ABSTRACT
Background: The aim was to study cataract surgery incidence in an urban community of 100,000 peoples in Mumbai.Methods: A retrospective observational community based study was performed for the period from January 01, 2008 to December 31, 2015. Electronic patient records were used to track surgeries performed in the members of community. Mid-year community census was considered as baseline population to estimate gender specific and age specific incidence of cataract surgery. Logistic regression was performed assuming gender and age-group as independent variables.Results: The rate of cataract extraction surgery varies from 786 to 952 surgeries per 100,000 per year. 6971 cataract surgeries were recorded with an overall average of 872/100,000/years. Increase in age was strongly associated with increase in incidence of cataract surgery and peak incidence was recorded for age group of 66–70 years. The odds of having surgery were similar in females and males 1.012 (95% CI 0.952 - 1.077).Conclusions: This study documented the rate of 872 cataract surgeries per year in an Indian population over eight years. Average incidence is found in the similar range of studies published from United States and Sweden. This community-based estimates of cataract surgery are useful for planning and managing resources at the national level.
ABSTRACT
The current system of blood banks in India is such that rural patients are deprived of timely access to an adequate volume of life-saving blood, adding to preventable mortality. On the basis of an academic framework for a blood transfusion system, we describe an alternative approach in which rural practitioners utilise unbanked blood transfusions from a voluntary pool of pre-screened donors. This system would provide safe blood – as evidenced by international experience and limited projected increase in transfusion-transmissible infection in India – at a fraction of the financial cost imposed by the current system. Given the failing status quo and the undue burden placed on rural clinicians and patients to procure blood, it is imperative that policy-makers further explore the use of unbanked, direct blood transfusion for patients facing emergent, life-threatening haemorrhage
ABSTRACT
Unsafe healthcare is a well-recognized issue internationally and is attracting attention in India as well. Drawing upon the various efforts that have been made to address this issue in India and abroad, we explore how we can accelerate developments and build a culture of patient safety in the Indian health sector. Using five international case studies, we describe experiences of promoting patient safety in various ways to inform future developments in India. We offer a roadmap for 2020, which contains suggestions on how India could build a culture of patient safety.
Subject(s)
Humans , India , Organizational Culture , Patient SafetyABSTRACT
Background & objectives: Wide variability in serum prostate specific antigen (PSA) levels exists in malignant conditions of the prostate. PSA is expressed in normal range in 20 to 25 per cent of prostate cancer cases even in presence of high grade Gleason score. This study was aimed to assess the influence of genetic variants exhibited by PSA and androgen receptor (AR) genes towards the variable expression of PSA in prostate cancer. Methods: Pre-treatment serum PSA levels from 101 prostate cancer cases were retrieved from medical record. PSA genotype analysis in promoter region and AR gene microsatellite Cytosine/Adenine/Guanine (CAG) repeat analysis in exon 1 region was performed using DNA sequencing and fragment analysis techniques. Results: A total of seven single nucleotide polymorphisms (SNPs) in the PSA promoter region were noted. Only two SNPs viz., 158G/A (P<0.001) in the proximal promoter region and -3845G/A (P<0.001) in enhancer region showed significant association with serum PSA levels. The carriers of homozygous GG genotype (P<0.001) at both of these polymorphic sites showed higher expression of PSA whereas homozygous AA genotype (P<0.001) carriers demonstrated lower PSA levels. The combination effect of PSA genotypes along with stratified AR CAG repeats lengths (long, intermediate and short) was also studied. The homozygous GG genotype along with AR long CAG repeats and homozygous AA genotype along with AR short CAG repeats at position -3845 and -158 showed strong interaction and thus influenced serum PSA levels. Interpretation & conclusions: The genetic variants exhibited by PSA gene at positions -3845G/A and -158G/A may be accountable towards wide variability of serum PSA levels in prostate cancer. Also the preferential binding of G and A alleles at these polymorphic sites along with AR long and short CAG repeats may contribute towards PSA expression.
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The noble intention of helping fellow human beings can have consequences that are both risky and life-threatening. Increasingly, humanitarian health workers and the healthcare system in conflict zones are themselves becoming targets of assault. On January 5, 2012, Dr Khalil Rashid Dale, an International Committee of the Red Cross (ICRC) delegate working as health programme manager, was abducted by unknown armed men while returning to his residence in Quetta, the capital of Baluchistan province in Pakistan. While the perpetrators of the abduction maintained intermittent contact with various authorities, the beheaded body of the kidnapped official was found in an apple orchard on April 29, 2012.
Subject(s)
Drug Industry , Ethics, Medical , Gift Giving , Guidelines as Topic , Humans , India , Interprofessional Relations , PhysiciansABSTRACT
We conducted a qualitative study to determine the range of promotional practices influencing drug usage in Mumbai. Open-ended interviews were conducted with 15 senior executives in drug companies, 25 chemists and 25 doctors; focus group discussions were held with 36 medical representatives. The study provided a picture of what might be described as an unholy alliance: manufacturers, chemists and doctors conspire to make profits at the expense of consumers and the public's health, even as they negotiate with each other on their respective shares of these profits. Misleading information, incentives and unethical trade practices were identified as methods to increase the prescription and sale of drugs. Medical representatives provide incomplete medical information to influence prescribing practices; they also offer incentives including conference sponsorship. Doctors may also demand incentives, as when doctors' associations threaten to boycott companies that do not comply with their demands for sponsorship. Manufacturers, chemists and medical representatives use various unethical trade practices. Of particular interest was the finding that chemists are major players in this system, providing drug information directly to patients. The study also reinforced our impression that medical representatives are the least powerful of the four groups.