Analyzing the Role and Liability of Paramedics in the Indian Healthcare System

The Nursing and staff serves as backbone of a healthcare system. Despite being central to any healthcare system, not much has been written about them, especially on the issue of their regulations and legal liabilities emanating from their professional activities. Though they are governed by National and State councils, the implications of their acts are different in Civil Law, Criminal Law and under their respective regulations. These differences are primarily the subject matter of this paper.

A Study to Assess the Effectiveness of Balloon Therapy on Lung Capacity of Patients with Lower Respiratory Tract Infections in Selected Hospital of Chitrakoot U.P.

As per 2019 report of the National Health Portal of India, 41,996,260 cases and 3,740 deaths from respiratory infections were recorded across India in 2018. The main aim of the study was to assess the effectiveness of balloon therapy on increased level of oxygenation of patients with lower respiratory tract disorders. Quasi experimental design was used for this study. Balloon therapy improves pulmonary functions. Daily practice of blowing up balloon, once a day, 10 times per day for 10 days will steadily increase lung capacity. The data pertaining to lung capacity was collected using self-administered questionnaire. Respiratory assessment viz Vital, Tidal and Lung capacity were measured using balloon therapy. The pre-test mean and SD were 6.83 & 1.30 respectively where as posttest mean & SD were 7.16 & 1.26, with t-test value of 6.12. These reading indicate the effectiveness of Balloon therapy on lung capacity in patients with lower respiratory tract infections. The result of this study guides that regular practice of balloon therapy can improve the lung capacity to a greater extent among patients with lower respiratory tract infection. Off course, large sample size is recommended for generalization.

Effectiveness of Structured Teaching Program on Knowledge of First aid Management of Minor Injuries Among Mothers of Kinder Garten Students of SPA Campus Bhauri, Bhopal

Quasi- Experimental one group pretest –post test design was conducted to assess the effectiveness of structured teaching program on first aid management of minor injuries among mothers of kindergarten children at Bhauri, 60 samples were selected by simple random sampling technique and assessed their knowledge score by structured questionnaire. Structured teaching program on first aid management of minor injuries were given .After seven days of the post test were conducted by using same questionnaire. There was significant improvement in knowledge score and practices related to prevention of minor abrasions at 0.01 level. Out of 60 mothers 3.3%(2) had adequate knowledge, 13.4%(8) had moderately adequate knowledge, 83.3%( 50) had inadequate knowledge score in pre-test. 1.66 %( 1) had inadequate knowledge, 86.7 %( 52) had adequate knowledge, 11.64 %( 7) had moderately adequate knowledge in post test..there is no significant difference between demographic variables of pre test and post test scores of knowledge and knowledge on practice.

Ileosigmoid knotting: An unusual cause of intestinal obstruction.

Ileosigmoid knot or double volvulus is an unusual cause of intestinal obstruction and presents as a surgical emergency. It affects men of middle and old age. It occurs due to entangling of ileal and sigmoid loops producing obstruction and strangulation. Here, We have described a case 60 years old male presented with features of intestinal obstruction. Emergency laparotomy revealed ileosigmoid knotting with gangrene of involved segment. Resection of unviable portion with knot was done with double primary anastomosis and covering ileostomy.

Prevalence of pathogens and their antimicrobial susceptibility in catheter associated urinary tract infection.

Hospital-acquired urinary tract infection (UTI) is the most common infection acquired in hospitals. Up to 25% of hospitalised patients undergo urinary catheterisation, a similar proportion of patients cared for in residential homes will have long term indwelling catheters. Although often necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of total number of nosocomial infections. Most nosocomial infections associated with urinary tract follow instrumentations, usually with the catheter. Results of several studies demonstrated that this antibiotic drug prophylaxis has increased the rate of isolation of resistant organisms. To ensure appropriate therapy, current knowledge of organisms that cause UTI and the antibiotic susceptibility is mandatory. The aim of present study was to assess the bacterial profile for catheter associated UTI and the antimicrobial sensitive to most commonly used antibiotics, used in the therapeutic or prophylactic settings before the results of the urine culture are available. In our study, the incidence of infection in catheterized patients was found to be 27% which was low but comparable to studies done in India and Western studies. E. coli was the most common cause of catheter associated infection and highest sensitivity was found to Amikacin.

