Gujarat state to the Gulf of Khambhat. Hatnur reservoir (750 90扙, 210 12扤) formed due to an earth-fill dam on Tapi river near Hatnur village in Jalgaon district of Maharashtra state. Water quality parameters were assessed using standard methods described by APHA and fish diversity was evaluated in the Hatnur reservoir. Results: Seasonal fluctuations in water quality parameters and their relationship with ichthyofauna inhabiting the Hatnur reservoir were assessed. The results obtained in the present study indicated that physicochemical properties of water samples collected from the Hatnur reservoir were within recommended limits of the Bureau of Indian Standards (BIS). Conclusion: It is concluded that water in Dam was less polluted, suitable for agricultural and domestic use and suitable to inhabit the fish diversity. Future studies should focus on under-explored and unexplored areas of the Tapi riverine system in North Maharashtra to comprehensively document the fish diversity.

Development & validation of scales to assess stigma related to COVID-19 in India

Background & objectives: COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community. Methods: COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants’ interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test–retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach’s alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test–retest reliability. Results: Items in the scales were relevant and comprehensible. Both the scales had Cronbach’s ? above 0.6 indicating moderate-to-good internal consistency. Test–retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement. Interpretation & conclusions: Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.

Sports-related facial trauma in the Indian population - A systematic review

Background: Sports injuries are a growing concern which requires immediate attention. Dental injuries are the most common type of orofacial injuries sustained during sports activities. Objectives: This study aims to review the prevalence of sports-related facial trauma in India, to identify the most common types of oro-facial injury incurred due to sports, and to assess the level of awareness regarding preventive measures used in sports. Methodology: The present review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. All articles published from 2005 to 2019 on sports-related facial trauma were analyzed. PubMed, Google Scholar, and Cochrane reviews databases were searched using primary keywords. Results: A total of 24 articles published in the period of 2005–2019 were included. The prevalence of sports-related facial trauma was found to be the highest in the study conducted by Selva et al., in 2018, at a rate of 75%, whereas it was found to be minimal in the study conducted by Bali et al. in 2013. While the awareness of mouthguards was reported the highest in a study conducted by Ramagoni et al., in 2007. Conclusion: This study shows that there is a definite need to improve the awareness as well as the usage of protective gear, from the level of schooling, where children are introduced to sports. Prevention of sports-related facial trauma is essential to avoid the serious and lifelong consequences which could be the aftermath of such injuries.

Analysis of a Targeted Intervention Programme on the Risk Behaviours of Injecting Drug Users in India: Evidence From the National Integrated Biological and Behavioural Surveillance Survey / 예방의학회지

Objectives@#This study provides insights on the impact of a targeted intervention (TI) programme on behaviour change among injecting drug users (IDUs) in India. @*Methods@#This paper examined the data from the Integrated Biological and Behavioural Surveillance 2014-2015 for IDUs in India. Logistic regression was performed to understand the factors (TI programme services) that affected injecting risk behaviours by adjusting for covariates. Propensity score matching was conducted to understand the impact of the TI programme on using new needles/syringes and sharing needles/syringes in the most recent injecting episode by accounting for the covariates that predicted receiving the intervention. @*Results@#Participants who received new needles and syringes from peer educators or outreach workers were 1.3 times (adjusted odds ratio, 1.29; 95% confidence interval [CI], 1.09 to 1.53) more likely to use new needles/syringes during most recent injecting episode than participants who did not receive needles/syringes. The matched-samples estimate (i.e., average treatment effect on treated) of using new needles in the most recent injecting episode showed a 2.8% (95% CI, 0.0 to 5.6) increase in the use of new needles and a 6.5% (95% CI, -9.7 to -3.3) decrease in needle sharing in the most recent injecting episode in participants who received new needles/syringes. There was a 2.2% (95% CI, -3.8 to -0.6) decrease in needle sharing in the most recent injecting episode among participants who were referred to other services (integrated counselling and testing centre, detox centres, etc.). @*Conclusions@#The TI programme proved to be effective for behaviour change among IDUs, as substantiated by the use of new needles/syringes and sharing of needles/syringes.

