Organisation et le fonctionnement de la surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-est, Côte d'Ivoire de janvier 2022 à juin 2022 / NA

La rougeole est une maladie infantile banale, peut être mortelles quand elle est sous-estimée. Nous avons initié cette étude dont l'objectif général est d'analyser le système de surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-Est.MéthodesNous avons procédé à une évaluation normative de la surveillance épidémiologique de la rougeole réalisée en 6 (Six) mois dans ledit district sanitaire. Les critères de sélection nous ont permis de sélectionner 30 personnels de santé impliqués dans la surveillance de la rougeole. RésultatsLes médecins étaient les plus représentés (40%), suivi des infirmiers (33,3%). Les agents avaient plus de 3 ans de service (73,3%). Plus de la moitié des agents étaient formés (56%) la moyenne d'année de service était de 5,33 ans.Dans notre étude, 93,3 % des agents connaissaient la définition d'un cas de rougeole. Les seuils d'alerte et épidémique étaient connus par 56,6% des agents enquêtés. La disponibilité des registres de consultation, fiche de notification hebdomadaire de cas au niveau des structures de santé étaient de 86,7 %. Pour la transmission des données, 70% des enquêtés avaient déclarés que les rapports se transmettaient au district hebdomadairement.Les prélèvements de sang avaient été réalisés chez tous les cas suspects (100%). Les cas confirmés de rougeole représentaient 26,8 % des échantillons.ConclusionLa rougeole est une maladie de l'enfance qui est évitable par la vaccination. Cependant à défaut de vaccination, il est impérieux de mettre en place une organisation pour la détection des cas de rougeole afin d'éviter des épidémies

THE IMPACT OF SUPPLY CHAIN MANAGEMENT PRACTICES ON PRODUCTIVITY

The purpose of the study is to test the impact of supply chain management practices on productivity of the organisation. Additionally, investigated the relationship between supply chain management practices and organisational productivity. The type of research used is descriptive in nature.. The study was conducted on the basis of various factors like risk management, process, delivery and planning and how organisational productivity can be improved through these factors of supply chain management practices. The paper revealed that there is a relationship between supply chain management practices and organisational productivity. It also revealed that there is an impact of supply chain management practices on organisational productivity. As far as the researcher is aware,this paper is rst to investigate the impact of supply chain management practices on organisational productivity with factors like quality management, inventory management and transportation and the researcher has done the study on different factors like risk management, planning, process and delivery

Uncovering The Sociological Interpretation of Visual Impairment-Related Inequities and Their Social Determinants in India

Introduction: Determinants of health are divided into four types, such as “Biological-Psychological-Environmental-Social Determinants”. The social determinants of health include gender disparities, economic status, ethnicity, race, geographic isolation, or having a specific health condition. Moreover, the social deter-minants are interdependent and interrelated with one another. There can also be a primary determinant that affects the other determinants. For example, educational level of the patients is associated with knowledge and awareness of eye care and its conditions. However, education might have a different effect than income in should be access of eye care when needed. Methodology: The study is mainly dependent on secondary data analysis. Results: The primary objective of the study is to illustrate the sociological aspects of visual impairment-related inequities and to identify the social determinants of visual impairments and disparities in India. An-other aim of the paper is to present a deeper understanding of how inequities impact the incidence of visual impairment and blindness based on the social determinants of health. The present study adopts the ecological and Commission on Social Determinants of Health (CSDH) framework 2008. We reaffirm the fact that inequi-ties negatively affect the visual impairment and blindness conditions. The national health policies should take into account the social determinants of visual impairment in their policies relating to comprehensive eye care. Social and economic factors are connected with health and welfare; those socio-economic inequalities con-tribute to health inequalities. For reducing the health inequalities around the world, we need effective policy implementation and proper fund pools. Furthermore, committed action on societal determinants of health, sufficient human resources are also necessary to control the health disabilities, include visual impairment

An analysis of the performance of the Karnataka State Cooperative Agricultural and Rural Development Bank

