An overview of health care delivery in India is essential, if we are to plan and to improve health care delivery and the indices of health in the coming decades. The health sector in India is a mix of private and government services. While some health care indices appear dismal, several others, including life expectancy are heartening. A balance between regulation and free enterprise is possibly the best option. In this paper we provide a glimpse of health and health related statistics & a n overview of the public health care delivery systems. In the end, we offer suggestion on rationalisation of health care delivery to provide maximum services for the majority of our population within the budget of an optimal health care system outlay

The pattern of lung injuries has gradually changed globally in last two decades from penetrating chest injuries to blast lung injury. This has mainly occurred due to trauma setting in the global war on terror and accidental explosions in confined space in military service conditions. Blast Lung Injury (BLI) presents unique triage, diagnostic and management challenges. A high index of suspicion and timely intervention in these cases is the key to improved outcomes.

Highly Active Anti - Retroviral Therapy (HAART) is a triple combination of ART drugs and is a n effective tool to control disease progression in HIV disease. HAART is not started in all patients of HIV and indication to start HAART depends on clinical symptoms, CD4 cell count, HIV viral load. Advantages of HAART includes suppression of viremia and virus shedding in semen and vaginal secretions , increased CD4 + T cell count, reduced immune activation, restoration of lymph node architecture, clinical improvement, prolonged survival, fewer opportunistic infections and HIV - associated malignancies. Problem with therapy are pill burden, non-availability of drugs, food and storage restrictions, drug-drug interactions, severe side-effects, reduction in quality of life measures, emergence of multiple drug resistance mutations.

Indian Navy is expanding its fleet for its geo-political and economical expansion in South Asia. In the recent past, quite a few ships have been built indigenously. We have come a long way in designing world class ships in India and still a lot has too be done for an ideal sickbay on board. A case study was performed onboard modern frigade class of ships from Aug 2009 to Mar 2010 and certain recommended changes were incorporated. The authors aims to highlight the essentials of a modern sickbay onboard Indian Naval Ships with the normal day to day working as well as a change over to a hospital ship in case of operational requirement.

Objective: To evaluate the antibiotic resistance patterns of Pseudomonas aeruginosa isolated from various clinical samples in a tertiary care hospital. Materials and Methods: Between Mar 2013 to Feb 2014, 386 strains of P. aeruginosa were isolated from different clinical specimens and fully characterized by standard bacteriological procedures. Antimicrobial susceptibility patterns of each isolate were carried out by Kirby- Bauer disk diffusion method and results were interpreted according to Clinical Laboratory Standard Institute guidelines. Results: The isolation rate of P. aeruginosa in this study was 11.5%. Pus,urine and tracheal aspirates were important sources of P. aeruginosa. The highest resistance was reported to Ciprofloxacin while the lowest resistance to Imipenem. 17% of P. aeruginosa isolates were foundto bem ulti - drug resistant (MDR). Conclusion: The clinical significance of thesefindings emphasizes the importance ofjudicious and rational treatment prescription to limit the spread of antimicrobial resistance among P. aeruginosa strains. There is a need for periodical antimicrobial surveillance to monitor the resistance patterns in hospitals and prevent further spread of MDR strains.

Background: The treatment of carcinoma breast requires a multidisciplinary approach with the integration of surgery, chemotherapy and radiation therapy. The advent of screening and increased awareness among the public has led to a increased number of cancers being detected at e arlier stages. Materials and Methodology: We reviewed the case sheets of 51 patients with cancer breast who underwent treatment for their cancers at our centre between 2008 and 2011 . Descriptive statistics are reported using mean (95%CI) or frequency (percentage), as appropriate. Results: Total Number of evaluable patients was 51 . Their average age was 49.37 (95% CI- 46.42–52.32 yrs) with 35.29% being premenopausal. 1.96% of the patients was DCIS (Stage 0), 3.92% had stage I carcinom a breast, 3 5 .29% stage II and 58.82% patients had stage III carcinoma breast. Of these 51 patients 21.57% patients were treated with breast conserving surgery and the rest underwent modified radical mastectomy. All patients except with DCIS underwent chemotherapy-06 cycles. However all the patients had radiotherapy. There were 56.86% left sided breast cancers as opposed to 43.14% right sided cancers. All patients of stage0 and stage 1 underwent breast conservation surgery (n=1+2) , however only 47.06% (08) patients of stage II and 3.22%(01 patient) of stage III underwent breast conservation. All patients with breast conservative surgeries received an electron boost to the scar. All patients with stage III and 58.82% with stage II breast cancers underwent nodal irradiation. Only TO, T1, T2 lesions with N0 nodal status were considered eligible for elimination of nodal radiation (19.61%). Conclusion: Carcinoma breast is a disease which affects both men and women. Age groups from 20 to 70 may be affected .The treatment involves surgery, chemotherapy and radiotherapy. Early detection and management is the cornerstone of treatment. However mastectomy remains the surgical option of choice due to the advanced stage of cancers seen in India.

