Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly

Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program’s implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home‑based care, and integrating digital health technologies and other existing welfare schemes.

Intrinsic Capacity of Rural Elderly in Thar Desert using World Health Organization Integrated Care for Older Persons Screening Tool: A Pilot Study

Integrated Care for Older Persons (ICOPE) screening tool helps to address declines in physical and mental capacities in older people. In India, majority of the older population resides in rural areas and there is a paucity of studies that demonstrates the utility of the ICOPE screening tool in India. Thus, a cross-sectional study was conducted to demonstrate the feasibility of using the World Health Organization ICOPE screening tool in a rural population. Comprehensive geriatric assessment of intrinsic capacity revealed cognitive decline in 31.5% (n = 142) participants, diminished mobility 52.1% (n = 235) participants, eye problems in 49.4% (n = 223) participants, and hearing loss in 68.3% (n = 308) participants. Gender difference was statistically significant with mobility limitation (P = 0.005; ?2 = 7.95) and feeling of pain (P = 0.001; ?2 = 15.64), being more in females than males. This tool seems suitable in identifying the intrinsic capacity of the rural elderly.

Undergraduate public health degree courses in India: selected overview

Background: Building the public health workforce in India along with strengthening the public health systems across the Nation are essential components necessary to achieve the sustainable development goals for India. In the Indian context, there is limited information available for undergraduate public health education. The central aim of this brief study is to elucidate the undergraduate public health education landscape at selected institutions in India.Methods: A mixed methods approach was used in this brief study. First, cross-sectional, scoping review was used. Then, to describe student perceptions and attitude towards undergraduate public health curriculum, primary data were collected by using a questionnaire. A self-administered questionnaire was developed after extensive literature search. Descriptive statistics were used to summarize questionnaire results. Chi-square tests were used to help identify factors that may influence student perceptions and attitudes.Results: Through scoping rapid review and internet search, eight institutions were identified that are offering undergraduate public health courses in India. Most institutes in India have 3 years duration for the undergraduate public health degree courses. Most of students (89%) believed that the undergraduate public health course increased their knowledge in the field of public health. We found an association between student perceptions about community benefits from trained undergraduate public health workforce.Conclusions: The undergraduate public health education initiatives should be promoted and envisioned as a new strategy for public health capacity-building in public health in India.

Study of heart disease in pregnancy and its effect on maternal outcome

Background: Heart diseases in pregnant women and has higher incidence of maternal mortality and morbidity and is regarded as risk factor for unfavourable outcome of pregnancy both for the mother and the foetus. Heart disease in pregnancy was found to be second indirect cause contributing to maternal mortality in India.Methods: This study is a hospital based prospective analytical study carried out in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal over a period of 1 year from 1st March 2017 to 28th February 2018. Patients were evaluated clinically by both obstetrician and cardiologist and followed all through their hospital stay till discharge.Results: Total 51 cases of heart disease were found during the study period. Incidence of heart disease in our study during study period was found 0.25%. Most patients were unbooked 33(64.71%) and maximum number of patients belonged to NYHA functional class II 24 (47.06%), RHD cases were 4 times more common than CHD. 24 (47.06%) patients had undergone surgical intervention for heart disease. Congestive cardiac failure was most common complication seen. Three maternal deaths were seen. All cases belonged to NYHA functional class III. All 3 cases were unbooked presented first time in labor.Conclusions: We found that pregnancy outcome was good in booked cases with regular checkup by obstetrician and cardiologist, surgically corrected cases and those with NYHA functional class I and II. Hence, joint management by obstetrician, cardiologist, and anesthetist is required to ensure better maternal outcome.

Bacterial Isolation and Antibiogram of Uterine Lavage from Repeat Breeder Cows Suffering from Subclinical Endometritis

A total 500 cows were randomly selected from college livestock farm, Kuthuliya and different villages in and around Rewa (M.P.). After recording history all the animals were subjected to gynaeco-clinical examination, Whiteside test and endometrial cytology by cytobrush technique. On the basis of above tests performed all the animals were selected for the study. They were divided into three groups as follows: Normal (n=280), Clinical endometritis (n=80) and Subclinical endometritis (n=140). All the animals were subjected to aseptic collection of uterine fluid by low volume lavage technique. Uterine fluid samples obtained were used for microbial assay and antibiotic sensitivity tests. Among the bacterial isolates Staphylococcus species (36.31%) was highly prevalent. The antibiotic sensitivity of isolates was found to be maximum for ceftriaxone and sulbactum combination 91.67 per cent followed by levofloxacin 89.07, ciprofloxacin 79.69, ceftriaxone 73.43, enrofloxacin 61.45 and gentamicin 56.78 per cent, respectively. It was concluded that Staphylococcus species was highly prevalent bacteria isolated and a combination of ceftriaxone and sulbactum was found to be highly sensitive