Rural development was once equated with agriculture, allied sectors, and infrastructure. Rural development has become a strategy to enhance the rural poor's economic and social existence. It concerns rural development. Rural development is the process through which rural society progresses up the economic ladder, improving its social and economic standing. The study tries to analyse the financial performance of the Karnataka State Co-Operative Agriculture and Rural Development Bank. The study relies on secondary data extracted from numerous NABARD Annual Reports, Sahakari Soudha, the Department of Cooperatives, Bangalore, and other publications and periodicals. The research spans a decade, from 2006 to 2021. Several statistical measures, including mean, percentage, and growth rate, are employed to evaluate the study. The study found that between the research periods, the KSCARD bank deposits, reserve money, total loan disbursed, and total share capital have all increased; however, the loan recovery percentage has fallen throughout the same period. In general, the KSCARD is an organisation that makes significant contributions to the growth of rural communities.

A STUDY TO EVALUATE THE IMPORTANCE OF FASTING LIPID PROFILE ESTIMATION AS THE PART OF INITIAL EVALUATION OF HIV POSITIVE PATIENTS BEFORE STARTING HAART

BACKGROUND:-There is evidence that ART is associated with lipodystrophy syndrome, a disturbance of lipid metabolism characterised by insulin resistance, dyslipidaemia, and fat maldistribution, metabolic bone disease (osteopenia and/or osteoporosis), and lactic acidosis. ART- associated dyslipidaemia is characterized by elevated serum concentrations of total cholesterol, triglycerides, low density lipoprotein 2(LDL-c), very low-density lipoprotein (VLDL), and Apo lipoprotein B (apoB) and low levels of high density lipoprotein (HDL-c) constituting an atherogenic lipid 1pro?le . In this study 143 young patients who were attending the Antiretroviral Therapy Plus MATERIAL AND METHODS:- Centre & Medicine Wards, ACSR GMC NELLORE were included randomly. 5ml Sample preparation and Biochemical assay :- of venous blood sample was collected by venipuncture from 12 hours overnight fast and centrifuged at 3000 cycles per minute and serum was separated for lipid pro?le measurement within one hour of blood collection. The serum levels of TC, HDL-C, LDL-C, VLDL and TG were measured using AU480 BECKMANS random access fully automated auto analyzer at Biochemistry laboratory, ACSR GMC, NELLORE. TC, LDL and TC/HDL lipid pro?les are signi?cant. F-Signi?cant values are RESULTS;- <0.05, reject null hypothesis. It means that the difference among the lipid pro?les of TC, LDL and TC/HDL in the study group is statistically signi?cant with respect to regimen groups. HDL, TG and VLDL lipid pro?les are not signi?cant. F-Signi?cant values are >0.05, no evidence to reject null hypothesis. It means that the no signi?cant difference among the lipid pro?les of HDL, TG, and VLDL in the study group is not statistically signi?cant with respect to regimen groups. Signi?cant CONCLUSIONS:- metabolic and morphological alterations occur in HIV infected patients especially in patients on HAART. The patients on HAART had an elevated Castelli Index I, indicating an increased risk for atherosclerotic cardiovascular disease in this population. There is need to assess lipid pro?les at baseline before initiation of HAART treatment and lipid pro?le monitoring during therapy to monitor any rising trends. New medications with more lipid friendly pro?les within existing drugs such as darunavir (PI), etravirine (NNRTI), new classes of drugs such as integrase inhibitors (raltegravir) and CCR5 inhibitors (maraviroc) can be used to avoid dyslipidaemia

Strengthening the oral health system in Nigeria: A health systems building block approach

Aim: The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. Methodology: This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. Results: More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Conclusion: Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Profiles of sugar fermenting bacteria of the oral cavity among children with dental caries attending stomatology services at Ruhengeri referral hospital in Musanze District, Northern Rwanda

Background: Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally. Objective: This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children. Materials and Methods: This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables. Results: About 67.6% were male, while children of age 7­9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x2 = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901­0.5785), S. aureus (x2 = 34.59, P < 0.00001, 95% CI = 0.3541­0.6292), Enterobacter aerogenes (x2 = 13.5, P = 0.000239, 95% CI = 0.151­0.4622), Serratia marcescens (x2 = 11.64, P = 0.00645, 95% CI = 0.1275­0.4418) and Klebsiella pneumonia (x2 = 13.51, P = 0.000237, 95% CI = 0.1511­0.4623) were significantly associated with dental caries. Teeth loss (x2 = 51.04, P < 0.00001, 95% CI = 0.4757­0.7205), teeth pain (x2 = 5.05, P = 0.0246, 95% CI = 0.0249­0.33499), and infection (x2 = 4.73, P = 0.02964, 95% CI = 0.0186­0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant. Conclusion: Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

