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The retrospective analysis of clinical attributes and incidence of uterine torsion was worked out from the last ten year’s records, 2012-21, maintained at the Veterinary Clinical Complex of the institute. The overall incidence of uterine torsion was 14.17 %, with a higher occurrence in pluriparous (63.89%) compared to primiparous goats (36.11%). The majority of goats suffered from post-cervical torsion (77.78%) than that of pre-cervical torsion (22.22%), whereas the degree of torsion, 180 vis-a-vis direction of uterine rotation either to the right or left, distributed equally. Goat-carried single kids (97.22%) had significantly (P

Background: Menopause is a natural transition in a women’s life. Menopausal transition has been linked to impairment of respiratory function. Female hormones play an important role in overall lung health. Yoga is an ancient Indian science as well as the way of life, which includes practice of yogasana in specific posture and pranayama which includes the regulated breathing techniques. The aim of the study was to evaluate the cumulative effect of practicing yoga and pranayamas on certain respiratory parameters and physical characteristics in post-menopausal women. Methods: A total of forty post-menopausal women (46-60 years) were divided into two groups. Group I was control group (women not doing yoga) and group II was regularly doing yoga for one year. Based on the duration of yoga- pranayama and meditation, the respiratory parameters such as VC, FVC, FEV1, PEFR, and FEF50 was measured with the help of vitalograph (pneumotrac; 11). Data collected were compiled, categorized and statistically analyzed, t-test was used for comparing the effect of yoga between the two groups and p≤0.05 was considered as statistically significant. Results: One-year yoga showed a significant decrement in Body weight (p

The rising prevalence of dermatophytosis in tropical countries coupled with drug resistance necessitate an objective scoring system to define the severity, monitor therapeutic response and predict prognoses. We attempted to establish and validate a new scoring system -Dermatophytoses Severity Score (DSS), for dermatophytoses affecting non-glabrous skin.A consensus group was convened to develop an objective and reproducible scoring system to describe the extent and severity of dermatophytosis of 200 consecutive patients with dermatophytosis. A second assessment entailed independent DSS scoring of the same patients by dermatologists and residents who were not part of the consensus group. The main outcome measured was index reliability, assessed in two steps, between the observers.The reliability of the DSS system was done in 2 steps. A 2 step assessment and DSS grading of 200 consecutive patients with clinically diagnosed dermatophytoses showed high reliability (Cronbach α test and intraclass correlation coefficient (ICC)) CONCLUSIONS: The DSS has demonstrated high reliability and it could serve as a novel, reproducible and objective scoring tool for dermatophytosis.

In the present study, seismic performance of Open Ground Storey (OGS) RCC frames is investigated using ETABS software. Bare frame, OGS frames and frames with RCC walls at ground storey are considered and infill walls are modelled as equivalent diagonal strut as per IS 1893–Part 1 (2016) codal provisions and equation given by Paulay and Priestley (1992). Seismic parameters viz. storey displacement, drift ratio, stiffness, shear and overturning moments for the developed RCC models are obtained by response spectrum analysis as per IS 1893–Part 1 (2016) in seismic zone III.

The present era is an age of speed, intensity, running, rush, and competition. In this age, human society has tried to touch the peak of material progress and has also achieved hopeful success in it. But in this bug, the process of development of various dimensions of personality got blocked, that is why human personality has been torn apart in the indulgent storm of the era. People left no moral-immoral way to get material comforts, due to which problems like anarchy, war hysteria, terrorism, violence, atrocities, women oppression are taking a mountainous form in the society. These are the external replicas of the internal disintegration of the human personality. Emotional health is the most important aspect towards meaningful life. Yoga has profound clarity about emotional wellbeing and related bhakti and mantra practices (Bhavna P. Harne, 2019). Om is regarded as name of God and ultimate mantra. In this research paper researcher would try to study scientific and philosophical background of om sound and its effects on emotional and physical health.

