ABSTRACT
The blood–retinal barrier (BRB) alteration is the hallmark feature of diabetic retinopathy. Vascular endothelial growth factor (VEGF) is a potent vasopermeability factor that has been implicated in the pathogenesis of BRB alteration. Inflammation also plays a crucial role in this process with involvement of several chemokines and cytokines. Multiple anti‑VEGF drugs are widely used as in the treatment of diabetic macular edema (DME) as well as proliferative diabetic retinopathy. Several clinical trials have proved the beneficial effects of these drugs in improvement of vision and prevention of vision loss. However, the response to anti‑VEGF drugs in DME is not complete in a significant number of patients. The effect seems transient in this latter group, and many patients do not show complete resolution of fluid. Potential novel therapies targeting molecules beyond VEGF are being developed and examined in clinical trials.
ABSTRACT
Objectives: The objective of this formative research was to develop a locally appropriate home fortification program for children (6-24mo) and to explore feasibility and acceptability within an integrated family health program in Bihar. Methods: The study consisted of three phases over a six month period. In Phase 1, we tested the acceptability of multiple micronutrient powders and developed contextualized packaging and counseling materials integrated with existing complementary feeding messages. We used focus group discussions (FGD, n=11) with frontline workers (FLWs), community members, mothers, mothers-in-law, and fathers to obtain feedback on product and supportive tools. In Phase 2, we explored community acceptability in 27 households (HHs) with children 6-24mo using a Trials of Improved Practices methodology. In-depth interviews (IDI) were held with HHs at baseline, midline and endline (day 10). Phase 3 was designed to evaluate the implementation process using existing program delivery platforms with FLWS in 3 health sub-centers (HSC). FLWs were trained to distribute products and counsel HHs on home fortification and complementary feeding. 5 FGDs and 3 IDIs were held with FLWs in addition to monthly HH monitoring data (n=20/HSC). Results: As a result of this formative work, counseling materials, FLW trainings and delivery approach were substantially revised to better reflect local context and program realities. Preliminary data suggest home fortification is well-accepted by community members and FLWs are willing to incorporate into existing work activities. Conclusions: This formative research methodology was vital for developing an integrated and locally acceptable home fortification program and informing future scale-up activities.
ABSTRACT
Objectives: The main objectives of the study were to explore the feasibility of using Frontline health Workers (FLW) as a platform to deliver Multiple Micronutrient Powders (MMP) to the target population (children of 6-18 months) and to assess the acceptability of MMP among the community. This work was part of a multi-phase formative research study for contextualizing a home fortification strategy in Bihar. Methods: The program was implemented in three Health Sub Centers (HSCs) in West Champaran over a two-month duration. Key programmatic activities included FLW training for MMP distribution and counseling on complementary feeding; and community sensitization events to increase MMP acceptability. We conducted 5 focus group discussions and 3 in-depth interviews with FLWs along with monthly monitoring at the household level (n=20/HSC) to assess the program implementation. Results: Important implementation findings emerged through the soft roll-out. Firstly, the HSC meetings were found to be suitable as a FLW training platform but not for MMP distribution to FLWs due to logistical constraints. Secondly, the counseling brochures and community sensitization meetings were perceived to be important facilitators for MMP uptake by the community. Thirdly, FLWs reported positive levels of engagement, low perceptions of work burden and adopted diverse strategies for program delivery. Lastly, community uptake was found to be positive and primary barriers to compliance were mainly associated with supply issues rather than user preferences. Conclusions: The implementation study proved to be a valuable step in identifying critical operational and programmatic factors to inform future large-scale program activities.
ABSTRACT
BACKGROUND: The epidemiological association of lichen planus (LP) with hepatitis C virus (HCV) infection has been recorded from some countries and HCV RNA3 has been isolated from lesional skin in patients with LP and chronic HCV infection. The observed geographical differences regarding HCV infection and LP could be immuno-genetically related. AIM: To determine whether HCV has a causal relationship with LP. METHODS: Histopathologically proved cases of LP were subjected to antibody to HCV test by the Third Generation Enzyme Immunoassay Kit for the detection of antibody to HCV (Anti-HCV) in human serum or plasma. They were routinely screened in the virology department by the reagent kit, HIVASE 1 + 2, adopting the "direct sandwich principle" for the assay to detect antibodies to HIV-1 and/or HIV-2. There were 150 age and sex matched controls (not suffering from LP) and HIV-I and II negative, and negative for HCV. RESULTS: Of the 104 patients studied only 2 patients (1.92%) of generalized LP with disease duration of more than 3 months were found to be positive for antibodies to HCV. This was not a significant finding and no statistical methods, e.g. Chi square test etc. could be applied. CONCLUSION: Hepatitis C virus is not significant to the causation of LP in India.