Enteric coated HPMC capsules plugged with 5-FU loaded microsponges: a potential approach for treatment of colon cancer

The work was aimed at developing novel enteric coated HPMC capsules (ECHC) plugged with 5 Florouracil (5-FU) loaded Microsponges in combination with calcium pectinate beads. Modified quasi-emulsion solvent diffusion method was used to formulate microsponges based on 32 factorial design and the effects of independent variables (volume of organic solvent and Eudragit RS100 content) on the dependent variables (Particle size, %EE & % CDR) were determined. The optimized microsponges (F4) were characterized by SEM, PXRD, TGA and were plugged along with calcium pectinate beads in HPMC capsules and the HPMC capsules were further coated with enteric polymer Eudragit L 100 (Ed-L100) and/ or Eudrgit S 100 (Ed-S 100) in different proportions. In vitro release study of ECHC was performed in various release media sequentially SGF for 2 h, followed by SIF for the next 6 h and then in SCF (in the presence and absence of pectinase enzyme for further 16 h). Drug release was retarded on coating with EdS-100 in comparison to blend of EdS-100: EdL-100 coating. The percentage of 5-FU released at the end of 24 h from ECHC 3 was 97.83 ± 0.12% in the presence of pectinase whereas in control study it was 40.08 ± 0.02% drug. The optimized formulation was subjected to in vivo Roentgenographic studies in New Zealand white rabbits to analyze the in vivo behavior of the developed colon targeted capsules. Pharmacokinetic studies in New Zealand white rabbits were conducted to determine the extent of systemic exposure provided by the developed formulation in comparison to 5-FU aqueous solutions. Thus, enteric coated HPMC capsules plugged with 5-FU loaded microsponges and calcium pectinate beads proved to be promising dosage form for colon targeted drug delivery to treat colorectal cancer.

O trabalho teve como objetivo o desenvolvimento de novas cápsulas com revestimento entérico HPMC (ECHC) conectadas com microesponjas carregadas com fluoruracila (5-FU) em combinação com grânuos de pectinato de cálcio. O método de difusão de solvente modificado quasi-emulsão foi usado para formular microesponjas com base no planejamento fatorial 32 e determinaram-se os efeitos das variáveis independentes (volume de solvente orgânico e conteúdo Eudragit RS100) sobre as variáveis dependentes (tamanho de partícula, EE% e % CDR). As microesponjas otimizadas (F4) foram caracterizadas por SEM, PXRD, TGA e ligadas aos grânulos de pectinato de cálcio em cápsulas de HPMC e estas foram, ainda, revestidas com polímero entérico Eudragit L 100 (Ed-L100) e/ou Eudrgit S 100 (Ed S 100) em diferentes proporções. No estudo de liberação in vitro de ECHC foi realizada em vários meios de liberação sequencial SGF durante 2 h, seguido de SIF para as próximas 6 h, e, em seguida, em SCF (na presença e na ausência de enzima pectinase por mais 16 h). A liberação do fármaco foi retardada em revestimento com a EDS-100, em comparação com mistura de EDS-100: EDL-100, de revestimento. O percentual de 5-FU liberado de ECHC 3 ao final de 24 h foi 97,83 ± 0,12% em presença de pectinase, enquanto que para o controle foi de 40,08 ± 0,02% do fármaco. A formulação otimizada foi submetida a estudos Roentgenográficos in vivo, em coelhos brancos Nova Zelândia, para analisar o comportamento das cápsulas desenvolvidas direcionadas ao cólon. Os estudos de farmacocinética em coelhos brancos da Nova Zelândia foram conduzidos para determinar a extensão da exposição sistêmica propiciada pela formulação desenvolvida, em comparação com solução aquosa de 5-FU. Assim, cápsulas entéricas de HPMC revestidas e conectadas com microesponjas carregadas com 5-FU e grânulos de pectinato de cálcio se mostraram promissoras como formulação para liberação do fármaco no cólon no tratamento do câncer colorretal.

Advances in nasal trans-mucosal drug delivery.

Transmucosal nasal delivery is a promising drug delivery option where common drug administrations, such as intravenous, intramuscular, or oral are inapplicable. Recently, it has been shown that many drugs have better bioavailability by nasal route than the oral route. This has been attributed to rich vasculature and a highly permeable structure of the nasal mucosa coupled with avoidance of hepatic first-pass elimination, gut wall metabolism and/or destruction in the gastrointestinal tract. The physiology of the nose presents obstacles, but offers a promising route for non-invasive systemic delivery of numerous therapies and debatably drug delivery route to the brain. Intranasal microemulsions, gels and microspheres have gained increased interest in recent years as a delivery system for protein and peptides through the nasal route. Thus this review focuses on nasal drug delivery, various aspects of nasal anatomy and physiology, nasal drug absorption mechanisms, various nasal drug delivery systems, and their applications in drug delivery.

An overview on: trade-related aspects of intellectual property rights.

