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Conventionally, GDP or GNP is considered as a measure of well-being of a country. In spite of their simplicity and objectivity, voices are raised against these income-based measures on the ground that human well-being is primarily subjective in nature. According to human development approach, the perception of well-being covers different dimensions of well-being, viz., quality of education, healthcare quality, the standard of living and labor market, personal safety, overall satisfaction with freedom of choice and life and perceptions about community and government. This paper presents a brief overview of the concept of well-being in the context of human development approach and analyses the role of well-being indicators in determining the perception of overall human well-being for different countries, regions and at the global level on the basis of HDR 2016 published by UNDP.
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India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen.
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India is a heliophobic country; despite ample sunshine, almost 490 million people are vitamin D deficient in the country. Additionally, the Indian diet has not been successful in providing the daily need for vitamin D, leading to a vitamin D deficiency. The need to fortifying food with vitamin D has been raised several times. Besides, there have been discussions about whether vitamin D is a hormone or a vitamin? In this review, the authors have reviewed vitamin D deficiency and its status in India, assessment and screening, the role of vitamin D in various disease conditions, dosage recommendation and regimen.
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The options for prenatal genetic testing have evolved rapidly in the past decade, and advances in sequencing technology now allow genetic diagnoses to be made down to the single-base-pair level, even before the birth of the child. This offers women the opportunity to obtain information regarding the foetus, thereby empowering them to make informed decisions about their pregnancy. As genetic testing becomes increasingly available to women, clinician knowledge and awareness of the options available to women is of great importance. Additionally, comprehensive pretest and posttest genetic counselling about the advantages, pitfalls and limitations of genetic testing should be provided to all women. This review article aims to cover the range of genetic tests currently available in prenatal screening and diagnosis, their current applications and limitations in clinical practice as well as what the future holds for prenatal genetics.
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Child , Pregnancy , Female , Humans , Prenatal Diagnosis , Knowledge , ParturitionABSTRACT
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have varied metabolic effects beyond increasing glycosuria. This consensus review examines the role of dapagliflozin in health promotion, particularly its benefits in patients with and without type 2 diabetes mellitus (T2DM) and in cardiorenal rehabilitation post-coronavirus disease 2019 (COVID-19). Consensus recommendations were developed by subject experts in Endocrinology and Diabetology based on the online meeting held on 27 June 2020 to review the available evidence related to the role of SGLT2 inhibitors, with a focus on cardiovascular and renal metabolic therapy. Evidence suggests that dapagliflozin has a direct role in improving clinical outcomes in patients with chronic kidney disease (CKD) or heart failure (HF). These benefits of dapagliflozin were independent of reduction in blood pressure, glycemic control and weight, and also extend to patients without diabetes. The use of dapagliflozin in metabolic syndrome was endorsed by the majority of the experts; however, this would be off-label. It was opined that the role of dapagliflozin would currently be limited to treating T2DM with a focus on preventing HF or kidney disease progression. The need for conducting multidisciplinary academic meetings to have a balanced approach regarding the use of dapagliflozin among nondiabetic patients and the need for detailed evaluation of the role of SGLT2 inhibitors in vasculometabolic and cardiorenal rehabilitation post-COVID was also suggested.
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In order to assess the well-being of a country and to make comparative analysis across countries, Gross National Income (GNI) per capita is the most commonly and frequently used indicator of well-being. Apart from that, this paper discusses another well-being marker: Happy Planet Index (HPI) which is relatively new in its kind with a view of incorporating higher degree of subjectivity. For the purpose of establishing correspondence (if any) between these well-being indicators, a large number of countries are considered and grouped accordingly
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Background: Seizure is a common problem evaluated in pediatric emergency departments. Seizure disorders are among the most frequent neurologic problems that occur in childhood. Around 4 to 10% of children experience at least one episode of seizure in the first 16 years of their life. Objectives: To study clinical and etiological profile of children presenting with seizures. Material and Methods: A total of 126 consecutive children aged 1 month to 18 years presenting with seizures defined as per international league against epilepsy classification, participated in this study. A detailed history was taken, and clinical examination was done, along with the investigation for the aetiology of seizures with routine and specific tests, computerized tomography (CT) scan and/or magnetic resonance imaging (MRI) and electroencephalography (EEG) as and when needed. Results: In our present study, we recorded the highest incidence of seizures in the age group of 1year to 5 years. The incidence of seizures in our study was more in males, accounting for 73 cases (57.4%) while females were 53 cases (42.06%). Generalized seizures were the commonest, among them GTCS accounting for 88 cases (69.84). The identified major etiologic factors were febrile convulsions followed by CNS infections. Conclusion: The incidence of convulsions is highest in the age group of 1 month to 5 years and in males. The commonest type of seizure is generalized tonic-clonic (40.6%).The most common cause of convulsion is febrile seizures. Milestones were achieved normally in majority of cases.
