Two Parallel Roads Impacting the Functional Preparedness of Accredited Hospitals: The Indian Healthcare Quality Standards and Disaster Management Act 2005.

Background: Quality management of healthcare service providers and disaster preparedness are two important aspects that affect patient safety and the overall outcome of care delivery. Accreditation standards and legal framework for disaster management are intertwined and pave the way for achieving the optimum level of safety in healthcare system. Aims: The aim of the study is to evaluate the functional preparedness of hospital staff for managing disaster situations. Materials and Methods: It was a quantitative, cross-sectional, ex-post-facto study to understand the functional elements by deeply studying the Knowledge, Attitude and Practice (KAP) scores of various level hospital staff. Results: Knowledge scores of the participants showed positive correlation with attitude scores (r = 0.424, P < 0.001) and practice scores (r = 0.446, P < 0.001). The study showed a significant difference between mean KAP score of males (14.96 ± 3.5) and female (16.38 ± 2.6). Similarly, the staff who obtained excellent scores in the KAP study belonged to a higher age group while those who obtained poor were in the lowest age group (F (2, 715) =10.739; P < 0.001). The performance of staff significantly increased (P < 0.01) with increase in age as number of years of experience and on-the-job training enriched their understanding. Inspite, of the same level of inputs in terms of training and sensitization inputs, the staff of Administration departments showed higher knowledge than other staff (χ2 =97.37, P < 0.001). Analysis of educational qualification of participants elicits that it has a statistically significant effect on their performance in KAP study (F (5, 709) = 12.82; P < 0.001). Conclusion: The KAP scores are direct indicator of effectiveness of quality standards in preparing the hospital for disaster management. The study shows that variables like age, gender, department, educational qualification are correlated with performance and affect the attitude and practice during a disaster event.

Quest for Biomarkers of Positive Health: A Review.

The positive health of a person can be defined as the ability to live long in good health, possibly with no activity limitation. No method is yet available for its objective assessment in individuals, and we propose a framework in this communication that can operationalize this concept. Instead of distal factors, such as diet and lifestyle because these are subjective and difficult to measure, we concentrate on the objectively measurable biomarkers such as immunity level, endorphins, and handgrip strength. The focus is on the major parameters that may protect from diseases and infirmity and can be assessed by noninvasive methods. A combination of such parameters may signify positive health. This may be a novel way to measure positive health at the individual level. In this communication, we briefly review the literature and identify a few major biomarkers that provide a protective shield and could determine the status of positive health at the individual level. This exercise demonstrates that the assessment of the positive health of a person is feasible. A scale based on these and other relevant parameters can be developed later that could quantitatively measure the exact level of positive health. As the exact combination of the parameters that protects from ailments is not fully known yet, a framework such as this may help in identifying the data gaps that require attention in this context. The proposed framework may initiate a discussion on indicators of positive health and characterize the parameters for intervention that could increase a healthy life.

Clinicoradiological Risk Factors Associated with Inability to Achieve Minimum Clinically Important Difference in Operated Cases of Cervical Spondylotic Myelopathy.

STUDY DESIGN: This is a retrospective cohort study. PURPOSE: This study aimed to identify the clinicoradiological risk factors associated with the inability to achieve minimum clinically important difference (MCID) on the modified Japanese Orthopaedic Association (mJOA) Scale in operated cases of cervical spondylotic myelopathy (CSM). OVERVIEW OF LITERATURE: Only a few studies have evaluated the outcomes of surgery performed for CSM using MCID on the mJOA scale. METHODS: We analyzed 124 operated CSM cases from March 2019 to April 2021 for preoperative clinical features, cervical sagittal radiographic parameters, and magnetic resonance imaging (MRI) signal intensities (SI). The risk factors associated with missing the MCID (poor outcome) on mJOA at the final follow-up were identified using binary logistic regression. Multivariate analysis was used to find significant risk factors, and odds ratios (OR) were computed. RESULTS: A total of 110 men (89.2%) and 14 women (10.8%) with an average age of 53.5±13.2 years were included in the analysis. During the last follow-up, 89 cases (72.1%) achieved MCID (meaningful gains following surgery) while 35 (27.9%) could not. The final model identified the following parameters as significant risk factors for poor outcome: increased duration of symptoms (OR, 6.77; p=0.001), lower preoperative mJOA scale (OR, 0.75; p=0.029), the presence of multilevel T2-weighted (T2W) MRI SI (OR, 4.79; p=0.004), and larger change in cervical sagittal vertical axis (ΔcSVA) (OR, 1.06; p=0.013). Also, an increase in cSVA postoperatively correlated with a reduced functional recovery rate (r=-0.4, p<0.001). CONCLUSIONS: Surgery for CSM leads to significant functional benefits. However, poorer outcomes are observed in cases of greater duration of symptoms, higher preoperative severity with multilevel T2W MRI SI, and a larger increase in the postoperative cSVA (sagittal imbalance).

