Background The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. MethodsIn this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31-62), of whom 19 937 (63•8%) were men, and 14 524 (46•5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71•9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27•5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88•7%] of 195 patients with open fractures; 426 [44•7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47•7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50•5%]), while Second Delays ...

Rapid urbanization and deforestation have led to increased areas of wasteland in the northern region of the Akola district of Maharashtra, India. This study investigates land use variations in the arid region with the help of multi-temporal images. Land use maps were employed for analysis of different classes using image classification tools in ArcGIS software. Multispectral satellite imagery data were used to create land cover variation maps and land use forecast maps for the study area. The land use classification change maps were produced from LISS-III satellite images and Landsat Enhanced Thematic Mapper Plus (2008 and 2015) using supervised classification techniques. Land use was divided into five major classes, i.e. agricultural land, developed land, wasteland, water bodies, and forestland. We observed significant changes in agricultural and forestland as a result of many factors including population growth, drought conditions, road infrastructure development, flooding, and soil erosion in the arid area. The overall accuracy of the supervised classification was 94.10% for 2008 and 88.14% for 2015, using the kappa method, which was a satisfactory result. The analysis of land use maps in the arid region revealed different patterns of use between 2008 and 2015. The results of this study may be useful for developing and implementing valuable management strategies for resource protection in the study area. These results show the potential for land use planning and development in arid regions using remote sensing and GIS technology.

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In India, the national nutritional anaemia control programme (NNACP) was started in 1970 and is being implemented through primary health centers and sub centers. It recommended pregnant women to take one iron tablet per day for at least 100 days (each tablet containing 100 mg of natural iron and 500 mcg of folic acid) after first trimester of pregnancy; a similar dose applies to lactating women. Study Design: Randomized clinical trial. 160 pregnant ladies going to antenatal clinic at 14-36 weeks of gestation with Hb 7- 9.9g%. Who met the inclusion criteria were arbitrarily distributed into two groups. One with odd registration number was given iron sucrose and one with even was given FCM. Hematological profile includes Haemoglobin, Reticulocyte count, Blood indices (MCH, MCHC, MCV) Fringe smear, Serum iron and Serum TIBC. 52% cases from FCM group observed in the age gathering of 21-24 years and 39% cases from Iron Sucrose group were observed in the age gathering of 25-28 years. 54% cases from FCM and 46% cases from Iron sucrose were observed in the gestational Age of 29 to 36 weeks. 43% cases from FCM and 46% cases from Iron sucrose were primigravida. Patients from FCM group and 4 patients from Iron sucrose group did not follow up. 2 pts. From FCM group and 1 pt. from Iron sucrose group refused treatment. The rise in mean Hb level after 1 week and 4 weeks of treatment with FCM is more than Iron sucrose. The rise in mean Sr. Iron level after 1 week and after 4 weeks of treatment with FCM is more than Iron sucrose. The reduction in mean Sr. TIBC level after 4 weeks of treatment with Iron sucrose is more than FCM. The rise in mean MCH, MCHC and MCV levels after 1 week and 4 weeks of treatment with FCM is more than Iron sucrose. There was no serious adverse effect noted in both groups.

Chorioangioma is a benign angioma of placenta arising from chorionic tissue. large chorioangioma has unfavorable effects on both mother and fetus. We had a rare case of large chorioangioma with uneventful pregnancy and labour and no adverse effects on both mother and fetus. KEYWORDS: placenta, chorioangioma CASE: A 23 yrs patient got admitted in KIMS on 10/10/2010 with H/O 8 months of amenorrhea and C/O pain in abdomen since morning. She was primigravida with gestational age of 34.2 weeks. She had no major medical illness or surgery in past. On general examination vitals were stable. On her abdomen examination, uterus was 34 weeks size with cephalic presentation and FHS-140/ min. Per vaginally-Cx 2 c.m. dilated, 25 % effaced, bag of membranes present. So, diagnosis was made-G1 with 34.2 weeks pregnancy with early preterm labour. Patient had spontaneous, vaginal delivery at 5.30 am on 11/10/2010 with no intrapartum or postpartum complications. Female baby-wt. 1.921 kg, 2 loops of cord around neck, no anomalies, and maturity-34 weeks. Baby shifted to NICU for detailed evaluation. By god grace, baby was fine & had no congenital abnormality. Placenta with two large masses sent for histopathological examination.