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Background: Inguinal hernia is a very common surgical problem for which, mesh-based techniques, particularly the Lichtenstein repair is considered standard. However, problems like foreign body sensation, wound infection, cord fibrosis, chronic pain and recurrence are major concern. Desarda tissue repair (non-mesh technique), which was given by an Indian surgeon, is now being used in many countries because of low cost of procedure with very low recurrence rates. The objective of this study was to evaluate the feasibility of Desarda tissue repair at a tertiary care centre of Central India as a treatment of primary inguinal hernia, by comparing it with Lichtenstein repair in terms of various post-operative parameters.Methods: Patients between age of 18 and 70 years with primary inguinal hernia were included in this randomised controlled trial. Patients with strangulated, obstructed or recurrent hernia, surgically unfit patients and patients having unmanaged urinary obstruction, cough or constipation were excluded. Randomization was done by sealed envelope method into Lichtenstein and Desarda arm and respective surgeries were performed.Results: 90 patients were included in the study and average duration of follow-up was 15.1 months. Operative time was significantly less in Desarda arm (14.75 min compared to 21.32 min in Lichtenstein arm). Cost, incidence of seroma formation, post-operative pain, foreign body sensation and chronic pain were also significantly less in Desarda arm. No recurrence was observed in both arms.Conclusions: Desarda repair is easy to perform and takes less time to perform and proves cost effective. Desarda repair is comparable to Lichtenstein repair in terms of many parameters and superior in terms of post-operative pain and foreign body sensation and can be preferred for young patients. In infected and strangulated cases, Desarda repair can be used effectively without fear of mesh infection.

BackgroundQuality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period.MethodsStandalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization.DiscussionTo our knowledge, this is the first randomized evaluation of a peer-led quality improvement network that has examined the impact of participation on both patient-level and service-level outcomes. The study has the potential to help shape future efforts to improve the quality of inpatient care.Trial registrationCurrent Controlled Trials ISRCTN79614916. Retrospectively registered 28 March 2014]

Aims:This study was conducted retrospectively to define early demographic and clinical predictors for acute kidney injury (AKI) among snake bite patients at the time of hospital admission.Materials and Methods:We analyzed 138 cases with a poisonous snake bite. Patients were classified into two groups according to the presence and absence of AKI. The data regarding clinical features and demographic profile of these patients were collected from the hospital records in a prestructured pro forma and statistically compared.Results:Of the 138 patients of venomous snake bite, 62 developed AKI (44.92%). Patients who developed AKI were older in age. Moreover, prolonged bite to anti-snake venom (ASV) time had a significant relationship in developing AKI (P < 0.05). Among the clinical features, there was an independent positive association of AKI with abdomen pain, tenderness and vomiting, cellulitis, bleeding tendencies, myalgia, and black or brown urine (P < 0.05). Neurological features were inversely associated with renal involvement.Conclusion:We found that marked abdominal pain, tenderness and vomiting, myalgia, black or brown urine, bite site cellulitis, bleeding tendencies, and prolonged (>2 h) bite to ASV time were significantly associated with the development of AKI in snake bite patients.

IntroductionAround 9% of India’s children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures.MethodsThis 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants’ GMs twice, that is, within 2 months after birth and at 3–5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12–24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12–24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA.Ethics and disseminationG.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.

Background:Academic excellence is essential to provide opportunities for students to work together to improve their understanding of concepts in their academic core. Academic excellence helps students to teach problem-solving and collaborative learning strategies.Objective:The objective of this study was to assess Guna (personality traits) in students undergoing Yoga Instructor's Course (YIC).Materials and Methods:In all, 68 YIC students with a mean age of 28.03 ± 9.38 years participated in this single group pre–post study. The Personality Inventory data were collected before (pre) and after (post) the YIC.Statistical Analysis:Means, standard deviations, Kolmogorov–Smirnov test, and Wilcoxon signed rank test were used for analyzing the data with the help of SPSS 16.Results:The data analysis showed 11.33% decrease (P < 0.01) in Tamas Guna (dull personality trait), 0.68% decrease (P =0.819) in Rajas Guna (violent personality trait), and 10.34% increase (P <0.01) in Sattva Guna (balanced personality trait) scores.Conclusion:This study suggests that YIC can result in the improvement of Sattva Guna (balance personality trait) among students, thus paving the way for their academic excellence.

Abstract:The approximate analytical solution of fractional order, nonlinear, reaction differential equations, namely the nonlinear diffusion equations, with a given initial condition, is obtained by using the homotopy analysis method. As a demonstration of a good mathematical model, the present article gives graphical presentations of the effect of the reaction terms on the solution profile for various anomalous exponents of particular cases, to predict damping of the field variable. Numerical computations of the convergence control parameter, used to evaluate the convergence of approximate series solution through minimizing error, are also presented graphically for these cases.

In this article, the approximate analytical solution of the time-fractional Cahn-Hilliard equation with quadratic form of the source/sink term is obtained using the powerful homotopy analysis method, which permits us to select a convergence control parameter that minimizes residual errors. The concerned method is more general in theory and widely valid in practice to solve nonlinear problems even for fractional order systems as it provides a convenient way to guarantee the convergence of the approximate series. The results have been given to show the effect of the reaction term on the solution profile in both fractional and standard order cases for different particular cases. The main feature of this study is the authentication that only a few iterations are required to obtain the accurate approximate solution of the present mathematical model. This is justified through error analysis for both fractional and standard order cases. This striking feature of savings in time is exhibited through graphical presentations of the numerical values when the system passes from standard order to fractional order in the presence or absence of the reaction term.