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Background: Fixed dose combinations are widely used in India, they are either irrational or prescribed irrationally. Moreover, the government has recently banned over 300 fixed dose combinations (FDCs) because of a lack of therapeutic justification. This study was conducted to study the prescribing pattern of FDCs in a tertiary care teaching hospital and to highlight the rationality of FDCs, and adverse drug reactions (ADRs) associated with them.Methods: In the present prospective observational study, a total of 500 inpatients were evaluated for prescribing pattern, cost analysis, and adverse drug reactions (ADRs) of FDCs. The FDCs were assessed for their rationality. The ADRs and severity were assessed using the WHO causality scale, Hartwig severity scale respectively.Results: Out of total 103 FDCs, 58 were approved, 86 were rational and 17 were irrational. 5 FDCs were banned and irrational. 48.54% of rational FDCs had rationality score from 7 to 9. The most commonly prescribed FDCs belonged to the anatomic therapeutic and chemical class of respiratory system, followed by anti-infectives in younger age group and cardiovascular FDCs in the elderly. The 886 ADRs occurred in 500 patients with a mean of 1.81�9. Banned FDCs contributed to 76 ADRs. According to causality and severity assessment, most of the ADRs were possible (62.53%) and mild (70.77%) respectively.Conclusions: Although FDCs were rational in most cases but banned FDCs were also prescribed. As these FDCs were associated with ADRs, monitoring of patients is necessary. Knowledge and attitude of healthcare professionals can be assessed through awareness programs.
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Background: Sublingual Misoprostol 200 ug 4 hrly is as effective or less effective than vaginal Misoprostol 200ug 4hrly with 200mg oral Mifepristone in termination of second trimester pregnancy.To compare effectiveness, side-effects, and patient satisfaction of sublingual vs vaginal misoprostol administration.Methods: It was prospective randomized open label study. 60 women 13-20 weeks of gestation with a valid legal indication for termination of pregnancy as per MTP act in INDIA were enrolled for study, randomly divided into Group A- Sublingual (n=30) group B-Vaginal (n=30). For group A, 200 mg of Mifepristone was given, 48h later Misoprostol 200 µg was given sublingually 4hrly up to a maximum of 5 doses. If abortion does not occur, the pregnancy was terminated with vaginal misoprostol, in group A. Same procedure repeated in group B. If abortion fails to occur after 5 doses, then second course of vaginal misoprostol was given in group B. Failure of procedure was defined as failed expulsion of foetus at 48 hrs. Results: Mean induction-abortion interval in vaginal group was 12.8±4.38h and 11.47±4.42h in sublingual group was comparable with insignificant p value (p=0.136). All the side effects were comparable in both groups. The overall success rate was 93.3% in the sublingual group while it was 100% in the vaginal group.Conclusion: Vaginal misoprostol with oral mifepristone priming in second -trimester medical abortion has a shorter time to pregnancy termination compared with a sublingual regimen. However, both the routes are equally effective for induction of abortion.
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Background: India is endemic for rabies accounting for 36% of the world death. Low awareness of the need to seek health care after a dog bite claims the lives of more than 55,000 people each year, mostly Asia and Arica. The objective of the study was to estimate the level of knowledge about rabies among adult population in urban area and also to find out the factors associated with level of knowledge. Methods: The cross sectional study was carried out among 200 adult population of Agartala Municipal Corporation area for a period of one month and study subjects were selected by using multistage sampling technique. A predesigned, pretested, structured interview schedule was used for data collection. Data were analyzed by SPSS version 20. Chi-square and Fisher's exact was used to find out the factors associated with level of knowledge and p value <0.5 considered as a significant. Results: The present study showed that mean age of the respondents was 45.23±14.7 years. Among them 54.5% were female, 32% home maker and 39% had completed graduation. Out of 200 respondents, 167 respondents were heard about the term ‘Rabies’ i.e., 83.5% and 33 respondent’s i.e., 16.5% never heard about the term ‘Rabies’ but only 20.5% subjects knew correctly that rabies was caused by virus. In our study, adequate knowledge on rabies was found 40% and only one factor i.e., literacy (p=0.002) was found significantly associated with level of knowledge. Conclusions: The study findings indicate that still there is need to be increase adequate level of knowledge about rabies among adult residents in urban area.
