Cost of implementing the QualityRights programme in public hospitals in Gujarat providing mental healthcare

Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems’ perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (?) 0.59 million to ? 2.59 million [1United States Dollars (US $) = ? 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.

Utilization rate of corneal tissue obtained from donors over 75 years of age in Western India for keratoplasty

Purpose: To examine the utilization patterns of cornea procured from diseased individuals ?75 years of age at an eye bank in western India. Methods: In this retrospective study, data from 1,217 eyes of 653 donors with age ?75 years were reviewed from October 2008 to December 2019. Donor age, lens status, endothelial cell count (ECD), utilization of the tissue for transplantation or non?clinical purposes (e.g., research, training/discarded), and causes of non?utilization were noted. Results: The mean age of the donors was 80.9 ± 4.6 years and the tissue utilization rate was 36.5% (445 out of 1,217 eyes). The eyes used for keratoplasty procedures had a lower donor age (79.6 ± 5.7 vs. 81.5 ± 5.1; P < 0.001), a higher endothelial cell count (2493 ± 531 vs. 2034 ± 581; P < 0.001), and were more often phakic (61% vs. 36.6%) compared to the unused group. A multivariable logistic regression analysis showed that the likelihood of tissue utilization for keratoplasty was 13% higher with every 100?cell increment in donor ECD (odds ratio [OR] = 1.13, 95% CI = 1.10–1.16, P < 0.001) and 33% lower with having a pseudophakic status in the donor eye (OR = 0.67, 95% CI = 0.52–0.87, P = 0.03). Age was not a significant determinant of tissue utilization when used in the same multivariable model. Conclusion: More than one?third of the eyes (36.5%) can be utilized even when the donors are above 75 years of age. Eyes that were more likely to be utilized for keratoplasty were phakic and had a significantly higher ECD; age was not a determinant in tissue utilization

Management of blight of bell pepper (Capsicum annuum var. grossum) caused by Drechslera bicolor

Abstract Sweet or bell pepper is a member of the Solanaceae family and is regarded as one of the most popular and nutritious vegetable. Blight, in the form of leaf and fruit blight, has been observed to infect bell pepper crops cultivated at the horticulture farm in Rajasthan College of Agriculture, Udaipur, India. Based on disease severity, we attempted to curb this newly emerged problem using different fungicides, plant extracts, bio-control agents, and commercial botanicals against the fungus in laboratory and pot experiments. Bio-control agent Trichoderma viride and plant growth promoting Rhizobacteria (PGPR) isolate Neist-2 were found to be quite effective against bell pepper blight. All evaluated fungicides, botanicals, commercial botanicals, and bio-control agents in vitro were further studied as seed dressers and two foliar sprays at ten days interval in pot experiments. The combinations of Vitavax, PGPR isolate Neist-2, and Mehandi extract were found to be very effective against bell pepper blight followed by Vitavax, T. viride, and Mehandi extract used individually. All treatments in the pot experiments were found to significantly reduce seedling mortality and enhance plant biomass of bell pepper. Thus, these experimental findings suggest that a better integrated management of bell pepper blight could be achieved by conducting field trials in major bell pepper- and chilli-cultivated areas of the state. Besides fungicides, different botanicals and commercial botanicals also seem to be promising treatment options. Therefore, the outcome of the present study provides an alternate option of fungicide use in minimizing loss caused by Drechslera bicolor.

Tracing causes of death in neonates in urban and rural communities in Ahmedabad and Gandhinagar Districts.

Objective:To Study the socio-demographic characteristics of neonatal deaths in urban and rural communities. Methods:A Cross-sectionalCommunity- based study on Neonate was carried out during November-2004 to October-2005 with help ofPre-designed and Pre-tested Proformaof “Sample Registration System” of India, for every Neonatal death in the study area, using a structured interview schedule. Results:The population had 380(0.78%) neonates.Majority of the deaths70.27% occurred in a premature and preterm birth ofneonates. Neonatal Mortality was 31.65/1000 live births and it was1.70 times higher in rural area than urban area.Only 56.76% deceased were born inInstitutions. Exclusive breast feeding among deceasedwas 89.19%.Utilization of Antenatal Care Services by Mothers of deceased neonates was82.43%. Conclusion:The present study has been carried out to determine causes and factors related to neonatal death. The most of neonatal deaths occurred in preterm and low birth weight babies that need more strengthening of health care services.Knowledge and Practice of mothersrequired for positioning and attachment of neonate during breast feeding. The diagnosis of cause of death was mainly symptom-based according to the information collected by verbal autopsy.

Diagnosis and management bronchopleural fistula.

The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and mortality. Diagnosis and localisation of BPF is sometimes difficult and may require multiple imaging and bronchoscopies. Successful management of a fistula is combined with treatment of the associated empyema cavity. The first step, therefore, should be control of active infection and adequate drainage of the hemithorax. When deemed required, definitive surgical repair should be accomplished expeditiously, minimising the number of procedures performed. In cases of a small fistula or where the surgical risk is high, various bronchoscopic methods have been used to close the fistula. When treatment is protracted, secondary complications are more likely and survival is adversely affected. In this article, approaches to the diagnosis and treatment of BPF are discussed, with particular emphasis on bronchoscopic management options.

Imaging features in Hirayama disease.

Purpose: To evaluate the MR findings in clinically suspected cases of Hirayama disease. Materials and Methods: The pre and post contrast neutral and flexion position cervical MR images of eight patients of clinically suspected Hirayama disease were evaluated for the following findings: localized lower cervical cord atrophy, asymmetric cord flattening, abnormal cervical curvature, loss of attachment between the posterior dural sac and subjacent lamina, anterior shifting of the posterior wall of the cervical dural canal and enhancing epidural component with flow voids. The distribution of the above features in our patient population was noted and correlated with their clinical presentation and electromyography findings. Observations: Although lower cervical cord atrophy was noted in all eight cases of suspected Hirayama disease, the rest of the findings were variably distributed with asymmetric cord flattening, abnormal cervical curvature, anterior shifting of the posterior wall of the cervical dural canal and enhancing epidural component seen in six out of eight (75%) cases. An additional finding of thoracic extension of the enhancing epidural component was also noted in five out of eight cases. Conclusion: Dynamic post contrast MRI evaluation of cervicothoracic spine is an accurate method for the diagnosis of Hirayama disease.