Vr Vijay

Child mortality continues to pose a major public health challenge in South Asia, where under-five and neonatal mortality remain high, especially in Afghanistan, Pakistan, and parts of India. Here, we synthesised evidence from 38 studies published between 2012 and 2024, examining predictors of mortality, barriers to effective nursing and midwifery interventions, and strategies to strengthen these roles. We identified four barrier domains: inadequate education and professional development, socio-cultural and gender constraints, infrastructure and resource shortages, and systemic policy challenges. Across several countries, over half of midwives lacked adequate pre-service training, more than 60% of facilities reported critical equipment shortages, and restrictive policies limited midwives' autonomy. Despite these challenges, community-based interventions and targeted policy reforms demonstrated measurable improvements, including up to 49% increases in institutional deliveries and reductions in neonatal mortality by 2-3 per 1000 live births. Strengthening midwifery and nursing capacity through competency-based education, investment in rural health systems, and culturally sensitive community engagement - guided by World Health Organization and International Confederation of Midwives frameworks - represents a feasible pathway for reducing preventable child deaths and advancing progress toward Sustainable Development Goal 3 in South Asia.

Mental disorders are a major contributor to the global burden of non-fatal diseases, with anxiety and depression being the most frequently reported [1]. While some mental disorders may be resolved without treatment, others require extensive management. Anxiety involves feelings of worry and fear related to specific situations, and a certain amount of anxiety can motivate […]

Introduction: Vaccination pain is the most common distress for young children and their parents. Non-pharmacological interventions significant impact on vaccination pain in infants. This systematic review and meta-analysis aimed to appraises the evidence concerning the non-pharmacological interventions on vaccine related pain in infants. Methods: This study was followed Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement and recommendation of Cochrane guidelines. Electronic databases, including PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE, Web of Science, and Clinical Key, were searched for original trails. Pooled data were analyzed using a random‐effects model with 95% confidence intervals (CIs). The subgroup analysis including breastfeeding, sucrose, kangaroo mother care, massage, heat-cold applications, and pain scales were presented in forest plots using RevMan software 5 version 4.1. Results: A total of 1,739 infants were included from 19 trials. Of these, 1,055 infants received interventions, while 684 infants given usual care. Eight trails used breastfeeding as an intervention, standard mean difference (SMD): -3.28. 95% (CI): -4.16 to -2.4, P=0.0, I²=95%. Similarly, six trials employed sucrose [SMD -2.22, CI: -3.68 to -0.75, P=0.0, I²=97%]. Three studies utilized kangaroo mother care (KMC), SMD: -1.1 CI: -2.18 to -0.02, P=0.0, I²=89%) and hot and cold applications [SMD: -1.14, CI: -2.86 to 0.58, P=0.0, I²=95%]. Conclusion: Noninvasive therapies such as breastfeeding, massage, sucrose, KMC, and hot and cold applications were effective interventions in reducing vaccination pain in infants. Studies have proved that nonpharmacological interventions were ideal and acted as analgesics among children with fewer side effects.

Acute limb ischemia is a serious vascular emergency that can result in severe impairment, limb loss, and significant fatality rates. Patient was admitted with impending gangrene and dusky discolouration with loss of pain sensation & movement below the knee. Satisfactory improvement in postoperative follow‐up. A 46‐year‐old female was admitted with complaints of impending gangrene. After that, leg discolouration appeared with a rapid course of the disease in the last 10–14 days. It is a case of acute limb ischemia with a non‐palpable common femoral artery. Hence, ipsilateral thromboembolectomy was planned as an emergency on the right side of the leg as a measure of revascularisation. The right common femoral artery was opened, and thrombus was extracted out. After that flow is established, distal vessels become palpable. The patient was put on low molecular weight heparin (subcutaneously), and 60 mg was given to prevent any clot formation & thromboembolism as well. If there is any short history of critical ischemia & gangrene, it is not settled enough. We should go for thromboembolectomy at the earliest for re‐establishment of the vasculature of the area together with higher injectable antibiotics & other supportive measures to prevent anticipated re‐perfusion injury to multiple organs. Almost lost right leg is saved.

