Factors predicting infective complications following percutaneous nephrolithotomy and retrograde intrarenal surgery according to systemic inflammatory response syndrome and quick sequential organ failure assessment: A prospective study.

Purpose: Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Materials and Methods: Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA. Results: The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures. Conclusion: Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients.

Population control bill of Uttar Pradesh (two-child norm): An answer to population explosion or birth of a new social problem?

Recently, the Government of Uttar Pradesh (UP) unveiled a draft bill of the UP Population Policy (2021-2030) on World Population Day to bring down the gross fertility rate and stabilization of the population. The history of the two-child norm in India has shown that different state governments had tried to implement it at different timelines during the past 20 years. Global evidence suggests that Vietnam and Bangladesh have stabilized their population and control birth rate despite not having two-child policies. Moreover, sex-selective abortion, preference for male children, denying the paternity of female children, pre-natal sex determination, and violence against women for giving birth to girl children will be on rise. Female literacy, empowerment, and addressing unmet needs of contraceptives are the time-tested solutions for population control rather than raising a new social problem with a "two-child policy" bill/act.

Do we need to vaccinate every child against COVID-19: What evidence suggests-A systematic review of opinions.

It is still debatable whether all children should receive the COVID-19 vaccine. The comparatively mild cases and low risk of COVID-19 in children compared to adults, as well as the lack of clarity on the relative effects of the disease and vaccine, indicate that the risk-benefit ratio of vaccination in children is more nuanced. To consider and highlight the complexity of policy decisions regarding COVID-19 vaccination in children, we outlined the points regarding for and against vaccination of children against COVID-19 in this systemic review. Using Medical Search Headings (MeSH) terms and keywords, we searched PubMed, PubMed Central, Scopus, and Google Scholar. The primary search term was COVID-19 vaccination (all synonyms), factors (all synonyms), and among children (all synonyms). A total of 367 articles were searched. Finally, 64 articles met the inclusion criteria and were included in the review. The major theme/tone of 28 (43.75%) articles was in favor of children's COVID vaccination, and they were highlighting the positive factors, whereas the major theme/tone of 20 (31.25%) articles was against it. Approximately 16 (25.0%) articles were in a neutral position. Major factors highlighted by articles in favor of childhood COVID vaccination were as follows: the increasing rate of disease burden (29 articles), prevention of interruption of academic activities of children or school reopening (24 articles), and a role in defense against COVID infection (21 articles). Major factors against childhood vaccination were as follows: mild infection among children (27 articles), ethical concerns and legal problems regarding the consent of minors (17 articles), and vaccine hesitancy among parents for childhood vaccination (11 articles). Whereas, factors of uncertainty were the role in the reduction of community transmission (19 articles), protection against MIS-C (10 articles), and defense against long COVID (7 articles). Considering all the factors of COVID-19 disease progression among children, a cautious approach will be essential before proceeding with COVID-19 vaccination in children.

Transition in dietary quality: evidence from India.

Despite significant economic growth over the past decades, poor nutritional status in India is a serious concern. The social transformation led by growth in income influences both the composition of food and the quality of diet consumed. Against this backdrop of changing lifestyles and the rise in obesity and non-communicable diseases, in this study, we examined changes in diet quality and the critical socio-economic correlates of this quality from 1983 to 2012 using three rounds of nationally representative surveys providing information on food consumption for more than 100 000 households in each round. We constructed diet quality indices at the household level using deficient and excess intake of macro and micronutrients compared with the recommended daily allowances (RDA) for different age-sex groups of the Indian population. We found that in relation to the RDA, fat consumption increased over time while protein and energy consumption decreased. The average diet quality index improved in the rural sector while it deteriorated in the urban sector. Caste and religion are significant correlates of the diet quality index. The deficiency index of nutrients decreased for poor households as they get richer; however, it increased with affluence level for the non-poor. It is suggested that the Indian Government may play a more proactive role in implementing coherent national policies in trade, food and agriculture to protect public health by promoting the demand for a healthy diet.

Maternal education, health care system and child health: Evidence from India.