Unique sphingolipid signature identifies luminal and triple-negative breast cancer subtypes.

Breast cancer (luminal and triple-negative breast cancer [TNBC]) is the most common cancer among women in India and worldwide. Altered sphingolipid levels have emerged as a common phenomenon during cancer progression. However, these alterations are yet to be translated into robust diagnostic and prognostic markers for cancer. Here, we present the quantified sphingolipids of tumor and adjacent-normal tissues from patients of luminal (n = 70) and TNBC (n = 42) subtype from an Indian cohort using targeted liquid chromatography mass spectrometry. We recorded unique sphingolipid profiles that distinguished luminal and TNBC tumors in comparison to adjacent normal tissue by six-sphingolipid signatures. Moreover, systematic comparison of the profiles of luminal and TNBC tumors provided a unique five-sphingolipid signature distinguishing the two subtypes. We further identified key sphingolipids that can stratify grade II and grade III tumors of luminal and TNBC subtype as well as their lymphovascular invasion status. Therefore, we provide the right evidence to develop these candidate sphingolipids as widely acceptable marker/s capable of diagnosing luminal vs TNBC subtype of breast cancer, and predicting the disease severity by identifying the tumor grade.

Assessing the Structural and Functional Similarity of Insulin Glargine Biosimilars.

BACKGROUND: A biosimilar product is expected to exhibit similar safety, efficacy, and quality as that of the approved reference product. Only a few reports of thorough evaluation of the quality of insulin glargine biosimilars are available in literature. Here, we examine the structural and functional similarity of biosimilars of insulin glargine, the first basal long-acting insulin analogue with respect to its innovator product (Lantus® from Sanofi Aventis). METHODS: Structural similarity was established using mass spectrometry, chromatographic, and spectroscopic techniques. Stability was compared by performing accelerated thermal stress studies. Functional similarity was established via in vitro assay. RESULTS: Biosimilar 4 exhibited greater content of high molecular weight species (HMWs) (0.80%) and related substances (RS) (0.45±0.06%) vs others (HMWs of 0.04% and RS of 0.17%). Biosimilars 1 and 3 exhibited higher rate of impurity generation (0.78% and 0.73% per week, respectively), as compared with other drug products (0.02% to 0.43% per week). Furthermore, %aggregation at 14 days was found to statistically correlate (R2= 0.99, root mean square error (RMSE) = 0.095) with %aggregation at 0 day (linearly) and the number of months from expiry (nonlinearly), highlighting the overpowering impact of the latter. CONCLUSIONS: While an overall structural and functional similarity was observed across insulin glargine biosimilars with respect to the innovator product, low amounts of product-related variants were seen in some biosimilars and these impact product stability. The %aggregation at 14 days exhibits statistical correlation with %aggregation at 0 day and the number of months from expiry. The order of biosimilarity was denoted as Lantus®>Biosimilar 2>Biosimilar 4>Biosimilar 1>Biosimilar 3.

Radiological changes in sagittal parameters after C1-C2 arthrodesis and their clinical correlation: is there a difference between traumatic and non-traumatic causes?