This study on the comparative biology Pectinophora gossypiella (Saunders) was carried out at the University of Agricultural Sciences, Raichur, Karnataka, in insect rearing growth chamber (25 ± 1°C, 65 ± 5% RH and photoperiod of 14:10 hr, L: D) during 2018-19. The results revealed that the incubation period was 3.5 ± 0.82 and 3.05 ± 0.55 days in non-diapausing and diapausing populations, respectively; a total larval period of 18.60 ± 2.28 and 19.65 ± 1.53 days, respectively was observed without any significant difference; and adult longevity of male and female was 9.05 ± 0.55 and 9.55 ± 0.83 days, respectively in non-diapausing population, while in diapausimg population it was 9.75 ± 0.26 and 10.25 ± 0.43 days. Total life cycle of non-diapausing population was significantly shorter (42.85 ± 4.99 days) as compared to diapausing one (134.3 ± 12.91 days) with fecundity of 112.34 ± 10.31 and 104.54 ± 9.96 eggs, respectively. The longer lifecycle of diapausing population was due to long resting diapausing period ranging from 72 to 108 days.

The goal of this project is just to create a model that will assist craftsmen in selling their services. Our app gives a platform to the sellers that they can give their information about product details and their delivery service. The main goal of our app is to help sellers as Handicraft’s people face many issues to sell their products. Indian artisans, typically manufactured by rural craftsmen, exude a certain charm of their own handiwork that has always been praised around the world for its vibrant colour schemes and fine craftsmanship. Rural units, often known as cottage industries, create 78.2percent of all crafts grown in the country. They represent the artistic representation of the producers, both women and men, and are grounded in India's traditions and social history. Around 77percent of artisans are self-employed, with the rest 23% working as daily workers. They must rely on exhibitions, tourism seasons, and the weather to make a living. But based on present pandemic situations one should follow the safety precautions as well as government guidelines so, it is impossible to run the exhibitions in large crowds. so that handicrafts men face several issues to sell their products. so by using our app they can sell their goods in a friendly way. It is a platform where a seller can sell his products on his own and there is no third-party involvement directly; the profit will be taken by the seller.

Field experiments were carried out at Zonal Agricultural and Horticultural Research Station, Navile, Keladi Shivappa Nayaka University of Agricultural and Horticultural Sciences, Shivamogga, Karnataka India during kharif 2020 and 2021. A total of seven acaricides were evaluated, and the results revealed that spiromesifen 22.9SC @ 0.8 ml/ l was the most effective in reducing mites (87.21% reduction) followed by diafenthiuron 50WP @ 1.0 gm/ l (84.49%). Maximum marketable pod yield was obtained with spiromesifen 22.9SC (21.36 t/ ha) and it was closely followed by diafenthiuron 50WP (20.15 t/ha). Maximum cost benefit ratio was observed with these, and thus spiromesifen 22.9SC @ 0.8 ml/ l and diafenthiuron 50WP @ 1.0 g/ l can be recommended against mites in yard long bean.

Nepal is a small landlocked country with complex topography and fragile geology which coupled with its lower-middle income economy, natural resources dependent population, and weak institutional capacity, all combine to rank it as the 4th most climate-vulnerable country in the world (http://maplecroft.com). A climate risk assessment carried out specifically for the Strategic Program for Climate Resilience (SPCR) at the sector, district and community levels identified the following critical risks: i) water quantity and quality, ii) food security, iii) ecosystem health, iv) animal and human health, v) vulnerable groups, and vi) economic growth and sustainability. Realizing this potential, the Government of Nepal (GoN) with support from the World Bank (WB) launched the Building Resilience to Climate-related Hazards (BRCH) Project in June 2013 with the aim to minimize overall climate risks in Nepal under the global initiatives of Pilot Program for Climate Resilience (PPCR). It is designed to demonstrate ways that developing countries can make climate risk and resilience part of their core development planning. The results-based monitoring adopted by the BRCH project is a legendary good practice in Nepal, an effective measure towards addressing climate hazards – the ultimate goal of the project and it could be instrumental for the South Asia as well.

The selection of suitable material having significant property for any structure or a component is an issue for a designer where the material used in fabricating most components is preferred according to their mechanical properties to sustain for various applied loads. Many components, however, fail under either fracture or fatigue loadings which fall below the applied loads before their life expectancy. These loads initiate, propagate and elongate along the cracks, leading to the failure of the component. Protective treatments like coatings are used to enrich the resistance to corrosion and abrasion, improve physical or mechanical properties, or improve the surface finish, improve aesthetic appearance, etc. In various structures in aerospace, automotive, ocean engineering, nuclear power plants, etc., many coated and treated components are used under different service temperatures. Protecting the alloys and metals from damage due to the surrounding medium is the focus of today’s technology. This area of technology for protecting alloys and once considered to be an important field confined to the practical aspects of galvanizing, chromizing, enameling, etc. of certain industrial and household appliances has now gained its practical importance in various fields of engineering and technology which deserves to be treated as an independent aspect of scientific investigation. In this paper, the effect of variable thickness of the copper coating on the plane strain fracture toughness is studied and concluded that the increase or decrease in the fracture toughness of the coated materials depends mainly on the parameters like the coating thickness, the environment under which coating is done, the temperature at which coating process is carried out and the duration of time for which the material is kept under these conditions during coating.