Incidence of Postpartum Anoestrus and Oestrus Behavior and Gynecological Symptoms in Hormonal Treated Postpartum Anoestrus Buffaloes

The present investigation was aimed to evaluate the incidence of anoestrus in postpartum buffaloes and compare the intensity of oestrus in anoestrus and oestrus induced buffaloes. A total of 500 postpartum buffaloes were selected from different villages situated around Rewa (M.P.). Calving and breeding history of animals was recorded and Gynaeco-clinical examination. The incidence of anoestrus in postpartum buffaloes was recorded as 33.40 per cent. Out of 167 postpartum buffaloes found to be positive for anoestrus, 24 buffaloes were again randomly divided into three treatment (n=18) and control group (n=06). These treatment group animals were again divided into 03 groups on the basis of hormonal treatment protocols given to animals of groups. Ovsynch group, Heatsynch group, CIDR plus Heatsynch group while control group animals were left untreated. Oestrus intensity score of buffaloes ranged from 80-90, 68-72 and 46-52 in intense, moderate and weak oestrus intensities at induced oestrus respectively, with a mean weighed score of 84.88±1.30, 70.00±0.81 and 49.00±3.00, respectively. Thus it was concluded that the incidence of anoestrus recorded to be 33.40 per cent. Oestrus intensity score card pattern is a good tool to designate intensity of oestrus which has positive relationship with fertility

Proximal Fibular Osteotomy: A Novel Technique for Management of Medial Compartment Knee Osteoarthritis

For medial compartment knee OA, which is usually seen in the age group 40-50 years, total knee replacement is not recommended ideally. Hence, for these patients, there is need of a new procedure which would be safe, effective & affordable. Objective: The aim of this study is to evaluate the early benefits of proximal fibular osteotomy (PFO) in medial compartment knee OA. Methods: Total 50 patients (70 knees) with medial compartment OA included in this study from march 2017 to august 2017. All patients were managed by PFO and followed-up prospectively for minimum upto 12 months. Visual analogue scale to assess knee pain, American knee society score (AKSS) to evaluate knee functions and medial/lateral joint space ratio were used for radiological assessment. Statistical analysis done by using SPSS 20.0 software.. Results: All patients observed significant relief in knee pain after PFO. AKSS and medial/lateral joint space ratio improved significantly postoperatively. Most of the patients showed increased walking distance post-operatively. Conclusion: This study concludes that PFO is a safe & effective method for the management of medial compartment knee OA. It relieves knee pain significantly and improves knee joint function

Primary total hip arthroplasty versus hemiarthroplasty for displaced neck femur fractures in older patients

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. Objectives: To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Materials and methods: We prospectively as well as retrospectively studied 46 patients treated with total hip replacement or hemiarthroplasty. Pain, range of motion, hip function, haris hip score and complications were assessed clinically while hip stability, femoral anteversion, acetabular cup inclination and acetabular erosions were assessed radiographically. Results: In our study according to Harris hip score, group A (hemiarthroplasty group) showed 58.33% excellent to good result whereas 33.34% shows fair to poor result. In group B (total hip replacement group) 90.91% showed excellent to good result and 9.08% showed fair to poor result. In this study, the overall Harris hip score was 76.33 with SD±19.091 in hemiarthroplasty group and 86.45 with SD±6.363 in Total hip replacement group with p-value 0.0224(<0.05). Nitin Kumar Singh, Himanshu Jain, Sonal Garg, Sachin Yadav. Primary total hip arthroplasty versus hemiarthroplasty for displaced neck femur fractures in older patients. IAIM, 2017; 4(10): 209-215. Page 210 Conclusion: So we concluded in our one year of study that total hip replacement had better functional outcome in fracture neck of femur in elderly treated by either hemiarthroplasty or total hip replacement and total hip replacement is less painful than hemiarthroplasty.