A brief review on Pleiotropic effects of Pirfenidone - novel and ongoing outcomes

Presently, there is a huge hype and excitement in the field of synthetic biologics and engineering regarding growing cases of their implication in various fields including health care systems. Furthermore, despite its large body of suggestive and fascinating accomplishments, the synthetic area is always been subject of much more prejudice and debate. However, over a couple of years, the generation of researchers had tested one of such disease modifying compound Pirfenidone (Esbriet®), to unleash their potential in the different disciplines of interventional pharmacology and therapy. In this pipeline, depending on its success of multiple missions, in context to advancing the therapy for different diseases, it became the first prescribed medicine to treat the people with one characteristic lung disorder called idiopathic pulmonary fibrosis (IPF). This review discusses the different therapeutic strategies beyond its well-known anti-fibrotic activity in several well-characterized animals, cell-based and human models and also regarding facts of Pirfenidone (PFD) as anti-inflammatory, anti-fibrinogenic, anti-oxidants including in the treatment of diabetic neuropathy, liver cirrhosis etc. This review also contains current investigations, focusing mainly on the novel findings and their outcomes in improving the quality of life of patients with different conditions and also suggests their implication on the basis of fundamental existential evidences to break the major impediment in transforming this disease-modifying drug into a personalized medicine.

A Study Of Clinical Manifestations Among Clinical Sepsis And Blood Culture Positive Sepsis Patients In Nicu

In developing countries sepsis is the commonest cause of mortality responsible for 30% to 50% of 5 million neonatal deaths every year.A Sincere effort has been put in this study to understand Clinical Manifestations among clinical sepsis and Blood Culture Positive Sepsis Patients in NICU. Neonatal Sepsis is the most important cause of morbidity and Mortality in developing countries. Neonatal sepsis is diagnosed when Generalized systemic features are associated with pure growth of bacteria from one or more sites.In developing countries, neonatal mortality (death in the first 28days of life per 1000 live births) due to all causes is about 34 per 1000 live births, most of these deaths occur in the first week of life.

Awareness and willingness to pledge for eye donation among adult population of an urban re-settlement colony of Delhi

Blindness is one of the major public health problems in India. Visual rehabilitation by corneal transplantation remains a major treatment option in those who are already blind due to corneal diseases. To combat with shortage of corneal donation in India, spreading awareness among masses regarding eye donation becomes important. Objectives: (1) To determine the awareness regarding eye donation amongst adults (>20 years) in an urban re-settlement colony of Delhi. (2) To assess their willingness to pledge for eye donation. (3) To determine the factors influencing their decision for eye donation. Material and Methods: This was a cross sectional study, conducted in the urban health centre attached to a medical college of Delhi between October to December 2013. Systematic random sampling was used and every alternate adult patient >20 yrs attending the UHC was recruited. Data entry and analysis was done using SPSS by a single investigator. Results: Majority (84.4%) had heard of eye donation. Only 21.2% were aware about contraindications for donating eyes. A little over quarter (27.6%) had heard of eye bank facility. When asked whether the retrieved eye can be stored before transplantation, majority (59.2%) didn’t know. More than half (54%) didn’t know which part of eye is removed. Mass media was major source of information in three forth respondents (74.9%). 45.5% were willing to pledge their eyes, a similar proportion was not willing (44.1%), five (2.4%) had already pledged and 17 (8.1%) were yet undecided to pledge. Conclusion: While majority of participants had heard of eye donation, but their knowledge regarding certain aspects of eye donation was found to be poor.

Universal health coverage in relation to antenatal care services and its correlates

Universal health coverage (UHC) means all people receiving the health services they need, of sufficient quality to be effective while at the same time ensuring that the use of these services does not expose the user to financial hardship. So, we did this study to assess the extent of UHC in relation to antenatal care services in Palam area of Delhi. Objectives: 1) To study the extent of coverage of antenatal services in Palam area of Delhi. 2) To assess the correlates of coverage of antenatal services among mothers. Material and methods: study type- a community based descriptive study was conducted between September 2015 to March 2017, among 250 mothers who delivered during the year 2015. A pretested, self-designed, semi-structured interview schedule and health records was used to collect information. Data was analysed using software – statistical package for social sciences (SPSS) version 20. Results: Out of 250 study participants, complete coverage of antenatal care services was seen in only 28.8% women. Literacy and presence of complication in previous pregnancy found to have statistically significant correlation with the extent of coverage of antenatal services. Conclusion: Women need to be educated about their health needs and services available to them, in order to increase the demand of maternal health services and improve utilization of available services.

Childhood Morbidity and Mortality in India – Analysis of National Family Health Survey 4 (NFHS-4) Findings

National Family Health Survey (NFHS)-4 report was recently released for health-related data. This review compares the child healthindicators across NFHS-3 and NFHS-4 with a background of existing health programs catering to child health. Reports of NFHS-4 andNFHS-3, along with ministry reports and existing literature were reviewed to understand the current status of child health. Child healthindicators were compared between the two rounds of NFHS and among Empowered Action Group states of India. National Health Policy2017 and National Health Programs related to child health were also analyzed. There has been an improvement in almost all child healthindicators from NFHS-3 to NFHS-4. The infant mortality rate has reduced to 41 per 1000 live births. The immunization rate is 62%, andhas almost doubled in the states of Uttar Pradesh, Rajasthan and Madhya Pradesh. Despite existence of many health programs, there isstill a substantial lack of achievement in most of the indicators.a