This paper proposed the methodology of dissimilar welding of Inconel materials in Friction stir welding process. For the great mechanical and thermal properties the Inconel alloys are preferered. Inconel alloys are used in aerospace and petro chemical industries for its good thermal properties. The requirement for prudent and productive utilization of materials regularly requires the joining of different metals. This research analyse the, welding between Inconel 600 and Inconel 718, was endeavored to utilize rotating grating welding. The qulity of the weld is achived by the weld deposite without unwanted Laves or delta stages. Grain coarsening in weld affected zone was investigated by the weld thermal cycle. At room temperature tractable tests, the joints were found to fall flat in the HAZ of Inconel 718, showing great extreme elasticity (759 MPa) without a critical deficiency of malleable flexibility (21%). A filtering electron infinitesimal assessment of the break surfaces uncovered fine dimpled crack highlights, recommending a break in a pliable mode.

મારા આ લેખનું પ્રયોજન બાલાશંકર કંથારિયાને ફારસી ભાષા અને મધ્યકાલીન ઈતિહાસના અભ્યાસ તરફ દોરનારા પ્રારંભિક જીવનના પરિબળો દર્શાવીને, ગુજરાત ભાષામાં ઇતિહાસનું પ્રથમ માસિક ‘ઈતિહાસમાલા’ શરુ કરીને મધ્યકાલીન ગુજરાતના ઈતિહાસના ઐતિહાસિક ચર્ચાના મંડાણ કરીને ઈતિહાસની સાચી હકીકત બહાર લાવવાના તેમને જે પ્રયત્ન આદર્યો હતો, તે આલેખવાનો છે

Magnet ingestion has become more frequent in children as magnetic toys and jewellery have been popularised, with the potential to cause significant morbidity. Our aim was to describe our experience at a tertiary paediatric surgical centre.Retrospective review of patients admitted with multiple magnet ingestion (January 2011-December 2020). Division into an intervention group and conservative group. Comparisons included demographics, number of magnets and clinical outcomes. Data analysis with a Student's t-test and ROC Curve, P value of0.05 was significant.A total of 23 patients were identified with a total of 150 magnets ingested. The majority required an intervention for magnets retrieval (15/23, 65.2%), 11/15 (73.3%) surgical and 4/15 (26.7%) endoscopic. In the surgery group, 6/11 (54%) presented with an initial perforation and 1/11 (9.1%) an entero-enteric fistula. One patient (9.1%) had a multi-site anastomotic leak post-operatively. The conservative group had a significantly lower median number of ingested magnets (2 (2-6) vs. 7 (2-40), P = 0.03) and median length of stay (1 (1-4) vs. 7 (1-24), P = 0.03). ROC curve analysis revealed ingestion of3 magnets had a sensitivity of 86.7% (95% CI: 62.1-97.6%) and specificity of 87.5% (95% CI: 53.0-99.4%) for requiring an intervention.This series highlights a significant morbidity in children with a higher incidence of intervention following ingestion of more than three magnets. There is a strong requirement for the creation and adherence to new legislature involving industry standards.

