Institutional Disrespect and Abuse during Health-Care Utilization in Public Health Facilities of Tamil Nadu: A Facility-Based Cross-Sectional Survey

Background: Disrespect and abuse have a negative impact on the quality of care provided in the public health facilities, thereby impacting the public health‑care utilization of the patients. Objectives: This study aims to capture the burden and determinants of disrespect and abuse faced by the patients who seek care from public health facilities in Tamil Nadu. Methods: This study was conducted among 4917 participants at outpatient and inpatient levels in 18 public health facilities across six districts in Tamil Nadu. Institutional disrespect and abuse were reported as proportion with 95% confidence interval (CI). Logistic regression model was done to assess the determinants of institutional disrespect and abuse. Results: Overall, the proportion of participants facing some form of institutional disrespect and abuse was 9.8% (95% CI: 9.0%–10.6%). Elderly patients (≥60 years) (adjusted odds ratio [aOR] = 2.71; 95% CI: 1.27–5.76), widowed/separated/divorced (aOR = 1.99; 95% CI: 1.11–3.57), patients with higher educational qualification (aOR = 1.82; 95% CI: 1.25–2.64), patients belonging to the richest quintile in terms of socioeconomic status(aOR = 4.96; 95% CI: 3.59–6.84), and patients having some form of chronic disease (aOR = 1.37; 95% CI: 1.07–1.75) had significantly higher odds of facing institutional disrespect and abuse. Conclusion: Almost one in ten patients visiting secondary and tertiary care public health facilities in Tamil Nadu had faced some form of disrespect during their hospital visit/stay. The findings from our study should be taken up and further qualitative exploration to identify the reasons for such disrespectful care and corrective solutions should be suggested.

The effects of aquatic and land exercise on resting blood pressure and post-exercise hypotension response in elderly hypertensives

Objective: This study compared resting blood pressure (BP) using ambulatory BP monitoring (ABPM) responses in two groups of subjects trained in land exercise (LE) and aquatic exercise (AE), and assessed post-exercise hypotension (PEH) using ABPM, after land- and aquatic-based exercises.Methods: ABPM (24 hours) was used to measure the baseline BP in elderly hypertensive women trained in LE and AE and the PEH induced by exercise. For this, 40 subjects were evaluated at rest and after a land- or aquatic-based exercise session (aerobic: 75% of reserve heart rate combined with resistance exercise).Results: The daytime BP was lower for AE [systolic BP (SBP) 124 ± 1.0 mmHg, diastolic BP (DBP) 70 ± 1.5 mmHg] than for LE (SBP 134 ± 0.9 mmHg, DBP 76 ± 0.9 mmHg), but there were no differences at night-time. The aquatic exercise-induced PEH in the second hour was maintained at the 24th hour post-exercise. For land exercise-induced PEH, it was maintained at the 12th hour post-exercise. The SBP and DBP were lower at the 24th hour for AE than for LE.Conclusion: Elderly hypertensive people trained in AE had lower baseline BP during the daytime. SBP and DBP values were lower for individuals trained in AE, and their PEH was more rapid and longer lasting after AE

Silage from heart-of-palm waste produced from Alexander palm tree / Ensilaje de residuos de palmito producidos a partir de Palma Real / Silagem de resíduos de palmito produzidos a partir da Palmeira Real

Abstract Background: Production of heart-of-palm from Alexander palm tree generates a waste that could be used as silage for feeding ruminants. Objective: To evaluate the chemical composition, fermentation parameters, and quality of silage made from waste of heart-of-palm production using Alexander palm. Methods: Three types of silage made from waste of heart-of-palm production were evaluated: 1) leaf silage, 2) sheath silage, and 3) compound (leaf + sheath) silage. The processed waste was packed in experimental silos and distributed in a completely randomized design with 10 replications. Means were compared pairwise using Tukey's test at the 5% significance level. Results: Leaf silage had the highest pH (p<0.05) and the lowest ammonia nitrogen (p<0.05) in relation to the other silages. No difference was observed (p>0.05) for lactic and butyric acids, whereas acetic acid was higher (p<0.05) in the sheath and compound silages. Dry matter and crude protein contents were the highest (p<0.05) in leaf silage. Neutral detergent fiber was higher (p<0.05) in sheath silage, followed by leaf and compound silages, respectively. The highest lignin content (p<0.05) was observed in sheath silage. Conclusions: Based on the fermentative parameters, waste from heart-of-palm from Alexander palm tree has potential for silage production. However, differences in silage composition at the time of feeding ruminants should be considered.