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Background: Pulmonary embolism is a common and potentially life threatening condition. Most patients who succumb to pulmonary embolism do so within the first few hours of the event. The aim of the study was to observe the clinical profile, management and outcome in patients of pulmonary embolism.Methods: A prospective observational study was conducted in the Department of Medicine in a Tertiary care hospital in Western Maharashtra for a period of two years. 55 patients with confirmed diagnosis on CTPA (Computed tomography pulmonary angiography) were included in our study. A detailed history, examination and investigations like D dimer were done in all cases.Results: Mean age of the study cases was 44.98 years with 40% of the cases between 31-50 years of age. Overall male predominance was seen (83.6%). Most common associated co-morbidity was diabetes (32.7%). The commonest risk factor seen in the present study was history of smoking (29.1%). Dyspnoea was the most common presenting complaint (72.7%). Commonest presenting sign was tachycardia (43.6%). In present study, mortality rate among cases of pulmonary embolism was observed as 3.6%..Conclusions: Mean age of the study cases was 44.98 years with 40% of the cases between 31-50 years of age. Overall male predominance was seen (83.6%). Most common associated co-morbidity was diabetes (32.7%). The commonest risk factor seen in the present study was history of smoking (29.1%). Dyspnoea was the most common presenting complaint (72.7%). Commonest presenting sign was tachycardia (43.6%). In present study, mortality rate among cases of pulmonary embolism was observed as 3.6%.
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Sugarcane molasses, the by-product of sugar industry are rich in nutrients, growth factors and minerals and areefficiently utilized by the microorganisms for growth and production of primary as well as secondary metabolitesof commercial importance. In this communication, we report the utilization of sugarcane molasses as the solesource of carbon for the production of copolymers of polyhydroxyalkanoates (PHAs) with improved materialproperties. The endophytic bacterium Bacillus cereus RCL 02 (MCC 3436) produced 7.8 g/L of PHA whengrown in MS medium with 4% (w/v) sugarcane molasses under batch cultivation. Proton nuclear magneticresonance (1H NMR) analysis revealed that the copolymer so produced contain 12.4 mol% 3-hydroxyvalerate(3HV) along with 87.6 mol% 3-hydroxybutyrate (3HB). The copolyester, P(3HB-co-12.4 mol%-3HV)has been isolated and purified following standard solvent extraction method and partially characterized byFourier-transform infrared (FTIR), X-ray diffraction (XRD), thermogravimetric (TG) and differential scanningcalorimetric (DSC) analysis. The material and thermal properties of the copolyester so produced indicated itspotential for industrial application.
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Aims@#Microbiota endogenous to oleaginous plants have attracted special attention in recent years for their biotechnological potentials and applications including the production of biodegradable biopolyester poly(3- hydroxybutyrate) [P(3HB)] as an alternative to thermoplastics. The present study is aimed to screen the endophytic bacteria of selected oleaginous plants such as Arachis hypogaea L., Brassica napus L., Brassica nigra L., Helianthus annuus L., Ricinus communis L. and Sesamum indicum L. for the production of P(3HB). @*Methodology and results@#Bacteria endogenous to the oleaginous plants were isolated from surface sterilized healthy tissues following sterilization with 70% ethanol and 0.5% sodium hypochlorite and screened for P(3HB) production in mineral salts medium. Nile blue A staining method was used for detection of intracellular P(3HB), while the accumulated biopolyester was quantified spectrophotometrically following chemical conversion to chrotonic acid by treating with sulfuric acid. Five potent P(3HB) accumulating isolates have been selected and identified as Cellulosimicrobium cellulans AHS 01 (KX458038), Beijerinckia fluminensis AHR 02 (KX458039), Exiguobacterium acetylicum BNL 103 (KX458037), Bacillus toyonensis BNS 102 (KX458036) and Bacillus cereus RCL 02 (KX458035) based on morphological, physio-biochemical and 16S rDNA sequence analysis. These endogenously growing bacterial isolates accumulated intracellular biopolyester accounting 43-62% of their cell dry weight (CDW) when grown in mineral salts medium supplemented with yeast extract. Intracellular accumulation of P(3HB) by these isolates have also been confirmed by FTIR spectral analysis of lyophilized cell mass and 1HNMR spectra of the extracted polymer. @*Conclusion, significance and impact of study@#These findings, first of its kind point to exploration of endogenous bacterial communities of oil-producing plants as a potential bioresource for production of P(3HB) bioplastics in a sustainable manner.