BACKGROUND: Compensatory changes in cervical sagittal alignment after C1-C2 arthrodesis have been reported in a few studies. No studies have explored the differences in these compensatory changes between traumatic and non-traumatic pathologies. Conflicting reports exist on the correlation between cervical sagittal parameters and neck pain or function. METHODOLOGY: Medical records of 81 consecutive patients [Jan 2010-Dec 2018] who underwent Harms arthrodesis were retrospectively reviewed. 53 patients were included in the final analysis. Radiological parameters [C0-C1, C1-C2, C2-C7 angles and T1 slope] and clinical parameters [VAS (Visual analogue scale) and NDI (Neck disability index)] were compared between the two groups, Group A (traumatic) and Group B (non-traumatic). RESULTS: The 53 patients [Group A (n = 24,) and Group B (n = 29)] had a mean age of 49.98 ± 21.82 years (42 males, 11 females). Mean follow up duration was 48.9 months. Δ C1-C2 angle is significantly correlated with ΔC2-C7 angle (Group A, p = 0.004; Group B, p = 0.015) but not with ΔC0-C1 angle (Group A, p = 0.315; Group B, p = 0.938). Though significant improvement in the clinical parameters (VAS/NDI) has been noted in both groups, Group A showed a greater improvement in VAS scores [Group A, (p < 0.001); Group B, (p < 0.023)]. CONCLUSIONS: The sub-axial sagittal profile was strongly correlated with the ΔC1-C2 angle in both groups. Group B showed greater changes in sagittal parameters after Harms fixation and Group A showed greater improvement in long-term functional outcomes. The final functional outcomes were not related to the initial or final radiological sagittal profile in both groups.

New Onset Sacroiliac Joint Pain After Transforaminal Interbody Fusion: What Are the Culprits?

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: Only a few studies have studied the incidence of new-onset SI joint pain following lumbar spine fusion surgery. We aimed to explore the association between new-onset SI joint pain following Transforaminal Lumbar Interbody Fusion (TLIF) for degenerative spine disorders and changes in spinopelvic parameters. METHODS: A retrospective review of hospital records and imaging database of a tertiary care institute was done for patients who underwent TLIF from October 2018 to October 2019. The 354 patients who satisfied the eligibility criteria were divided into 2 groups(Group A, new-onset SI joint pain group, n = 34 and Group B, normal controls, n = 320). Symptomatic relief (>70% reduction in the VAS [Visual Analogue Scale] score) after 15 minutes of SI joint injection was considered diagnostic of SI joint pain. Clinical and radiological spinopelvic parameters were compared between the 2 groups. RESULTS: Patients with postoperative SI joint pain (Group A) had significantly less preoperative and postoperative lumbar lordosis (p < 0.001) compared to the other group. Most of the patients in Group A had a cephalad migration of the apex postoperatively (30/34 patients) whereas majority of patients in group B had either predominant caudal migration (44/320 patients) or no migration of the lumbar apex (272/320 patients). CONCLUSIONS: The preoperative and postoperative lumbar lordosis are significantly less and the postoperative pelvic tilt is significantly high in patients with new-onset SI joint pain compared to the control group. The cephalad migration of the lumbar apex is significantly associated with new-onset SI joint pain.

Introduction of a Novel "Segmentation Line" to Analyze the Variations in Segmental Lordosis, Location of the Lumbar Apex, and Their Correlation with Spinopelvic Parameters in Asymptomatic Adults.