Global evidence suggests that maternal education is a crucial determinant of a child's health. The health system moderates the maternal education and child health relationship. However, there is sparse evidence on which direction health system moderates this relationship, especially in developing nations because of limited data availability. In order to address this gap in the evidence, we study this question in the Indian context, where the health system is still in a transitioning phase. We use two nationally representative surveys, the fourth round of the National Family Health Survey (2015-16) and the fourth round of the District Level Health Survey data (2012-13), to estimate the effects of maternal education and the health care system on child death and child anaemia. We map district-level data on health infrastructure and human resources information with individual-level information on health outcome, insurance, and antenatal care coverage along with other socio-economic characteristics. In accordance with global evidence, we find that maternal education remains an important determinant of child health outcomes in India too. However, the association between maternal education and child health outcomes weakens in the presence of a poor health care system. Health system improvement first benefits the already privileged in the Indian context. Yet, it should not hinder the policy focus either on the improvement of women's education or the medical care system.

A Meta-analysis of Complication Rates Among Various Surgical Modifications of Pectoralis Major Myocutaneous Flap.

The purpose of this study is to aggregate and summarize the complication rates among various modified techniques of pectoralis major myocutaneous flap harvesting. Various databases were searched from its inception to September 2020. Studies describing surgical management of head and neck oncologic reconstruction using pectoralis major myocutaneous flap and its surgical modifications were included in study. All included studies: (1) described a pectoralis major flap harvesting technique categorized by author as conventional technique, bipaddle or bilobed flap, segmental flap, flap transfer using subclavicular route, skin paddle over Pectoralis Major, Flap with Multiple vascular supply, U shaped skin paddle, modified short incision technique; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total 183 studies were included. Segmental flap (0.20%), flap with multiple vascular supply (5.18%) and parasternal skin flap (6.38%) had the highest rates of total complications and were the only techniques to show a statistically significant increase in odds ratio compared with conventional technique (odds ratio 1.89, 9.05 and 7.26, respectively, P < 0.05). Bipaddle flap (57.48%) and u shaped skin flap (78.05%) show statistically significant decrease in odds ratio as compared to conventional technique. Among all the modifications in surgical technique of pectoralis major myocutaneous flap harvesting bipaddle flap and u shaped skin flap show least total complication rates. But on the contrary rates of partial flap necrosis and fistula are significantly higher in bipaddle flap as compared to conventional technique. As such, the choice of surgical technique should primarily be made based on the defect size, patient selection and surgeons' discretion rather than the presumed complication rate.

Universalisation versus targeting in maternal and child health care provisioning: Evidence from India.

To eradicate the persistent inequality in utilisation of Maternal Health Care Services (MHCS), India's Government has adopted various programmes under the National Rural Health Mission (NRHM) in 2005. The Janani Suraksha Yojana (JSY), a demand-side intervention, is one of the flagship programmes under the NRHM. Using two rounds of the nationally representative National Family Health Survey (NFHS) data collected in 2005-06 and 2015-16, respectively, we attempt to map the extent to which inequality in MHCS utilisation has changed over time across states after the implementation of NRHM; analyse whether there are differences in the patterns of inequality prevalent in the universal and targeted states; and find evidence to decide whether universalisation is more effective than targeting in reducing inequality in MHCS utilisation. We measure relative inequality and use the difference in difference technique to answer the research questions. For analysis, we have considered five outcome variables spanning across three stages of the continuum of care in maternal health. We find that relative inequality in MHCS utilisation declined across states during the period 2006-16, though in varying degrees. Universal states experienced a higher level of inequality as compared to the targeted states. However, universal states observed a higher decline in inequality over time relative to the targeted states controlling for other state-level characteristics. The study establishes that the programme implementation strategy and conditional cash transfer programmes influence the reduction of inequality in MHCS utilisation. This study makes an important contribution to the literature on public health policy and inequality in health care utilisation by highlighting the differential impact of universalisation and targeting on reducing inequality in the use of MHCS.

Affordability versus innovation: Is compulsory licensing the solution?

In an era which marks an exceptional phase of growth in science and technology, the acute disparities in access to healthcare still persist. So where on one hand scientific advancement in medicine aims at increasing life expectancy, on the other hand there are millions who are denied access to existing medicines. Patents on medicines also pose a significant barrier to access new drugs, especially in low and middle income countries which already suffer from poor health financing mechanisms. The patent laws were built on the assumption of incentivizing the innovators by rewarding them with the exclusive right to produce, sell or market the innovation. The basic premise for granting patents was based on the thought that it would increase investment in research and development promoting dynamic gains through newer innovations. However, evidence found to support this justification is meager. So in a situation where the drug gap still persists and we aim to achieve sustainable development goals by 2030, this paper attempts to focus on understanding how compulsory licensing has been used in selected cases to alleviate the major legal and political barriers to access medicines. The methodology comprises of cross-country comparison of patent framework and compulsory licensing cases. The sample selected for study includes both developed as well as developing countries. The aim is to evaluate the policy approaches used by selected countries to grant compulsory licenses and to identify the best practices for evidence-based policy making on international issues related to pharmaceutical patents. In each case, a driving factor has been the international extension of patent laws through trade agreements; first bilaterally (US-Canada) and subsequently internationally (1995 Uruguay round, under which low- and middle-income countries were granted a grace period until 2005 to comply).