Objectives: The objective of this review was to analyze quantitative data on autism spectrum disorder (ASD) and to increase the accuracy of estimates of the prevalence of ASD.Methods: This review, which was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, included studies conducted from January 2008 to June 2024 on children aged 3 to 18 years that used standardized measurement tools and reported cut-off scores for ASD. The prevalence of ASD was the primary outcome analyzed in this review. The PubMed, Clinical Key, Scopus, Embase, CINAHL, and Web of Science databases were reviewed for relevant studies. The review protocol was registered with PROSPERO and followed the Cochrane collaboration guidelines.Results: A total of 66 studies reported on the prevalence of ASD, screening 21,313,061 children worldwide. Among these, 25 studies were conducted in Europe, 22 in Asia, and 13 in America. Additionally, 3 studies each were reported from Africa and Australia. According to a meta-analysis, 0.77% of children globally are diagnosed with ASD, with boys comprising 1.14% of this group. Notably, Australia showed the highest prevalence rate, with an effect size of 2.18, highlighting it as a critical area for public health focus.Conclusion: ASD represents a significant global health burden. Early detection, increased awareness among parents, and prompt intervention are crucial for mitigating developmental problems in children later in life. It is essential for health policymakers to acknowledge the prevalence and growing trends of ASD in order to implement effective interventions.

Introduction: Snakebite envenomation is a significant life-threatening public health problem in Southeast Asia (SEA). In this region, India reported the largest number of snakebite deaths from 2000 to 2019 (1.2 million), with an average of 58,000 deaths yearly. Methods: This prospective observational study was carried out among snakebite victims at the emergency department (ED) of a tertiary care public sector hospital in eastern India. Results: A total of 145 cases of venomous snakebite were investigated. More than half ( n = 81, 56%) of the snakebite victims were between 17 to 45 years. Most of the snakebite victims were male (68%) and were farmers (53%) by occupation. The majority of snakebites occurred during the daytime (76%) and while outdoors (67%). Most victims sustained a bite on the lower extremity (71%). The peak incidence of snakebites occurred from June to September (69%). Three-quarters of all patients were unaware of the required first aid measures following a snakebite. Among the 145 venomous snakebites, 48 were presumptively identified as the Indian cobra, 32 by the Indian krait, 56 by the Russel's viper, and 9 by saw-scaled viper. The mean duration from the snakebite to the onset of systemic effects in the Indian cobra was 52 ± 14.28 min, 66 ± 18.35 min in the Indian krait, 42 ± 13.47 min in Russel's viper, and 48 ± 16.38 min in saw-scaled viper. Respiratory failure was the commonly observed complication following an elapid envenomation. The mortality rate was 2.1% among the patients treated with antivenom. Conclusions: Snakebite is considered an occupational hazard in India, commonly affecting the young population in their productive period. The peak incidence was during monsoon season, and the majority had neurotoxic envenomation following an elapid bite (55%) that contributed to the increased mortality and morbidity among young adults. Of the 145 patients, the majority (84%) recovered fully with treatment; 16% of the victims developed morbidity viz cellulitis, respiratory failure, acute renal failure, compartment syndrome, local tissue necrosis, intracerebral hemorrhage, and disseminated intravascular coagulation. Appropriate first aid measures and timely medical intervention can significantly improve the treatment outcome following snakebites.

Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.

Background The internet is an integral part of everyone’s life. College going adolescents are highly vulnerable to the misuse of the internet. Aims To estimate the pooled prevalence of internet addiction (IA) among college students in India. Methods Literature databases (PubMed, Web of Science, Scopus, EMBASE, PsycINFO and Google Scholar) were searched for studies assessing IA using the Young Internet Addiction Test (Y-IAT) among adolescents from India, published in the English language up to December 2020. We included studies from 2010 to 2020 as this is the marked era of momentum in wireless internet connectivity in India. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated using the fixed-effects model. Publication bias was evaluated using Egger’s test and visual inspection of the symmetry in funnel plots. Results Fifty studies conducted in 19 states of India estimated the prevalence of IA and the overall prevalence of IA as 19.9% (95% CI: 19.3% to 20.5%) and 40.7% (95% CI: 38.7% to 42.8%) based on the Y-IAT cut-off scores of 50 and 40, respectively. The estimated prevalence of severe IA was significantly higher in the Y-IAT cut-off points of 70 than 80 (12.7% (95% CI: 11.2% to 14.3%) vs 4.6% (95% CI: 4.1% to 5.2%)). The sampling method and quality of included studies had a significant effect on the estimation of prevalence in which studies using non-probability sampling and low risk of bias (total quality score ≥7) reported lower prevalence. The overall quality of evidence was rated as ‘moderate’ based on the Grading of Recommendations Assessment, Development and Evaluation criteria. Conclusions Our nationally representative data suggest that about 20% to 40% of college students in India are at risk for IA. There is a need for further research in the reconsideration of Y-IAT cut-off points among Indian college students. PROSPERO registration number CRD42020219511.