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Background: Presently drug utilization studies (DUS) are in an evolving era. Current literature search has shown paucity of epidemiological studies in the field of paediatric pharmacology. Hence the present study was designed to assess the drug utilization pattern in neonatal intensive care unit to improvise the current prescription practices, if required and to determine areas in neonatal pharmacology in need of further research.Methods: A prospective, observational study spanned for a period of one year from January 2015 to December 2015 was conducted at the neonatal intensive care unit (NICU), Government teaching tertiary care hospital, Maharashtra. Data of prescribed drugs was collected. WHO prescribing indicators were used for evaluating DUS. Assessment of exposure rates of different class of drugs in different gestational age groups was done. Data were analysed using descriptive studies.Results: Data of 205 neonates, showed male preponderance (53.17%) over female neonates (46.83%). With regard to the gestational age, 47.31% were term, 52.68% preterm. Average number of drugs per encounter was 6.69. 76.29% drugs were prescribed by generic name and 69.80 % drugs were from IAP list of essential medicines for children. Mean drug use was 6.23�34 per patient. Most common class of drug to which neonates were exposed was antibiotics (96.10%) and amikacin topped the list with exposure rate of 91.22%.Conclusions: The present study substantiates the need for implementation of institutional antibiotic policies, awareness regarding IAP list of essential drugs for children, prescription by generic name and rational drug use.
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<p><b>INTRODUCTION</b>Management of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities that still lack advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using radiofrequency ablation (RFA) and selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS), and present the latter as a potential model for aspiring fetal therapy units.</p><p><b>METHODS</b>Five pregnancies with fetal complications were identified for RFA. Three pregnancies with Stage II TTTS were selected for SFLP. While RFA techniques utilising ultrasonography skills were quickly mastered, SFLP required stepwise technical learning with an overseas-based proctor, who provided real-time hands-off supervision.</p><p><b>RESULTS</b>All co-twins were live-born following selective feticide; one singleton pregnancy was lost. Fetoscopy techniques were learned in a stepwise manner and procedures were performed by a novice team of surgeons under proctorship. Dichorionisation was completed in only one patient. Five of six twins were live-born near term. One pregnancy developed twin anaemia-polycythaemia sequence, while another was complicated by co-twin demise.</p><p><b>DISCUSSION</b>Proctor-supervised directed learning facilitated the rapid provision of basic fetal therapy services by our unit. While traditional apprenticeship is important for building individual expertise, this system is complementary and may benefit other small units committed to providing these services.</p>
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Background: Congenital hereditary endothelial dystrophy (CHED) is an autosomal recessive disorder characterized by bilateral, symmetrical, noninflammatory corneal clouding (edema) present at birth or shortly thereafter. This study reports on an unusual delayed presentation of CHED with compound heterozygous SLC4A11 mutations. Materials and Methods: A 45‑year‑old female, presenting with bilateral decreased vision since childhood that deteriorated in the last 5 years, was evaluated to rule out trauma, viral illness, chemical injury, glaucoma, and corneal endothelial dystrophies. Tear sample was sent for herpes simplex viral (HSV) antigen testing. Genomic DNA from peripheral blood was screened for mutations in all exons of SLC4A11 by direct sequencing. Full‑thickness penetrating keratoplasty was done and corneal button was sent for histopathological examination. Results: Slit‑lamp findings revealed bilateral diffuse corneal edema and left eye spheroidal degeneration with scarring. Increased corneal thickness (762 μm and 854 μm in the right and left eyes, respectively), normal intraocular pressure (12 mmHg and 16 mmHg in the right and left eyes, respectively), inconclusive confocal scan, and specular microscopy, near normal tear film parameters, were the other clinical features. HSV‑polymerase chain reaction was negative. Histopathological examination revealed markedly thickened Descemet’s membrane with subepithelial spheroidal degeneration. SLC4A11 screening showed a novel variant p.Ser415Asn, reported mutation p.Cys386Arg and two polymorphisms, all in the heterozygous state and not identified in 100 controls. Conclusions: The study shows, for the first time, compound heterozygous SLC4A11 mutations impair protein function leading to delayed onset of the disease.
