Trans-thoracic echocardiography (TTE) improves the diagnostic skills of anesthesia trainees during the perioperative period. We compared performance between two educational intervention, simulation-based hands-on training and video-based training as measured by a novel TTE Competency Score (TCS). Fifty novice anesthesia residents were randomized into an intervention group-I (received simulation-based training) and a control group-C (received video-based training). Both groups underwent evaluations of their knowledge and skills on live volunteers or ICU patients using TCS right after the training and again six months thereafter. An independent sample t-test was employed to compare TCS between the groups, while a paired t-test was used to assess intragroup TCS at the baseline, after training, and six months post-training. The two groups had no significant difference in the pre-test assessment scores. Immediately following the training session, Group I exhibited a significantly higher TCS compared to Group C (25.2 ± 2.7 and 22.4 ± 2.5, p = 0.01). Compared to the I-group, the C-group made more attempts to achieve competence. Group I exhibited higher confidence levels both immediately and six months later. After a six-month follow-up, the TCS scores in both groups were lower than the scores recorded immediately. This study demonstrates that a structured, problem-based simulator course improved immediate TCS and 6-month confidence compared with video-based training. However, a decline in TCS in both groups over time highlights the need for periodic refreshers within six months to improve retention. CTRI [CTRI/2021/07/034684].

BACKGROUND:Tobacco use among healthcare workers compromises their role as cessation advocates. This study focuses on nicotine dependence, quit intentions, and cessation efforts among daily tobacco-using healthcare students, professionals, and staff in Eastern India. METHODS:A multicentric cross-sectional study using a structured questionnaire was conducted in 24 healthcare institutions across Bihar and Jharkhand during July-August 2023, analysing data from 729 daily tobacco users among a total of 7619 participants. RESULTS:The mean nicotine dependence score was 4.6 ± 2.3, with 49.2% showing moderate dependence, 38.4% low, and 12.3% high. Among daily users, 63.1% expressed quit intentions. Two-thirds (67.9%) attempted to quit in the past year, with 36.6% using nicotine replacement therapy and 62.0% trying unaided. Participants without quit intentions had higher odds of moderate dependence [adjusted odds ratio (AOR) = 9.36] and high dependence (AOR = 28.8). Receiving no cessation advice increased the odds of moderate (AOR = 5.30) and high dependence (AOR = 16.15). Quit intentions were associated with lower nicotine dependence (AOR = 29.9 for low and 4.04 for moderate), receiving quit advice (AOR = 2.03), and awareness of tobacco control laws (AOR = 1.08 per unit). Quit attempts were influenced by quit intentions (AOR = 13.03), lower nicotine dependence (AOR = 2.68 for moderate), and receiving cessation advice (AOR = 2.82). CONCLUSIONS:The study population showed moderate nicotine dependence and substantial quit intentions, emphasizing the need for stronger healthcare-led cessation efforts to enhance success and empower healthcare workers as tobacco control advocates.

Background Cardiovascular disease (CVD) poses major public health challenges in low-resource settings like India, where it contributes significantly to premature mortality and morbidity. This study assessed 10-year CVD risk and its associated factors among community-dwelling older adults in Eastern India. Methods This cross-sectional study, conducted in rural and urban areas of Deoghar, Jharkhand, in 2023, assessed 477 adults (aged 40-74 years) using the World Health Organization/International Society of Hypertension (WHO/ISH) South Asian Region (SAR) non-laboratory risk chart. Multinomial logistic regression identified predictors of moderate-to-high CVD risk. Results Among participants, 75.8% had a low 10-year CVD risk (< 10%), 22.2% had moderate risk (10% to <20%), and 1.9% had high risk (≥20%). Predictors of moderate-to-high CVD risk (≥10%) identified through multinomial logistic regression included increasing age (adjusted odds ratio (AOR): 2.0; 95% confidence interval (CI): 1.8-2.3), male gender (AOR: 16.0; 2.4-106.3), lower per capita monthly income (PCMI) (AOR: 3.0; 1.0-8.9), family history of hypertension, diabetes, or heart disease (AOR: 5.7; 1.8-18.4), central obesity (AOR: 11.9; 3.5-40.9), and tobacco use (AOR: 8.2; 2.0-33.6). Regular physical activity (≥30 minutes/day) was a protective factor (AOR: 0.2; 0.1-0.8). The model accounted for 81.8% of the variability in cardiovascular risk outcomes. Conclusions About one-fourth of older adults were identified as having moderate-to-high 10-year CVD risk. Central obesity and tobacco use emerged as significant predictors, while regular physical activity offered protective benefits. Implementing targeted interventions to address modifiable risk factors is the need of the hour to mitigate CVD risk.

