Homologous Assay Development for Detection of Dexamethasone using HRP as Label Enzyme

Background: Dexamethasone is a synthetic corticosteroid similar to cortisol produced naturally by the adrenal glands. As an anti- inflammatory and immunosuppressive agent, it is used in many diseases such as rheumatoid arthritis and allergic anaphylactic shock, and its suppression test to diagnose Cushing's syndrome. Its further use includes its administration before antibiotics in bacterial meningitis, antitumor treatment, for treatment of glucocorticoid resistance, Addison抯 disease, and congenital adrenal hyperplasia. The drug is abused by using it in animal husbandry as a growth promoter and in horse sports to enhance their performance. Methods: In this study, the development of homologous ELISA using Dexamethasone-21-hemisuccinate (DEX-21-HS)-Bovine serum albumin antiserum and Dexamethasone-21-hemisuccinate (DEX-21-HS)-Horseradish peroxidase enzyme conjugate has been done. The n-hydroxysuccinimide ester method was used to prepare the immunogen and enzyme conjugate. Results: The sensitivity 0.25 ng/mL, affinity 2.8x10-8 L/mol and ED50 4.98 ng/mL of the assay were found. The cross-reactivity of the assay was checked and found with three steroids (Corticosterone- 1.13%, Progesterone- 2.25% and Prednisolone- 6.3%) out of 48 structurally related steroids. Then, analytical variables of the developed assay were studied, such as recovery (98.55% to 105.08%), precision (Inter and Intra- assay coefficient of variation <9.28%), correlation (R2= 0.98) by utilizing a commercially available Dexamethasone kit for comparison. Conclusion: This study concluded that low-cost indigenous ELISA for Dexamethasone had been developed, which can give results within 75-80 minutes.

In-vitro Anti-hyperglycemic Evaluation of Hydroalcoholic Extract of Delonix regia Bark

Anti-hyperglycemic agents is a substance that helps a person with diabetes control their level of glucose (sugar) in the blood. It includes insulin and oral anti-hyperglycemic agents. Diabetes is a metabolic disorder characterized by increased blood glucose levels leading to other major complications. Thus, obtaining these anti hyperglycemic agents through easily available flora is necessary. Delonix regia , a tree cultivated worldwide, has also been used as traditional medicine in various disorders. Aim of the project work was to evaluate the anti-hyperglycemic activity in the hydroalcoholic extract of D. regia bark for the treatment of hyperglycemia. The collected bark was dried, powdered and extracted through cold maceration method. The extract was further concentrated to obtain a gummy mass of the hydroalcoholic extract. The extract was subjected to phytochemical analysis through conventional chemical tests and GC-MS. After the identification of the phytoconstituents, they were studied for their clinically proven properties. In-vitro anti-hyperglycemic studies were carried out through assays like alpha-amylase inhibition assay and alpha-glucosidase inhibition assay. The results of the extract were compared with results of standard acarbose. The IC 50 standard values in alpha-amylase inhibition assay and ?-glucosidase inhibition assay were 98.77 and 84.33 ?g/mL, respectively. The IC 50 values of hydroalcoholic extract of D. regia bark in alpha-amylase and alpha-glucosidase inhibition assay were 167 and 116.31 ?g/mL, respectively. From the study, the hydroalcoholic extract of bark of D. regia exhibit anti-hyperglycemic activity compared to standard acarbose.

IDENTIFICATION AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF ENTEROBACTER SPECIES BY VITEK-2 SYSTEM ISOLATED FROM VARIOUS CLINICAL SPECIMEN IN GOVT MEDICAL COLLEGE KOTA (RAJASTHAN)