Role of vertebroplasty in osteoporotic compression fracture

xMajority of osteoporotic vertebral compression fracture present with back pain and some of them with spinal deformity. Percutaneous vertebroplasty not only addresses pain relief but also the correction of spinal deformity with least post-operative morbidity. 72 patients with osteoporotic compression fracture and spinal deformity with chronic invalidating pain treated with percutaneous vertebroplasty were followed for 2.8 years with an average of 1.3 years.47% showed excellent,13% showed good and 40% showed fair result on vas score. There was good improvement in stature in 43%, fair in 40% and 17% showed no improvement.

Tuberculous dactylitis: A case report.

Tuberculous dactylitis (TD) is an uncommon presentation. It is also known as spina ventosa. Mycobacterium tuberculosis is the causative agent responsible for Tuberculosis. We here present a case of a young adolescent female presenting with complaints of pain and swelling in middle finger region for the last seven month. She was diagnosed as case of tubercular dactylitis and was managed surgically along with anti-tubercular chemotherapy.

Two Staged Surgery for Gap Non-Union of Patella Fracture: A Good Alternative.

Gap Nonunion of patella fractures are rare conditions whose treatment is challenging for surgeons. Strict protocol for such fracture gap nonunion of patella is not well documented in the literature. The decision in treatment of these conditions is based on many factors such as functional demands of the patient, factors leading to nonunion, and presence of an intact extensor mechanism of the knee. We present a case of neglected gap nonunion of a transverse fracture of patella treated at 5 months after injury with a two stage reconstruction procedure.

Post Partum Pubic Diastasis: A Case Report.

Post-partum pubic symphysis diastasis is termed as abnormally wide gap between the two pubic bones following vaginal delivery. It is a rare and under diagnosed condition following acute pelvic pain. We are presenting a case of post partum pubic diastasis, in a 31 year old female with complain of pain, tenderness over pubic area and unable to walk. Patient was diagnosed with x-ray and MRI and treated surgically.

Severe Hallux Varus; an Uncommon Deformity —A Case Report and Review of Literature.

Hallux varus is relatively uncommon and few cases have been reported in the orthopedic literature. In this article, we report the case of a 63 years old, female patient with severe hallux varus deformity, associated with deformity of other toes. Here we describe the case report of hallux varus managed by surgical intervention at our tertiary care hospital in Mumbai, India.

Tuberculosis of Medial Cuneiform: A Case Report.

Isolated tuberculosis of cuneiform is rare in literature. Diagnosis of tuberculosis of cuneiform remains a dilemma because of its rarity in the lower limb. Chance of misdiagnosis and delay in diagnosis may add to morbidity. Presumptive diagnosis can be made on the basis of X-ray, MRI, histopathology of the pathological tissue, which reveals granulomatous inflammation with or without caseation. Here we are reporting a case of 15 year old girl with swelling and pain over a mid foot diagnosed as tuberculosis of cuneiform on subsequent X-ray, MRI and biopsy.

Macrodystrophia Lipomatosa- A Rare Congenital Anomaly: A Case Report and Review of Literature.

Macrodystrophia lipomatosa is a rare presentation and only few cases are reported in scientific literature. We report a case of Macrodystrophia lipomatosa in a 7 year young girl from a tertiary care hospital Mumbai. Case presentation: A 7 year old female was presented to outpatient department with progressive enlargement of right lower limb with increase in size of right great toe since birth. On clinical examination there was non tender fluctuant soft tissue swelling with good functional limb. Scannogram showed reduction of the medial compartment of right knee joint and the right lower limb length was slightly longer compared to the left side with presence of soft tissue swelling on medial distal thigh and knee region. MRI showed un-encapsulated subcutaneous fatty tissue involving the entire right lower limb along its medial aspect up to the great toe with fatty infiltration of the vastus medialis muscle suggestive of macrodystrophia lipomatosa. Arterial and venous colour Doppler study of right lower limb was normal. Conclusion: Macrodystrophia lipomatosa is a rare congenital, non hereditary condition with localized macrodactyly and proliferation of mesenchymal element and marked increase in fibroadipose tissue. X-ray and MRI are investigation of choice. Doppler study shows normal vascularity.

Cytotherapy for Osteonecrosis of Hip.

Osteonecrosis of hip is a pathological condition that leads to collapse of the femoral head, & the need for total hip replacement (THR). Research has shown that at the cellular level there is decrease in osteoblastic activity & the local mesenchymal stem cells (MSC) population that leads to osteonecrosis of femoral head (ONFH). Cellular therapy could thus be used to improve the local cellular environment. Th is can be achieved by implanting bone marrow, containing osteogenic precursors into the necrotic lesion of the femoral head.

