BACKGROUND:Young age in osteonecrosis of the femoral head (ONFH) demands bone-preserving, short-stem arthroplasty. Several designs including neck-preserving stems and neck-resecting, shortened, standard stems are classified as short stems. There is a paucity of literature investigating risk factors and outcomes of intraoperative complications of neck preserving, short-stem arthroplasty in ONFH.METHODS:A total of 107 hips operated with METHA short-stem arthroplasty for ONFH were retrospectively evaluated. The mean age of patients was 43.7 years (range, 27-60 years). Nine patients had an intraoperative fracture. Seven hips received prophylactic cerclage wiring for poor bone quality. Patients were invited for clinical and radiological evaluation at the latest follow-up.RESULTS:The mean follow-up of patients was 47.2 months. Significant association with intraoperative fractures and the need for prophylactic cerclage wiring were found in steroids-, alcohol-, and chronic renal failure-induced ONFH. However, patient sex, body mass index, traumatic/idiopathic ONFH, previous implant in situ, prosthesis size, and single-sitting bilateral total hip replacement (THA) were not the risk factors. All hips showed signs of osteointegration at final follow-up. No revision was done during the study period for any cause.CONCLUSIONS:METHA short-stem THA offers excellent functional and radiological outcomes in ONFH. However, precaution must be exercised in patients with steroids-, alcohol-, and renal disorders-induced ONFN due to poor bone quality and higher chances of intraoperative fractures. Also, additional measures such as the use of a high-speed burr and prophylactic cerclage wiring in ONFH may allow predictable and safe use of short stems.

Backgroud Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient selection, correct implant positioning, and limb alignment. Computer navigation has a proven value over conventional systems in reducing mechanical errors in total knee arthroplasty (TKA). However, the lack of strong evidence impedes the universal use of computer navigation technology in UKA. Therefore, this study was proposed to investigate the accuracy of component positioning and limb alignment in computer navigated UKA and to observe the role of navigation in proper patient selection. Methods A total of 50 knees (38 patients) underwent computer navigated UKA between 2016 and 2018. All operations were performed by the senior surgeon using the same navigation system and implant type. The navigation system was used as a tool to aid patient selection: knees with preoperative residual varus > 5° on valgus stress and hyperextension > 10° were switched to navigated TKA. We measured the accuracy of component placement in sagittal and coronal planes on postoperative radiographs. Functional outcomes were also evaluated at the final follow-up (a minimum of 16 months). Results Nine patients had tibia vara and 14 patients had preoperative hyperextension deformity. We observed coronal outliers for the tibial component in 12% knees and for the femoral component in 10% knees. We also observed sagittal outliers for the tibial component in 14% knees and for the femoral component in 6% knees. There was a significant improvement in the functional score at the final follow-up. On multiple linear regression, no difference was found in functional scores of knees with or without tibia vara (p = 0.16) and with or without hyperextension (p = 0.25). Conclusions Our study further validates the role of computer navigation in desirable implant positioning and limb alignment. We encourage use of computer-assisted navigation as a tool for patient selection, as it allows intraoperative dynamic goniometry and provides real-time kinematic behavior of the knee to obviate pitfalls such as significant residual varus angulation and hyperextension that predispose early failure of UKA.

Among new smear-positive pulmonary tuberculosis (TB) patients aged >= 15 years from marginalised populations in India, one in four had a history of a household member with TB and one in 10 had a TB-related death in the household. This contribution of household transmission to overall TB transmission provides evidence for a potential population-level benefit of TB preventive treatment for all household contacts (without active TB). Females with TB had a significantly higher household TB exposure than males. Targeted TB preventive treatment (if implemented in a phased manner) among female household contacts may be explored after considering other factors.

Conducting multicentre operational research is challenging due to issues related to the logistics of travel, training, supervision, monitoring and troubleshooting support. This is even more burdensome in resource-constrained settings and if the research includes patient interviews. In this article, we describe an innovative model that uses open access tools such as Dropbox, TeamViewer and CamScanner for efficient, quality-assured data collection in an ongoing multicentre operational research study involving record review and patient interviews. The tools used for data collection have been shared for adaptation and use by other researchers.

Pre-diagnosis attrition needs to be addressed urgently if we are to make progress in improving MDR-TB case detection and achieve universal access to MDR-TB care. We report the pre-diagnosis attrition, along with factors associated, and turnaround times related to the diagnostic pathway among patient with presumptive MDR-TB in Bhopal district, central India (2014).

Aim: The aim of study was to evaluate various types of stoma with regard to their indications, their complications and methods to reduce them, at a tertiary hospital of central India. Methods: The study was carried out in Department of surgery at M.L.N. Medical College, Allahabad from August 2013 to July 2014. Adult patients who were admitted here and had Ileostomy/colostomy formation/closure as a part of their treatment were included. Data was collected by meticulous history taking, clinical examination and investigations. Results: A total of 100 patients were included (Avg. 34 year) and male: female ratio was 1.6:1. The most common stoma constructed was ileostomy (82%) with loop ileostomy (62%) being the most common subtype. Among colostomies, loop was most common (50%). Main indication of stoma formation was intestinal perforation (63%). In individual causes, Typhoid Perforation (44%) was most common indication. 85% patients had stoma complications, most common being peristomal skin excoriation (80%). Study of closure of stoma was done in a total of 50 patients. Closure of 43 ileostomies and 7 colostomies was done. Mean length of postoperative stay was 11 days. 28% developed complication among which paralytic ileus, (16%) was most common. Conclusion: Despite extensive surgical experience, complications of intestinal stomas still occur frequently and result in high morbidity. Meticulous skin care with regular follow-up, early detection of complications with their timely management along with education and counseling can decrease morbidity.

