Anterior Cruciate Ligament Reconstruction with Semitendinosus Tendon Autograft among Paramilitary Patients Undergoing Arthroscopic Surgery in a Tertiary Care Centre.

Introduction: In orthopaedic practice, injuries to the anterior cruciate ligaments occur almost on an epidemic scale, yet it continues to be of interest in orthopaedic surgery whether semitendinosus or gracilis hamstring autografts can be used for better anterior cruciate ligament reconstruction. This study aimed to determine the prevalence of anterior cruciate ligament reconstruction using semitendinosus tendon autografts among paramilitary patients undergoing arthroscopic surgery in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among paramilitary individuals who had knee injuries and were admitted between 6 february 2020 and 26 January 2022 for arthroscopic surgery after obtaining ethical approval from the Institutional Review Committee. Demographic details and the mode of injury were obtained from the patients. The treating orthopaedic surgeons evaluated the pre- and post-analysis Lysholm Knee Score and Lysholm Knee Scale based on the patient's response. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 166 patients, anterior cruciate ligament reconstruction using a semitendinosus tendon autograft was done in 58 (34.94%) (27.69-42.19, 95% Confidence Interval). Most of the patients in the pre-analysis had mild/periodic limp issues 52 (89.66%), followed by instability during athletics or other severe exertion 43 (74.14%). Conclusions: The prevalence of anterior cruciate ligament injuries in our study is higher than other studies done in similar settings. Keywords: anterior cruciate ligament; grafts; semitendinosus tendon.

Displaced Midshaft Clavicular Fractures among Patients with Clavicular Fracture Admitted to the Orthopaedic Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Midshaft clavicular fractures are common among young adults. Open reduction and internal fixation of displaced midshaft clavicular fractures with plate and screws have been shown to decrease nonunion, symptomatic malunion, and residual shoulder disability compared with non-operative treatment allowing early pain-free movement and early return to work. The aim of this study was to find out the prevalence of displaced midshaft clavicular fractures among patients with clavicular fractures admitted to the orthopaedics department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Orthopedics of a tertiary care centre from 31 January 2016 to 31 December 2019 after receiving ethical approval from the Institutional Review Committee (Reference number: 659/2021 P). Data were collected using hospital-based records from patients of the age group 18 to 50 years. Convenience sampling method was used. Point estimate and 95% confidence interval were calculated. Results: Among 120 patients, the prevalence of displaced midshaft clavicular fractures was 40 (33.33%) (24.90-41.76, 95% Confidence Interval). Among them 39 (90%) were males and 4 (10%) were females and the mean age of 31.45 years. The average Constant-Murley score were 95.68±5.59. Conclusions: The prevalence of displaced midshaft clavicular fractures among patients with clavicular fractures admitted to the Department of Orthopedics was lower than the other studies done in similar settings. Keywords: clavicle; fracture; open fracture reduction; orthopedics.

Stress Fractures among Paramilitary Trainee Visiting a Paramilitary Hospital of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Young paramilitary recruits, who undergo strenuous exercise during basic training, are often presented with stress fractures, which could be due to an inadequate vitamin D (25-hydroxyvitamin D) intake. This study aimed to find the prevalence of stress fracture among young paramilitary trainees visiting the orthopedic outpatient department of a paramilitary hospital. METHODS: This was a descriptive cross-sectional study done among paramilitary trainees in a paramilitary Hospital of Nepal between April 2019 to April 2021. The study was approved by the Ethical Review Board (Reference number: 1003) of the Nepal Health Research Council. Convenience sampling was used. Anthropometric variables, serum 25-hydroxyvitamin D level, and bone mineral density of spine and hip were determined. Data analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency, proportion for binary data and mean, standard deviation for continuous data. RESULTS: Among 417 young paramilitary trainees, 24 (5.76%) (3.52-7.99 at 95% Confidence Interval) were found to have a stress fracture. The stress fracture patients had a serum 25-hydroxyvitamin D level of 21.47ng/mL±6.98. Similarly, the bone mineral density value of the spine and hip among the patients was -1.34g/cm2±1.37 and 0.36g/cm2±1.24, respectively. CONCLUSIONS: The prevalence of stress fracture among young paramilitary trainee was high compared to previous studies. Additionally, average Vitamin D and the bone mineral density value of the spine and the total hip among stressed fractured patients were also low.

Estimation and probabilistic projection of levels and trends in the sex ratio at birth in seven provinces of Nepal from 1980 to 2050: a Bayesian modeling approach.

BACKGROUND: The sex ratio at birth (SRB; ratio of male to female births) in Nepal has been reported around the normal level on the national level. However, the national SRB could mask the disparity within the country. Given the demographic and cultural heterogeneities in Nepal, it is crucial to model Nepal SRB on the subnational level. Prior studies on subnational SRB in Nepal are mostly based on reporting observed values from surveys and census, and no study has provided probabilistic projections. We aim to estimate and project SRB for the seven provinces of Nepal from 1980 to 2050 using a Bayesian modeling approach. METHODS: We compiled an extensive database on provincial SRB of Nepal, consisting 2001, 2006, 2011, and 2016 Nepal Demographic and Health Surveys and 2011 Census. We adopted a Bayesian hierarchical time series model to estimate and project the provincial SRB, with a focus on modelling the potential SRB imbalance. RESULTS: In 2016, the highest SRB is estimated in Province 5 (Lumbini Pradesh) at 1.102, corresponding to 110.2 male births per 100 female births, with a 95% credible interval (1.044, 1.127) and the lowest SRB is in Province 2 at 1.053 (1.035, 1.109). The SRB imbalance probabilities in all provinces are generally low and vary from 16% in Province 2 to 81% in Province 5 (Lumbini Pradesh). SRB imbalances are estimated to have begun at the earliest in 2001 in Province 5 (Lumbini Pradesh) with a 95% credible interval (1992, 2022) and the latest in 2017 (1998, 2040) in Province 2. We project SRB in all provinces to begin converging back to the national baseline in the mid-2030s. By 2050, the SRBs in all provinces are projected to be around the SRB baseline level. CONCLUSIONS: Our findings imply that the majority of provinces in Nepal have low risks of SRB imbalance for the period 1980-2016. However, we identify a few provinces with higher probabilities of having SRB inflation. The projected SRB is an important illustration of potential future prenatal sex discrimination and shows the need to monitor SRB in provinces with higher possibilities of SRB imbalance.

