Difficulties of the hearing impaired have increased due to COVID-19, leading to lack of inclusiveness along with the breakdown of their mental, physical, and social health. The study objective was to assess the challenges faced by the deaf and hearing-impaired people during COVID-19 by a literature review. Literature search was done using keywords such as “challenges” OR “barriers” and “COVID-19” OR “Deaf” OR “Hearing Impaired” OR “Communication” on PubMed and Google Scholar from November 2019 to June 2020. The challenges faced were lack of information, face mask making communication difficult, social distancing affecting their physical, mental health, stigma and barriers related to the health-care system. Strategies included use of technology, help from sign language instructors, and preparedness of health-care settings for the hearing disabled. System strengthening, tele-medicine, and policy amendments can be the pillars to build up the support system for the hearing impaired to protect them from COVID-19.

Background: It was observed that adult users start tobacco use in childhood or adolescence. The influence of digital and print media, social acceptance among peers, and in order to mimic role models from films attracts youth towards tobacco. Hence this study was conducted to assess the prevalence of smokeless tobacco (SLT) use among school-going adolescents with the assessment of the influencing factors such as exposure at school, home, and public places along with the role of various media in SLT use by adolescents. Methods: Cross sectional study was conducted with 860 students of class 9 th -12 th enrolled in schools. Purposive sampling of three schools was done from the study area to reach desired sample size. All the students of class 9 th -12 th within selected schools were given chance to participate in the study. Data collection was done using pretested modified Global Youth Tobacco Survey (GYTS) questionnaire. Results: Consumption of smokeless tobacco (SLT) was observed in 79 (11%) of 714 subjects. Significantly higher proportion (18.4%) of study subjects consumed SLT who were exposed to tobacco at school premises and 19.1% of study subjects who were exposed to teacher using SLT in schools compared to non-exposed group. (p=0.016). It was observed that 8.1% of subjects without any exposure to tobacco at home and 9.8% of subjects without exposure to tobacco at outdoor public space consumed SLT. Consumption of SLT use was highest (16.7%) among subjects exposed to tobacco advertisement or promotion through social media (p=0.04). Conclusion: High prevalence of SLT was detected among adolescents in school. Factors such as exposure to tobacco at home, public places, school and school teacher using SLT, exposure of tobacco advertisement and promotion via different modes of media was found to be significantly associated with the use of SLT in the adolescents of school.

Objective: Tobacco use is associated with mortality in low-and middle-income countries including India with dual burden of smoking and smokeless tobacco (SLT). Aligning with the FCTC, India has made substantial amendments in strengthening graphic warning under Cigarettes and Other Tobacco Products Act (COTPA) for sections 7,8 9 and "Specified warning". Compliance assessment studies are necessary to understand current status of implementation for packaging laws. This study aimed to assess the compliance of COTPA sections 7,8 9 and Cigarettes and other Tobacco Products (Packaging and Labelling) Third Amendment Rules, 2020 in Delhi. Methods: Cross-sectional study was conducted in two districts of Delhi selected by simple random sampling. Fifteen points of sales were selected from each district through purposive sampling and 57 smoking and smokeless tobacco products were collected with Indian and foreign origin. An observation checklist for product analysis was prepared and pack analysis done based on COTPA sections 7,8 and 9 along with Third Amendment,2020 which included pictures and warnings to be circulated in 2021. Result: Total 57 samples has smoking (49.1%), smokeless (50.9%) with no SLT product of foreign origin. SLT and foreign products had low compliance of Section 7 and third amendment 2020 rules which includes manufacturing date and origin. Indian smoking products were highly compliant to section 8 and 9 whereas foreign and SLT products showed low compliance to section 8. COTPA Third Amendment Rules (2020) compliance was seen in Indian products with regards to SW (68.4%), PW (61.4%) and quit line (78.9%) with no compliance at all for foreign products. Conclusion: Foreign brands and SLT products had low compliance with sections 7 and 8 of COTPA and its amendments (2020). Compliance with illicit trade and SW needs regulation and strict implementation of law for SLT products.

IntroductionIllicit smokeless tobacco (ST) trade has seldom been documented despite ST use in at least 127 countries across the world. Based on non-compliance with packaging regulations, we report the proportion of illicit ST products from samples on sale in Bangladesh, India and Pakistan where 85% of global ST users reside.MethodsWe purchased unique ST products from tobacco sellers in two purposively selected administrative areas (division/district) in each of the three countries. The criteria to determine illicit ST products were based on country-specific legal requirements for ST packaging and labelling. These requirements included: ‘market retail price disclosure’, ‘sale statement disclosure’, ‘pictorial health warning (PHW) pertinence’, ‘appropriate textual health warning’ and ‘using misleading descriptors (MDs)’. Non-compliance with even one of the legal requirements was considered to render the ST product illicit.ResultsAlmost all ST products bought in Bangladesh and India were non-compliant with the local packaging requirements and hence potentially illicit, all products in Pakistan lacked desirable features. The most common feature missing was health warnings: 84% packs in Bangladesh, 93% in India, and 100% in Pakistan either did not have PHW or their sizes were too small. In Bangladesh, 61% packs carried MDs. In India and Pakistan, the proportions of such packs were 32% and 42%, respectively.ConclusionsWeak and poorly enforced ST control policies may be slowing the progress of tobacco control in South Asia. Standardised regulations are required for packaging and labelling ST. Improving compliance and reducing sale of cheap illicit products may require business licensing and market surveillance.

During the past decades, practice of routine investigations prior to surgery has been challenged as it has little impact on perioperative management but increases cost, causes delay and increases laboratory load. We aimed to prospectively assess the influence of pre-operative investigations on resource utilisation and peri-operative management in elective surgeries. Materials and Methods: Prospective observational study was done in 500 Patients, who attended preanaesthetic check-up (PAC) for elective surgeries. Number of investigation already performed before arriving in PAC and their results in terms of normal and abnormal tests were noted. Based on National Institute for Health and Care Excellence (NICE) guideline, the test was considered as indicated or unindicated. These patients were then followed up till the post-operative period and any referral, further investigation or delay done during pre-operative was noted. An abnormal test result was said to be impactful if it resulted in referral, delay or further investigations. Cost analysis was done for every test that was considered not necessary based on NICE guidelines. Results: Majority (60.6%) of the patients had at least one abnormal test results on routine pre-operative tests, but only 6.93% of all tests performed had any impact in terms of referral, further testing or delay. Only 5 (0.14%) of all 3462 abnormal test had significant impact which it lead to change in perioperative management. Conclusion:The practice of prescribing large number of routine pre-operative investigations is prevalent in the institution. Most of the investigations are done without following any guidelines, which leads to wastage of resources.