Background: Enterobacter were proposed as a genus in 1960 by Hormaeche and Edwards based on the division of the former genus Aerobacter into motile, ornithine decarboxylase (ODC)–positive strains (Enterobacter) and nonmotile ODC-negative strains (Klebsiella). The Vitek-2 system is the second generation of Vitek and offers a more sophisticated model of data analysis as well as a fully automated process for card identification, organism suspension dilution and card filling. To study Aim and Objectives: identification and antimicrobial susceptibility pattern of Enterobacter species by Vitek-2 system isolated from various clinical samples. Material and Methods: A total of 100 Enterobacter species obtained from various clinical samples like urine, pus, sputum, endotracheal aspirate and body fiuids (pleural, ascitic, peritoneal and CSF) etc. of patients received at Department of Microbiology, Government Medical College & Associated Group of Hospitals, Kota during a period of approximately 1 year from May 2021 to May 2022 were taken for the identification and Antibiotic sensitivity testing by Vitek-2 system. Out of 100 Enterobacter isolates, 69% w Result: ere E.cloacae and 31% were E.aerogenes. Antimicrobial susceptibility results of Enterobacter species revealed the susceptibility of 56.41% for Nitrofurantoin, 69% for Piperacillin/ Tazobactam and 72% for Cefoperazone/ salbactam. Enterobacter seems to be emerged with increasi Conclusion: ng resistance to multiple antibiotics.

Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety

Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.

New cost-effective human leukocyte antigen testing algorithm for screening of human leukocyte antigen-matched related donor in thalassemia major patient pretransplant workup: A single-center study from resource-constrained settings

Introduction: India has a huge disease burden of thalassemia major with an estimated 40 million carriers and over a million thalassemia major patients. Very few patients are optimally treated, and the standard of care “hematopoietic stem cell transplant” (HSCT) is out of reach for most patients and their families. The cost of HSCT is significant, and a substantial proportion of it goes to human leukocyte antigen (HLA) testing of family members (HLA screening) in hope of getting a matched related donor (MRD) for HSCT. The aim of this study was to establish that a new proposed testing algorithm of HLA typing would be more cost-effective as compared to the conventional HLA screening within MRD families for possible HSCT. Material and Methods: Buccal swab samples of 177 thalassemia patients and their prospective family donors (232) were collected. Using a new HLA testing algorithm, samples were tested for HLA typing in a sequential manner (first HLA-B, then HLA-A, and finally HLA-DR) using the sequence-specific oligonucleotide probe method on the Luminex platform. Results: The new sequential HLA-A, HLA-B, and HLA-DRB1 testing algorithm showed a 49.1% reduction in cost compared to the conventional HLA testing algorithm. Furthermore, 40 patients (22.59%) were found to have HLA-MRD within the family among other samples that were tested. Conclusion: The new HLA testing algorithm proposed in the present study for identifying MRD for HSCT resulted in a substantial reduction in the cost of HSCT workup.

Dacryocystectomy: A fibrin glue-assisted subfascial excision

This article describes a technique of dacryocystectomy involving dissection within the subfascial plane, in which the lacrimal sac fascia is preserved and the orbital fat remains undisturbed. The lacrimal sac cavity was directly injected with Tisseel fibrin glue mixed with trypan blue. This led to sac distension and facilitated its separation from surrounding periosteal and fascial attachments. Staining the lacrimal sac epithelium improved definition of the mucosal lining. Transverse sections of the lacrimal sac specimen were histologically analyzed, which confirmed that dissection was completed within a subfascial plane. The technique herein described facilitates en bloc excision of the lacrimal sac without breaching the fascial plane that separates the sac from orbital fat.

Efficacy and safety of topical 2% rebamipide ophthalmic suspension in dry eye disease at tertiary care centre