Background Acute appendicitis is classified into simple (SA) and complicated (CA). Ultrasound scans (USS) can be useful in clinically equivocal cases, by visualising primary and secondary signs. This study explores the utility of sonographic signs to diagnose and differentiate appendicitis in children. Methods Single-centre retrospective cohort study over a 2-year period. Consecutive USS for suspected appendicitis were included; sonographic signs were extracted from standardised institutional worksheets. USS results were compared with pre-defined intraoperative criteria for SA and CA, confirmed with histological analysis. Data are reported as median [interquartile range], percentages (number), area under the curve (AUC), conventional diagnostic formulae and adjusted odds ratios following multiple logistic regression (p Results A total of 934 USS were included, with median age 10.7 [8.0–13.4] years, majority were female (54%). One quarter (n = 226) had SA, 12% (n = 113) had CA, 61% (n = 571) had no appendectomy and 3% (n = 24) had negative appendicectomy. Appendix visualisation rate on USS was 61% (n = 569), with 62% (n = 580) having a conclusive report. Sonographic signs suggesting appendicitis included an appendiceal diameter > 7 mm (AUC 0.92, [95% CI: 0.90–0.94]), an appendicolith (p = 0.003), hyperaemia (p = 0.001), non-compressibility (p = 0.029) and no luminal gas (p = 0.004). Secondary sonographic signs included probe tenderness (p p 10.1 mm (AUC 0.63, [95% CI: 0.57–0.69]), an appendicolith (p = 0.003) and peri-appendiceal fluid (p = 0.004). Conclusion Presence of specific sonographic signs can aid diagnosis and differentiation of simple and complicated appendicitis in children.

Cervical Erosion may present with symptoms like vaginal discharge or serious problems of female infertility and thus gains importance in the gynaecological practice1. This entity is correlated with GarbhashayaMukhaGata Vrana (GGV), of Vatakaphaja variety. In the present study, Kushtadi YoniVarti (KYV) 2 is proposed as a local treatment for Cervical Erosion. The present study has two groups: Group A:30 patients, were treated with Kush- tadi Yoni Varti, followed by Sukhoshna Jala Prakshalana for 7 consecutive days. Group B:30 patients were ad- vised with Pathya and apathy for 7 days. The Follow up for both groups were on 14th Day and 21st Day. The re- sults were analysed statistically with paired and unpaired t-test. On comparing the two groups, it was found that the efficacy of treatment in Group A was better than the efficacy of treatment in Group B with reference to amount and odour of discharge, appearance and degree of erosion. Keywords: Cervical Erosion, Kushtadi Yoni Varti, GarbhashayaMukhaVrana, PAP Smear.

Chronic mesenteric ischemia has traditionally been treated with either open surgical revascularization or endovascular therapy. Endovascular surgery has typically been preferred due to the lower rates of peri-procedural and post-procedural morbidity, yet this comes at the expense of long-term durability. Intravascular shockwave lithotripsy is a technique utilized to modify intimal and medial calcified plaque in order to improve vessel expansion and patency. Intravascular lithotripsy has been investigated as both primary and adjunctive treatment for peripheral arterial and coronary arterial lesions, however, its use in the treatment of chronic mesenteric ischemia requires further investigation. We present a case of a 75-year-old woman with symptomatic mesenteric ischemia who underwent intravascular shockwave lithotripsy of a 99% stenosis superior mesenteric artery with an excellent outcome.

Hypertension / High blood pressure is a very common disease and is a major risk factor for total organ failure, cardiovascular diseases (CVD) and premature death around worldwide. Prevalence of hypertension varies across regions and country and is dramatically variable in presentation. Sometimes it act as a silent killer i.e. the patients are unaware that they have the condition. According to estimation 46.5% of adults are unaware about their hypertensive condition, 36.9% are diagnosed and treated and the remaining 13.8% with hypertension have it under control. The investigation regarding the chronobiology, chronotherapy and chronopharmacology in treatment of hypertension began a long back ago. Hypertension is a lifestyle disease largely exhibit circadian variation. Also the condition is more evident to surge during early morning hours. Hence this requires chronotherapy. The chronobiology of hypertension along with its treatment in relation to the circadian variation is reviewed in this article. Keywords: Hypertension, Chronobiology, Chronotherapy, Circadian rhythm, Chronopharmacology, ABPM

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Genital elephantiasis is associated with sexually transmitted infections such as lymphogranuloma venereum. Here we present an unusual and rare non-venereal cause of Saxophone penis.

Pyoderma gangrenosum is a rare neutrophilic inflammatory skin disorder commonly seen over lower limbs. Involvement of penile area is rare. We report this rare case of occurrence of ulcerative type of pyoderma gangrenosum over penis with pustular type elsewhere over the body, healing with keloids in an immunocompetent young man with no systemic associations.

Eri silk is one of the wild silk varieties which are mainly available in the north-eastern areas of India. It exhibits goodmechanical and thermal resistance properties. In this concern, the present study focused to develop a bi-layer knittedstructure made from Eri silk yarn as one side(next to skin) and on another side bamboo yarn knitted fabric. Similarly,Tencel knitted fabric was used instead of bamboo. Twenty-four bi-layer knitted fabrics were developed and thenanalysed for its thermal comfort property. The air permeability, and wick-ability were found to be higher and the thermalresistance was found to be higher for bi-layer plated interlocked knitted fabric made out of Eri silk compared to bambooand Tencel.