STUDY DESIGN: Cross-sectional study. PURPOSE: This study aimed to understand the sagittal spinopelvic parameters, segmental lumbar parameters, and lumbar apex location in asymptomatic adults and analyze their correlations with each other. OVERVIEW OF LITERATURE: Roussouly and his colleagues reported that pelvic incidence (PI) influences the lower arc of lumbar lordosis, whereas Pesenti and his colleagues reported that PI influences only the proximal part of lordosis and not the distal part. Both studies have their shortcomings. METHODS: One hundred asymptomatic adult volunteers (mean age, 29.1±7.9 years; 69 males, 31 females) who satisfied the selection criteria were enrolled in this study. Standing antero-posterior and lateral whole spine and pelvis X-rays were performed, and the radiographic parameters were analyzed. We introduced a "segmentation line" bisecting the apical vertebra/disk to divide the upper arc of lumbar lordosis (ULL) and lower arc of lumbar lordosis (LLL). RESULTS: The mean PI was 48.02°, ULL 29.12°, LLL 16.02°, total lumbar lordosis (TLL) 45.14°, lumbar tilt angle 4.73°, and location of the apex of lumbar lordosis (LLA) 4.11°. The location of the lumbar apex moved higher as the PI increased. The PI was strongly positively correlated with the LLL (r =0.582, p <0.001) and TLL (r =0.579, p <0.001) but not with the ULL (r =0.196, p =0.05). The LLA was strongly positively correlated with the ULL (r =0.349, p <0.001), negatively with the LLL (r =-0.63, p <0.001), and not correlated with the TLL (r =-0.177, p =0.078). CONCLUSIONS: The PI influences the location of the lumbar apex, the LLL, and the TLL but not the ULL. The location of the lumbar apex significantly influences the segmental lordosis but not the TLL.

Outdoor Physical Activity in an Air Polluted Environment and Its Effect on the Cardiovascular System-A Systematic Review.

Air pollution is a global public health threat. Evidence suggests that increased air pollution leads to increased cardiovascular morbidity and mortality. The aim of this review was to systematically review and synthesize scientific evidence to understand the effect of performing outdoor physical activity (PA) in a polluted environment on cardiovascular outcomes. This review was developed and reported in accordance with the PRISMA guidelines. Electronic searches in Embase, Web of Science, and PubMed were undertaken through March 2021 initially, and later updated through to 31st January 2022, for observational studies published in peer-reviewed journals that report cardiovascular mortality or morbidity due to outdoor PA in air polluted environment. These searches yielded 10,840 citations. Two reviewers independently reviewed each citation for its eligibility. Seven studies were found to be eligible. Of these, five were cohort studies and two were cross-sectional studies. Pollutants measured in the selected studies were Particulate Matter (PM)-PM10, PM2.5, nitrogen oxides (NOx), and ozone (O3). The most common study outcome was myocardial infarction, followed by cardiovascular mortality, hypertension and heart rate variability. Six studies emphasized that the PA has beneficial effects on cardiovascular outcomes, though air pollutants attenuate this effect to an extent. Two studies showed that walking, even in the polluted environment, significantly reduced the heart rate and heart rate variability indices. The beneficial effects of outdoor PA outweigh the harmful effects of air pollution on cardiovascular health, though the benefits reduce to an extent when PA is carried out in a polluted environment. Because a limited number of studies (n = 7) were eligible for inclusion, the review further emphasizes the critical need for more primary studies that differentiate between outdoor and indoor PA and its effect on cardiovascular health.

Modifiable (Sleeping Pattern and Stress) and Non-Modifiable Risk Factors Associated with Breast Cancer: A Matched Case-Control Study in Delhi, India.

BACKGROUND: An utmost increase of breast cancer burden during the last several decades was reported in Asian countries. Findings from literature confirm that risk factors of breast cancers can be modifiable and non-modifiable in nature. OBJECTIVE: The present study is designed to identify specific modifiable and non-modifiable risk factors associated with breast cancer. METHODS: A matched case-control study was conducted considering 187 cases as women diagnosed with breast cancer and 187 hospital-controls as women without having breast cancer visiting the hospital. Other than standard risk factors, stress is measured using Perceived Stress Scale (PSS) and stress is measured using Pittsburgh Sleep Quality Index (PSQI). Several modifiable and non-modifiable risk factors were assessed using conditional logistic regression to find out significant association with breast cancer. RESULTS: Regular multi-vitamin uptake (OR = 3.38; 95%CI = 1.69 - 6.77; p-value = 0.001), poor sleep (OR = 11.29; 95%CI = 4.36 - 29.25; p-value < 0.001), irregular sleep (OR = 34.11; 95%CI = 10.03 - 115.92; p-value < 0.001) and severe stress (OR = 6.74; 95%CI = 3.06 - 14.81; p-value < 0.001) were found to be the highest odds ratio among all modifiable risk factor of breast cancer. Also, age at first childbirth less than 30 years (OR = 0.44; 95%CI = 0.25 - 0.78; p-value = 0.005) was found protective against breast cancer. CONCLUSION: In our study, stress, sleeping pattern, and regular multi-vitamin uptake were found to be significant modifiable risk factors of breast cancer. None of the non-modifiable risk factors were found to be significantly associated with the risk of breast cancer.