Purpose: To evaluate the effect and side effects of topical 2% rebamipide ophthalmic suspension in dry eye disease. Method: This prospective randomized case control study included total 80 patients (40 cases and 40 controls) of dry eye. Symptoms were graded according to OSDI scoring system and specific tests for dry eye included Tear film breakup time (TBUT), Schirmer’s test, Fluorescein corneal staining (FCS), Rose Bengal staining) were performed. Case group received 2% rebamipide ophthalmic suspension four times daily and control group given carboxymethylcellulose 0.5% four times daily. The follow ups had done at two, six and twelve weeks. Results: The maximum numbers of patients were between 45-60 years. Patient with mild moderate and severe OSDI Score shows marked improvement. Mild TBUT score showed improvement but statistically not significant (P value-0.34). In moderate and severe TBUT Score statistically significant improvement (P value- 0.0001, 0.0001). In all grade FCS shows statistically significant improvement with p value-0.0001, 0.0001, and 0.028 respectively. Schirmer’s test score in all cases had shown improvement but statistically not significant and P value were 0.09, 0.07, and 0.07 respectively. In mild, moderate and severe Rose Bengal staining statistically significant improvement (P value -0.027, 0.0001, and 0.04) .The only side effect was dysgeusia (10% patients). Conclusion: Rebamipide 2% ophthalmic suspension showed significant improvement in symptoms and signs of dry eye. It able to modify epithelial cell function, improve tear stability, and suppress inflammation suggests that it may be a first drug of choice for severe dry eye disease.

Dodecanoic acid & palmitic acid disarms rifampicin resistance by putatively targeting mycobacterial efflux pump Rv1218c

Background & objectives: Drug-resistant tuberculosis (TB) jeopardizes the treatment process with poor outcomes. Efflux pumps (EPs) belonging to the ABC transporter family in Mycobacterium tuberculosis confer resistance to rifampicin (RMP) besides genetic mutations thus serving as a target for a potential adjunct therapeutic inhibitory molecule. Rv1218c is one such pump that was previously reported to be active in multidrug-resistant TB clinical isolates. Methods: In this study, the inhibition potential of Rv1218c-EP was tested on 8 molecules that were shortlisted by in silico methods. These molecules were subjected to the minimum inhibitory concentration (MIC) determination, checkerboard drug combination assay, ethidium bromide-DNA binding assay, and in vitro and ex vivo cytotoxicity assay. Results: Based on the outcome of the study, two molecules dodecanoic acid (DA) and palmitic acid (PA) were found to be potential enough to decrease the MIC of RMP by 8 to 1000 folds against multidrug-resistant clinical isolates and Rv1218c expressing recombinant Mycobacterium smegmatis. Interpretation & conclusions: These molecules were also found to reduce the time taken by RMP to kill these drug-resistant Mycobacteria to 48 h, unlike control isolates that survived more than 240 h of RMP exposure. The functional concentration of both molecules was non-toxic to the epithelial and blood mononuclear cells. With further comprehensive scientific validation, PA and DA could be recommended as adjunct therapeutic molecules with first-line anti-TB drugs to treat drug-resistant TB.

Risk of Childhood Obesity in Children With High Birth Weight in a Rural Cohort of Northern India

Objective: To compare the risk of early childhood obesity (BMI zscore of ?+2SD) among children of more than 7 years of age with a birth weight of more than 3500 g to a birth weight of 2500- 2999 g. Methods: Retrospective birth cohort study among children of 7 to 10 years of age in 22 villages of Himachal Pradesh with notexposed (birth weight: 2500 to 2999 g) and exposed (> 3500 g) group. Results: A total of 379 and 377 participants were enrolled in notexposed and exposed group, respectively. Adjusted relative risk (aRR) between exposed and high BMI (>+2SD) was 4.9 (95%CI: 1.3-17.5) adjusted for mean age, gender, mean years of schooling, consumption of butter, fruits, vegetables, and indoor playing. Conclusion: High birth weight (>3500 g) increases and normal birth weight decreases the risk of childhood obesity up to five times in rural India.