To date, there is no published information on the Holocene bryozoans from India. In this study, we describe 10 species of lepraliomorph bryozoans collected from Holocene rocks along the Konkan coas...

Aortic valve replacement has long been the standard of care for many aortic valve diseases. Neo sinus reconstruction and aortic valve reconstruction with native pericardium, known as the Ozaki procedure, is a relatively new technique with early studies showing good mid-term durability and hemodynamics without the need for life-long anticoagulation. We present the case of a 56-year-old male presenting with aortic valve endocarditis and severe aortic insufficiency who underwent successful aortic valve reconstruction via the Ozaki procedure complicated by postpericardiotomy syndrome and cardiac tamponade. Although the Ozaki procedure is a promising alternative to conventional aortic valve replacement, further study is needed to determine long-term re-operation rates, stability and mortality.

Background: In India and worldwide overweight or obesity in paediatric age group has become one of the most important health problems. Overweight / obesity is a proved risk factor for several signicant complications and tracks in adulthood. Body mass index (BMI) is used as a clinical assessment of overweight and obesity in children and mid-upper arm circumference (MUAC) is used as an assessment for nutritional status. I would like to compare Mid upper arm circumference and Body mass index. To Objective: compare the mid upper arm circumference (MUAC) with that of body mass index (BMI) of the study population 7-12 years in Ganukul village, Ramanagara district, Bengaluru rural. Materials And Methods: This is a study done in children aged 7-12 years in Ganukul village, Ramanagara district, Bengaluru rural. Following ethical clearance from the institutional ethical committee, the study was conducted in schools belonging to the study area. The children were visited in the school and after consent being obtained from the parents by visiting their house. Base line data including age, gender, demographic data, socioeconomic status was noted. Following this standard anthropometric measurement including weight in Kilogram, Height in centimeters, mid upper arm circumference in centimeter, body mass index was measured using standard measurement protocols. Weight was measured without shoes with the help of digital machine to the nearest 500 grams. Height was measured with stadiometer to the nearest completed centimeter or child standing against the wall with the bare foot should look straight, standing in relaxed manner with arms hanging by the side, they should stand with both feet and knees closes together, head kept in Frankfurt plane (the line joining the lower margin of the orbit and upper margin of the external auditory canal should be parallel to ground). Age was calculated from date of birth. MUAC was measured with non-stretchable measuring tape to nearest millimeter. BMI was measured by weight in KG / height in m2 Results: Compared to MUAC and BMI, BMI was the best predictor for overweight and obesity compared to MUAC as evidenced by statistically signicant adjusted odd's ratio. On the other hand MUAC was a better predictor of underweight compared to BMI but the adjusted odd's ratio was not statistically signicant. Conclusion: BMI is a better predicator for over weight , MUAC is a better predictor for underweight. K

Overall Equipment Effectiveness (OEE) is an indicator to assess the utilization of machinery. This paper's primary goal is to identify and solve the loss elements to enhance the Performance efficiency & Man time. This study aimed at carrying out Gemba walk in the industrial set up to analyse the problems faced by the machine operator and continuous improvement solutios were suggested for the performance enhancement.

Background: Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) represent adverse drug reactions characterized by generalized rash, blisters, epidermal detachment, mucosal and systemic involvement presenting as dermatological emergencies. Drugs are the most common culprits implicated in the pathogenesis of SJS /TEN. The primary step in the management of SJS/TEN is identification and stopping the offending drug. Materials and methods: This was a multi-centric retrospective as well as prospective observational study conducted in 7 tertiary care hospitals including Father Muller Medical College Hospital , Mangalore, India. A detailed evaluation of the hospital in patient record for 10 years retrospective from September 2015 and all new cases of SJS/TEN as well as SJS-TEN overlap presenting to these centres for 1 year prospective was performed. Detailed history was taken and clinical examination was recorded and different modalities of treatment was noted and compared. Results: A total of 152 patients with clinical diagnosis of SJS ,TEN and SJS-TEN overlap were analysed. Males were more commonly affected than females and history of drug intake was present in 118 patients (77.6%). The most common drugs which caused SJS/ TEN in our study were antibiotics in 40 patients (26.3%) followed by anti epileptics in 35 patients (23%) and nevirapine in 10 patients (6.5%). In our study the most common finding on cutaneous examination was maculopapular rash (19.3%). Conclusion: SJS and TEN form part of a spectrum of severe cutaneous drug reactions that can lead to high morbidity which can be reduced by early withdrawal of the offending drug and timely intervention. Individuals with known drug allergies need to be educated and drug allergy card has to be carried.