Patent implications in the pharmaceutical industry: Are static high prices leading to dynamic innovations?

Agreement on Trade Related aspects of Intellectual Property Rights (TRIPS) was laid on the premises of rewarding monopolistic patent rights to the innovator. Stronger patent protection was advocated to promote technology transfer from developed nations to the rest of the world. To boost domestic innovative potential and to maintain trade ties, most developing countries signed the TRIPS agreement. Impact of patent laws in the pharmaceutical industry was crucial as it posed threat to access health. This paper aims to analyze the impact of pharmaceutical product patent laws incorporated under the TRIPS agreement using 65 countries panel dataset from 1995 to 2016. The data is empirically analyzed using negative binomial regression and Poisson regression. Results clearly indicate that the number of pharmaceutical patents filed in US Patent and Trademark Office (USPTO) has decreased after TRIPS compliance in both low and middle income countries. However, the decline is larger in upper middle and lower middle income countries than in low income countries. The phenomenon of low patent activity has an increasingly declining trend across low and middle income countries. Hence the claimed hypothesis that stronger patent rights would increase innovative potential does not seem to stand true, which raises serious affordability concerns of bringing patents in the pharmaceutical sector.

Unintentional injury and role of different predictors among 1-5 years children: a community based cross sectional study in a rural population of a developing country.

Injury has been increasing exponentially, especially in children, and it has become a public health concern. The present study was conducted with the objective of determining the prevalence and profile of unintentional injury among children of 1-5-year age group in a rural community of India and also to find out the predictors. Primary caregiver was interviewed by using a structured interview schedule. Parent supervisory behaviour was assessed using Parent Supervision Attributes Profile Questionnaire (PSAPQ), and child injury risk-taking behaviour was assessed by using injury behaviour checklist (IBC). Children encountered any unintentional injury event during last three-month period were 261 (62.7%). PSAPQ score was significantly higher in those parents where children had no episode of injury compared to others. Among four components of the PSAPQ, protectiveness (p = 0.049) and risk tolerance (p = 0.001) score had significant positive association with the incidence of unintentional injury. Binary multivariable logistic regression technique had found that age of the child, gender, primary care giver, birth order of the baby, the number of siblings, social class and IBC score has significant association with history of unintentional injury. There is utmost need for the development of effective programmes and training strategies to prevent unintentional injury among under-five children in future.

Investigating Mumps Outbreak in Odisha, India: An Opportunity to Assess the Health System by Utilizing the Essential Public Health Services Framework.

AbstractMumps, a highly contagious, viral disease continues to spread in India, despite the availability of an effective vaccine. On November 24, 2014, we came across a suspected case of mumps in a 6-year-old boy in a village of Bhusandapur sector in Odisha. We initiated an outbreak investigation using standard techniques outlined by the Centers for Disease Control and Prevention, Atlanta, GA. This uncovered a silent epidemic of 94 case patients (10% of the population) over a period of 16 weeks between August and December 2014, in a single village, which had gone completely unnoticed by the existing health-care system. Since the index case was one of the last case patients of the outbreak, investigation for immediate control was not a priority. Hence, we have used this exercise to describe the outbreak and identify causes that led to its nondetection. Age range of the case patients was between 2 and 40 years; 85 (90.4%) case patients were ≤ 15 years of age and 54 (57.4%) were females. Average duration of illness was 9 days. No child had received the mumps vaccine. The outbreak had led to a community expenditure of 538 USD. The exercise uncovered a number of weak links in the essential public health services within the health-care delivery system in the area.

Coverage of health-related articles in major local newspapers of Manipur.