Resumen Antecedentes: Los residuos de la producción de palmito de Palma Real podrian utilizarse como ensilaje para alimentación de rumiantes. Objetivo: Determinar la composición, parámetros químicos de fermentación, y calidad del ensilaje elaborado a partir de residuos procedentes de la producción de palmito de Palma Real. Métodos: Tres tipos de ensilaje hechos con los residuos generados a partir de la producción de palmito fueron evaluados: 1) ensilaje de hojas, 2) ensilaje de vainas, y 3) ensilaje compuesto (hojas + vainas). Los residuos tratados fueron empacados en silos experimentales y distribuidos en un diseño completamente al azar con 10 repeticiones. Las medias fueron comparadas mediante la prueba de Tukey, con un nivel de significancia del 5%. Resultados: El ensilaje de hojas mostró el pH más alto (p<0,05) y el nivel más bajo de nitrógeno amoniacal (p<0,05) en comparación con los otros ensilajes. No se observaron diferencias (p>0,05) en los ácidos láctico y butírico, mientras que el ácido acético fue mayor en el ensilaje de vainas y en el compuesto en relación con el otro ensilaje. La materia seca (MS) y el contenido de proteína cruda (PC) fueron mayores (p<0,05) en el ensilaje de hojas. Los contenidos de fibra detergente neutra fueron mayores (p<0,05) en los ensilajes de vainas, seguido por los ensilajes de hojas y compuesto, respectivamente. El contenido de lignina fue más alto (p<0,05) en el ensilaje de vainas. Conclusiones: Según los parámetros fermentativos, los residuos de la producción de palmito de Palma Real tienen potencial para la producción de ensilaje. Sin embargo, se deben considerar las diferencias en la composición de los ensilajes al momento de alimentar rumiantes.

Resumo Antecedentes: Resíduos da produção de palmito da palmeira Real são um problema para a agroindústria devido sua falta de utilização e o seu uso na forma de silagem pode ser uma alternativa na alimentação de ruminantes. Objetivo: Avaliar a composição química e os parâmetros fermentativos, e verificar a qualidade da silagem produzida a partir do resíduo da produção de palmito da Palmeira Real Australiana. Métodos: Foram avaliadas três tipos de silagem de resíduo da produção de palmito da Palmeira Real: silagem de folha, silagem de bainha e silagem da composta (folha + bainha). O resíduo processado foi acondicionado em silos experimentais e distribuídos em um delineamento inteiramente casualizado com 10 repetições e as médias comparadas pelo teste de Tukey a 5% de significância. Resultados: A silagem de folha apresentou maior pH (p<0,05) em relação as demais silagens, enquanto para o nitrogênio amoniacal (p<0,05), apresentou menor teor em relação as demais silagens. Não observou-se diferença (p>0,05) para os ácidos lático e butírico, enquanto o ácido acético foi maior para as silagens de bainha e composta em relação as demais silagens. O teor de matéria seca (MS), proteína bruta (PB) foi maior (p<0,05) na silagem de folha em relação as demais silagens. A fibra em detergente neutro analisada estimada apresentou maiores valores (p<0,05) para a silagem de bainha, seguida pela silagem de folhas e silagem composta, respectivamente. O teor de lignina foi maior (p<0,05) para a silagem de bainha. Conclusões: De acordo com os parâmetros fermentativos, os resíduos da produção de palmito da Palmeira Real apresentam potencial para a produção de silagem. No entanto, as diferenças na composição das silagens devem ser consideradas quando oferecidas para animais ruminantes.

Chest Radiograhic Patterns of Smear Positive Tuberculosis in Relation to HIV: A Cross-Sectional Study in a Population with a High Burden of HIV and Tuberculosis.