Safety and efficacy of low-energy small incision lenticule extraction for the correction of myopia and myopic astigmatism: A retrospective analysis

Purpose: To determine the safety and efficacy of low?energy settings in small incision lenticule extraction (SMILE) for correcting myopia and myopic astigmatism. Methods: We included patients aged ?18 years with the myopia of ?0.5 to ?10 D and myopic astigmatism of ?0.5 to ?5 Dcyl in this retrospective case series performed at a private eye hospital in South India. All patients had preoperative best?corrected visual acuity of LogMar 0.0 ± 0, with stable refraction for 1 year and normal corneal topography. Ocular surface disease and other pathology cases were excluded. The repetition rate of the laser was 500 kHz, and the pulse energy was 110 nJ. The lenticule diameter was set at 6.5 mm, cap diameter was 7.20 mm, and intended cap thickness was 110–130 ?. The spot distance was 4.5 ?m. All patients were evaluated immediately postoperation and on postoperative days 1, 8, and 30. Results: Overall, 541 eyes were included. The mean patient age was 25.03 ± 4.1 years. The mean spherical error was ?3.76 ± 1.84 Ds. The mean cylinder was ?1.24 ± 0.91. The mean spherical equivalent of refraction was ?4.22 ±1.94 D. The logMAR on postoperative day 1 was 0.0 ± 0. The mean spherical equivalent at 1 month was 0.28 ± 1.06 D. There was no loss of Snellen’s lines after the procedure. The mean spherical equivalent of refraction to the target was 95% within ± 0.50 D. The postoperative astigmatism was within 0.5 Dycl. No intraoperative complications of SMILE including retained lenticule fragments, tears of incision, or improper dissection occurred. Conclusion: Low?energy settings in SMILE are safe and effective in correcting myopia and myopic astigmatism including high cylinders (>3 Dcyl).

EVALUATION AND PROGNOSTIC CORRELATION OF ACUTE PANCREATITIS USING CT SEVERITY INDEX

Background: Of all abdominal emergencies, pancreatitis is one of the most complicated and clinically dif?cult. The preferred imaging technique for determining the severity of acute pancreatitis and its consequences is computed tomography (CT). To evaluate the clinical outcome of acute pancreatitis and prognostic Aim: correlation based on the CT severity index. We included 30 patients with suspected acute pancreatitis Settings and Design: attending department of Radio Diagnosis, KVG medical college and hospital during the study period (January 2022 to May 2022). All the patients were evaluated by contrast enhanced CT. The severity of pancreatitis was scored using CT severity index (Balthazar), modi?ed severity index (Mortele) and revised Atlanta classi?cation and the cases were classi?ed into mild, moderate and severe. The outcome parameters studied were Length of hospital stay, Need for surgery or percutaneous intervention, incidence of infection or organ failure and death. The age group of patients was 16 to 69 years with Results: maximum patients (36%) between 25 and 35 years. Majority were males (81%). According to Modi?ed CT Severity Index, 15% patients had mild, 42% patients had moderate and 43% had severe pancreatitis. Majority of the cases (44%) were categorized as severe pancreatitis according modi?ed Mortele CT score. Majority of the cases were categorized as mild pancreatitis according Balthazar CTSI score and revised Atlanta classi?cation. 38% patients are considered to have end organ failure. Hepatic failure is the most common system failure seen in 22% patients. 36% patients had evidence of systemic infection. 10% patients required surgical interventions. The score is simpler to calculate and the inter-observer variability is Conclusions: decreased using the modi?ed CT severity index.

Usage Pattern of Fixed-dose Combinations at ICMR Network of Rational Use of Medicine Centres across India: Recommendations for Policymakers and Prescribers

Aim: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. Methods: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. Results: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Conclusion: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Blind docking of 4-Amino-7-Chloroquinoline analogs as potential dengue virus protease inhibitor using CB Dock a web server-Supplemenntary data

Currently, there is no approved drug to combat dengue. Various quinoline derivatives are known for potential antimalarial, antiviral activities, etc. In the present work docking between 4-Amino-7-Chloroquinoline analogs was performed with dengue virus NS2B/NS3 protease using CB dock, a web server. Lys74, Ile165, Val147, Asn152, Asn167, Trp83 and Leu149 amino acid residues were found to be in contact with designed 4-Amino-7-Chloroquinoline analogs. Different modes of binding like hydrogen bonding, hydrophobic interactions, etc with designed compounds improve potential anti-dengue characteristics in silico. ADME results are in acceptable range.