Sustentabilidade: um conceito de organização social das ordens de conservação e transformação do mundo / Sustainability: a social organization concept concerned with preserving and transforming the world / Sostenibilidad: un concepto de organización social de órdenes de conservación y transformación del mundo / Durabilité: un concept d'organisation sociale des ordres de conservation et de transformation du monde

Resumo Este estudo apresenta uma análise semântica do termo sustentabilidade, procurando identificar se seria possível extrair do seu uso estratégico um projeto social. Parte-se da hipótese de que existe uma vacuidade conceitual em seu uso, de modo que suas projeções semânticas não são suficientes para estruturá-lo como conceito organizador de processos sociais compatíveis. Sob o enfoque deste trabalho, o termo sustentabilidade se constituiria no interior da atividade psicológica imanente ao sujeito, que busca interpretar seu mundo e explicar suas ordens de conservação e transformação. O método da pesquisa envolve a construção de um sistema de interpretação do termo sustentabilidade que designa forças semânticas presentes no seu emprego. Observou-se que não é possível extrair do seu uso um conceito de organização social, mas de construções teóricas transformacionistas que se impõem como necessidades lógicas com resignado apelo às referências tecnocientíficas e, ao mesmo tempo, como elemento intersubjetivo regulador de processos socioambientais não revolucionários.

Abstract This study presents a semantic analysis of the term 'sustainability,' seeking to identify whether one could draw a social project from its use. Assuming the existence of a conceptual vacuity in its use, its semantic projections would be insufficient to structure 'sustainability' as an organizing concept of compatible social processes. Hence, sustainability would be constituted within the psychological activity immanent to the historical subject that seeks to interpret their world and explain its preservation and transformation. The research method involved constructing a system of interpretation to designate the semantic forces present when the term is employed. It is not possible to extract a concept of social organization from its use, only transformational theoretical constructions that impose themselves as logical needs that appeal to technoscientific references, as well as a regulating intersubjective element of non-revolutionary socio-environmental processes.

Resumen Este estudio presenta un análisis semántico del término sostenibilidad, buscando identificar si es posible extraer un proyecto social de su uso estratégico. Se parte de la hipótesis de que existe un vacío conceptual en el uso de este término, una vez que sus proyecciones semánticas no son suficientes para estructurarlo como un concepto organizador de procesos sociales compatibles. Bajo el enfoque de este trabajo, el término sostenibilidad se constituiría a través de la actividad psicológica del sujeto que busca interpretar el mundo y explicar sus órdenes de conservación y transformación. El método de investigación implica la construcción de un sistema de interpretación de este término que designa las fuerzas semánticas presentes en su uso. Se observó que no es posible extraer de su uso un concepto de organización social, sino construcciones teóricas transformacionalistas que se imponen como necesidades lógicas con apelación a referencias tecnocientíficas, al mismo tiempo como elemento intersubjetivo de procesos socioambientales no revolucionarios.

Résumé Cette étude présent une analyse sémantique du terme « durabilité ¼, cherchant à identifier s'il est possible d'extraire de son utilisation un projet social. On suppose qu'il existe une vacuité conceptuelle dans son usage, de sorte que ses projections sémantiques ne sont pas suffisant pour le structurer en tant que concept organisateur de processus sociaux compatibles. Ici, le terme « durabilité ¼ se constituerait au sein de l'activité psychologique immanente au sujet qui cherche à interpréter son monde et à expliquer ses ordres de conservation et de transformation. La méthode de recherche implique la construction d'un système d'interprétation du terme qui désigne les forces sémantiques présentes dans son emploi. On a observé qu'il est impossible d'extraire de son utilisation un concept d'organisation sociale, juste des constructions théoriques transformationnelles qui s'imposent comme des besoins logiques, ainsi qu'un élément intersubjectif régulateur de processus socio-environnementaux non révolutionnaires.