Aim: The purpose of this study was to investigate the chest radiographic patterns of smear positive pulmonary tuberculosis patients in relation to HIV co-infection. Study Deign: Cross-sectional descriptive study Place and Duration of the Study: The study was conducted at Gondar University hospital between May 2004–December 2007. Methodology: We studied chest radiographs of 207 (128 HIV negative and 79 HIV positive) consecutive sputum smear positive pulmonary tuberculosis patients according to the standard classification. Mean and percentages/ proportions were used for descriptive analysis. Chi square test was used to measure association. Results: The prevalence of HIV in patients with smear positive pulmonary tuberculosis was 38.2%. The most common chest radiographic patterns were fibronodular (83.1%), cavity (60.4%), lobar consolidation (49.8%), and brochopnemonic consolidation (9.2%). Lymphadenopthy and pleural effusion were more common in HIV co infected patients (p<0.01). Cavities, upper lobe disease and increased mean number of lung lobes involved were more prominent in HIV negative patients (P<0.05). Despite a higher rate of patients with far advanced CXR patterns in HIV negative TBC patients compared to HIV positive (p<0.026), there was no significant difference in the radiographic, sputum smear conversion or clinical response in terms of increased body mass index after 8 weeks of anti TBC treatment between HIV negative and HIV positive patients. Conclusion: Post primary pulmonary tuberculosis was the commonest chest radiographic pattern at presentation in both HIV positive and HIV negative patients, but atypical chest radiographic presentations were associated with co-infection. It was more common for HIV negative tuberculosis patients to have a radiologically far advanced pattern which did not correspond to the clinical and radiological response. This may prompt a need for revision of the current radiological classification.

Pathophysiology of bacterial infection of the central nervous system and its putative role in the pathogenesis of behavioral changes

Invasion of the central nervous system (CNS) by microorganisms is a severe and frequently fatal event during the course of many infectious diseases. It may lead to deafness, blindness, cerebral palsy, hydrocephalus, cognitive impairment or permanent neurological dysfunction in survivors. Pathogens can cross the blood-brain barrier by transcellular migration, paracellular migration and in infected macrophages. Pathogens may breach the blood-brain barrier and be recognized by antigen-presenting cells through the binding of Toll-like receptors. This induces the activation of nuclear factor kappa B or mitogen-activated protein kinase pathways and subsequently induces leukocyte infiltration and proliferation and the expression of numerous proteins involved in inflammation and the immune response. Many brain cells can produce cytokines, chemokines and other pro-inflammatory molecules in response to bacteria stimuli; as a consequence, polymorphonuclear cells are attracted and activated, and release large amounts of superoxide anion and nitric oxide, leading to peroxynitrite formation and oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage and blood-brain barrier breakdown, contributing to cellular injury during neuronal infection. Current evidence suggests that bacterial CNS infections can play a role in the etiopathogenesis of behavioral disorders by increasing pro-inflammatory cytokines and bacterial virulence factors. The aim of this review is to summarize the current knowledge of the relevant pathophysiologic steps in CNS infections.

Standardisation of a two-site PTH immunoradiometric assay using various solid phase formats.

Background & objectives: Estimation of parathyroid hormone (PTH) levels is important in the management of metabolic bone disorders. Here we describe a simple, sensitive and specific second generation immunoradiometric assay (IRMA) to detect intact PTH levels using different solid phase matrices. Different methods for immobilization of antibodies have also been evaluated. Methods: Experiments were carried out with physical adsorption of antibodies, covalent coupling using 2 per cent glutaraldehyde and N,N`carbonyldiimidazole. In all cases, antibodies raised against C-terminal were used as solid phase agent. Detector antibodies were N terminal antibodies that were radio-iodinated with 125I followed by gel purification. Several of the antibodies coupled to various solid phase matrices were incubated with PTH standards and the detector antibody as well as the commercially available tracer from DiaSorin kit to identify a suitable match pair. Results: The best pair was polyclonal C-terminal PTH antibody along with the kit tracer from DiaSorin with regards to antibody coated to magnetic cellulose particles. Among the various antibodies and the solid phases evaluated, the best assay was obtained with the matched pair of antibodies (70×G67 and 70×G68) from Fitzgerald immobilized on polystyrene tubes. The polyclonal antibody against C-terminal PTH was chosen as the capture antibody and 125I labelled polyclonal antibody against N-terminal PTH as the tracer. The sample values obtained in the antibody coated tubes were comparable to those obtained using a commercial kit. Interpretation & conclusions: The results indicated the feasibility of adopting this system for further development into a PTH IRMA for regular production as there is no indigenous kit available for intact PTH.