Objective: To assess the efficacy of reconstruction of a cranial defects with the craniectomy bone graft (bone flap) banked in a subcutaneous pocket of the abdominal wall after emergency decompressive craniotomy. Materials and methods: A retrospective study was performed on five patients who underwent emergency decompressive craniectomy and bone graft placement in the abdominal wall followed by cranioplasty for reconstruction of the cranial defect using the autologous calvarial graft banked in the abdominal wall. Clinical outcome after reconstruction was determined post operatively by the adequacy of the recovered craniectomy graft to achieve satisfactory contour and cosmesis, post op infection, requirement for surgical re-intervention and take up of the graft on one year clinic-radiographic follow up. Results: All five patients had an uneventful recovery with no post operative complications or surgical site infection. Excellent cosmetic results in terms of restoration of cranial contour and symmetry was achieved in all five cases. Clinic-radiographic follow up for one year revealed successful take up of the autologous grafts in all five cases. Conclusion: Subcutaneous storage preserves viability of autogenous calvarial bone grafts. Cranioplasty performed with a subcutaneously preserved craniectomy graft has advantage of no donor site mobidity, excellent cosmesis, and satisfactory take up.

Background: Nursing staff requirements for Neonatal Intensive Care Unit (NICU) are often determined by number of admitted patients even though activity analysis provides a more objective estimation. This study estimates nursing staff requirements by activity analysis in an Armed Forces facility. Materials & Methodology: A prospective observational study between 2 7 January 2014 and 26 February 2014 (31 days) in the NICU of tertiary care teaching hospital of Armed Forces where timing of all nursing activities performed during study period by NICU staff was recorded to the nearest minute by self-reporting. Nursing activities were classified as Direct (40 activities) and Indirect (23 activities) α-priori. Data was entered on an electronic spreadsheet (Microsoft Excel) and relevant analysis performed. Results: During study period, there were 32 neonates (total 238 patient-days) in NICU and 18 (57patient-days) in step-down nursery. There was no patient on invasive ventilation nor was any surgical neonate admitted during this period. Direct Nursing Care activities totaled 59499 minutes (80.4.0) and Indirect ones 14490 minutes (19.6%). All nursing activities took 44 hours per day when 24 nurse-hours per day was the available time. This worked out to a practical requirement of three nurses in each shift for such activity load. Conclusions: Based on activity analysis, this study identifies the need for three nurses in each shift for a NICU providing Level II neonatal care with an average of 8 neonates in the NICU and 2 in the step-down nursery and agrees with other such studies available in literature.

Background: A low back ache (LBA) is a common cause of outpatient referral which might lead to loss of man hours in service hospitals. In this survey we attempt to determine the proportion of all new referrals of LBA back pain across different specialities and possibly delineate patterns of their management at a tertiary care Naval Hospital. Materials & Methods: This was a retrospective cross-sectional study which was conducted from 30 Jun to 15 July 14 at INHS Asvini in 11,673 patients who had visited various Departments including Rheumatology/Orthopaedic/Neurosurgery OPD over preceding 06 months ie. from 01 Jan 14 to 30 Jun 14. Results: Participants were men and women aged 20–70 years with a history of LBA pain for at least 3 months and a visual analogue scale (VAS) score of at least 30 in the previous week. The overall prevalence of LBA was 46.77% in patient population reporting to above named Departments. Conclusion: The proportion of patients with low backache who needed tertiary care treatment including biological or Spinal surgery was approx.0.38% and 1.28% respectively.