The World Trade Organisation’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) substantially changed the international intellectual property regime by introducing the principle of minimum intellectual property standards. In effect, this principle means that any intellectual property agreement negotiated subsequent to TRIPS among and/or involving WTO members can only create higher standards – commonly known as “TRIPS plus”. The TRIPS-plus concept covers both those activities aimed at increasing the level of protection for right holders beyond that which is given in the TRIPS Agreement and those measures aimed at reducing the scope or effectiveness of limitations on rights and exceptions. Such intellectual property rules and practices have the effect of reducing the ability of developing countries to protect the public interest and may be adopted at the multilateral, plurilateral, regional and/or national level. The TRIPS Agreement addresses a wide range of intellectual property subject matter areas (copyright, trademark, patent, and so forth). It also covers competitive markets, enforcement measures, dispute settlement, and transitional arrangements. This Module provides an introduction to these various aspects of the TRIPS Agreement, and seeks to focus on the kinds of questions that should be asked when approaching dispute settlement. In some areas, the questions are answered, but the entire field of intellectual property rights protection, including enforcement measures, cannot be covered in a single Module or short course. Moreover, the questions will change along with the technologies that form the subject matter of intellectual property rights protection. The objective of this Module is to provide sufficient background so that as specific issues arise, the diplomat or lawyer understands how to approach them.

Pandemic Influenza A (H1N1) 2009 in India: Duration of virus shedding in patients under antiviral treatment.

Background: National Centre for Disease Control (NCDC), Delhi, is a national nodal centre for surveillance of pandemic Influenza A (H1N1) in India. The present study was undertaken to see the period of infectivity in positive cases undergoing antiviral therapy. Objective: To assess the duration of virus shedding by real-time polymerase chain reaction (real-time PCR) in some of the positive patients taking Oseltamivir treatment. Materials and Methods: Clinical samples (throat swabs, nasal swabs and nasopharyngeal swabs) collected by the clinicians from patients quarantined in government hospitals in different parts of India are being sent to the designated reference laboratory at Delhi for screening presence of pandemic Influenza virus. The samples are tested by Real-Time PCR using CDC recommended reagents and protocol for confirmation of the H1N1 novel influenza virus. In 150 of the positive cases, we requested the clinicians to send samples for 5 consecutive days after administration of antiviral therapy, to see the trend of therapy response on viral shedding. Samples for more than 5 days were received from patients till they showed no amplification for any of the three target genes (Influenza A, Swine Influenza A or Swine H1). Results and Conclusion: In 99.33% (149/150) cases, the influenza infection resolved within 10 days. Sixty-four percent (96/150) of the positive patients turned negative within 5 days of the start of antiviral treatment. Only one patient belonging to high risk group showed prolonged virus shedding (19 days).

Characterization of RPO B gene for detection of rifampicin drug resistance by SSCP and sequence analysis.

Purpose: Because of the emergence of multidrug-resistant tuberculosis in recent times, the rapid detection of resistance to the first-line anti-tuberculosis drug rifampicin was felt worldwide. Accordingly, this study was conducted to evaluate the diagnostic potential of polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) for checking its utility as a rapid screening test for determination of rifampicin drug resistance. Materials and Methods: A total of 34 isolates of Mycobacterium tuberculosis ( M. tuberculosis ) (22 rifampicin resistant, 11 rifampicin sensitive and one control H37Rv) strains were analysed by PCR-SSCP and DNA sequencing within the 157-bp region of the rpo B gene (Ala 500 -Val 550 ). Results: Rifampicin resistance was detected successfully by PCR-SSCP in 20/22(90.90%) of rifampicin-resistant strains showing a total of nine different mutations in seven codon positions: codon 513 (CAA→CCA), 516 (GAC→GTC), 507 (GGC→GAC), 526 (CAC→GAC, TAC), 531 (TCG→TTG, TGG), 522 (TCG→TGG) and 533 (GTG→CCG). Two rifampicin-resistant strains showed an identical PCR-SSCP pattern with the wild type H37Rv; 77.27% rifampicin-resistant strains showed a single point mutation and 9.09% had no mutation. Three rifampicin-resistant strains showed characteristic double mutations at codon positions 526 and 531. Sensitivity and specificity were calculated as 90.90% and 100%. Conclusions: Rifampicin-resistant genotypes were mainly found in codon positions 516, 526 and 531. PCR-SSCP seems to be an efficacious method of predicting rifampicin resistance and substantially reduces the time required for susceptibility testing from 4 to 6 weeks to a few weeks.

Intestinal trematode infection in North Bihar.

