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Case Series of Neurotrauma Managed by General Surgeon at Ladakh - The Highest Plateau State of India.

ABSTRACT: Trauma including neurotrauma is one of the major killers in the world. The health infrastructure in developing countries has a huge disparity, with super specialist care confined to big cities only. Adding to this problem is factors like poverty, poor road condition and no organised emergency evacuation system. The utopian scenario where specialist and infrastructure are made available in every village is a distant dream. So at present, the most feasible and cost-effective way to prevent death due to neurotrauma in rural and remote setting is putting the general surgeon working in remote area at the forefront. Our study is an effort in this direction and is reporting operative management of patients with neurotrauma in remote high-altitude Ladakh. So today, the need of hour is continuing skill enhancement training for capacity building of rural surgeon, where they are trained to do burr hole and craniotomy for reducing mortality and morbidity from neurotrauma.

Supplementary information

The online version contains supplementary material available at 10.1007/s12262-021-03002-x.

SUBMITTER: Deskit P

PROVIDER: S-EPMC8224252 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Case Series of Neurotrauma Managed by General Surgeon at Ladakh - The Highest Plateau State of India.

Deskit Padma P

The Indian journal of surgery 20210624 3

Trauma including neurotrauma is one of the major killers in the world. The health infrastructure in developing countries has a huge disparity, with super specialist care confined to big cities only. Adding to this problem is factors like poverty, poor road condition and no organised emergency evacuation system. The utopian scenario where specialist and infrastructure are made available in every village is a distant dream. So at present, the most feasible and cost-effective way to prevent death d ...[more]

PMID: 34188368

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Project description:In light of their unique and challenging environment, the high-altitude Chumathang geothermal springs in Ladakh, India, are undeniably intriguing for microbiological study. The purpose of this study was to employ a culture-independent sequencing approach to give a comprehensive characterization of the unknown bacterial and archaeal community structure, composition and networks in water and soil from the Chumathang geothermal spring. A total of 50%, and 42.86% bacterial phyla were found in the water, and soil samples respectively and this analysis also showed a total of 9.62% and 7.94% of archaeal phyla in both the samples, respectively. Further, the presence of unclassified (derived from other sequences, water: 17.31%, and soil: 19.05%) and unclassified (derived from bacteria, water: 13.46%, and soil: 12.70%) were also observed in the current metagenomics investigation. Firmicutes and Proteobacteria were the most abundant bacterial phyla in water, whereas Proteobacteria and Bacteroidetes were the most abundant bacterial phyla in geothermal soil. Crenarchaeota and Euryarchaeota dominated archeal communities in soil and water, respectively. This metagenomic study gave a detailed insight into the microbial diversity found in Chumathang geothermal spring and surrounding area, located in Ladakh, India. Surprisingly, this finding indicated the existence of geographically distinct microbial communities that were suited to various geothermal water habitats along the Himalayan Geothermal Belt. Future studies must take into account the metabolic pathways of these microbial communities that exist in these extreme environments. This will allow us to obtain a better knowledge of the microbial metabolisms that are common at these geothermal locations, which have a lot of potential for biotechnological applications. They will also enable us to establish links between the microbial community composition and the physicochemical environment of geothermal water and area.

Project description:BackgroundThe partial and complete lockdown to curb the spread of COVID-19 caused enormous economic and social disruptions throughout the world. India witnessed the sharpest decline in its Gross Domestic Product (GDP), and the unemployment rate rose sharply in the first quarter of 2020-21. Odisha, one of the low income states of India, has faced a steep rise in unemployment, with lakhs of migrant workers returning to the state. This article attempts to examine Odisha's unemployment situation compared to the low-income states of India as well as with the national average during COVID-19. This also investigates to what extent the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) provided relief to the people by providing short-term employment opportunities.DesignThis is a descriptive study and is based upon repetitive cross sectional secondary data on unemployment rate and labour force participation rate across the low-income states of India.MethodThe study used descriptive statistics to analyze the secondary data from the Center for Monitoring Indian Economy (CMIE) and MGNREGA report. The labour force participation rate (LFPR) and unemployment rate (UER) data were collected from the CMIE trimester reports. The information related to number days of employment demanded and employment provided were collected from the MGNREGA reports. Total time period was divided in to two parts - 2017-19 pre pandemic period and 2020-2021 pandemic period.ResultsThe analysis of UER revealed that the unemployment situation in Odisha was better than the low-income states and overall India. The UER during COVID-19 (Sep-Dec 2020 to Sep-Dec 2021) was lower than the pre COVID-19 level in Odisha (1.6% in Sep-Dec 2020), compared to all India, where this was more than the pre-COVID-19 level (7.4% in Sep-Dec 2020). Odisha government had nearly doubled the employment generation through MGNREGA during 2020-21.The state government undertook a number of proactive measures - increasing wage rate, providing extra days of work in vulnerable districts to address the unemployment situation during the pandemic.ConclusionThe state government's effort to manage the livelihood crisis was notable during the pandemic.. Proper implementation of the wage employment programmes led to higher decline in the UER in Odisha compared to other states These experiences can be emulated by other states or countries.

Project description:BackgroundIn vasovasostomy (VV) surgery, the micro-surgical technique has consistently been shown to provide superior outcomes to both macroscopic and loupe-assisted techniques, with large studies showing overall patency rates of ~86% and pregnancy rates of ~52%. However, the question of whether a single- or double-layer anastomosis offers the best outcomes remains contentious, and despite the popularity of the two-layer technique, a meta-analysis suggests little difference in outcomes. This study records the outcomes of a single-surgeon series of a simplified single-layer technique, along with the comparative outcomes and predictive factors.MethodsA retrospective analysis of 237 consecutive patients undergoing microsurgical vasectomy reversal between 2010 and 2022 in a single institution was performed. A microsurgical, single-layer, six-point, 8-0 nylon anastomosis was performed with macroscopic intra-operative assessment of vasal fluid. An ipsilateral vasoepididymostomy (VE) was only performed in cases of complete absence of vasal fluid or the presence of toothpaste-like discharge (bilateral VE were excluded from this series). Semen analysis was performed 3 months postoperatively to assess for the presence of motile sperm.ResultsA total of 237 men underwent microsurgical vasectomy reversal over a 12-year period. The median age of men at vasectomy was 34 years. The median age at vasectomy reversal was 42 years. The median obstructive interval was 7.3 years. An overall patency rate of 85.8% was achieved (motile sperm present), with 53.8% having a sperm count greater than 15 million/mL on initial 3-month assessment. For obstructive intervals of <3, 3-8, 9-14, and ≥15 years, there were declining patency rates of 96.3%, 90.5%, 80.0%, and 74.1%, respectively (P=0.04). These are the equivalent outcomes to published high-volume two-layer studies. We found no difference between patency rates of VV performed on the straight vas vs. the convoluted vas, and no difference when only one side could be re-anastomosed (20 patients).ConclusionsUsing a micro-surgical technique in high volume, similar outcomes can be achieved from a simplified single-layer VV technique with fewer sutures, as compared to the more complex two-layer techniques described. We postulate that this may be due to reduced ischaemia relating to fewer sutures and less tissue-handling. Given the associated time and cost savings, as well as the easier learning curve involved, we would advocate the use of this technique in routine VV practise.

Dataset Information

Case Series of Neurotrauma Managed by General Surgeon at Ladakh - The Highest Plateau State of India.

Supplementary information

Publications

Case Series of Neurotrauma Managed by General Surgeon at Ladakh - The Highest Plateau State of India.

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