BACKGROUND:Tobacco use poses a significant global health challenge, particularly within the healthcare sector. This study assessed tobacco use prevalence, legal awareness, control attitudes and the need for greater emphasis on tobacco control in healthcare curricula among professionals, students and staff in Eastern India, specifically in Bihar and Jharkhand. METHODS:In July and August 2023, an extensive online survey was conducted across 24 tertiary healthcare institutions involving medical, dental and nursing students, as well as faculty, resident physicians, nursing professionals and support staff. RESULTS:The study revealed that 15.9% of participants currently use tobacco, with 9.6% reporting daily use. Notably, non-users demonstrated higher awareness of tobacco-related laws compared to users. Multifactor logistic regression analysis identified several determinants of tobacco use including age, sex, marital status, occupation, family income and geographic origin. A significant finding was that less knowledge about tobacco laws correlated strongly with higher rates of tobacco use. Furthermore, regional variations were observed, with a lower prevalence of tobacco use in participants from southern states. CONCLUSIONS:Our findings underscore the necessity of integrating comprehensive tobacco education into healthcare curricula and reinforcing awareness campaigns to effectively mitigate tobacco use within this critical sector.

Background: Managing difficult airways with restricted mouth opening remains a challenge. In this regard, flexible bronchoscopes (FB) are considered the gold standard, offering precise tube placement. However, they require expertise and can be time-consuming. Video-laryngoscopes (VLs), such as the CMAC D-blade, provide enhanced glottic visualization and may reduce intubation time. While VLs are gaining popularity, data comparing them with FBs in this setting are limited. This study evaluates whether the CMAC D-blade VL can reduce intubation time compared to FB while maintaining similar success rates. Methods: In this randomized controlled trial, 100 adult patients scheduled for elective head and neck or oral and maxillofacial surgery with anticipated difficult airways were randomized to receive awake nasotracheal intubation using either an FB or CMAC D-blade VL. The primary outcome was intubation time. Secondary outcomes included first-attempt success rate, overall success rate, and satisfaction scores. Results: Out of 100 patients, 97 patients completed the study (FB: n = 49, VL: n = 48). Median intubation time was significantly shorter in the VL group (62 [53-71] sec) compared to the FB group (118 [107-134] sec; p < 0.0001). Success rates and intubation scores were similar, but anesthesiologist and patient satisfaction scores were better in the FB group. Conclusion: The CMAC D blade video-laryngoscope reduces intubation time while maintaining similar success rates compared to the flexible bronchoscope for awake nasotracheal intubation with limited mouth opening. Despite the time advantage, the flexible bronchoscope was preferred by anesthesiologists and patients had more comfort.

Tribal populations in India face multiple health challenges, including high tobacco use. However, national-level estimates specific to tribal communities are lacking. This systematic review and meta-analysis assessed the prevalence of tobacco use among tribal populations in India, disaggregated by gender and type of tobacco product. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, four databases, PubMed, Embase, Scopus, and Web of Science, were searched up to 31 January 2024. Studies reporting tobacco use among tribal populations in India were included. Meta-analysis was performed using a random-effects model. Subgroup analyses were conducted by gender and tobacco type. Heterogeneity was assessed using the I-squared (I²) statistic. Publication bias was assessed using the deviation from ordinary least squares (OLS) regression line (DOI) plots and the Luis Furuya-Kanamori (LFK) index. Thirty-nine studies involving 56,883 tribal individuals were included. The pooled prevalence of tobacco use was 60% (95% confidence interval (CI): 49%-70%; I² = 99.6%). Among male individuals, prevalence was 66% (95% CI: 42%-83%; I² = 99.2%), and among female individuals, it was 42% (95% CI: 22%-66%; I² = 99.6%). The prevalence of smokeless tobacco use was 45% (95% CI: 30%-62%) versus 20% for smoked tobacco (95% CI: 14%-27%). Nine studies lacked separate data on smoked and smokeless forms. The LFK index score of 0 indicated no asymmetry in the DOI plot, suggesting an absence of publication bias among the included studies. The majority of studies demonstrated a low risk of selection bias (78.5%), whereas fewer studies showed a low risk of information bias (57.1%) and reporting bias (53.5%). Tobacco use among tribal populations in India is alarmingly high, especially among men and for smokeless products. These findings warrant urgent, culturally appropriate public health interventions.