Reports of intestinal trematode infections are not common from Bihar, India. However, we herewith report one case of fasciolopsiasis from North Bihar, India. A 14 years old girl presented with diarrhea, vomiting, generalized pain abdomen and loss of weight. Routine stool examination and upper gastrointestinal endoscopy revealed fasciolopsis buski in large numbers. Her rural life style and food habit (ingestion of raw vegetables- caltrops and water chest nuts) supported the cause of infestation. Despite treatment with praziquantel, the patient died after two days. Mild infestations of Fasciolopsis buski may pass on unnoticed. However, heavy infestations may cause considerable prostration, illness and even death in younger age groups. Awareness regarding this parasitic infestation (endemic in some regions), especially in the rural set up is still a much needed entity.

A comparison between radiography and ultrasonography in the diagnosis of zygomatic arch fracture.

A comparison between submentovertex view radiograph and real time ultrasonography in the diagnosis of zygomatic arch fractures. The materials are 6 patients with zygomatic arch fracture alone and 6 patients with combination of zygomatico-maxillary complex with arch fracture. In 34% of patients with zygomatico-maxillary complex with arch fracture. In 34% of patients with zygomatico-maxillary complex fractures, zygomatic arch fractures were confirmed by radiographs, in 66% of the cases the isolated arch fractures were confirmed by radiographs. In 100% of the cases ultrasonography confirmed arch fractures in both the sets of cases.

Coagulase negative Staphylococci as causative agents of urinary tract infections-prevalence and resistance status in IGIMS, Patna.

Previously considered solely as the laboratory contaminants and normal flora of skin in man, coagulase negative Staphylococci are now a major cause of nosocomial and opportunistic infections. This study was conducted at IGIMS, Patna to find out the coagulase negative Staphylococcus isolates from urine and their antimicrobial resistance. In a period of ten months, the relative frequency of main coagulase negative Staphylococci were as follows--Staphylococcus epidermidis-45.90%, Staphylococcus saprophyticus 34% and Staphylococcus haemolyticus-8.50%. others were 11.60%. most of the Staphylococcus saprophyticus was isolated from young female patients suffering from uncomplicated acute cystitis and Staphylococcus epidermidis was mainly from patients with indwelling catheters and complicated cases. Staphylococcus saprophyticus showed the highest sensitivities to all the antimicrobials whereas Staphylococcus haemolyticus had the highest resistance rates. 66.6% of staphylococcus epidermidis and 60% of staphylococcus haemolyticus were resistant to oxacillin, whereas only 10% of staphylococcus saprophyticus resistant and 90% were sensitive to it. As is in the emerging state, vancomycin resistance was very less but in future it may cause a major problem to treat these cases. So this area needs further exploration.

Isatin, a putative anxiogenic endocoid, induces memory dysfunction in rats.

Isatin (2,3-dioxoindole), one of the components of tribulin, which has been postulated to function as an endogenous marker of stress and anxiety, was shown to induce a dose-related attenuation of learning acquisition in an active avoidance test and inhibition of learning retention, or memory, in a step-down passive avoidance paradigm and transfer latency in an elevated plus-maze, in rats. Earlier studies have indicated that isatin functions as a 5-hydroxytryptamine (5-HT)3 receptor agonist in its anxiogenic activity in rats and is an antagonist at mammalian atrial natriuretic peptide (ANP) receptors. Since 5-HT3 receptor antagonists and centrally administered ANP have been shown to facilitate learning and memory, the observed memory dysfunction induced by isatin can be attributed to its receptor activity at 5-HT3 and ANP receptors. The investigation also indicates that anxiogenic agents are likely to disrupt memory functions.

Molecular cloning and restriction endonuclease analysis of 0.4 kb Hin dIII'O' fragment of bovine herpesvirus 1 DNA.

Bovine herpesvirus 1 DNA has been isolated by SDS lysis of the virus purified from potassium tartrate (10-50%) density gradient centrifugation. The quality and quantity of viral DNA was checked by UV spectrophotometry and ethidium bromide stained agarose gel electrophoresis. The 0.4 kb Hin dIII'O' fragment of BHV-1 DNA was selectively cloned into Hin dIII cut pUC9 plasmid DNA (2.665 kb). Recombinants were screened by white/blue colonies as well as Hin dIII restriction enzyme analysis. On restriction endonuclease analysis of recombinant plasmid DNA (p-BH-0) with several restriction enzymes, viz., Sau 3A, Hin fI, Rsa I, Sal I, Dra I, Bgl I, Bgl II, Sma I, Hpa I, Stu I, Mlu I, Xho I, Kpn I, Hae III, Eco RI, Bam HI, Pst I, Pal I, revealed insert viral DNA having sites for Hin fI, Hae III, Rsa I, Sma I, only. Further, the partial restriction map of the recombinant plasmid DNA was constructed using above enzymes.