Ligamentum Flavum Buckling vs Hypertrophy in Cervical Myelopathy Using Dynamic Imaging: Are Instability and Loss of Disc Height the Culprits?

BACKGROUND: The literature has not distinguished between LF "hypertrophy" and "buckling" when addressing cervical spondylotic myelopathy. The identification of buckling on dynamic magnetic resonance imaging can determine the levels for decompression more accurately and modify the surgical plan accordingly. No studies have been performed in the cervical spine to analyze the factors affecting LF buckling. PURPOSE: Our objective was to investigate the factors affecting static ligamentum flavum (LF) "hypertrophy" and dynamic LF "buckling." STUDY DESIGN: Retrospective cohort study. METHODS: We conducted a retrospective study of hospital records and imaging database from January 2014 to January 2020. The relation of age, disc height, and intervertebral instability to LF hypertrophy and buckling were assessed. RESULTS: Measurements were performed from C2-3 to C7-T1 in 169 patients who satisfied the eligibility criteria, making a total of 1014 levels. The samples were divided into 2 groups: 798 levels with buckling <1 mm (group A) and 216 levels with buckling >1 mm (group B). Of those, 161 levels satisfied the criteria for radiological instability (sagittal translation/rotation). No correlation was observed between age/disc height and buckling. Intervertebral instability showed significant association (P = 0.046) with buckling. No correlation was found between age/intervertebral instability and hypertrophy. CONCLUSION: LF buckling but not hypertrophy is related to intervertebral instability in the cervical spine. LF buckling in the cervical spine is not related to age or disc height in the cervical spine. CLINICAL RELEVANCE: Intervertebral instability on dynamic x-ray imaging of the cervical spine can be a predictor of ligamentum flavum buckling and can be utilized for surgical planning.

Circulatory hepcidin levels association with gestational diabetes mellitus: a meta-analysis of observational studies.

OBJECTIVES: Hepcidin is linked to glucose metabolism in women with gestational diabetes mellitus (GDM). This systematic review and meta-analysis was conducted to determine the association between hepcidin levels and GDM. A literature search was performed using different databases to identify potential studies investigating hepcidin association in GDM patients. The effect sizes were calculated based on the standardized mean difference (SMD) and Fisher's Z value with a 95% confidence interval (CI). KEY FINDINGS: Out of 827 articles, only 7 case-control studies satisfied the inclusion and exclusion criteria. The pooled SMD of circulatory hepcidin levels in GDM patients was considerably higher than normal pregnant women (SMD = 1.69; 95% CI, 0.86 to 2.53; P < 0.0001). This study also observed that hepcidin levels were positively correlated with ferritin levels (r = 0.264; Z = 0.27; P < 0.0001). Furthermore, a subgroup analysis of serum and plasma groups revealed significantly higher hepcidin levels in serum (SMD = 2.12; 95% CI, 0.44 to3.79; P = 0.001) than in the plasma group (SMD = 1.28; 95% CI, 0.32 to 2.2; I2 = 96%). SUMMARY: Our findings suggest that hepcidin levels may be elevated in GDM patients, making it a viable marker for GDM diagnosis, and regular monitoring of its levels could be helpful in aiding clinical decisions.

In-hospital mortality in people with complete acute traumatic spinal cord injury at a tertiary care center in India-a retrospective analysis.

