RESALE OF REFURBISHED INSULIN PUMPS, IS IT POSSIBLE?

There is no doubt that CSII with Insulin pump Therapy has proved superior to MDI (multiple Dose Injection) therapy in Type1DM as well as Type2DM patients. Economics has been a very important issue while advocating the Pump to either patients, type 1 or type 2 Diabetes Mellitus patients. Out of 9 (Nine) patients using Insulin Pumps in our centre GANDHI CLINIC, PUNE, INDIA, there are 5(FIVE) Type 2 patients and 4(FOUR) Type 1DM patients. Two Pumps are deposited at my Clinic due to the sad demise of the Type2DM patients. The relatives of these patients do wish to sell these pumps with some depreciation price i.e. at lower price than the new one. One patient (type2DM) has stopped using the Insulin pump due to the adverse advice from another healthcare provider. This person with Diabetes also wants to sell the pump at some discounted price. As per my survey in the Metro city of Pune (INDIA) approximately 700 insulin pumps are sold, out of these at least 5-7% of total pumps are not being used anymore. The unused pumps are at least 50 in number in this city of PUNE. Total number of pumps used in INDIA is 70000-72000 pumps approx. The total unused pumps by the patients in INDIA could be about 3000 to 5000 pumps approximately. This revenue loss in this resource constrained country could be in millions of Dollars. This scenario may be same in many developing countries wherein the healthcare budgets are limited. In INDIA, Insulin Pump Therapy is not yet covered by Insurance policy of all the patients. Since the pumps are usually purchased by pocket expenses or with Loan or selling some assets like land or Gold, the relatives of the patients are not wrong in expecting some financial recovery after losing the most important thing ie the PERSON. This is also to be considered if patient does not want to continue the use of pump due to any reason. We do see refurbished cars sold and there are eligible and deserving candidates available who cannot purchase a new model of the Car. I am sure INDIA is an important market of Diabetes Technology related Products like Insulin Pump and CGMs. This article is aimed at KOLs in Diabetology and Economists in the world for a basic policy change in favour of the patient care and economics.

Polyherbal decoction modulates redox homeostasis during Malachite green induced metabolic stress in Saccharomyces cerevisiae

Malachite green (MG) is aquatic pollutant that induces oxidative stress when comes in contact with the living organisms. In Saccharomyces cerevisiae, MG produces intracellular reactive oxygen species (ROS) and these ROS disturb redox homeostasis and cellular functions leading to early cell death. Exogenous supply of natural antioxidants containing polyherbal decoction may play a crucial role in re-establishment of redox homeostasis by ensuring the cell survival. Exposure of MG to Saccharomyces cerevisiae resulted in a significant decrease (97.8%) in colony forming units (CFU). An Ayurvedic polyherbal formulation ‘Vayasthapana Rasayana’ (VR) which contains natural antioxidants from plants viz. Terminalia chebula, Clitoria ternatea, Boerhaavia diffusa, Centella asiatica, Phyllanthus emblica, Asparagus racemossus and Tinospora cordifolia at 1.0 mg/mL concentration could arrest the oxidative stress during MG exposure. Levels of ROS elevated up to 67.3% on MG exposure; while VR supplementation reduced it by 54.7%. MG induced cellular apoptosis in 38% and necrosis in 27% cells, while VR augmentation reduced it to 8%. Activities of antioxidant enzymes like catalase, superoxide dismutase and glutathione peroxidase in MG exposed cells were induced by 408, 144 and 140%, respectively, whereas, VR supplementation lowered the expressions to 102, 57 and 111%, respectively. Induction in caspases 3/7 activity was also found to be reduced by 65.39% after VR augmentation. Similarly, VR modulated activities of oxido-reductases like lignin peroxidase, laccase, NADH-DCIP reductase and MG reductase. VR supplementation also maintained the MG utilization potential of S. cerevisiae up to 20th exposure cycle which was otherwise arrested to 8th cycle. The treatment also decreased the ROS accumulation and nuclear damage, restoring the cell viability up to 94% and retained normal growth dynamics. Thus, VR supplementation could significantly decrease oxidative stress, enhance cell viability and ultimately protect the dying S. cerevisiae cells during MG exposure.

Analgesic and Anti‑inflammatory action of Opuntia elatior Mill fruits.