Blind docking of 4-Amino-7-Chloroquinoline analogs as potential dengue virus protease inhibitor using CB Dock a web server

Currently, there is no approved drug to combat dengue. Various quinoline derivatives are known for potential antimalarial, antiviral activities, etc. In the present work docking between 4-Amino-7-Chloroquinoline analogs was performed with dengue virus NS2B/NS3 protease using CB dock, a web server. Lys74, Ile165, Val147, Asn152, Asn167, Trp83 and Leu149 amino acid residues were found to be in contact with designed 4-Amino-7-Chloroquinoline analogs. Different modes of binding like hydrogen bonding, hydrophobic interactions, etc with designed compounds improve potential anti-dengue characteristics in silico. ADME results are in acceptable range.

RELIGIOUS LIBERTY

Almost all the countries in the world guarantee freedom of religion in some form or the other. Such a guarantee assumes special importance in a multi- religion country like India which owes its religious diversity to history rather than any recent or contemporary phenomena. Religion is a volatile issue in India and religious conversions add more to the volatility of the issue therefore various state governments have enacted anti-conversion laws with the purported aim of preventing conversions brought about by coercion or inducements. Such laws have been a subject of intense criticism and have been alleged as infringing on one's right to freedom of religion. The paper examines the issue of religious conversion in the light of existing constitutional provisions, judicial pronouncements, and secularism and through the lens of contemporary political philosophy

Chemical constituents and strong larvicidal activity of Solanum xanthocarpum among selected plants extracts against the malaria, filaria, and dengue vectors

Background & objectives: The role of mosquitoes is instrumental in the transmission of various diseases. Mosquitoeborne diseases account for a significant share of the global burden of total infectious diseases. Vector control is the principal method for the control of these mosquito-borne diseases. Plant-derived insecticides serve as an effective alternative to chemical insecticides. The present study has been undertaken to assess the larvicidal potential of methanol and petroleum ether extracts of leaves of Solanum xanthocarpum, Parthenium hysterophorus, Manihot esculenta, and Chamaecyparis obtusa. Methods: Larvicidal activity was tested against the early four-stage instar larvae of laboratory-reared susceptible strains of the malaria vector, Anopheles stephensi, dengue fever vector, Aedes aegypti, and the lymphatic filariasis vector, Culex quinquefasciatus at 20 to 120 ppm concentrations. Further, liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectroscopy (GC-MS) analyses were carried out to identify the bioactive compounds present in the methanolic leaf extracts of Solanum xanthocarpum for designing a larvicidal product in future. Results: After 72 h of exposure high larvicidal activities were observed in methanolic and petroleum ether leaves extract of S. xanthocarpum against An. stephensi, Ae. aegypti and Cx. quinquefasciatus. The larvicidal activities for methanol and petroleum ether leaf extract of S. xanthocarpum with LC50 = 09.201 and 12.435 ppm and LC90 = 21.578 and 27.418 ppm for An. stephensi; LC50 = 11.450 and 10.026 ppm and LC90 = 26.328 and 22.632 ppm for Ae. aegypti and LC50 = 12.962 and 13.325 ppm and LC90 = 26.731 and 30.409 ppm for Cx. quinquefasciatus, respectively, were found to be most effective. GC-MS analysis revealed 43 compounds, amongst these phytol (13.09%), 3-allyl-2- methoxy phenol (9.55%), (9Z, 12Z)-9, 12-octadecadienoyl chloride (7.93%), linoleic acid (5.45%), alpha-tocospiro B (5.08%) and hexadecanoic acid (4.35%) were identified as major compounds. Interpretation & conclusion: Present work showed that leaf extracts of S. xanthocarpum are a source of potential natural candidate that possess several phytochemicals which can be explored further for the development of ecologically safer mosquito control products.