Pattern of Orthopaedic Injuries Among Patients Attending the Emergency Department in a Tertiary Care Hospital – An Analytical Study.

Introduction: Th is study was aimed at analyzing the pattern of Orthopaedic injuries among patients attending the Emergency department in a tertiary care hospital. Retrospective study was conducted in the Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre. Methods: Th e record analysis of injured patients seen at the emergency department over a 12 months period from June 2012 to may 2013 was done. Th e data was analyzed with special reference tothepattern of Orthopaedic injuries. Results: A total of 1110 records of injured patients that attended the emergency department were analyzed. Study showed that themajority of victims were in the age group of 11-44 years (n=909, 81.89 percent). 71.09 percent (n=789) were males and 28.9 percent (n=321) were females. Road traffi c accident was the most common cause of injuries being responsible for 59.72 percent, (n=663) followed by fall from height (22.5 percent, n=247). Study revealed that the most common presentation of injuries was fracture (68.64 percent, n=762) and the most common site was lower limbs in 48.16 percent cases, (n=367). Next most common site was upper limbs (28.08 percent, n=214) followed by pelvic fracture (10.01 percent, n=77), spine fractures (8.26 percent, n=63), facial fracture (2.88 percent, n=22) & Ribs fracture (2.49 percent, n=19). Th ere were 71.65 percent cases (n=546) of simple fracture and 28.34 percent cases (n=216) ofthecompound fracture. Th ere were 3.87 percent cases (n=43), of various dislocations, shoulder dislocation being the most common. Crush injury was seen in 7.5 percent cases. Most commonly associated visceral injury wasthehead injury in 17.20 percent cases (n=191). Conclusion: Fractures were the most common pattern of Orthopaedic injuries, frequently associated with head injuries. Research in to appropriate strategies for prevention of injuries, especially RTA is required in tertiary care hospitals.

siMacro: A Fast and Easy Data Processing Tool for Cell-Based Genomewide siRNA Screens

Growing numbers of studies employ cell line-based systematic short interfering RNA (siRNA) screens to study gene functions and to identify drug targets. As multiple sources of variations that are unique to siRNA screens exist, there is a growing demand for a computational tool that generates normalized values and standardized scores. However, only a few tools have been available so far with limited usability. Here, we present siMacro, a fast and easy-to-use Microsoft Office Excel-based tool with a graphic user interface, designed to process single-condition or two-condition synthetic screen datasets. siMacro normalizes position and batch effects, censors outlier samples, and calculates Z-scores and robust Z-scores, with a spreadsheet output of >120,000 samples in under 1 minute.

Reversible germ cell toxicity of sulphasalazine and ampicillin combination in male rats

The antifertility effect of ampicillin [AMP, 40 mg/kg] and sulphasalazine or salicylazosulfapyridine [SASP, 300, 450 and 600 mg/kg] in male rats has been reported earlier. The combination of AMP and SASP is generally used in certain pathological conditions, but the combined effect of these two drugs on the fertility is not clear. So, the aim of this study was to investigate the antifertility effect of ampicillin and sulphasalazine combination in male rats. In the present study, forty rats were randomly divided into five groups [n=8]. Group 1 served as the control, while Group 2 and 3 received AMP and SASP at the doses of 20 mg/kg and 200 mg/kg respectively. Moreover, group 4 and 5 received the combination of SASP [100 mg/kg] and AMP [10 mg/kg]. However, for evaluating the reversible effect of the combination, a washout period of 30 days was given in group 5. After 45 days of drug treatment, each rat was sacrificed. The testes, seminal vesicles and epididymis were dissected and weighed. Furthermore, fertility tests, sperm characteristic analysis, histopathological studies, testosterone assay and tissue biochemistry were performed. The data were analyzed using ANOVA and in case ANOVA shows statistical differences, post hoc analysis was performed. A decrease in parameters related to fertility of males such as sperm count, sperm motility, fertility ratio, serum testosterone level, glycogen and protein content in sexual organs was observed. Although AMP and SASP significantly [p<0.001] reduced the reproductive activity separately, but their combination was found to be impairing the reproductive activity at a considerably lower dose. However, on withdrawing the treatment, all these parameters were restored which was confirmed by the histopathological analysis of the testis. The combination produces synergistic antifertility effect in male rats and the effect was reversible. The dose and efficacy of results could be extrapolated in future clinical trials