Several potential etiologic risk factors have been evaluated for the development of complete hydatidiform mole. The two established risk factors that have emerged are extremes of maternal age and prior molar pregnancy. Advanced or very young maternal age has consistently correlated with higher rates of complete hydatidiform mole. Compared to women aged 21- 35 years, the risk of a complete mole is 1.9 times higher for women both more than 35 years and less than 21 years as well as 7.5 times higher for women more than 40 years. (49, 50) The risk of repeat molar pregnancy after 1 mole is about 1% or about 10-20 times the risk for the general population. The present study on the gestational trophoblastic disease (GTD) was carried out as it is one of the fascinating gynaecological tumours. Hence a clinicopathological study of gestational trophoblastic disease was undertaken with relevance to the histopathological study of GTD and clinical correlation.

The present study on the histomorphology of lower gastrointestinal tract lesions in patients presenting with per rectal bleeding was two years (June 2015 to May 2017) cross-sectional study carried out in the department of pathology of a tertiary care hospital and included 40 cases. Constipation was the most typical associated symptom along with per rectal bleeding. Clinical details and radiological investigations helped in making the diagnosis of all lesions of the lower gastrointestinal tract causing per rectal bleeding. The mean age at presentation in benign lesions was 33 years, while the mean age at presentation in malignant lesions was 61 years. The mean age at presentation of adenocarcinoma was 62 years. Majority of cases of adenocarcinoma presented with Astler-Coller stage C1. The other malignancies of the lower gastrointestinal tract causing per rectal bleeding were clonogenic carcinoma, neuroendocrine carcinoma and moderately differentiated squamous cell carcinoma. The most common cause of per rectal bleeding amongst the lower gastrointestinal tract is a neoplastic lesion. The lesions of the lower gastrointestinal tract causing per rectal bleeding are seen more commonly in male patients with a predominant age group of above 40 years, and constipation is the most typical associated symptom in these cases. The most common cause of per rectal bleeding amongst the lower gastrointestinal tract is a neoplastic lesion.

Background: Obesity is a global epidemic. Obesity is associated with a number of dermatoses, including acanthosis nigricans, skin tag, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, and adiposis dolorosa. Objective: To elucidate the various skin changes in obesity and to determine if it is considered as an obesity marker. Methodology: 100 patients, aged 18 years or above satisfying the inclusion and exclusion criteria were drawn for a period of 18 months. Results: Out of 100 patients 54% were female, in their third and fourth decade. By occupation most of the females were housewives (40%) and the majority of males were farmers (14%). Type 2 diabetes mellitus was the most common systemic illness (24%). Pseudoacanthosis nigricans was the most prevalent skin change. 51% of patients had skin tags. 48% had striae distensae as a skin change. 10.86% male and 14.81% female patients had stasis dermatitis, 6% had leg venulectasias and 2% had leg ulcer. 26% had plantar hyperkeratosis. 41% of our patients had one or other types of fungal infections. Bacterial infections were detected in 15% cases, folliculitis being the commonest. Conclusion: Obesity is strongly related to several skin alterations that could be considered as markers of excessive weight. The dermatoses that showed a statistically significant relationship with obesity were Pseudo acanthosis nigricans, Skin tag, Striae, Plantar hyperkeratosis and Fungal infections. Prevention of obesity is important to prevent these dermatoses and dermatologists must work with primary care physicians and patients to reduce the harmful effects of obesity on the skin.

The first 1000 days of a child’s life are important for his/her long-term physical, mental and emotional development especially from a nutritional perspective. Inadequate nutrition during this phase can have severely negative consequences like impaired intellectual development.1General under-nutrition is more prevalent amongst rural children, scheduled castes and tribes, and amongst children with illiterate mothers. The contributing factors among these children are household food insecurity and intra-household food distribution, poor diets, inadequate preventative and curative health services and insufficient knowledge of care and infant feeding practices.