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To analyze the causes and risk factors of mortality in people admitted with complete acute traumatic spinal cord injury (ATSCI). SETTING: The study was performed at the Indian Spinal Injuries Centre, New Delhi. METHODS: Data between 2000 and 2016 were retrospectively collected from case records of people with ATSCI. Risk factors for mortality were examined using multivariable logistic regression. RESULTS: Mortality rate in ATSCI admissions (n = 758) during the study period was 10%. Median (IQR) age of study participants was 34 (21) years with a range of 14-85 years. Respiratory complications, septicemia, and cardiovascular causes were responsible for 42%, 28, and 18% of deaths. Mortality rate in people with paraplegia and tetraplegia was 3% and 22%, respectively. The proportion surviving at 6 weeks was significantly different across people with paraplegia and people with high and low tetraplegia (p < 0.001). Greater age (OR (multivariable models) = 1.03, 95% CI = 1.01-1.06), associated injuries (OR = 2.42, 95% CI = 1.11-5.27), high tetraplegia (OR = 5.09, 95% CI = 2.21-11.72), low tetraplegia (OR = 4.84, 95% CI = 1.29-18.09), need for ventilator support (OR = 31.32, 95% CI = 14.92-65.35), septicemia (OR = 4.60, 95% CI = 1.05-20.07), respiratory complications (OR = 3.46, 95% CI = 1.63-7.33), and cardiovascular causes (OR = 39.03, 95% CI = 8.29-183.89) were significant risk factors associated with mortality. CONCLUSION: Respiratory complications, septicemia, and cardiovascular causes were the commonest causes of in-hospital mortality in people with complete ATSCI. Greater age, presence of associated injuries, tetraplegia, and ventilator support were risk factors significantly associated with mortality. To reduce morbidity and mortality in the acute phase, there is a need to focus on respiratory management and prevention of infections, especially in tetraplegics.

Incidence and Risk Factors for Neurological Deterioration in Posterior Corrective Surgeries for Severe Angular Kyphotic Deformities: A 10-Year Institutional Retrospective Study.

STUDY DESIGN: Retrospective case-control study. OBJECTIVE: Neurological deficit is one of the dreaded complications of kyphotic deformity correction procedures. There is inconsistency in the reports of neurological outcomes following such procedures and only a few studies have analyzed the risk factors for neurological deficits. We aimed to analyze the factors associated with neurological deterioration in severe kyphotic deformity correction surgeries. METHODS: We performed a retrospective study of 121 consecutive surgically treated severe kyphotic deformity cases (49 males, 56 females) at a single institute (May 1st 2008 to May 31st 2018) and analyzed the risk factors for neurological deterioration. The demographic, surgical and clinical details of the patients were obtained by reviewing the medical records. RESULTS: 105 included patients were divided into 2 groups: Group A (without neurological deficit) with 92 patients (42 males, 50 females) and Group B (with neurological deficit) with 13 patients (7 males, 6 females) (12.4%). Statistically significant difference between the 2 groups was observed in the preoperative sagittal Cobbs angle (p < 0.0001), operative time (p = 0.003) and the presence of myelopathic signs on neurological examination (p = 0.048) and location of the apex of deformity (p = 0.010) but not in other factors. CONCLUSIONS: Preoperative Sagittal Cobbs angle, presence of signs of myelopathy, operative time and location of apex in the distal thoracic region were significantly higher in patients with neurological deterioration as compared to those without neurological deterioration during kyphotic deformity correction surgery. Distal thoracic curve was found to have 4 times more risk of neurological deterioration compared to others.

Surgical Outcomes of Transpedicular Decompression with or without Global Reconstruction in Thoracic/Thoracolumbar Pott's Spine: A 7-Year Institutional Retrospective Study.