Evaluation of anxiolytic effect of furosemide in Albino rats

Background: Anxiety disorders are the most prevalent class of psychiatric condition. Medications commonly given for treatment can elicit several central nervous system (CNS) side-effects that patients find difficult to tolerate. So there is a need for new pharmacotherapeutic approaches to treat anxiety with greater efficacy and fewer side effects. Hence this study has been taken up to evaluate the anxiolytic effect of furosemide at three different doses (75mg/kg, 150mg/kg and 200mg/kg) in Albino rats.Methods: After obtaining approval from the institutional animal ethical committee 30 Albino rats weighing about 150-200gm were taken and divided into 5 groups of 6 rats each. Group 1: Normal Saline 10ml/kg (control); Group 2: Diazepam 2mg/kg (standard); Group 3: Furosemide 150mg/kg (test group 1); Group 4: Furosemide 200mg/kg (test group 2); Group 5: Furosemide 75mg/kg + Diazepam 1mg/kg (sub threshold dose). The anxiolytic activity of furosemide was tested by elevated plus maze and digital actophotometer models. Data was analysed using one way ANOVA followed by Posthoc Tukey’s test.Results: Furosemide (150mg/kg and 200mg/kg) have shown significant increase in open arm entries (p<0.05) and time spent in open arm (p<0.05) compared to control. Also furosemide (150mg/kg and 200mg/kg) have shown statistically significant decrease in locomotor activity (p<0.05) compared to control in actophotometer model. Potentiation of time spent and number of entries in open arm and decrease in locomotor activity were noticed when sub threshold doses of combination of diazepam and furosemide were used.Conclusions: These results suggest that furosemide possesses significant anxiolytic activity at both the doses. Furosemide given in sub threshold dose potentiates the antianxiety effect of sub threshold dose of diazepam when used in combination. Hence, after further studies, furosemide can be used as an anxiolytic drug.

Lo básico, lo clínico y lo histórico para el trabajo educativo con los epónimos médicos / The basic, the clinical and the historic for the educational work with medical eponyms

Introducción: el vínculo básico clínica amplía la visión para adquirir habilidades mediadoras de los procesos lógicos del pensamiento que conducirán desde los conocimientos básicos al diagnóstico clínico. El trabajo educativo desarrollado a partir del diseño de las asignaturas debe incorporar elementos de la historia de la medicina con un acento interdisciplinar como fuente de inspiración para el mejoramiento humano de estudiantes y profesores y como un método para alcanzar el perfil ético humanista del modelo del profesional al que se aspira. Objetivos: relacionar las ciencias básicas con la clínica a través de las personalidades que dieron origen a epónimos médicos, exponiendo su utilidad para el trabajo educativo curricular. Desarrollo: el potencial educativo de cada asignatura determina las actividades pedagógicas que vincularán en la clase los conocimientos básicos con la práctica clínica desde la historia de su descubrimiento, las personalidades involucradas, su biografía y las consecuencias para las ciencias médicas y la humanidad en general. La vida y la obra de Camilo Golgi, Paul Langerhans, Wilhem His y Hans Adolf Krebs, entre otros ejemplos es una fuente de inspiración para la formación de valores en los estudiantes de medicina y punto de unión entre lo básico y lo clínico en la práctica médica. Conclusiones: la obra de personalidades que dieron origen a epónimos utilizados en ciencias básicas permite relacionar estas con la aplicación clínica de los conocimientos por ellos descubiertos, sirviendo además de modelos para el trabajo educativo desde lo curricular por su dedicación a la profesión y las extraordinarias circunstancias de sus vidas(AU)

Introduction: The association between the basic and the clinical aspects broadens the vision in order to acquire mediating skills in the logical processes of thought that will lead from basic knowledge to clinical diagnosis. The educational work developed upon the design of the subjects must include elements of history of medicine with an interdisciplinary focus as a source of inspiration for the human improvement of students and teachers and as a method to achieve the humanist- ethical profile of the professional model that is the aspiration. Objectives: To relate the basic sciences with the clinical aspect through the personalities that gave rise to medical eponyms, exposing their usefulness for curricular educational work. Development: The educational potential of each subject determines the pedagogical activities which, in the class, shall link the basic knowledge with the clinical practice upon the history of its discovery, the personalities involved, its biography, and the consequences for the medical sciences and the humanity in general. The life and work of Camilo Golgi, Paul Langerhans, Wilhem His and Hans Adolf Krebs, among other examples, are sources of inspiration for the formation of values in medical students and a crossing point between the basic and the clinical in the medical practice. Conclusions: The work of personalities that gave rise to eponyms used in basic sciences makes it possible to relate these to the clinical application of the knowledge discovered by them, also serving as models for educational work upon the curriculum, for their dedication to the profession and the extraordinary circumstances of their lives(AU)

Factors associated with utilization of antenatal care services among tribal women: A study of selected States.