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<p><b>INTRODUCTION</b>The study aimed to assess the level of awareness and knowledge of contraception among women in Singapore, and identify the factors that influence contraception choice.</p><p><b>METHODS</b>We conducted a cross-sectional survey of 259 female patients, aged 21-49 years, who attended the Obstetrics and Gynaecology Clinic at National University Hospital, Singapore. An original questionnaire on nine contraceptive methods was used. Respondents who had ≥ 2 correct answers for a method (out of four questions) were considered to have good knowledge of the method. Participants were asked to rate factors known to influence contraceptive choice as important or not important.</p><p><b>RESULTS</b>Awareness of the following methods was high: condom (100.0%), oral contraception pill (89.2%), tubal ligation (73.0%) and copper intrauterine device (IUD) (72.2%). The women were least aware of hormonal IUD (24.3%). Women who were parous, had a previous abortion, had completed their family or used contraception previously were more likely to have a higher awareness of contraception. 89.2% of the women had good knowledge of the condom; among those aware of hormonal IUD, only 46.0% had good knowledge of it. Women who had used hormonal IUD and the condom were more likely to have good knowledge of them. Many rated efficacy (90.5%) and a healthcare professional's advice (90.1%) as important in contraceptive choice. Few considered peer influence (21.0%) and cultural practices (16.3%) to be important.</p><p><b>CONCLUSION</b>Women in Singapore have poor awareness and knowledge of contraception, especially long-acting reversible methods. More effective ways are needed to educate women about contraceptive methods.</p>
Subject(s)
Adult , Female , Humans , Middle Aged , Young Adult , Abortion, Induced , Choice Behavior , Condoms , Contraception , Methods , Contraceptives, Oral , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Intrauterine Devices , Parity , Patient Education as Topic , Singapore , Social Class , Sterilization, Tubal , Surveys and QuestionnairesABSTRACT
Natural killer [NK] cells constitute our bodies' frontline defense system, guarding against tumors and launching attacks against infections. The activities of NK cells are regulated by the interaction of various receptors expressed on their surfaces with cell surface ligands. While the role of NK cells in controlling tumor activity is relatively clear, the fact that they are also linked to various other disease conditions is now being highlighted. Here, we present an overview of the role of NK cells during normal body state as well as under diseased state. We discuss the possible utilization of these powerful cells as immunotherapeutic agents in combating diseases such as asthma, autoimmune diseases, and HIV-AIDS. This review also outlines current challenges in NK cell therapy
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Mycobacterium aurum [M. aurum] is an environmental mycobacteria that has previously been used in studies of anti-mycobacterial drugs due to its fast growth rate and low pathogenicity. The M. aurum genome has been sequenced and assembled into 46 contigs, with a total length of 6.02 Mb containing 5684 annotated protein-coding genes. A phylogenetic analysis using whole genome alignments positioned M. aurum close to Mycobacterium vaccae and Mycobacterium vanbaalenii, within a clade related to fast-growing mycobacteria. Large-scale genomic rearrangements were identified by comparing the M. aurum genome to those of Mycobacterium tuberculosis and Mycobacterium leprae. M. aurum orthologous genes implicated in resistance to anti-tuberculosis drugs in M. tuberculosis were observed. The sequence identity at the DNA level varied from 68.6% for pncA [pyrazinamide drug-related] to 96.2% for rrs [streptomycin, capreomycin]. We observed two homologous genes encoding the catalase-peroxidase enzyme [katG] that is associated with resistance to isoniazid. Similarly, two embB homologues were identified in the M. aurum genome. In addition to describing for the first time the genome of M. aurum, this work provides a resource to aid the use of M. aurum in studies to develop improved drugs for the pathogenic mycobacteria M. tuberculosis and M. leprae
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Aims: Poly(3-hydroxybutyrate) [P(3HB)], the microbially produced biodegradable thermoplastics has find wide range of applications in recent years. Development of low cost production strategies utilizing novel organisms is a crucial challenge. Present study is aimed to isolate and screen bacterial endophytes of Brassica nigra L. for the production of P(3HB). Place and Duration of Study: The experiments were performed in the Microbiology Laboratory, Department of Botany, University of Calcutta, Kolkata during 2012-2014. Methodology: Culturable bacterial endophytes were isolated from surface sterilized healthy tissues of B. nigra L. and screened for P(3HB) production in mineral salts medium. The chloroform extracted dried polymer was treated with H2SO4 and quantified spectrophotometrically at 235 nm. Results: About 78% of the bacterial endophytes recovered from surface sterilized B. nigra L. tissues showed different degrees of P(3HB) accumulation. Isolates (9) showing P(3HB) accumulation exceeding 10% of the cell dry weight (CDW) were characterized and tentatively identified as members of Bacillus, Pseudomonas, Xanthomonas, Alcaligenes and Acetobacter. The most potent isolate, BNL 06 identified as Bacillus pumilus BNL 06 (GenBank Accession No. KP202723), accumulated P(3HB) accounting 18% of CDW with an yield of 0.55 g/l. Finally the nature of the polymer was further confirmed by FTIR analysis. Conclusion: Exploration of the endophytic bacterial diversity of B. nigra L. have clearly revealed the potential of Bacillus pumilus BNL 06 for P(3HB) production as an alternative source of thermoplastics.