Current process and outcomes of the surgical management of LUTS due to benign prostatic enlargement: how consistent are we? - results from the multi-institutional audit of surgical management of BPE (AuSuM BPE) in the United Kingdom.

OBJECTIVE: In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. MATERIALS AND METHOD: A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. RESULTS: 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. CONCLUSION: Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.

Physiological workload assessment with the help of heart rate and perceived exertion rating on handcart pullers of wholesale trade markets of Delhi.

Background . Handling a heavy load on a handcart is common in the wholesale and retail trade markets in India and many parts of the globe. These carts transport goods between major markets, warehouses and transporters. We assessed the physiological workload among handcart pullers in terms of cardiovascular load (CVL), energy expenditure (EE), heart rate (HR), physiological cost of work and subjective rating of perceived exertion. Methods . Physiological workload was assessed with the help of HR during resting, working (15 minutes) and recovery state with a smart wearable device to extrapolate percentage of CVL, EE and physiological cost of work among handcart pullers. Subjective assessment of exertion was measured with the Borg 5-point rating scale among 35 cart pullers. Data were analysed using Microsoft Excel version 2010. Results . It was found that in handcart-pulling activity, EE was 11.706 kJ/minute, average working HR was 128 beats/minute and physiological cost of work was 89.09 beats/minute with no loads on handcart. This signifies that the activity falls under heavy physiological workload. The average percentage of CVL was found to be 50.5%, which falls under acceptable category for persons with a healthy cardiovascular system. Thirty-one (88.6%) of the participants reported the activity to be moderately heavy, whereas 4 (11.4%) participants mentioned it to be light. Conclusions . Handcart-pulling operation in this study without load on cart was found to be a heavy physiological workload. In real-time situations, the load, road conditions, long duration and traffic congestion is likely to result in a higher range of physiological workload on cart pullers.

Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study.

OBJECTIVES: To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. DESIGN: Longitudinal prospective cohort study with preintervention and postintervention cohorts. SETTING: Major trauma centre in India. PARTICIPANTS: Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. INTERVENTION: A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. MAIN OUTCOME MEASURES: The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. RESULTS: Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). CONCLUSIONS: The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. TRIAL REGISTRATION NUMBER: NCT02877342.

Incidence and prevalence of toxoplasmosis in Indian pregnant women: a prospective study.

PROBLEM: Toxoplasmosis is a major cause of congenitally acquired infections causing high degree of morbidity and mortality in the newborns. METHODS OF STUDY: IgG avidity method was used to distinguish the recent and more than 4 months old infection in a prospective cohort study for the first time in India. One hundred and eighty pregnant women presented in their first 4 months of pregnancy were included in this study. Their sera were tested for anti-Toxoplasma gondii antibodies using direct agglutination test, immunoglobulin (Ig)G and IgM-enzyme-linked immunosorbent assay, IgM-immunosorbent agglutination assay and VIDAS-IgG avidity. RESULTS: Overall IgG seroprevalence rate of toxoplasmosis was 45%. Only seven women (3.3%) were found to have IgM antibodies and only two of these showed low IgG avidity indicating recent infection of