Background: Opuntia elatio Mill is a xerophytic plant with potentially active nutrients. It is traditionally appreciated for its pharmacological properties; however, the scientific information on this plant is insufficient. Objective: The present study evaluates the antinociceptive and anti‑inflammatory action of prickly pear. Materials and Methods: Writhing and tail‑immersion tests were carried out to evaluate analgesic action, while the carrageenan‑induced paw edema and neutrophil adhesion tests were conducted in Albino wistar rats to assess anti‑inflammatory action. Results: ED50 values of the fruit juice in writhing, tail immersion, and paw edema test were 0.919, 2.77, and 9.282 ml/kg, respectively. The fruits of Opuntia produced analgesic and anti‑inflammatory action in a dose‑dependent manner. Conclusion: The results establish the folklore use of prickly pear may be due to the presence of betacyanin and/or other phenolic compounds.

Site selection for vascular access creation in hemodialysis in end stage renal disease.

Background: Chronic kidney failure is characterized with progressive and irreversible diminishing of glomerular filtration rate. AVF has been unanimously considered the gold standard vascular access of choice for hemodialysis. Arterio-venous fistula (AVF) for hemodialysis should be created in patients with endogenous creatinine clearance < 20 mL/min/1,73m2. Aim of current study was to choose the proper site for arteriovenous fistula creation with minimal complications. Methods: It was a prospective study, carried out in the dept. of surgery from April 2008 to August 2013. A total of 140 patients were studied over the period. The fistulae were created using radial artery cephalic vein side to side and brachial artery cephalic vein side to side or end to side anastomosis. Statistical analysis used: Mean, Standard deviation, Standard error. Results: A total 140 patients were studied, out of them 104 were males and 36 were females. The radiocephalic site was used for 82 (58.57%) patients and 58 (41.43%) patients were operated on brachiocephalic site. The mean inner diameter of radial artery, brachial artery and cephalic vein (intima to intima) at elbow and wrist were 21.49001 ± 0.901 (SE - 0.28492), 3.72533 ± 1.06837 (SE - 0.30841) and 0.68079 ± 0.49551 (SE - 0.116790) respectively. The mean flows velocity of brachial and radial artery were 76.10526 ± 4.54477 (SE - 1.04264) and 52.64286 ± 5.5968 (SE - 1.495810) respectively. The success rate of AV fistula on table was 97.85% (137 out of 140). The incidence of complication was 18.57%. Conclusion: The site for fistula creation depends on the quality of the artery and vein. To achieve good success rates preoperative color Doppler is essential to evaluate the vessels. The complication rates can be minimised by following standard operating protocols.

A Case-control Study Examining Association between Infectious Agents and Acute Myocardial Infarction.

Background: Coronary heart disease is multi-factorial in origin and its burden is expected to rise in developing countries, including India. Evidence suggests that the inflammation caused by infection is associated with the development of atherosclerosis and heart disease. An increasing number of clinical and experimental studies point to a contribution of various infectious organisms to the development of atherosclerosis in humans. Acute myocardial infarction (AMI) is associated with atherosclerosis. Objectives: The objective of the following study is to study the association between Helicobacter pylori, Chlamydia pneumoniae and C-reactive protein (CRP) with AMI. Materials and Methods: This group-matched case-control study was carried out in Government Medical College, Nagpur, Maharashtra, India. The study compared the risk of occurrence of AMI (outcome) if subjects were ever-infected with H. pylori or C. pneumoniae; and their CRP positivity (exposure). Incident cases of myocardial infarctions in a tertiary care hospital were included as cases. Results: The study recruited 265 cases and 265 controls and detected an odds ratio (OR) of 2.50 (95% confidence interval [CI]: 1.69-3.70) and an OR of 2.50 (95% CI: 1.71-3.65) for C. pneumoniae and H. pylori, respectively. Raised CRP levels had an OR of 3.85 (95% CI: 2.54-5.87). Conclusion: Although our study indicates the role of infections in the etiology of AMI in study population, the relative public health impact of these agents in the overall prevalence of AMI needs urgent research attention.

Assessment of Essential Newborn Care Services in Secondary-level Facilities from Two Districts of India.