Aakash Ganju,1 Alessandra C Goulart,2 Amrit Ray,3 Anurita Majumdar,4 Barrett W Jeffers,3 Gloria Llamosa,5 Henry Cañizares,6 Ianne Jireh Ramos-Cañizares,6 Ibtihal Fadhil,7 Kannan Subramaniam,8 Lee-Ling Lim,9 Luna El Bizri,10 M Ramesh,11 Mathew Guilford,12 Raghib Ali,13 Ratna Duddi Devi,14,15 Rayaz A Malik,16 Shekhar Potkar,17 Yuan-Pang Wang18 1Executive Office, Saathealth, Mumbai, India; 2Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; 3Research, Development and Medical, Upjohn – a Pfizer Division, New York, NY, USA; 4Research, Development and Medical, Emerging Markets, Upjohn – a Pfizer Division, Singapore; 5Mexican Neurology and Psychiatry Society, Mexico City, Mexico; 6Vicente Sotto Memorial Medical Center, Cebu City, Philippines; 7Eastern Mediterranean NCD Alliance, Kuwait City, Kuwait; 8Research, Development and Medical, Upjohn – a Pfizer Division, Sydney, Australia; 9Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 10School of Pharmacy, Lebanese University, Hadath, Lebanon; 11Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore; 12Executive Office, Common Health, Kuala Lumpur, Malaysia; 13Public Health Research Center, New York University, Abu Dhabi, United Arab Emirates; 14Executive Office, DakshamA Health and Education, Gurgaon, India; 15Board of Directors, International Alliance of Patient Organizations, London, England; 16Weill Cornell Medicine, Doha, Qatar; 17Research, Development and Medical, Upjohn – a Pfizer Division, Dubai, United Arab Emirates; 18Instituto de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BrazilCorrespondence: Kannan SubramaniamResearch, Development and Medical, Upjohn – a Pfizer Division, Sydney, NSW 2000, AustraliaTel +61 413 569 077Email Kannan.Subramaniam@pfizer.comAbstract: Non-communicable diseases (NCDs) have been on the rise in low- and middle-income countries (LMICs) over the last few decades and represent a significant healthcare concern. Over 85% of “premature” deaths worldwide due to NCDs occur in the LMICs. NCDs are an economic burden on these countries, increasing their healthcare expenditure. However, targeting NCDs in LMICs is challenging due to evolving health systems and an emphasis on acute illness. The major issues include limitations with universal health coverage, regulations, funding, distribution and availability of the healthcare workforce, and availability of health data. Experts from across the health sector in LMICs formed a Think Tank to understand and examine the issues, and to offer potential opportunities that may address the rising burden of NCDs in these countries. This review presents the evidence and posits pragmatic solutions to combat NCDs.Keywords: low- and middle-income countries, multisectoral, non-communicable diseases, public–private partnership, universal health coverage

Characteristics of women who access the cell for assistance as well as the types of violence they face. Over half the women who sought help from the cell did so in the first five years of abuse. For women who had experienced violence for more than five years, the numbers drop sharply. In nearly 60 percent of cases, women are reporting violence within joint or extended family households. As noted above, over a third of the women seeking help were involved in paid work. KEAWORDS: Women, Violence, Struggle, Sharpness, Households, Family

Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) optimize percutaneous coronary intervention (PCI) by characterizing lesion morphology, accurately measuring vessel dimensions, and optimizing stent characteristics. We sought to compare the utilization of OCT and IVUS to guide inpatient PCI and their relative association with in-hospital mortality and readmission rates. We queried the National Readmission Database to identify patients undergoing intracoronary imaging-guided PCI from 2010 to 2019 and compared outcomes and readmission rates between patients undergoing OCT-guided PCI and IVUS-guided PCI. Multivariable logistic regression was performed to generate adjusted odds ratios (aOR) of adverse outcomes between the 2 groups. Of 3,71,450 intracoronary imaging-guided PCI admissions, OCT (n = 12,808) was used less frequently than IVUS (n = 358,642). The use of OCT-guided PCI increased from 0.1% in 2010 to 0.6% in 2019 while the rate of IVUS-guided PCI increased from 7.2% in 2010 to 9.4% in 2019 (both ptrend0.001). Patients undergoing OCT compared to IVUS had lower in-hospital mortality (aOR 0.69, P = 0.015) and 30-day readmission rate (aOR 0.91, P = 0.040) with no statistical difference in 90-day readmission rate (aOR 0.93, P = 0.065). Heart failure was the most common cause of 30-day and 90-day readmissions in both cohorts. There was no difference in the rate of acute kidney injury between the 2 modalities. In this in-patient admission database of intracoronary imaging-guided PCI, OCT-guided PCI during index hospitalization appears to be associated with lower in-hospital mortality and 30-day readmission rates compared to IVUS-guided PCI with no difference in terms of the 90-day readmission rates.