STUDY DESIGN: Retrospective case-control study. PURPOSE: This study aimed to analyze the radiological and clinical outcomes of transpedicular decompression in spinal tuberculosis (or Pott's spine) with and without anterior reconstruction using polyetheretherketone (PEEK) or mesh cage. OVERVIEW OF LITERATURE: The outcomes of transpedicular decompression with and without global reconstruction in Pott's spine are insufficiently investigated. Additionally, the use of PEEK cages in Pott's spine has remained unestablished. METHODS: Using the hospital records and imaging database obtained from January 2014 to January 2020, this study retrospectively analyzed patients who underwent surgery for Pott's spine and met the eligibility criteria. RESULTS: This study included 230 patients with a mean±standard deviation age of 47.7±18.1 years (109 males, 121 females). The Visual Analog Scale score, Oswestry Disability Index, and Cobb angle were significantly improved in these patients (p<0.001). Patients who underwent anterior reconstruction had a greater correction in Cobb angle postoperatively (p=0.042) but also had a greater blood loss (p=0.04). During the follow-up, they experienced a significant loss of correction compared with those who only underwent transpedicular decompression (p=0.026). Nevertheless, patients who underwent anterior reconstruction using mesh/PEEK cages showed no significance difference in the clinical or radiological outcomes. CONCLUSIONS: Transpedicular decompression used in the surgical management of Pott's spine showed favorable clinical and radiological outcomes. The additional use of anterior reconstruction obtained equivalent clinical outcomes but resulted in excessive blood loss. Meanwhile, the use of mesh/PEEK cage for anterior reconstruction did not affect the clinical and radiological outcomes.

Evaluation and Impact of ASPIRE: An Interactive Tobacco Prevention Curriculum among University Students in India.

Online education approach provides innovative opportunities for engaging youths. Web-based, multimedia smoking prevention programs have been tested in high-income countries; however, efficacy of such programs is not well-investigated in low- and middle-income countries. The aim of this study was to evaluate the impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive tobacco prevention curriculum, among university students in India. A single-subject cohort study where each subject serves as their own control was conducted among university student participants engaged in ASPIRE, 60 minutes per week for five consecutive weeks during July to August of 2019. Assessments were conducted at baseline and immediately after exposure to ASPIRE. To evaluate the program, a structured instrument was specifically designed to measure the outcomes. A total of 103 university students participated voluntarily. Average age of the participants was 18.3±0.9 ranging from 17 to 20 years. Eighteen percent of students were curious to know about the various smoking products. More males were more susceptible to cigarette smoking as compared to females. The majority of participants felt that ASPIRE was culturally appropriate for young adults in India, but a modified version targeted toward Indian youth would be more acceptable. Pre- to postintervention knowledge of tobacco-related hazards increased from 70 to 97% ( p < 0.001). ASPIRE, a multimedia interactive program, demonstrated its considerable potential to discourage smoking initiation among Indian youth.

Is routine removal of syndesmotic screw justified? A meta-analysis.

BACKGROUND: Syndesmosis injuries are common with rotational ankle injuries, and placement of a positional syndesmotic screw to maintain its reduction is used as the ligaments heal. There is no clear consensus on routine removal or retention of syndesmotic screw. This study aimed to appraise the current evidence both on removal and retention of syndesmotic screw and to conduct a meta-analysis comparing outcomes and rate of complications of syndesmotic screw removal and retention. METHODS: Following PROSPERO registration, a systematic search using was performed using keywords ('Syndesmosis' OR 'Syndesmotic' OR 'Transsyndesmotic' OR 'distal tibiofibular') AND ('Screw') AND ('Removal' OR 'Retention') AND 'Outcome' in various databases. No language restrictions were applied and the meta-analysis incorporated the PRISMA statement. VAS (Visual analogue scale for pain), AOFAS (American Orthopaedic Foot And Ankle Society) scores expressed as mean ± SD, and both groups' complication rates were compared. Comparisons with a random-effects model were performed, and heterogeneity between the studies was calculated using the I2 statistic. T-test for two independent sample means was used to compare pooled mean and Z-test for two proportions to assess the difference in the proportion of complications. RESULTS: A total of 7 studies with 522 patients were included in this review for analysis. Pooled analysis showed non-significant difference in AOFAS score (MD = -1.84; 95% CI: -4.33 to 0.66; p = 0.150) as well as for VAS score (MD = -0.48; 95% CI: -1.56 to 0.60; p = 0.390) between the two groups. The value of z and p-value for complication rates was 0.6021 and 0.5485, respectively, which was not significant. CONCLUSION: There doesn't appear to be a difference in functional outcome, pain scores, and complication rates between patients who had their syndesmotic screws removed and those where screw was retained. The fear of inferior outcomes with retained screws is thus unfounded, and routine removal adds to morbidity and financial burden. In conclusion, present data does not support the routine removal of the intact syndesmosis screw, and a change in practice is needed to abandon routine syndesmotic screw removal.

