An assessment of "Organization Culture" in District Program Management Units established under National Health Mission in a western state of India.

Background: State programme management unit and District Programme Management Units (DPMU) are established under National Health Mission with an expectation to strengthen the management structures at the state and district levels, respectively. This is a major initiative to bring change in organisation structure and an effort to embrace change in working culture. The study was undertaken in a western Indian state to assess and compare the organisation culture in DPMUs. Methods: Districts of the state were divided into three strata based on the geographical and demographic features. One district from each stratum was randomly selected for the study. In-depth interview of nine key officials in each sampled DPMU was conducted with the use of standardised questionnaire-openness, confrontation, trust, authenticity, proactiveness, autonomy, collaboration and experimentation (OCTAPACE), developed by Pareek. Results: Values of OCTAPACE were diversely distributed with significant difference in distribution of scores between these domains (p < 0.05). Pro-action and Trust scores were relatively higher and consistent in the study units. Values of experimentation were lower and inconsistent. There was no significant difference in the distribution of scores between three sampled DPMUs for openness, confrontation, trust, authenticity, pro-action, autonomy and experimentation (p > 0.05). However, the distribution of collaboration score was significantly less in DPMU of desert district in comparison to DPMU of plain and tribal district (p < 0.05). Conclusion: The lacuna in values of organisation culture should be addressed to strengthen the existing management structures at the state and district levels.

An unusual case of pedal edema.

A 40-year-old male patient reported to medical outpatient department with bilateral pedal edema of 15 days duration which was progressive, bilaterally symmetrical, pitting and with minimal pain and redness. Examination revealed pallor and bilateral pitting pedal edema with mild tenderness. Investigations revealed dimorphic anemia with reduced vitamin B12 levels. All other biochemical and radiological including radiograph of the chest, ultrasonography of abdomen, color doppler of the both lower limbs, and two dimensional echocardiography were normal. For the next one month, the patient showed significant improvement and was discharged. Fifteen days later, the patient was again readmitted with progressively worsening breathlessness with orthopnea and increasing pedal edema of two days duration. Clinically and radiologically, patient had features of congestive cardiac failure which was corroborated with markedly raised levels of NT pro brain natriuretic peptide. He also had other organ involvement with raised serum creatinine (1.9 mg/dl) and elevated transaminases of >300 IU/L. Patient was managed with high flow oxygen, ventilatory support, intravenous loop diuretics, low-dose angiotensin-converting enzyme inhibitors, and supportive care. The next day, patient's son and wife also reported with bilateral pedal edema and breathlessness. Based on this history, the diagnosis of epidemic dropsy was suspected. Mustard oil from their kitchen tested positive for nitric oxide test which was later confirmed at Public Health Laboratory. The index case showed progressive downhill course and died after 3 days. Both son and wife recovered over the next few months.

Managing acute acromioclavicular joint dislocation during COVID 19 pandemic by minimally invasive technique with suture anchor and miniplate: A pilot study.

Background: Acromioclavicular (AC) joint dislocation is common in sportsmen and physically active population. Its management depends upon the grade of injury and functional demands of the patient. A variety of surgical procedures have been described with different limitations and advantages. The present study has assessed the clinical and radiological outcome of acute AC joint dislocation managed with a 3.5 mm Titanium suture anchor and 2 mm miniplate construct which requires lesser dissection, surgical time and thus contact with the patient as mandated by COVID-19 pandemic. Methods: We enrolled 10 patients of Rockwood type-III, IV and V acute AC joint injury (<3 weeks old) reporting at this hospital from Feb 2020 to May 2021. All were tested for COVID-19 using reverse transcriptase polymer chain reaction test (RTPCR) and managed by closed/open reduction and fixation with a 3.5 mm Titanium Suture Anchor and a 2 mm Titanium miniplate construct. Follow-up was done at 3, 6 and 9 month post-operatively. Results: The average age of patients was 31 yrs. RTPCR test for COVID-19 was negative in all patients. Median surgical time was 25 min (Interquartile Range[IQR] = 16-34 min) and median follow-up duration was 36 weeks (IQR = 33-39 weeks). Median visual analogue scale score and IQR at pre-operative, 3 month, 6 month and 9 month follow-up was 7(IQR = 6-8), 3.5(IQR = 2.5-4.5), 2(IQR = 0) and 1(IQR = 0), respectively. Median constant score at pre-operative, 3 month, 6 month and 9 month follow-up were 34(IQR = 25-43), 65.5(IQR = 60.5-70.5), 82.5(IQR = 77.5-87.5) and 88(IQR = 81-95). There was significant improvement in clinical status (non parametric-Friedman test p < 0.001). Radiographs showed no loss of reduction, fracture or implant failure till last follow-up. Conclusions: Minimally invasive technique with a 3.5 mm Ti-suture anchor and 2 mm plate is an easy, fast and reliable construct for the management of acute AC dislocation in physically active population.