The Gender Gap in Life Expectancy in Urban and Rural China, 2013-2018.

BACKGROUND: Gender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China. METHODS: We use age-, gender-, urban-rural- and cause-specific mortality data (2013-2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence. RESULTS: Women had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013-2018. In urban areas, the gender gap decreased from 5.17 years in 2013-2015 to 4.98 years in 2016-2018. In rural areas, the gender gap stayed rather constant (2013-2015: 5.68 years; 2016-2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: -0.07 years; rural: -0.10 years), especially in the 0-44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas. CONCLUSIONS: The urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity.

Future population and human capital in heterogeneous India.

Within the next decade India is expected to surpass China as the world's most populous country due to still higher fertility and a younger population. Around 2025 each country will be home to around 1.5 billion people. India is demographically very heterogeneous with some rural illiterate populations still having more than four children on average while educated urban women have fewer than 1.5 children and with great differences between states. We show that the population outlook greatly depends on the degree to which this heterogeneity is explicitly incorporated into the population projection model used. The conventional projection model, considering only the age and sex structures of the population at the national level, results in a lower projected population than the same model applied at the level of states because over time the high-fertility states gain more weight, thus applying the higher rates to more people. The opposite outcome results from an explicit consideration of education differentials because over time the proportion of more educated women with lower fertility increases, thus leading to lower predicted growth than in the conventional model. To comprehensively address this issue, we develop a five-dimensional model of India's population by state, rural/urban place of residence, age, sex, and level of education and show the impacts of different degrees of aggregation. We also provide human capital scenarios for all Indian states that suggest that India will rapidly catch up with other more developed countries in Asia if the recent pace of education expansion is maintained.

The human core of the shared socioeconomic pathways: Population scenarios by age, sex and level of education for all countries to 2100.

This paper applies the methods of multi-dimensional mathematical demography to project national populations based on alternative assumptions on future, fertility, mortality, migration and educational transitions that correspond to the five shared socioeconomic pathways (SSP) storylines. In doing so it goes a significant step beyond past population scenarios in the IPCC context which considered only total population size. By differentiating the human population not only by age and sex-as is conventionally done in demographic projections-but also by different levels of educational attainment the most fundamental aspects of human development and social change are being explicitly addressed through modeling the changing composition of populations by these three important individual characteristics. The scenarios have been defined in a collaborative effort of the international Integrated Assessment Modeling community with the medium scenario following that of a major new effort by the Wittgenstein Centre for Demography and Global Human Capital (IIASA, OEAW, WU) involving over 550 experts from around the world. As a result, in terms of total world population size the trajectories resulting from the five SSPs stay very close to each other until around 2030 and by the middle of the century already a visible differentiation appears with the range between the highest (SSP3) and the lowest (SSP1) trajectories spanning 1.5 billion. The range opens up much more with the SSP3 reaching 12.6 billion in 2100 and SSP1 falling to 6.9 billion which is lower than today's world population.

Meeting the Sustainable Development Goals leads to lower world population growth.

Here we show the extent to which the expected world population growth could be lowered by successfully implementing the recently agreed-upon Sustainable Development Goals (SDGs). The SDGs include specific quantitative targets on mortality, reproductive health, and education for all girls by 2030, measures that will directly and indirectly affect future demographic trends. Based on a multidimensional model of population dynamics that stratifies national populations by age, sex, and level of education with educational fertility and mortality differentials, we translate these goals into SDG population scenarios, resulting in population sizes between 8.2 and 8.7 billion in 2100. Because these results lie outside the 95% prediction range given by the 2015 United Nations probabilistic population projections, we complement the study with sensitivity analyses of these projections that suggest that those prediction intervals are too narrow because of uncertainty in baseline data, conservative assumptions on correlations, and the possibility of new policies influencing these trends. Although the analysis presented here rests on several assumptions about the implementation of the SDGs and the persistence of educational, fertility, and mortality differentials, it quantitatively illustrates the view that demography is not destiny and that policies can make a decisive difference. In particular, advances in female education and reproductive health can contribute greatly to reducing world population growth.

Global human capital: integrating education and population.

Almost universally, women with higher levels of education have fewer children. Better education is associated with lower mortality, better health, and different migration patterns. Hence, the global population outlook depends greatly on further progress in education, particularly of young women. By 2050, the highest and lowest education scenarios--assuming identical education-specific fertility rates--result in world population sizes of 8.9 and 10.0 billion, respectively. Better education also matters for human development, including health, economic growth, and democracy. Existing methods of multi-state demography can quantitatively integrate education into standard demographic analysis, thus adding the "quality" dimension.