BACKGROUND:Awareness of India's tobacco control laws, including the Cigarettes and Other Tobacco Products Act (COTPA) and the WHO Framework Convention on Tobacco Control (FCTC), remains limited among healthcare professionals. This study evaluated the effect of a brief sensitization session on improving awareness across key tobacco control domains. METHODS:A multicity pre-post interventional study was conducted at 22 academic conferences (17 offline, five virtual) across 14 Indian cities between May 2023 and April 2025. A 30-minute standardized session covered COTPA provisions, tobacco industry interference (TII), WHO FCTC Article 5.3, and state-level COTPA implementation. A total of 1,233 healthcare professionals completed both pre- and post-intervention assessments. Data were analyzed using McNemar's test, Wilcoxon signed-rank test, and Kruskal-Wallis test with post hoc comparisons. RESULTS:Significant improvements were observed in all four domains (p < 0.001 each). Awareness of COTPA increased from 533 (43.2%) to 1.040 (84.3%); TII from 596 (48.3%) to 1193 (96.8%); WHO FCTC Article 5.3 from 348 (28.2%) to 1117 (90.6%); and awareness of state-level implementation from 217 (17.6%) to 530 (43.0%). The median composite score rose from one (interquartile range (IQR): 0 to two) to three (IQR: three to four), with a median gain of two points (Wilcoxon W = 450775, p < 0.001; rank biserial correlation = 1.00). Score gains were significantly higher among medical faculty and participants from northern, eastern, and southern India (p < 0.001). CONCLUSION:A brief, structured sensitization session significantly enhanced awareness of tobacco control policies among healthcare professionals and can support capacity-building efforts in India.

BACKGROUND:India faces a mounting public health burden from tobacco use, with over a million annual deaths. The Cigarettes and Other Tobacco Products Act (COTPA) 2003 regulates tobacco control, but compliance in pilgrimage-based semi-urban towns remains under-researched. This study assessed COTPA adherence in public settings of Deoghar, Jharkhand, India. METHODS:A cross-sectional observational survey was conducted at 50 purposively selected public sites, educational institutions, health facilities, religious places, public transport hubs, and libraries using a structured checklist. Compliance with COTPA sections 4 (smoke-free public places), 5 (advertising ban), 6a (sale to/by minors), 6b (sale near educational institutions), and 7 to 9 (packaging and labeling) was evaluated. Data were summarized as frequencies and percentages; 95% confidence intervals were estimated for non-compliance. RESULTS:Overall non-compliance was highest for section 4 (26/50, 52.0%) and section 6b (10/24, 41.7%). Smoking occurred frequently in transport hubs, libraries, and religious places. Violations regarding sales to minors were present in 8/50 (16.0%) of sites, and tobacco sales within 100 yards of schools in 10/24 (41.7%) of educational institutions. Section 5 violations (advertisement) were seen in 3/50 (6.0%) of sites. Of the 28 sites that sold smokeless tobacco products, 26/28 (92.8%) had no warning pictures printed on the package, in violation of section 7(1). Sections 7.5 (1/28, 3.6%), 8.1 (0/28, 0.0%), and 9.2 (0/28, 0.0%) showed low or no violations. CONCLUSION:The enforcement of the COTPA in Deoghar is suboptimal, especially in high-footfall and community settings. Enhanced monitoring, awareness drives, and integration of tobacco control into existing health programs are needed to promote sustained compliance.

The cancer landscape in India is defined by a heavy burden of disease, stark mortality disparities, and significant gaps in survivorship care. Despite lower cancer incidence rates compared with high-income countries, the region experiences disproportionately high mortality rates due to late diagnoses, limited healthcare infrastructure, and widespread inequities in access to treatment. Distinctive risk factors, such as tobacco use and infection-related malignancies, further intensify the burden. Survivorship care remains underdeveloped, with cultural stigmas and systemic barriers compounding the challenges faced by cancer survivors. This review synthesizes the state of knowledge on cancer incidence, mortality, and survivorship care across India and other parts of Asia, presenting insights from epidemiological studies, projections, and qualitative data. Addressing these challenges will require an integrated, multidisciplinary approach that strengthens prevention, reduces morbidity and mortality, and improves survivorship outcomes tailored to regional realities.