Background & objectives: Despite various efforts by the Government of India, utilization of antenatal care (ANC) services continues to be low among women from rural areas particularly those belonging to the Scheduled Tribes. The present study was undertaken to examine the factors associated with the utilization of ANC services among women in four States including Rajasthan, Odisha, Chhattisgarh and Madhya Pradesh which constitute a good share of tribal population of the country. Methods: Data from third round of District Level Household and Facility Survey, 2007-08 (DLHS-3) have been used. Bivariate and multivariate analyses (logistic regression model) were used to study the association between the utilization of ANC services and the independent variables at individual, household and village levels along with the motivational factors (motivation by health workers and family members). Results: The utilization of ANC services among Scheduled Tribes women varied from about 4 per cent in Madhya Pradesh and Rajasthan to 10-14 per cent in Chhattisgarh and Odisha. Utilization was highest among those women with level of education 9th class and above (15-28%) and those women who visited health facility for pregnancy confirmation test (9-27%). Across the States, women who visited health facility for pregnancy testing (adjusted odds ratio, AOR = 1.5-2.5; P<0.001) except in Madhya Pradesh; registration of pregnancy (AOR = 2.1-4.5; P<0.01) and sought treatment of pregnancy related problems (AOR = 1.5-1.8; P<0.06) except in Rajasthan, were more likely to avail complete ANC services than their counterparts. Interpretation & conclusions: The utilization of antenatal care among Scheduled Tribe women across four States was very poor. The reasons behind non-utilisation include both socio-economic and health system factors. For improving ANC utilization among tribes, these factors need to be addressed with special emphasis on woman’s educational attainment of high school and above. In addition, the study highlighted the need to create awareness among both pregnant tribal women as well as her family members on the importance of early ANC care.

Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

Background: Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers. Methods: The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors. Results: All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline. Conclusion: The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed.

Antidepressant Activity of Phyllanthus Amarus Ethanolic Extract in Experimental Animal Model.

Objectives: The aim of the study was to investigate the antidepressant effect of Phyllanthus amarus ethanolic extract in Wistar albino rats. Methods: The ethanolic extract of leaves of Phyllanthus amarus [PAEE] at a dose of 100mg/kg/body weight was administered orally for ten days. On tenth day, after one hour, the animals were taken for forced swimming test, to assess the level of depression. Results: The results indicate PAEE has significant antidepressant activity Conclusions: The antidepressant activity of Phyllanthus amarus can be due to its effect on brain neurotransmitters or due to antioxidant property.

Add on dexmedetomidine in the treatment of severe alcohol withdrawal in a patient of emergency laparotomy.

According to American statistics 90% of people drink alcohol at some time in life. The estimated prevalence of alcohol abuse among hospitalized in patients is 20 % and 10- 33 % in patients admitted to the ICU. Approximately 18% of these patients will develop alcohol withdrawal syndrome (AWS) whose symptoms can include physical and psychological manifestations that range from mild to life threatening. Although AWS has been reported in literature in post-operative periods and in intensive care unit, there is less information on treatment and preparing of a patient with AWS, coming for emergency surgical procedure. The surgical stress and deranged liver functions possess an additional challenge to the anesthesiologist. Here we are reporting the successful management of a case of delirium tremens by using Dexmedetomidine in pre, intra and post-operative period in a patient with hollow viscous perforation for emergency laparotomy.

Levels, trends & predictors of infant & child mortality among Scheduled Tribes in rural India.

Background & objectives: the level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among scheduled tribes in rural areas. Methods: Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992–2006. Results: Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1.1-1.7) as compared with births to the mother’s aged 20-29 yr. Hazard of under-five mortality was 42 per cent (95% CI=1.3-1.6) higher among four or more birth order compared with the first birth order. The risk of infant dying was higher among male children (HR = 1.2, 95% CI=1.1-1.4) than among female children while male children were at 30 per cent (HR=0.7, 95% CI=0.6-0.7) less hazard of child mortality than female children. Literate women were at 40 per cent (HR=0.6, 95% CI=0.50-0.76) less hazard of child death than illiterate women. Interpretation & conclusions: Mortality differentials by socio-demographic and economic factors were observed over the time period (1992-2006) among Scheduled Tribes (STs) in rural India. Findings support the need to focus on age at first birth and spacing between two births.