2-Deoxy-D-Glucose: A Ray of Hope in COVID Pandemic

Coronavirus disease-19 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 is a respiratory tract infection that has already made a huge negative impact in global health situation. Transmission mainly occurs through droplets, and the virus is highly contagious. Mainly symptomatic treatments are given at present with some drugs for serious patients with unproven efficacy and safety. In this context, Institute of Nuclear Medicine and Allied Sciences, a research laboratory of Defence Research and Development Organization in collaboration with Dr. Reddy’s Laboratories, Hyderabad, has introduced a new medicine named 2-Deoxy-d-glucose (2-DG) (which has been previously tried in cancer) for the treatment of seriously ill COVID patients with a target to reduce the oxygen demand. Clinical trials showed evidence that 2-DG effectively reduces oxygen requirement in seriously ill patients, and real-time polymerase chain reaction conversion is also faster. Recently, 2-DG is approved for the use in critically ill patients by the Drug Controller General of India in May 2021. The introduction of 2-DG brings a new hope in reducing the mortality in COVID patients.

The organisational response of a hospital critical care service to the COVID-19 pandemic: The Groote Schuur Hospital experience

Background. There are limited data about the coronavirus disease-19 (COVID-19)-related organisational responses and the challenges of expanding a critical care service in a resource-limited setting.Objectives. To describe the ICU organisational response to the pandemic and the main outcomes of the intensive care service of a large state teaching hospital in South Africa.Methods. Data were extracted from administrative records and a prospective patient database with ethical approval. An ICU expansion plan was developed, and resource constraints identified. A triage tool was distributed to referring wards and hospitals. Intensive care was reserved for patients who required invasive mechanical ventilation (IMV). The total number of ICU beds was increased from 25 to 54 at peak periods, with additional non-COVID ICU capacity required during the second wave. The availability of nursing staff was the main factor limiting expansion. A ward-based high flow nasal oxygen (HFNO) service reduced the need for ICU admission of patients who failed conventional oxygen therapy. A team was established to intubate and transfer patients requiring ICU admission but was only available for the first wave. Results. We admitted 461 COVID-19 patients to the ICU over a 13-month period from 5 April 2020 to 5 May 2021 spanning two waves of admissions. The median age was 50 years and duration of ICU stay was 9 days. More than a third of the patients (35%; n=161) survived to hospital discharge. Conclusions. Pre-planning, leadership, teamwork, flexibility and good communication were essential elements for an effective response. A shortage of nurses was the main constraint on ICU expansion. HFNO may have reduced the requirement for ICU admission, but patients intubated after failing HFNO had a poor prognosis.

World Gastroenterology Organisation Global Guidelines: Helicobacter pylori / 胃肠病学

Helicobacter pylori (Hp) continues to be a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. The burden of disease falls disproportionately on less well-resourced populations. As with most infectious diseases, the greatest impact on reducing this burden comes from improvements in socioeconomic status, which interrupt transmission. This has been observed in many regions of the world, but the prevalence of infection remains high in many regions in which improvements in living standards are slow to occur. Meanwhile, the optimal clinical management and treatment pathways remain unsettled and are evolving with changing antimicrobial resistance patterns. Despite decades of research and clinical practice, major challenges remain. The quest for the most effective, safe, and simple therapy is still a major issue for clinicians. An effective vaccine also still appears to be elusive. Clinical guidelines not infrequently proffer discordant advice. It is very difficult for guidelines to achieve relevance across a variety of populations with varying spectrums of disease, antimicrobial resistance rates, and vastly different resources. As local factors are central to determining the impact and management strategies for Hp infection, it is important for pathways to be based on the best available local knowledge, rather than solely extrapolated from guidelines formulated in other regions, which may be less applicable. To this end, this revision of the World Gastroenterology Organisation Hp guideline uses a "cascades" approach that seeks to summarize the principles of management and offer advice for pragmatic, relevant, and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.