BACKGROUND:The pediatric sizes of BlockBuster supraglottic airway (SGA) have been introduced recently. Its efficacy as a conduit for endotracheal intubation in children has not been assessed. Newer devices are often compared with Air-Q SGA to assess their intubating capability.AIMS:The primary objective was to compare the time taken for fiber-optic-guided intubation through the BlockBuster and the Air-Q SGAs.METHODS:Sixty children aged 6 months to 12 years with normal airways were randomized into two groups: Air-Q SGA (Group A) and Blockbuster SGA (Group B). After administration of general anesthesia, an appropriately sized SGA was inserted. The time taken for fiber-optic-guided intubation through the SGA, success, ease, and time for SGA insertion and removal were noted. The glottic view was graded by fiber-optic bronchoscopy.RESULTS:Demographic parameters were comparable. The time to intubate with the BlockBuster 62.40 ± 17.2 s was comparable to the Air-Q 60.8 ± 18.5 s (mean difference 1.6 s, 95% CI -7.65 to10.85; p = .73). The average time for SGA insertion in BlockBuster and Air-Q was 14.57 ± 3.2 s and 16.67 ± 5.39 s, respectively (mean difference -2.1, 95% CI -4.39 to 0.19 s; p = .07). The first-attempt intubation success and overall intubation success rates were comparable in both groups, 96.7% and 100%, respectively. In Group B, 25/3/1/1/0 cases had a glottic view grade of 1/2/3/4/5, respectively. In Group A, 23/3/2/2/0 cases had grade of 1/2/3/4/5 glottic views respectively. The average time to SGA removal was comparable between the BlockBuster (20.17 ± 5.8 s) and the Air-Q (22.5 ± 12.8 s) groups (mean difference -2.3 s, 95% CI -7.5 to 2.82 s; p = .37). None of the children had any perioperative complications.CONCLUSION:BlockBuster SGA may be a useful alternative to Air-Q for SGA-assisted, fiber-optic-guided tracheal intubation in children.

Background: Reproductive morbidity includes various conditions affecting the reproductive tract or resulting from reproductive behavior. The relationship between BMI, body fat, and reproductive health is not well-understood, especially in India and Odisha. Objectives: To determine the prevalence of reproductive health morbidities and explore associations between BMI, body fat percentage, and these morbidities among urban women in Bhubaneswar, Odisha, India. Design: A community-based cross-sectional study. Methods: The study involved 210 women aged 15-49 from Bhubaneswar's urban areas. Information was gathered on sociodemographics, gynecological and menstrual history, obstetric history, family history of morbidities, and personal history of diet, lifestyle, and physical activity. Anthropometric measurements were assessed. Outcomes were self-reported symptoms of reproductive health morbidities experienced within the past year, categorized into menstrual disorders, RTIs/STIs, and PCOS. The presence of one or more symptoms was considered an outcome. Results: The mean age of participants was 30.49 ± 8.45 years, with 52.4% aged ≤30 years. Irregular menstruation was the most prevalent symptom (17.14%). Significant associations were observed between self-reported symptoms suggestive of menstrual disorders, RTI/STIs, PCOS, and BMI categories. Total body fat percentage and symptoms of menstrual disorders and PCOS were significantly associated with reproductive health morbidities. Among underweight women, 60% reported reproductive health morbidities. The logistic regression model indicated that the highest odds of experiencing reproductive morbidities were found among overweight women and those with high to very high body fat percentages. Conclusion: The study demonstrated the greatest prevalence of reproductive health morbidities (RTI/STI, PCOS, menstrual symptoms) among women in the overweight and underweight BMI category and those with high to very high body fat percentages. A binomial logistic regression analysis highlights the influence of age, employment status, regular exercise, and BMI classifications on reproductive health morbidities within the study population, urban women of Bhubaneswar. These associations were statistically significant, emphasizing the need to address BMI and body fat percentage in reproductive health initiatives in Bhubaneswar's urban areas, Odisha, India.