India faces a formidable burden of neonatal deaths, and quality newborn care is essential for reducing the high neonatal mortality rate. We examined newborn care services, with a focus on essential newborn care (ENC) in two districts, one each from two states in India. Nagaur district in Rajasthan and Chhatarpur district in Madhya Pradesh were included. Six secondary-level facilities from the districts─two district hospitals (DHs) and four community health centres (CHCs) were evaluated, where maximum institutional births within districts were taking place. The assessment included record review, facility observation, and competency assessment of service providers, using structured checklists and sets of questionnaire. The domains assessed for competency were: resuscitation, provision of warmth, breastfeeding, kangaroo mother care, and infection prevention. Our assessments showed that no inpatient care was being rendered at the CHCs while, at DHs, neonates with sepsis, asphyxia, and prematurity/low birthweight were managed. Newborn care corners existed within or adjacent to the labour room in all the facilities and were largely unutilized spaces in most of the facilities. Resuscitation bags and masks were available in four out of six facilities, with a predominant lack of masks of both sizes. Two CHCs in Chhatarpur did not have suction device. The average knowledge score amongst service providers in resuscitation was 76% and, in the remaining ENC domains, was 78%. The corresponding average skill scores were 24% and 34%, highlighting a huge contrast in knowledge and skill scores. This disparity was observed for all levels of providers assessed. While knowledge domain scores were largely satisfactory (>75%) for the majority of providers in domains of kangaroo mother care and breastfeeding, the scores were only moderately satisfactory (50-75%) for all other knowledge domains. The skill scores for all domains were predominantly non-satisfactory (<50%). The findings underpin the need for improving the existing ENC services by making newborn care corners functional and enhancing skills of service providers to reduce neonatal mortality rate in India.

Airway management in a patient with large antrochoanal polyp

Anesthetic management of patients with large antrochoanal polyps needs anticipation and adequate preparation for the associated problems. Presenting as nasal polyps, these may mislead and cause unexpected problems in ventilation as well as intubation. We present a case of a large antrochoanal polyp leading to bilateral nasal obstruction undergoing general anesthesia for polypectomy. A brief review of literature is included

Anesthetic management for removal of a huge intra-abdominal tumor: a case report

Large ovarian tumors are not very uncommon in rural India and developing countries, due to delayed reporting by the patients to the scarce healthcare facilities available, hence anesthesiologists must be aware of the anesthetic challenges that one may have to face in these cases. We report perioperative anesthetic management for a large ovarian tumor which was successfully removed. The tumor weighed 32 kg with a fluid volume of 15 lit

Social and Behavioural Science Teaching in Medicine and Public Health in India.

The importance of social determinants on health has been consistently highlighted in public health debates. However, this has not been the case in the sphere of medical or public health education. This review paper aims to discuss the status and problems associated with teaching social and behavioural sciences in medicine and public health programs in India. A country like India requires a medical / public health manpower that is responsive to social reality and sensitive to the role of social determinants in shaping health and health-inequity. Although social and behavioural sciences form a part of the curriculum in undergraduate and postgraduate medical, public health and health management programs, the space made available for such are limited. The problem rests on the institutional structures through which these programs are offered and on issues such as the way medicine is practiced vis-à-vis the patient and overriding emphasis on doctors in professional hierarchy in public health practice and research. In most medical institutions social and behavioural sciences (SBSs) are taught by people with no formal training in these disciplines. Correspondingly, the priority given to students is too low. Absence of efforts to make a tangible connection between social science learning and medical / public health practice, lack of well-defined career opportunities and professional dominance of mainstream medical disciplines over others are some of the reasons for this low priority. Problems also reside in the degree of heterogeneity in content, vastness of scope, diversity in perspectives within each discipline, and a lack of standardized curriculum and reading materials.

Dimensions of Nutritional Vulnerability: Assessment of Women and Children in Sahariya Tribal Community of Madhya Pradesh in India.

Background: Tribal communities are “at risk” of undernutrition due to geographical isolation and suboptimal utilization of health services. Objectives: The objective of this study was to assess the nutritional status of Sahariya tribes of Madhya Pradesh (MP), India. Materials and Methods: A cross-sectional study was conducted in villages inhabited by Sahariya tribal community (specifi cally women in reproductive age group and children under 5 years) in three districts of MP. Dietary surveys, anthropometric and biochemical assessments were carried out and descriptive statistics on the socio-economic and nutritional profi le were reported. Association between household (HH) food security and nutritional status of children was carried out using the logistic regression. Strength of effects were summarized by odd’s ratio. Results: Chronic energy defi ciency and anemia was observed in 42.4% and 90.1% of women respectively. Underweight, stunting and wasting among under fi ve children were 59.1%, 57.3% and 27.7% respectively. Low food security was found in 90% of HHs and the odds of children being underweight and stunted when belonging to HHs with low and very low food security was found to be signifi cant (P = 0.01 and 0.04 respectively). Calorie, fat, vitamin A, ribofl avin, vitamin C and folic acid intake among women was lower than recommended dietary allowance. Infant and young child feeding practices were suboptimal. Awareness on nutritional disorders and utilization of nutrition and health services was poor. Conclusion: A high prevalence of undernutrition and dietary defi ciency exists among Sahariyas. System strengthening, community empowerment and nutrition education may play a pivotal role in addressing this.