Universal health coverage as a global public health goal: the work of the International Labour Organisation, c. 1925-2018 / Cobertura universal como meta global de saúde pública: o trabalho da Organização Internacional do Trabalho, c. 1925-2018

Abstract We examine the efforts of the International Labour Organisation (ILO) to extend medical care under social security, through international conventions, advocacy and technical assistance. We consider the challenges faced by the ILO in advancing global health coverage through its labourist, social security model. The narrative begins in the interwar period, with the early conventions on sickness insurance, then discusses the rights-based universalistic vision expressed in the Philadelphia Declaration (1944). We characterize the ILO's postwar research and technical assistance as "progressive gradualism" then show how from the late-1970s the ILO became increasingly marginalized, though it retained an advisory role within the now dominant "co-operative pluralistic" model.

Resumo Analisamos os esforços da Organização Internacional do Trabalho (OIT) em ampliar o cuidado médico sob seguridade social, via convenções, amparo e assistência técnica internacionais. Consideramos os desafios da OIT no desenvolvimento da cobertura global de saúde por meio do modelo trabalhista e de seguridade social. A narrativa inicia no período entreguerras, com as primeiras convenções sobre seguro saúde, depois discute a visão universalista baseada em direitos da Declaração da Filadélfia (1944). Classificamos a pesquisa e a assistência da OIT no pós-guerra como "gradualismo progressivo" e mostramos como, a partir do final da década de 1970, a OIT foi marginalizada, embora mantivesse um papel de conselheira dentro do atual modelo "pluralista cooperativo" dominante.

Morphological spectrum and epidemiological profile of ovarian tumours in black West African women at Lagos state university teaching hospital, Ikeja, Nigeria

Background: This study was done to evaluate the histological types, frequency and age distribution of ovarian tumours in Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos State. This study also aims to classify ovarian tumours in this centre according to the World Health Organisation (WHO).Methods: A retrospective, descriptive hospital study of all ovarian specimens that were sent to the department of pathology and forensic medicine, LASUTH between 1st January, 2011 and 31st December, 2019 was done. Relevant data composed of the age distributions and histopathological types were extracted from the departmental information system and filed documents. The data was analysed using the IBM-SPSS version 25.0.Results: There were 198 cases of ovarian tumours. The mean age at diagnosis of ovarian tumours was 34.6±15.3 years. Unilateral ovarian tumour was observed in 91.9%% of cases while bilateral disease was seen in 8.1%. Primary ovarian tumours constitute 97.0% of all diagnosed tumours of the ovary. Germ cell tumour was the most frequently diagnosed ovarian tumour; and teratoma was the most common, representing 91.2% of germ cell tumours and 47.0% of all ovarian tumours. Primary ovarian cancer peaked at the 6th decade of life and metastatic ovarian cancer was infrequently seen. Serous carcinoma is the most commonly diagnosed ovarian cancer.Conclusions: Ovarian tumour presents most frequently at the 4th decade of life, and germ cell tumour is the most common.

The Aftermath of Corona Pandemic on the Psychosocial Life of Coimbatore South Population: A Cross-sectional Study

Introduction: Coronavirus disease is an infectious disease caused by a newly discovered coronavirus. Since the new coronaviruscan spread unnoticed so easily, many governments have felt the best way to ensure people having minimal contact with eachother is to order total lockdowns. This study is performed a month after lockdown to evaluate the impact of corona pandemicon the psychosocial life of Coimbatore south population.Materials and Methods: A cross-sectional randomized study was conducted at Coimbatore South, Tamil Nadu, India, betweenApril 26, 2020, and April 30, 2020. The sample size was 600. Pre-tested structured and self-structured e-questionnaire wassent to the study population and the answers were viewed using separate email id.Results: Of the 600 people, 59.5% were males and 40.5% were females. The majority (82.5%) of people felt that they weresafe during the pandemic majority of people (61%) felt that the modern lifestyle was the cause for the pandemic and 66.9% ofthe people increased the usage of traditional and natural remedies during the lockdown.Conclusion: We infer that the majority of the people (55%) enjoyed the break from their routine with an eye on their educationand career.

Correlation of Risk Factors with Severity of Diabetic Retinopathy - A Retrospective Study.