To evaluate the diagnostic accuracy of artificial intelligence-based algorithms in identifying neck of femur fracture on a plain radiograph. Systematic review and meta-analysis. PubMed, Web of science, Scopus, IEEE, and the Science direct databases were searched from inception to 30 July 2023. Eligible article types were descriptive, analytical, or trial studies published in the English language providing data on the utility of artificial intelligence (AI) based algorithms in the detection of the neck of the femur (NOF) fracture on plain X-ray. The prespecified primary outcome was to calculate the sensitivity, specificity, accuracy, Youden index, and positive and negative likelihood ratios. Two teams of reviewers (each consisting of two members) extracted the data from available information in each study. The risk of bias was assessed using a mix of the CLAIM (the Checklist for AI in Medical Imaging) and QUADAS-2 (A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies) criteria. Of the 437 articles retrieved, five were eligible for inclusion, and the pooled sensitivity of AIs in diagnosing the fracture NOF was 85

Introduction:Spine fixation surgery for traumatic vertebral fractures is associated with severe pain and is often difficult to control. Traditionally systemic opioids have been the mainstay of analgesia for these procedures, which can lead to hyperalgesia, nausea, ileus, sedation, cognitive impairment, dependence, etc., limiting usage of opioids. The Erector spinae plane block (ESPB) is a novel ultrasound-guided procedure with easily identifiable sonoanatomy. We hypothesized that a multimodal approach involving ESPB to a conventional analgesic regimen with local infiltration for patients undergoing major traumatic spine surgeries might provide better perioperative analgesia and reduce the need for postoperative opioid requirements. Material and Methods:A randomized control prospective trial was conducted on 34 ASA grade I -II patients aged 18 to 65 years who were scheduled to undergo elective posterior spine fixation surgery with ASIA B to E after traumatic spine fracture under general anesthesia. Patients were randomized to Group A which included patients who received general anesthesia with ESPB, and Group B, or the control group, included patients who received general anesthesia with systemic analgesics and postoperative local infiltration without ESPB. Intraoperative total fentanyl consumption, VAS score at 0, 3, 6, 12, 18, and 24 hours, time to activate patient-controlled analgesia (PCA) pump, total morphine consumption, and opioid-related side effects were monitored and compared in both groups. Results:Postoperative PCA morphine consumption was significantly lower in group A patients who received ESPB than those in the control group (17.06 9.59 vs 37.82 +/- 9.88 P value = <0.0001). VAS scores at rest and movement at 0, 3, 6, 9, 12, 18, and 24 hours were significantly lower (P value = 0.05) in the ESPB group compared with the control group at all time points. Conclusion:Bilateral ultrasound-guided Erector spinae plane block, when administered in traumatic spine patients undergoing spine fixation surgery, provides better analgesia with statistically decreased VAS scores and less postoperative opioid requirement.

Background: Healthcare professionals, students, and workers are vital change agents in the global battle against tobacco. Yet, it’s important to note a concerning trend: there’s a high prevalence of tobacco use among them in India, although data on this is limited. Objective: This study aimed to assess tobacco use prevalence, awareness of related laws, and attitudes among healthcare professionals, students, and staff in Bihar and Jharkhand, India. Methodology: In July and August 2023, we conducted an extensive cross sectional, online survey across 24 tertiary healthcare institutions. Participants included a diverse group of medical, dental, and nursing students, faculty, resident physicians, nursing professionals, and support staff. The survey covered sociodemographic factors, tobacco use, awareness of laws (26 items) [a: 0.924), compliance practices (9 items) (a: 0.929), and perceptions of tobacco control (10 items) (a: 0.728). Results: Our research revealed a significant prevalence of tobacco use: 15.9% reported current use, with 9.6% as daily users. Notably, awareness levels differed noticeably between users and non-users, with non-users displaying deeper knowledge of tobacco-related laws in 61.5% of cases. Our multifactor logistic regression models for current (R2: 0.184, PAR: 84.1%) and daily tobacco use (R2: 0.203, PAR: 90.4%) highlighted various associated factors, including age, gender, marital status, occupation, family income, and native state. Importantly, insufficient awareness emerged as a key factor, correlating with higher chances of current and daily tobacco use. Regional differences were evident, with lower prevalence in southern states. A majority of faculty (90.0%) and students (93.6%) expressed the need for increased emphasis on tobacco control in healthcare curricula. Conclusion: Our research highlights disparities in healthcare tobacco use, influenced by age, gender, marital status, occupation, income, and location. Awareness plays a crucial role, emphasizing the need for integrating tobacco education into curricula and sustaining awareness campaigns to address this issue effectively