Setting: A mixed-methods operational research (OR) study was conducted to examine the diagnosis and treatment pathway of patients with presumptive multidrug-resistant tuberculosis (MDR-TB) during 2012-2013 under the national TB programme in Puducherry, India. High pre-diagnosis and pre-treatment attrition and the reasons for these were identified. The recommendations from this OR were implemented and we planned to assess systematically whether there were any improvements. Objectives: Among patients with presumptive MDR-TB (July-December 2014), 1) to determine pre-diagnosis and pre-treatment attrition, 2) to determine factors associated with pre-diagnosis attrition, 3) to determine the turnaround time (TAT) from eligibility to testing and from diagnosis to treatment initiation, and 4) to compare these findings with those of the previous study (2012-2013). Design: This was a retrospective cohort study based on record review. Results: Compared to the previous study, there was a decrease in pre-diagnosis attrition from 45% to 24% (P < 0.001), in pre-treatment attrition from 29% to 0% (P = 0.18), in the TAT from eligibility to testing from a median of 11 days to 10 days (P = 0.89) and in the TAT from diagnosis to treatment initiation from a median of 38 days to 19 days (P = 0.04). There is further scope for reducing pre-diagnosis attrition by addressing the high risk of patients with human immunodeficiency virus and TB co-infection or those with extra-pulmonary TB not undergoing drug susceptibility testing. Conclusion: The implementation of findings from OR resulted in improved programme outcomes.

SETTING:Training courses on data entry are few and far between compared to analysis. To address this gap, we conducted a short 2-day course on quality-assured data capture using EpiData for public health professionals in Bangalore and Puducherry, India, in 2013.OBJECTIVE:To determine the proportion of participants who used EpiData and taught the software to others during the 2-years after training and explore the reasons for doing/not doing so.DESIGN:Cross-sectional study with self-administered, semi-structured questionnaire developed using web-based Google Forms. We performed a manual thematic analysis to identify the major reasons for using/not using EpiData.RESULTS:Of 46 participants, 38 (83%) responded. Of 31 participants involved in research, 17 (55%) had used EpiData, of whom 6 (35%) had performed double entry and validation. Of the 14 who did not use EpiData, 11 had used MS Excel or SPSS/Epi Info for data entry. Of the 38 respondents, 29 (76%) had taught EpiData to other colleagues and students. Reasons for using EpiData included its user-friendliness, its being open access and the ease in preventing data entry errors. Reasons for not performing double entry included lack of time and manpower.CONCLUSION:The short course on EpiData was effective in knowledge transfer and provides a scalable model for incorporation into the teaching curricula of medical schools and research institutions.

Introduction Indian is in a state of epidemiological transition with changes in urbanisation and risk factor profiles. In this context, our objective was to study the epidemiology of alcohol use among urban and rural populations. Methods The study was conducted in Ballabgarh block, India, during January–October 2006 using the WHO-STEPs approach. Participants were selected using multi-stage sampling for rural and urban stratum (sub-divided across town and slum). We targeted enrolling 250 male and female participants each in 10 year age-groups across 25–65 years and enrolled 5005 participants. In a 20% sub-sample, information was collected about the exposure to health communication messages regarding alcohol. Results One rural female reported current alcohol use. The prevalence of current consumption of alcohol, defined as consumption within preceding 12 months, was highest among urban males (26.2%; 95% CI 20.8 to 32.1) followed by urban slums (25.6%; 95% CI 19.2 to 32.4) and rural (23.2%; 95% CI 18.2 to 28.9). Among alcohol consumers 15.3% urban, 7.3% slum and 15.3% rural males reported reduction in alcohol use in preceding 1 year. 7.2% urban, 10.9% slum and 7.2% rural respondents who were current alcohol users reported intermittent cessation of alcohol consumption in preceding 1 year. 59.2%(n=603) urban, 27.2%(n=185) urban-slum and 39.5%(n=646) rural respondents reported receiving information (IEC) on health effects of alcohol with Mass media as the most common source of information. Conclusion Alcohol is a public health problem among males in Ballabgarh area. Interventions should focus on alcohol cessation services and improved IEC. Urbanisation does not appear to be associated with alcohol use in this community.

Re-orientation of medical education in India has not been fully successful because the development of medical teacher, a critical component has not been adequately addressed. Faculty development is a key factor. We have identified six shifting trends in faculty development that can contribute to the development of a medical educator in India. These include a shift from: One time training to continuing professional development; information based approach to project based approach; training to scholarship; lack of accountability to accountability and recognition; individual efforts to networking; and role of treatment providers to health promoters. We have discussed how these shifts are in tune with the global trends. We recommend that the initiatives taken in India in the recent past, viz., constitution of a Task Force by the Ministry of Health and Family Welfare, establishment of several medical education centers should be harnessed by forming a national working group. Such a group would provide policy directions for faculty development which will lead to a concrete plan for implementation and thereby addressing a critical component of the re-orientation of medical education.