Purpose Factors leading to mechanical complications following insertion of central venous access devices (CVADs) in children are poorly understood. We aimed to quantify the rates and elucidate the mechanisms of these complications. Methods Retrospective (2016–2021) review of children ( Results In total, 317 CVADs (245 children) were inserted. Median age was 5.0 (8.9) years, with 116 (47%) females. There were 226 (71%) implantable port devices and 91 (29%) Hickman lines. Overall, 54 (17%) lines had a mechanical complication after 0.4 (0.83) years from insertion: fracture 19 (6%), CVAD migration 14 (4.4%), occlusion 14 (4.4%), port displacement 6 (1.9%), and skin tethering to port device 1 (0.3%). Younger age and lower weight were associated with higher risk of complications (p p = 0.008]. Conclusion Mechanical complications occur in 17% of CVADs at a median of Level of evidence Level 4: case-series with no comparison group.

Criteria-led discharge (CLD) protocols have been suggested to increase efficiency of discharge from hospital following surgical interventions. Our aim was to assess the feasibility, clinical outcomes and parental satisfaction following the introduction of a pilot CLD for simple appendicitis (SA) in children.A prospective pilot cohort study was conducted including paediatric patients with SA who were managed with CLD and a control group who were managed with standard discharge procedures. A CLD pro forma was developed, standardising care guidelines and clinical criteria indicators to be met for children to be discharged post-operatively. A post-discharge parent survey was also utilised. The primary outcome measure was post-operative length of stay (pLOS), with secondary outcomes of post-operative complication rates and parental satisfaction.The control group consisted of 31 patients and CLD group 35 patients. There was no difference in the median pLOS (24 [16.7-44.6] vs. 25.3 [19.1-50.1] h, P = 0.3). Furthermore, there were no significant differences on any of the secondary outcomes. Parental confidence with time of discharge was very high in both control (85.7%) and CLD (88.2%) groups (P = 1.0).The introduction of CLD is safe and feasible. Whilst this pilot has not demonstrated a reduction in pLOS, our data suggest that it is well accepted by the parents.

Background Tissue adhesive, adhesive tape, and sutures are used to close surgical incisions. However, it is unclear which produces the best results in children, and whether combination wound closure is better than sutures alone. Methods In this parallel randomised controlled trial (ANZCTR: ACTRN12617000158369), children (aged 18 years or less) undergoing elective general surgical or urological procedures were randomized to skin closure with sutures alone, sutures and adhesive tape, or sutures and tissue adhesive. Participants were assessed 2 weeks, 6 weeks, and more than 6 months after operation. Outcomes included wound cosmesis (clinician- and parent-rated) assessed using four validated scales, parental satisfaction, and wound complication rates. Results 295 patients (333 wounds) were recruited and 277 patients (314 wounds) were included in the analysis. Tissue adhesive wounds had poorer cosmesis at 6 weeks: median 10-point VAS score 7.7 with sutures alone, 7.5 with adhesive tape, and 7.0 with tissue adhesive (P = 0.014). Respective median scores on a 100-point VAS were 80.0, 77.2, and 73.8 (P = 0.010). This difference was not sustained at over 6 months. There was no difference in parent-rated wound cosmesis at 6 weeks (P = 0.690) and more than 6 months (P = 0.167): median score 9.0 with sutures alone, 10.0 with adhesive tape, and 10.0 with tissue adhesive at both stages. Parental satisfaction was similar at all points, with a median score of 5 (very satisfied) for all groups. There was one instance of wound dehiscence in the tissue adhesive group and no wound infections. Conclusion Short-term wound cosmesis was poorer with tissue adhesive although it is unclear whether this difference is sustained in the long-term. There were no differences between techniques for the study outcomes. Registration number ACTRN12617000158369 (ANZCTR) (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372177&isReview=true).