Plataforma de monitoreo y evaluación para HEARTS en las Américas: hacia la mejora de los programas de control de la hipertensión a nivel poblacional en la atención primaria de salud / Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health care / Plataforma de monitoramento e avaliação do programa HEARTS nas Américas: melhoria dos programas de controle da hipertensão de base populacional na atenção primária à saúde

RESUMEN HEARTS en las Américas es el programa insignia de la Organización Panamericana de la Salud para acelerar la reducción de la carga de enfermedades cardiovasculares (ECV) mediante la mejora del control de la hipertensión y la prevención secundaria de las ECV en la atención primaria de salud. Es necesaria una plataforma de monitoreo y evaluación (M&E) para ejecutar el programa, establecer puntos de referencia y notificar a los responsables de las políticas. En este artículo se describen las bases conceptuales de la plataforma de M&E de HEARTS, como los principios de diseño del software, la contextualización de los módulos de recopilación de datos, la estructura de los datos, la presentación de información y la visualización. Se escogió la plataforma web District Health Information Software 2 (DHIS2) para ejecutar el ingreso de los datos agregados de los indicadores de resultados, procesos y factores de riesgo estructurales de las ECV. Además, se eligió PowerBI para la visualización de datos y la elaboración del panel de control para el análisis del desempeño y las tendencias más allá del nivel de los centros de atención médica. El desarrollo de esta nueva plataforma de información se centró en el ingreso de datos de los centros de atención primaria de salud, la presentación oportuna de datos, las visualizaciones y, en última instancia, el uso activo de los datos para impulsar la toma de decisiones en la ejecución del programa con equidad y la mejora de calidad de la atención. Además, se evaluaron las enseñanzas extraídas y las consideraciones programáticas con la experiencia del desarrollo de software de M&E. Lograr el apoyo y la voluntad política es esencial para desarrollar y poner en marcha una plataforma flexible en múltiples países que sea contextualmente específica según las necesidades de las diversas partes interesadas y los niveles del sistema de atención de la salud. La plataforma de M&E de HEARTS brinda apoyo para la ejecución del programa y muestra las limitaciones estructurales y gerenciales, así como las brechas en la atención. Esta plataforma será fundamental para monitorear e impulsar nuevas mejoras a nivel de la población en lo que respecta a las ECV y otras enfermedades no transmisibles relacionadas.

ABSTRACT HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.

RESUMO A iniciativa HEARTS nas Américas é o principal programa da Organização Pan-Americana da Saúde para acelerar a redução da carga de doenças cardiovasculares (DCV) por meio do melhoramento do controle da hipertensão e da prevenção secundária de DCV na atenção primária à saúde. Uma plataforma de monitoramento e avaliação (M&E, na sigla em inglês) é necessária para a implementação do programa, para fazer a avaliação comparativa e para informar os formuladores de políticas. Este documento descreve as bases conceituais da plataforma de M&E do HEARTS, incluindo princípios de design de software, contextualização dos módulos de coleta de dados, estrutura de dados, relatórios e visualização. A plataforma baseada na web do District Health Information Software 2 (DHIS2) foi escolhida para implementar a inserção de dados agregados de indicadores de fatores de risco estruturais, processos e desfechos de DCV. Além disso, o PowerBI foi escolhido para a visualização de dados e para fazer o dashboard da análise de desempenho e tendências para além do nível da unidade de saúde. O desenvolvimento desta nova plataforma de informações teve como foco a inserção de dados da unidade de atenção primária à saúde, a notificação oportuna de dados, visualizações e o uso ativo dos dados para orientar a tomada de decisões para a implementação equitativa do programa e a melhoria da qualidade do atendimento. Além disso, as lições aprendidas e as considerações programáticas foram avaliadas por meio da experiência do desenvolvimento do software de M&E. Fomentar vontade política e apoio é essencial para desenvolver e implantar uma plataforma flexível em vários países, que seja contextualmente específica para as necessidades das diferentes partes interessadas e níveis do sistema de saúde. A plataforma de M&E do HEARTS ampara a implementação do programa e revela limitações estruturais e gerenciais, bem como lacunas na atenção à saúde. A plataforma de M&E do HEARTS será central para monitorar e impulsionar mais melhorias no nível populacional em DCV e outras doenças não transmissíveis.