Diabetic retinopathy (DR) is a major microvascular complication of diabetes. It is the most common cause of blindness in the working-age population in developed countries. We wanted to analyse the correlation between risk factors of blindness like duration of diabetes, dyslipidaemia, hypertension, HbA1c with severity of diabetic retinopathy in order to design appropriate strategies for prevention and treatment of diabetic retinopathy.METHODSThis was a retrospective study of all diabetic patients with diabetic retinopathy who presented to the eye OPD at KS Hegde Medical Academy from April 1st 2018 to March 31st 2019 that fulfilled the inclusion criteria. A dilated fundus examination was done to note the grade of diabetic retinopathy. The demographic data along with the duration of diabetes, HbA1c values, Cholesterol levels and Blood pressure were documented and correlated with the severity of diabetic retinopathy.RESULTSThe study included 92 patients, of which 63 were males and 29 were females with a mean age of 54.5±2.8 years. We found that there was statistically significant association between the duration of diabetes and HbA1c levels with severity of diabetic retinopathy (p= 0.022 and 0.034 association), whereas there was no statistically significant correlation between blood pressure and cholesterol levels with severity of diabetic retinopathy (p= 0.52 and 0.456 respectively)CONCLUSIONSDiabetic retinopathy showed a male preponderance, with risk factors like duration of diabetes and HbA1c levels having a significant association with the severity of diabetic retinopathy. Therefore, it is essential to have a good systemic control of diabetes with diet and suitable medications. Diabetic retinopathy is a preventable cause of blindness when diagnosed early and screening of diabetic retinopathy must be done in all diabetics to prevent the progression of the disease.

Knowledge and attitudinal survey of drug promotional literature among second year undergraduate students: a questionnaire based study

Background: Promotion of drugs has been increased enormously with the advancement of technology and use of internet and media etc. Pharmaceutical manufacturers spend vast amount of money on promotion usually through medical representatives by providing printed advertisements. But, it has been seen that these printed advertisements are not up to the mark usually, they either overemphasize the efficacy or hide the safety profile for the sake of company抯 profit. All these promotional activities influence the prescribing pattern of doctors. So, the present study has been conducted to assess the knowledge and attitude of second year undergraduate students about promotional literature and to train them accordingly for improving the prescribing behaviour.Methods: A questionnaire based study containing 9 questions was conducted in 110 second year undergraduate students after taking informed consent. Statistical analysis was done by using descriptive statistics by graph pad prism version 6.01.Results: Among respondents 60 (61.2%) were males and rest 38 (38.8%) were females. 50 (51%) of the respondents have chosen Indian pharmacopoeia as a trusted source of information followed by others. Most common factor affecting the prescribing attitude was reported as updates from clinical trials 49 (50%) followed by prescriber抯 knowledge. Most important intervention taken to stop misleading drug promotional activities has been reported as formulation of strict regulation by the health care authorities against any misleading promotion.Conclusions: Promotional activities by manufacturers influence the attitude and prescribing pattern of doctors. So, it is important to teach the students about their rational use by critically analysing it.

A rare case of multilocular cystic renal neoplasm of low malignant potential diagnosed on intra-operative fine needle aspiration cytology

Multi-locular Cystic Renal Cell Carcinoma (MCRCC) is now considered as Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) in World health organisation classification (WHO) 2016. It is usually seen in elderly people where it can mimic most of the time as benign cystic lesion. Authors are reporting a case of MCRNLMP in a 70 year male diagnosed intraoperative with the help of Fine Needle Aspiration Cytology (FNAC). Radiological and other clinical findings are in favour of cystic renal lesion. And it is very important to differentiate it from conventional renal cell carcinoma which requires radical nephrectomy. So, radiological finding and FNAC is instrumental in diagnosing this rare case which require different mode of surgical management.

O Welfare State resiste? Desenvolvimentos recentes do estado social nos países da OCDE / Is the Welfare State resisting? Recent developments of the social state in OECD countries

Resumo Neste artigo buscamos analisar alguns dos principais indicadores da evolução do estado de bem-estar social em países da OCDE entre 1980 e 2016. Em particular, buscamos avaliar se a crise iniciada em 2007-2008 teria implicado em contração do estado social. Nossa análise se desdobra no estudo do comportamento de três dimensões: o gasto social, seu financiamento tributário e sua efetividade. Nossa investigação revela que o século XXI tem sido um período de expansão, com gastos crescentes e "catch up" de países retardatários. Em particular, todas as grandes áreas de política social sofreram aumentos, ao lado de apostas ainda incipientes em políticas sociais "ativas". O gasto social tem sido financiado por um esforço tributário crescente, não de todo indiferente à progressividade, e tem se traduzido em crescente esforço de redistribuição. Contudo, desigualdades e pobreza avançam em ritmo superior.