Transforming Public Health Education in India Through Networking and Collaborations: Opportunities and Challenges.

A competent and motivated health workforce is indispensable to achieve the best health outcomes possible through given available resources and circumstances. However, apart from the shortages and unequal distribution, the workforce has fallen short of responding to the public health challenges of 21st century also because of primarily the traditional training of health professionals. Although, health professionals have made enormous contributions to health and development over the past century, the 20th century educational strategies are unfi t to tackle 21st century challenges. One of the key recommendations of the Lancet Commission on Education of Health Professionals is to improve health through reforms of professional education by establishing networks and partnerships which takes advantage of information and communication linkages. The primary goal of this manuscript is to highlight the potential of networks and partnerships in advancing the agenda of educational reforms to revitalize public health education in India. It outlines the current status and expanding scope of public health education in India, existing networks of public health professionals and public health education institutions in the country, and opportunities, advantages and challenges for such networks. Although, we have networks of individuals and institutions in the country, there potential to bring about change has still not being utilized fully and effectively. Immediate collaborative efforts could be directed towards designing and adaptation of competency driven curriculum frameworks suitable of addressing public health challenges of 21st century, shifting the current focus of curriculum to multidisciplinary public health outlook, developing accreditation mechanisms for both the programs and institutions, engaging in creating job opportunities and designing career pathways for public health professionals in public and private sector. These efforts could certainly be facilitated through existing networks.

Courses in reproductive and child health in India: An overview.

Defining the human resource needs for providing quality maternal, newborn, and child health services across such a large and diverse population country like India is truly challenging. The effective response to significant challenges and increased requirements of evidence-based effectiveness of the public health projects on maternal and child health is putting pressure on existing program managers to acquire new advanced academic training and information. The data regarding the existing courses on reproductive and child health and related fields in the country were obtained by a predefined search made on the Internet through the Google search engine in December 2011. The collected data were the name and location of the institution offering the respective course, theme, course duration, course structure, eligibility criteria, and mode of learning. In India, around 15 institutes are offering certificate/postgraduate diploma courses on maternal and child health either as a regular program or through distance education program. The admission procedure for each institute is independent of others. The courses vary in terms of duration, eligibility criteria, and fee structure. Conceptualizing an educational initiative in response to national demands for increased workforce capacity to eliminate key medical and nonmedical educational barriers and financial and nonfinancial barriers to advanced academic preparation would enhance the quality of services available in the region.

Landscaping biostatistics education in India.

Biostatistics plays an important role in measuring, understanding, and describing the overall health and well-being of a population. Biostatistics as a subject evolved from the application of statistics in various research aspects of biology, biomedical care, and public health. However, with a recent increase in number of health and pharmacy related research, the demand for trained biostatisticians is also increasing. The present paper is an attempt to undertake a situational analysis of biostatistics education in India. A systematic, predefined approach, with three parallel strategies was used to collect and assemble the data regarding training in biostatistics in India. Our study results show that there is paucity of programs providing specialized training in biostatistics in India. Only about 19 institutions in India are offering various courses in biostatistics/medical statistics/health statistics/biometry. It is important to look into the current capacity building initiatives in this domain. Some other means for giving importance to biostatistics could be by making it a separate branch/specialization in a majority of the institutions, particularly in medical colleges.

Emerging need for health policy teaching in India.

The core functions of public health agencies at all levels of government are identified as assessment, policy development, and assurance. However, the public health agencies in India are struggling with issues of access, inefficiency, and inequity. There has been failure in terms of health service delivery by public sector. Health Policy is being increasingly recognized as a discipline that has much to offer developing countries in addressing the problems related to policy, governance, and regulatory failure. However, the information about skill-oriented courses on health policy especially from the context of translating public health science into policy action is incomplete and limited. This paper attempts to address this knowledge gap and stimulate discussion in this direction.

Tracking Survival of Institutional Births for Neonatal Period- Feasibility at District Hospitals.

We assessed the feasibility of involving routine district health system personnel in tracking survival of institutional births for neonatal period in two district hospitals (Nagaur in Rajasthan and Chhatarpur in Madhya Pradesh) for the month of March 2010. A centralized district level tracking system was used in Nagaur, whereas in Chattarpur, block-wise tracking of births was performed. A total of 607 live births were tracked with 17 identified neonatal deaths. Prematurity and infections were commonest causes of deaths with majority occurring within first week of life. The block-wise approach resulted in identifying extra neonatal deaths.