Effect of Raja yoga Meditation on Psychological and Functional Outcomes in Spinal Cord Injury Patients.

BACKGROUND: Spinal cord injury (SCI) is a debilitating disorder with dysfunction in daily activities and psychological consequences like anxiety as well as depression impacting the quality of life substantially. Existing treatments focus mainly on rehabilitation, symptom reduction, and secondary complications. However, psychological, social, and existential issues are least addressed in the prevailing models. AIMS: To study the role of meditation in addressing psychological impairment and any resultant improvement in functional outcomes in SCI patients. METHODS: Nonrandomized controlled study was conducted in a tertiary care center for SCI patients. Hospital inpatients were recruited into either experimental intervention group (add on easy raja yoga with conventional rehabilitation-ER n = 50) or control intervention group (conventional rehabilitation alone-CR n = 50). Patients in the ER group received easy raja yoga for 1 month, along with conventional rehabilitation and the CR group patients received only conventional rehabilitation. All the subjects were assessed for psychological (perceived stress scale [PSS], Hospital Anxiety and Depression Scale [HADS]) and functional impairment (spinal cord independence measure (SCIM), numeric pain rating (NPR) and WHO quality of life-BRIEF (WHOQOLBREF)] at baseline and after 1 month. RESULTS: After 1 month of add-on easy raja yoga, there was significant decrease in the scores of HADS (F[1,88] = 272.92, P < 0.001), PSS (F[1,88] = 274.41, P < 0.001) and NPR (F[1,88] = 60.60, P < 0.001) and significant increase in the scores of WHOQOLBREF (F[1,88] = 349.94, P < 0.001) and SCIM (F[1,88] = 29.09, P < 0.001) in the ER group compared to CR group in analysis of covariance. CONCLUSION: One-month add-on easy raja yoga improves psychological and functional outcomes (HADS, PSS, NPR, WHOQOLBREF and SCIM) in patients with SCI. Future studies with robust designs are needed to validate the results.

To study the role of pre-treatment microRNA (micro ribonucleic acid) expression as a predictor of response to chemoradiation in locally advanced carcinoma cervix.

BACKGROUND: Concurrent chemoradiotherapy followed by brachytherapy is the standard of care in locally advanced carcinoma cervix. There is no prognostic factor at present to predict the outcome of disease in locally advanced carcinoma cervix. AIM: Differential expression of microRNAs can be used as biomarkers to predict clinical response in locally advanced carcinoma cervix patients. METHODS: Thirty-two patients of locally advanced carcinoma cervix with International Federation of Gynecology and Obstetrics Stage IB-IVA were enrolled from 2017 to 2018. Expression of microRNA-9 5p, -31 3p, -100 5p, -125a 5p, -125b-5p, and -200a 5p in formalin-fixed paraffin embedded (FFPE) biopsied tissue were analyzed by real time quantitative reverse transcriptase polymerase chain reaction (RT qPCR). Pretreatment evaluation was done with clinical examination and MRI pelvis. All patients received concurrent chemoradiotherapy followed by brachytherapy. Patients were evaluated for the clinical response after 3 months of treatment, with clinical examination and MRI pelvis scan using RECIST 1.1 criteria. Patients with no residual disease were classified as Complete responders (CR) and with residual or progressive disease were classified as Nonresponders (NR). Results were statistically analyzed using Mann Whiney U test to examine significant difference between the expression of microRNA between complete responders (CR) and nonresponders (NR). RESULTS: microRNA-100 5p was upregulated in complete responders (CR) which showed a trend towards statistical significance (p value = 0.05). CONCLUSION: microRNA-100 5p can serve as a potential molecular biomarker in predicting clinical response to chemoradiation in locally advanced Carcinoma cervix. Its role should be further investigated in a larger study population.