Abstract In this paper an attempt was made to analyze some of the main indicators of the evolution of the welfare state in OECD countries between 1980 and 2016. In particular, an assessment was made to evaluate if the so-called Great Recession starting in 2008 led to a contraction of the social state. The analysis focused on three dimensions: social expenditure, funding, and effectiveness. The conclusion drawn was that the twenty-first century has been a period of expansion, both in terms of social expenditure and the catch-up of the latecomers. In particular, all traditional areas of social policy have expanded in tandem with a slight increase in "active" social policies. The rise in social expenditure has been financed by increasing taxation not thoroughly alien to progressivity principles. Overall, it has been translated into an increased effort for redistribution. However, inequality and poverty are advancing at a higher rate.

¿Qué es una Buena Elección?: El Uso de los Informes de las Misiones de Observación Electoral para Evaluar los Procesos Electorales Latinoamericanos (2013-2016) / O que Seria uma Boa Eleição? O Uso dos Informes das Missões de Observação Eleitoral na Avaliação dos Processos Eleitorais Latino-americanos (2013-2016) / What Constitutes a Good Election? Employing Reports on Electoral Observation Missions to Evaluate Latin American Electoral Processes (2013-2016) / Qu'est-ce qu'une Bonne Élection? L'Usage des Rapports des Missions d'Observation Électorale pour Évaluer les Processus Électoraux Latino-américains (2013-2016)

RESUMEN Aún cuando las elecciones son el corazón de la democracia representativa, todavía no existe consenso respecto a qué es una buena elección ni tampoco se ha garantizado que las prácticas políticas que se desarrollan cumplan con criterios de calidad, legitimidad y credibilidad siguiendo los parámetros establecidos internacionalmente. En muchos países considerados democráticos las elecciones conviven con irregularidades, malas prácticas y problemas de gobernanza electoral. Este artículo propone definir una "buena elección" como aquella que satisface tres condiciones necesarias: a) respeta los estándares internacionales de integridad electoral (procedimiento); b) garantiza el ejercicio de una serie de derechos políticos (contenido) y c) satisface las expectativas de la ciudadanía respecto al modo en que se organizan las elecciones y se consiguen sus objetivos (resultado). Tras evaluar los Informes de las Misiones de Observación Electoral de la Organización de los Estados Americanos de 18 elecciones en América Latina (2013-2016), se evidencia que aunque se han incrementado los niveles de calidad de las elecciones en dos dimensiones claves (organización técnica y respeto a los derechos políticos), aún existen problemas en cuanto a los resultados así como también en relación al contenido.

RESUMO Ainda que as eleições sejam o coração da democracia representativa, não existe consenso acerca do que é uma boa eleição e tampouco há garantias que as práticas políticas desenvolvidas atendam a critérios de qualidade, legitimidade e credibilidade, em conformidade com os parâmetros internacionalmente estabelecidos. Ademais, em muitos países considerados democráticos, as eleições envolvem irregularidades, práticas incorretas e problemas de governança eleitoral. Este artigo define uma "boa eleição" como aquela que satisfaz três requisitos imperativos: a) respeito dos padrões internacionais de integridade eleitoral (procedimento); b) garantia do exercício de uma série de direitos políticos (conteúdo); e c) satisfação das expectativas dos cidadãos com respeito à forma de organização das eleições e ao alcance dos seus objetivos (resultado). Após avaliação dos Relatórios das Missões de Observação Eleitoral da Organização dos Estados Americanos referentes a 18 eleições na América Latina (2013-2016), evidencia-se que, embora os níveis de qualidade das eleições tenham sido elevados em duas dimensões-chave (organização técnica e respeito pelos direitos políticos), ainda persistem problemas em termos de resultados, assim como em relação ao conteúdo.

