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\"This book introduces the diverse practices of documentary films in India. It examines the oeuvres of three non-canonical practitioners: ethnographic filmmaker, David MacDougall; northeast India-based moving-image artists group, Desire Machine Collective; and avant-garde filmmaker and cinema philosopher, Kumar Shahani. Sharma offers in-depth analysis of these practitioners' distinct documentary methods and aesthetics, exploring how their oeuvres constitute a critical and self-reflexive approach to documentary-making in India. The book commences with an overview of the factors that have shaped the political contours of documentary-making in India, before introducing the select practitioners as a counter-point to the dominant and canonical tendencies of documentary films in India. Three sections of the book take up one filmmaker each, whose oeuvre is studied in-depth with a view to explore and articulate how the critical discourse and aesthetic strategies of their films evolve\"-- Provided by publisher.

The risk of premature ovarian failure (POF) increases in association with alteration in immunological parameters and oxidative stress (OS). Adequate intake of trace elements is required for antioxidant property and immune defense mechanism. The aim of this study was to explore the involvement of trace elements, OS, and immunological parameters in POF. This was a cross-sectional, case-control study, involving 65 participants divided into the POF (n = 35) and control (n = 30) groups. Serum levels of Se, Zn, and Cu were determined along with hormonal, OS, and immunological markers. POF group had significantly lower levels of Zn, Cu, Se, and Zn:Cu ratio. However, Se:Cu ratio was not significant between the groups. FSH and LH levels were negatively correlated with Zn and Cu levels and positively correlated with Se levels. Estrogen levels were negatively correlated with all the studied trace elements. Inter-element association between Zn and Se was significant in POF (r = − 0.39, p = 0.02) compared to control group (r = − 0.078, p = 0.65). In all the POF patients, SOD and GPx activities were significantly (p < 0.05) lower and MDA level was higher (p > 0.05) than control group. B cell marker CD19 was significantly (p < 0.0001) high in POF group. There are involvement of trace elements in hormonal regulation and antioxidant defense mechanism, which once gets altered leads to high ROS generation and affect functions of the immune system. Exaggereative immune system causing higher expression of B cell associated markers (CD19) leading to autoimmune condition in POF.

Background: Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss. Aims: The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation. Settings and Design: A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS. Patients and Methods: The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss. Results: The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10). Conclusion: Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.

Metastases to the testis are uncommon. Signet-ring cell carcinomas from the gastrointestinal tract (GIT) can rarely disseminate to the testicles, mimicking primary testicular malignancies with signet-ring cells. We hereby describe a case of a 26-year-old male who presented with left testicular swelling, multiple lymphadenopathies, and normal serum tumor markers. Lymph node biopsy revealed clusters and singly lying signet-ring cells. Judicious use of immunohistochemistry confirmed the tumor to be GIT primary. Further investigations confirmed a gastric tumor extending to the duodenum. Although rare, metastatic tumors to the testis should be considered in differential diagnoses of testicular masses in a young patient, particularly when serum germ cell tumor markers are normal or mildly deranged.

Background Medical abortion with mifepristone and misoprostol can be provided up to 63 days’ gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India. Methods We applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021. Results Medicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment. Conclusion Opportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed. Plain language summary Medical abortion is popular in India and benefits from a liberal legal context. It is important to understand the availability of quality abortion medicines in the country. Using the World Health Organization country assessment protocol and availability framework for medical abortion medicines we examined the availability of these medicines from supply to demand. We used this information to identify opportunities for increasing availability of quality-assured medical abortion medicines. We found that the context for medical abortion varies across states. Strengthening procurement and supply chain management, with a greater emphasis on quality-assurance and regulation of manufacturing should be instituted at the state-level. Training is also needed to increase provider knowledge of the latest national guidelines and laws to ensure respectful and person-centered services. Finally, the public should be informed about medical abortion as a safe and effective choice, especially for early abortions.

Background Addition of adjuvants to routinely used intrathecal drugs is cornerstone in safe and effective prolongation of single shot spinal block for gynecological surgery. In resource deficient countries, where epidural anesthesia is usually not used because of cost factor, adjuvants are routinely used to prolong the effect of regional anesthesia. Alpha 2 agonists are considered best drugs as adjuvants, but there is inconclusive data in literature about the block characteristic, dose at which to be used and side effect after use of these drugs. Methods Clonidine 30 µgm or dexmedetomidine 5 µgm was used intrathecally as an adjuvant with 15 mg bupivacaine 0.5% in 90 female patients undergoing gynecological surgery in this randomized, prospective, single blind study. Results The mean time to onset of sensory block a (T6 level) and time to attain maximum sensory height were significantly early in group D over group C (124.44 ± 20.64 s, 175.09 ± 68.01 s, p  < 0.0001) and (13.53 ± 2.97 min, 18.64 ± 4.82 min, p  < 0.0001)respectively. Time to two segment sensory regression, total duration of analgesia, duration of motor blockade was (115.24 ± 8.9 min, 370.60 ± 17.98 min, 316.67 ± 21.39 min) in group D and (103.58 ± 11.25 min, 323.91 ± 23 min, 273.51 ± 18.95 min) in group C respectively ( p  < 0.001). The post-operative visual analogue scale score (VAS) was more in group C at 240 min onwards ( p  ≤ 0.01). Analgesic use and intraoperative complications were similar in both the groups. ( p  > 0.05). Conclusions We recommend clonidine 30 µg over dexmedetomidine 5 µg as an adjuvant to intrathecal bupivacaine, to effectively and safely prolong the effect of single shot spinal anesthesia.