BACKGROUND: Newspapers have immense potential for generating health awareness on diverse issues such as hygiene, immunization, environmental pollution, and communicable disease. The present study was conducted to determine the frequency of coverage and types of health-related articles published in local newspapers of Manipur. MATERIALS AND METHODS: This was a cross-sectional study conducted among the most regularly published 10 local newspapers (4 English and 6 Manipuri) of Manipur from February 2011 to January 2012. Health-related articles published in everyday local newspapers were collected after careful search and finally entered into a design Proforma under different categories. Data were analyzed using SPSS version 16. RESULTS: Total health-related articles published were 10,874 and maximum articles were published during February (12.8%). Maximum health-related articles were published on Wednesday (16.1%). Among all the health-related articles, almost half were related with injury followed by public health articles. Maximum public health and injury-related articles were published on Monday, but medical topics were published more on Wednesday. Newspapers of both the languages were publishing public health articles more compared to medical topics. Public health (72.9%) and injury-related articles (95.9%) were published maximum in the news items section, but medical topics (45.8%) were published maximum in the health section of the newspaper. Newspapers of both the languages published maximum small size articles. CONCLUSIONS: There is a room for improvement for newspapers of both the languages regarding number of health-related articles' publication, section of publication, and size of the health articles.

Operational Assessment of ICDS Scheme at Grass Root Level in a Rural Area of Eastern India: Time to Introspect.

INTRODUCTION: Integrated Child Development Service (ICDS), a flagship program of Government of India (GoI) for early childhood development hasn't delivered the desired results since its inception four decades ago. This could be due to infrastructural problems, lack of awareness and proper utilization by the local people, inadequate program monitoring and corruption in food supplies, etc. This study is an audit of 36 Anganwadi centres at Khordha district, Odisha, to evaluate the implementation of the ICDS. AIM: To assess operational aspects of ICDS program in a rural area of Odisha, in Eastern India. MATERIALS AND METHODS: A total of 36 out of 50 Anganwadi Centres (AWCs) were included in the study. We interviewed the Anganwadi Workers (AWW) and carried out observations on the AWCs using a checklist. We gathered information under three domains manpower resource, material resource and functional aspects of the AWC. RESULTS: Most of the AWCs were adequately staffed. Most of the AWWs were well educated. However, more than 85% of the AWCs did not have designated building for daily functioning which resulted in issues related to implementation of program. Water, toilet and electricity facilities were almost non-existent. Indoor air pollution posed a serious threat to the health of the children. Lack of play materials; lack of health assessment tools for promoting, monitoring physical and mental development; and multiple de-motivating factors within the work environment, eventually translated into lack of faith among the beneficiaries in the rural community. CONCLUSION: Inadequate infrastructure and logistic supply were the most prominent issues found, which resulted in poor implementation of ICDS program. Strengthening of grass root level facilities based on need assessment, effective monitoring and supervision will definitely help in revamping the ICDS program in rural areas.

Four new vaccines for routine immunization in India: what about hemophilus influenza B and pneumococcal vaccine?

Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. The Expanded Program on Immunization (EPI) was flagged off in India in 1978. According to the recommendation of National technical advisory group of India (NATGI), Government of India is going to include four new vaccines in the UIP for whole India. The four new vaccines are Inactivated Poliomyelitis Vaccine (IPV) for polio, rota viral vaccine, vaccine against rubella, and Japanese encephalitis vaccine (179 districts in India). Here, authors have tried to show a comparative descriptive analysis of the hemophilus influenza and pneumococcal pneumonia with rota virus, so that in near future Government of India can also consider their inclusion in the national UIP. In India, 39.2% of all diarrheal death are due to rota virus, whereas 0.72 million deaths are due to hemophilus influenza B and 1.3 million are due to pneumococcal pneumonia in <5 years age-group. India's indigenous developed rota viral vaccine's (Rotavac) efficacy is 56% in 1(st) year compared to H influenza B (Hib) efficacy 95% and PCV13 vaccine "3 + 1" dose efficacy 100% (South Africa). Rotarix incremental cost-effectiveness ratio is US $21.4 to US $34 per disability-adjusted life years (DALYs) compared to Hib US $ 819 per DALYs in India. In case of pneumococcal vaccine, India needs more trails on the serotype specificity, efficacy, and cost-effectiveness but there is enough evidence that hemophilus influenza burden is high in India and the present Hib vaccine is safe and highly effective. In future with the help of donor agencies, India should include the hemophilus influenza B and pneumococcal pneumonia vaccine in national UIP which will save millions of poor children's life.