History and evolution of public health education in India.

In order to respond to the changing paradigm of public health challenges, India needs adequately trained public health professionals. Public health education is a tool to create public health professionals. Public health education in India is at cross-roads on several fronts. Traditionally, public health education in India was offered through medical schools and was open for medical graduates only. However, recently the country has witnessed an emergence of institutions offering public health programs to nonmedical background graduates. An examination of the history and current status of public health education can provide us with an insight into the evolution of the discipline in the country. This is important as in order to respond to the public health education challenges in the present time, we need to understand the historical directions taken by the discipline in the past. This review captures how the public health education efforts in the country have been aided by concerted actions within the discipline and by an enabling environment and a positive intent at the national level, whereby we can better understand the context for the recent developments in Indian public health.

Qualitative research in applied situations: Strategies to ensure rigor and validity.

Traditionally, qualitative studies are founded on interpretative and constructive epistemology. The process of data collection in these studies is longer and intensive. This helps to build a strong rapport with the community, hence enabling to capture the field as naturally as possible. These characteristics provide an ample scope to take care of quality and validity of data. However, in applied situations, data collection is often a truncated activity. This robs away a number of taken-for-granted strengths of traditional qualitative research methods: No time is spent on rapport building; holism is left behind, instead we engage in selection; we focus narrowly on specific phenomenon of concern, divorced from its context; analysis does not evolve out of an iterative process. In this paper, we aim to discuss some of the issues related to rigor and quality of such studies and strategies available to address them.

Clinico-pathological Profile of Oesophageal Dysphagia.

Introduction: Dysphagia can cause significant morbidity and mortality, especially in the elderly and the paediatric population. The study was undertaken to determine the clinico-pathological profile of the patients diagnosed with oesophageal dysphagia in a rural tertiary care hospital of India. Methods: This cross sectional, descriptive study was carried out in the ENT Department of Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra. Patients attending the ENT Out Patient Department during 2009 and later diagnosed as cases of oesophageal dysphagia formed the statistical sample. Results: Out of 61 patients, 37 were male and 24 female. Majority of the patients belonged to age group 41-50 years (24.6%), were farmer by occupation (31.1%) and belonged to middle socioeconomic status (34.4%). Pain (throat, retrosternal or epigastric) was the most common (70.5%) presenting complaint. For 39.3% study subjects, the presenting complaint was 3 to 6 months old. Barium swallow study revealed a positive finding in 74.1% (n=40/54) patients, with carcinoma of oesophagus (27.8%) as the most common aetiology, followed by motility disorders and benign strictures. Oesophagoscopy detected lesions in 49 (90.74%) cases and like barium swallow, it also detected carcinoma oesophagus as the most common cause of oesophageal dysphagia. Reflux oesophagitis was the most common form of the oesophagitis and the microbiological examination and culture of samples of 14 patients diagnosed with any form of oesophagitis showed Candida albicans in 21.4%. Conclusion: Dysphagia is a common presenting complaint in the ENT clinic. There is a male preponderance with incidence of malignancy rising with age. Barium swallow may be used as the first line of investigation; however, oesophagoscopy gives a better diagnosis.

Health care delivery practices in the rural part of the Yavatmal district regarding IUD insertion.

A cross-sectional survey of Cu T users in a rural area of the Yavatmal district was carried out using stratified sampling, to identify interventions that can improve intrauterine device (IUD) service provision processes and their acceptance. The average age at Cu T insertion was 23.8 years. Cu T acceptance with one child was 55.5%. 80.8% of Cu Ts were inserted within 10 days of menstruation, while there were no post-partum Cu T insertions. 51.8% Cu Ts were inserted in PHC's. At the time of the survey, 48.2% users already have their Cu T removed. Only 22.7% couples utilized some alternate contraception after Cu T removal. Post-discontinuation contraceptive use was lower in a tribal area. 30% Cu T acceptors received less than two health checkups. 78.8% (58.1% in a tribal area and 84.9% in a non-tribal area) beneficiaries received information about Cu T from health workers. Only 6.6% Cu T acceptors received specific advice of checking the Cu T string. Utilization of private facility was more common among tribals. Reach of health service regarding Cu T need to be improved in tribal areas. Health service providers need to be more proactive, especially about utilization of the immediate post-partum period for Cu T insertion, clients counseling, and follow up of users.