Objectives To study the perinatal survival and procedure-related (PR)complications after intrauterine transfusions in red cell alloimmunization. Methods Prospective data of 102 women with Rh-alloimmunized pregnancy undergoing intrauterine intravascular transfusion for fetal anemia, from January 2011 to October 2014 were analyzed. Main outcome measures were perinatal survival and procedure-related (PR) complications. Results A total of 303 intrauterine transfusions were performed in 102 women. Of 102 fetuses, 22 were hydropic at first transfusion. The mean period of gestation and hematocrit at first transfusion was 26.9 ± 3.3 weeks (range 19.7–33.8 weeks) and 17 ± 7.82 % (range 5.7–30 %), respectively. Average number of transfusions was 2.97 (range 1–7) per patient. Overall survival was 93 % and mean period of gestation at delivery was 34.5 ± 1.94 (range 28.3–37.4) weeks. Mean hematocrit at delivery was 36.9 ± 8.77 % (range 10–66 %). Fetal death occurred in four cases (3PR), neonatal death occurred in three cases (2PR). Emergency cesarean delivery after transfusion was performed in four pregnancies. The total PR complication rate was 2.97 %, resulting in overall PR loss in 1.65 % per procedure. Conclusion Our results compare favorably with other studies published in the literature. Intravascular transfusion is a safe procedure improving perinatal survival in fetuses with anemia due to Rh-alloimmunization.

BackgroundBirth companion is a key component for providing respectful maternity care and has been recommended by WHO and Government of India. It is a low-cost beneficial intervention that is vital in improving quality of care during labour and delivery.Local problemDespite the available evidence on benefits of birth companion, there was no policy on allowing birth companion at our hospital in the past.Methods and interventionsWe aimed to establish the practice of allowing birth companions in all eligible women in labour ward from existing 0% to 50% in 6 weeks’ duration. This study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi. A quality improvement (QI) team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward. Changed ideas were executed in multiple plan-do-study-act (PDSA) cycles. Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned .ResultsThe median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal and sustain it.ConclusionsSimple steps of QI methodology can be used to address the prevalent problems in our healthcare. Implementation of any new practice comes with major challenges, but we could achieve our goal because of a motivated team working together on multiple changed ideas applied sequentially in PDSA cycles.

Anaemia in pregnancy is a critical public health challenge associated with adverse maternal and neonatal outcomes. Despite national programmes and guidelines, India continues to face high anaemia prevalence during pregnancy, with 42.2% in Delhi (National Family Health Survey-5). Addressing gaps in systematic screening, timely diagnosis and effective management is essential to reduce anaemia at delivery and improve maternal health outcomes. At AIIMS, New Delhi, baseline data revealed a 35.57% prevalence of anaemia among booked pregnant women at delivery. Key issues included limited screening, inconsistent management and poor patient adherence to anaemia treatment protocols. This prospective quality improvement (QI) initiative employed the Plan–Do–Study–Act (PDSA) cycle methodology to address anaemia in pregnancy. Interventions focused on systematic screening of women at 30–34 weeks gestation using point-of-care haemoglobin testing (HemoCue), the establishment of a dedicated anaemia management room and the development of standardised operating procedures for diagnosis and management. Weekly team meetings facilitated the identification of challenges and iterative improvements. Sustainability measures, such as structured intern orientation, real-time monitoring through WhatsApp and enhanced team communication, addressed barriers like frequent staff rotations and workflow integration. Over four PDSA cycles, screening coverage reached 95%–100%, with a median anaemia prevalence of 20.04% at delivery, reduced from 35.57% at baseline. Sustained improvements were achieved, with a 3-month median prevalence of 15%. Challenges included integrating workflows and ensuring continuity with rotating staff, mitigated through structured protocols and team reorientation. This QI initiative demonstrates a successful model for reducing anaemia at delivery through systematic screening, effective management and multidisciplinary collaboration. The findings provide a replicable framework for addressing anaemia in resource-limited settings, aligning with national initiatives like the ‘T4 Anemia Room’ concept.

Background Surgical site infections (SSIs) are a substantial cause of maternal morbidity and are associated with a significant increase in hospital stay and cost. The prevention of SSI is complex and requires the integration of a range of measures before, during, and after surgery. Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University (AMU) is one of the referral centers of India with a huge influx of patients. Methods The project was undertaken by the Department of Obstetrics and Gynaecology, JNMC, AMU, Aligarh. Our department was sensitized to the need for quality improvement (QI) through Laqshya, a Government of India initiative for labor rooms in 2018. We were facing problems like a high surgical site infection rate, poor documentation and records, no standard protocols, overcrowding, and no admission discharge policy. There was a high rate of surgical site infections, leading to maternal morbidity, increased days of hospitalization, more usage of antibiotics, and increased financial burden. A multidisciplinary quality improvement (QI) team was formed comprising obstetricians and gynecologists, the hospital infection control team, the head of the neonatology unit, staff nurses, and multitasking staff (MTS) workers. Results The baseline data were collected for a period of one month and it was found that the rate of SSI was around 30%. Our aim was to decrease the rate of SSI from 30% to less than 5% over a period of six months. The QI team worked meticulously, implemented evidence-based measures, regularly analyzed the results, and devised measures to overcome the obstacles. The point-of-care improvement (POCQI) model was adopted for the project. The rate of SSI decreased significantly in our patients and the rates are around 5% persistently. Conclusion The project not only helped in decreasing the infection rates but also led to vast improvements in the department with the formulation of an antibiotic policy, surgical safety checklist, and admission-discharge policy.