ABSTRACT Although elections lie at the heart of representative democracy, a lack of consensus remains on what constitutes a good election, as do guarantees that the political practices developed meet quality, legitimacy, and credibility criteria set by internationally-established parameters. Elections in many countries considered to be democratic are also rife with irregularities, cases of malpractice, and problems with electoral governance. The following article suggests defining a "good election" as one which necessarily satisfies three conditions: a) respect for the international standards of electoral integrity (procedure); b) a guaranteeing of the exercise of a series of political rights (content), and c) a satisfying of citizens' expectations on the way in which elections are organized and their aims achieved (result). By means of an evaluation of Reports on Electoral Observation Missions (2013-2016) carried out by the Organization of American States, we demonstrate that although election quality levels increased in the period for two key facets (technical organization and that regarding political rights), problems remain in terms of the results, as well as in terms of content.

RÉSUMÉ Même si les élections constituent le cœur de la démocratie représentative, il n'existe néanmoins aucun consensus quant à ce qui constituerait une bonne élection et rien ne garantit que les pratiques politiques en œuvre répondent aux critères de qualité, légitimité et crédibilité promus au niveau international. En effet, dans de nombreux pays considérés comme démocratiques, les élections sont souvent l'occasion d'irrégularités, de mauvaises pratiques et autres problèmes de gouvernance électorale. Cette article propose de définir une « bonne élection ¼ comme un scrutin à même de satisfaire trois conditions préalables : a) le respect des normes internationales d'intégrité électorale (procédure) ; b) la garantie de l'exercice d'une série de droits politiques (contenu), et c) la satisfaction des attentes citoyennes quant à la façon dont sont organisées les élections et atteints leurs objectifs (résultat). À partir de l'évaluation des rapports des Missions d'observation électorale de l'Organisation des États américains relatifs à dix-huit scrutins tenus en Amérique latine (2013-2016), on a mis en évidence qu'en dépit de l'augmentation des niveaux de qualité des élections quant à deux dimensions clés (organisation technique et respect des droits politiques), il existe encore de nombreux problèmes quant aux résultats ainsi qu'au contenu.

Envejecimiento y cuidados a largo plazo en Chile: desafíos en el contexto de la OCDE / Aging and long-term care in Chile: challenges in the OECD context / Envelhecimento e assistência a longo prazo no Chile: desafios no contexto da OCDE

RESUMEN Chile se encuentra en pleno proceso de transición demográfica y su población envejece rápidamente. Esta situación presenta múltiples desafíos de política pública, incluidos los del área de la salud pública. En concreto, la relación entre el envejecimiento y la pérdida de la autonomía exige diseñar con urgencia una política de cuidados a largo plazo en el país. El objetivo de este documento es describir el escenario actual de los cuidados a largo plazo en Chile usando la experiencia de los países de la Organización para la Cooperación y el Desarrollo Económico, para poner de manifiesto la necesidad de avanzar en el diseño y el financiamiento de una política coordinada en el país, que permita afrontar con antelación los desafíos del envejecimiento en las próximas décadas.

ABSTRACT Chile is fully in the process of demographic transition, with a rapidly aging population. This situation poses multiple public policy challenges, including those in the public health sector. Specifically, the association between aging and the loss of autonomy calls for the rapid design of a long-term care policy in the country. The purpose of this article is to describe Chile's current situation with respect to long-term care in aging, using the experience of the countries of the Organisation for Economic Co-operation and Development to draw attention to the need to move forward with the design and financing of a coordinated policy in the country that will permit early action to meet the challenges of aging in the coming decades.

RESUMO O Chile está em pleno processo de transição demográfica e a população do país está envelhecendo rapidamente. Esta situação apresenta vários desafios de políticas públicas, inclusive em saúde pública. Especificamente, a relação entre o envelhecimento e a perda de autonomia requer o planejamento com urgência de uma política de assistência a longo prazo no país. O objetivo deste documento é descrever o cenário atual de assistência a longo prazo diante do envelhecimento no Chile com base na experiência dos países da Organização para a Cooperação e Desenvolvimento Econômico a fim de evidenciar a necessidade de avançar no planejamento e financiamento de uma política coordenada que permita enfrentar com antecedência os desafios do envelhecimento no país nas próximas décadas.