Anti-inflammatory and analgesic activities of Melanthera scandens

<p><b>OBJECTIVE</b>To evaluate the anti-inflammatory and analgesic activities of leaf extract of Melanthera scandens (M. scandens).</p><p><b>METHODS</b>The crude leaf extract (39-111 mg/kg) of M. scandens was investigated for anti-inflammatory and analgesic activities using various experimental models. The anti-inflammatory activity was investigated using carragenin, egg-albumin induced oedema models, while acetic acid, formalin-induced paw licking and thermal-induced pain models were used to evaluate the antinociceptive property.</p><p><b>RESULTS</b>The extract caused a significant (P<0.05 - 0.001) dose-dependent reduction of inflammation and pains induced by different agents used.</p><p><b>CONCLUSIONS</b>The leaf extract possesses anti-inflammatory and analgesic effects which may be mediated through the phytochemical constituents of the plant.</p>

Immunodiagnosis of tuberculosis: state of the art

Undiagnosed and mismanaged tuberculosis [TB] continues to fuel the global TB epidemic. Rapid, accurate and early diagnosis of TB is therefore a priority to improve TB case detection and interrupt transmission. Although considerable improvements have been made in TB diagnostics, there are two major gaps in the existing diagnostics pipeline: [1] lack of a simple accurate point-of-care test that can be used for rapid diagnosis at the primary care level; [2] lack of a biomarker [or combination of biomarkers] that can be used to identify latently infected individuals who will benefit most from preventive therapy. Currently available commercial serological [antibody detection] tests are inaccurate and do not improve patient outcomes. Despite this evidence, dozens of serological tests are sold and used in countries [e.g. India] with weak regulatory systems, especially in the private sector. Recognizing the threat posed by these suboptimal tests, a World Health Organization [WHO] Expert Group has strongly recommended against the use of serological tests for the diagnosis of pulmonary and extra-pulmonary TB. Another WHO Expert Group has discouraged the use of interferon-gamma release assays for active pulmonary TB diagnosis in low-and middle-income countries. All existing tests for latent TB infection appear to have only modest predictive value and further research is needed to identify highly predictive biomarkers

Estudo da atividade mutagênica das plantas, Euphorbia milii Des Moulins e Ricinus communis L através do teste de Allium cepa / Mutagenic activity study of the plants Euphorbia milii and Ricinus communis L. through the Allium cepa test

O objetivo deste trabalho foi avaliar a mutagenicidade e o grau de toxicidade de duas plantas tóxicas, a "mamona" (Ricinus communis) e a "coroa-de-cristo" (Euphorbia milii), utilizando infusões das sementes de mamona e o látex da coroa-de-cristo, em células meristemáticas de Allium cepa. Foram analisados: o índice mitótico (IM), as anomalias do ciclo mitótico (ACM), anomalias interfásicas, (AI) e o total de anomalias (TA). As soluções testes foram preparadas em três concentrações: MT1 - 0,5 g/l, MT2 - 1,0 g/l, MT3 - 2,0 g/l, e MT4 como controle. Da coroa-de-cristo extraiu-se o látex e dissolveu-se em água destilada nas concentrações CT1 -0,5 ml/l, CT2 - 1,0 ml/l, CT3 - 2,0 ml/l, e CT4 controle. Os resultados constataram que somente a mamona aumentou a freqüência de anomalias do ciclo mitótico, assim como, as anomalias interfásicas, demonstrando, dessa forma, uma ação tóxica para o material genético, através do teste de Allium cepa.

The aim of this work was to evaluate the mutagenicity and the degree of toxicity of two toxic plants, "castor bean" (Ricinus communis) and the "crown-of-thorns" (Euphorbia milii), using infusions of the seeds of Ricinus communis and the latex of the Euphorbia milii, in meristematic cells of Allium cepa, which were analyzed: the mitotic index (IM), the interphasics anomalies (AI), the mitotic cycle anomalies (ACM), and the total of anomalies (TA). The solutions tests were prepared in three concentrations: MT1 - 0.5 g/l, MT2 - 1.0 g/l, MT3 -2.0 g/l, and MT4 as control. From the Euphorbia milii the latex was extracted and was diluted in distilled water in concentrations: CT1 - 0.5 ml/l, CT2 - 1.0 ml/l, CT3 - 2.0 ml/l, and CT4 as control. The results evidenced that Ricinus communis increased the frequency of mitotic cycle anomalies, as well, the interphasics anomalies, demonstrating, a toxic action for the genetic material, through the test of Allium cepa.