Trends in budget allocation for primary healthcare: a decadal perspective on prioritization in Tamil Nadu

The healthcare industry in Tamil Nadu has evolved significantly during the last decade, with changes in budget allocations and policy goals. This article examines the state's health budget from 2013 to 2023, focusing on public health programs and healthcare delivery systems. Examining budgetary trends and allocation patterns sheds light on the complex relationship between resource prioritizing and healthcare outcomes. Key findings indicate a large increase in the state's overall budget, but with variable distribution among health departments. While the directorate of medical education (DME) receives a substantial portion, there are concerns regarding the diminishing distribution of essential healthcare services, particularly within the directorate of preventive medicine and public health (DPH). Despite this, Tamil Nadu's commitment to addressing public health concerns is evident in its purposeful investments in health and wellness centers (HWCs) and in its steps to reduce out-of-pocket costs. According to the recommendations, budget allocations should be reevaluated to ensure equal distribution based on population requirements and illness load. Furthermore, optimizing resource allocation and improving primary healthcare services, notably through enhanced DPH assistance, are critical for maintaining the state's excellent healthcare results. To summaries, Tamil Nadu's healthcare environment is a dynamic interaction of funding allocations, policy agendas, and public health results. As the state navigates changing challenges and opportunities, a data-driven approach to decision-making and a renewed emphasis on outcome-based healthcare programs are critical for improving the well-being of its citizens.

Olfactory tract transection reveals robust tissue-level plasticity by cellular numbers and neurotrophic factor expression in olfactory bulb.

Nervous system lesions are characterized by the loss of neuronal numbers and types. The neurotrophic factor levels in an injured tissue reflect their potential for regeneration. This hypothesis was investigated in olfactory bulb (OB), where olfactory tract was surgically transected disrupting neuronal migration and turnover. The effects were followed with quantification of mitral cells and three neurotrophic factors mRNA levels for 6 weeks. The neuronal numbers decreased by 3rd- and 4th-week in transected OBs followed by their restoration, comparable with that of controls at 5th- and 6th-week. The endogenous levels of three neurotrophic factors – (brain derived neurotrophic factor, insulin growth factor-1 and fibroblast growth factor-2) using qPCR showed increase at 2nd-week by 136-, 8- and 2-fold respectively. Also, there was a significant increase in specific neurotrophic factors at 5th-week and 6th-weeks. The results propose a temporal link between deployment of neurotrophic factors and the plausible restorative events for mitral cell numbers in OB.

Olfactory tract transection in neonatal rats: Evidence for Mitral cell regeneration and restoration of functional connectivity with its targets.

Central Nervous System (CNS) regeneration and repair mechanism are two important aspects of functional recovery in the adult central nervous system following brain and spinal cord injury. Following olfactory tract transection in neonatal rats, functional connectivity between the olfactory bulb and the piriform cortex gets re-established by 120 days. The recovery of the dendritic morphology was associated with the synchronized oscillatory activity between olfactory bulb and piriform cortex. Mitral cells which were regenerated after the transection showed profuse branching, indicative of their undifferentiated state. However, normal dendritic morphology could be seen by 120 days after olfactory tract transection. These results thus provide a supportive evidence for the restoration of the functional connections between the olfactory bulb and the piriform cortex at 120 days.

Gastrointestinal stromal tumors: A 7-year experience from a tertiary care hospital.

Background: Gastrointestinal stromal tumor (GIST), now the most common mesenchymal tumor of the gastrointestinal tract (GIT), has been frequently studied, especially with regard to its successful targeted therapy using imatinib mesylate. Aim: Our aim was to describe the clinicopathological features of a large number of cases from a tertiary care hospital in India and report on the follow-up after treatment of some of the cases, comparing them with series described in the west. Design: This is a retrospective study of cases encountered over a 7-year period (1999-2005). Results: Ninety-two cases of GIST were studied, which made up the largest group (52.8%) of mesenchymal tumors of the GIT, with smooth muscle tumors comprising 38.1%, the next large group. GISTs were almost equally prevalent in the stomach and the small intestine, unlike in most studies where stomach is the most common site. GIST may be considered as a cause of bleeding when upper and lower GI endoscopy is normal. Ninety-five percent of the GISTs were positive for CD117 (KIT), as is known. A majority of them (70.4%) were of the high-risk malignant category, unlike most studies where high-risk tumors make up 30-45%. Histologically, the majority had a pure spindle cell morphology and skenoid fibers were rare. Follow-up of 11 cases, the majority with high-risk tumor, treated with adjuvant imatinib for 6 months after surgical resection showed stable disease for periods from 2 to 5 years. However, 11 cases treated with imatinib for longer than 6 months had a poorer outcome due to recurrent, metastatic, or inoperable disease. Conclusion: In our study of a large number of GISTs, which were equally prevalent in the stomach and small intestine, the majority were of the high-risk malignant category and of pure spindle cell morphology. Limited numbers had follow-up after imatinib therapy, which showed in one group treated for 6 months, after resection of high-risk GIST, stable disease for periods ranging from 2 to 5 years. Molecular studies and larger numbers are required for meaningful conclusions to be drawn.

Protective action of curcumin and vitamin e against the imbalance of electrolytes calcium, sodium and potassium in galactose-induced cataract.

Cataract is a clouding that develops in the crystalline lens of the eye leading to opacity. In this study we investigated the efficiency of curcumin and Vitamin E to regulate the altered levels of Ca+2, Na+ and K+ ions in cataract induced rat lens. Also specific activity of aldose reductase and the total and soluble lenticular protein levels in the lens were compared in treated as well as control groups of rats. The data was analyzed using one-way ANOVA, followed by post hoc test multiple comparisons and Karl Pearson’s correlation. Feeding of rats with Curcumin and Vitamin E had resulted in a significant decrease (p<0.05) in Na+ and Ca2+ concentrations and an increase (p<0.05) in K+ concentration which is otherwise found to be raised in cataractous condition. Also, a decrease in the specific activity of Aldose Reductase was found along with the conservation of total and soluble lenticular protein levels in lens treated with Curcumin and Vitamin E compared to cataract induced lens.

A giant syphilitic aneurysm in a young human immunodeficiency virus sero-positive individual.

A 35-year-old, human immunodeficiency virus sero-positive male presented with huge mediastinal mass for evaluation. After contrast enhanced computed tomography (CECT) angiogram, aneurysm of arch of aorta was diagnosed. The patient also proved to be co-infected with syphilis, which is the aetiological cause of aneurysm in this case. The present report highlights the need to suspect, diagnose and treat dual infections in individuals with high risk behaviour.

Influence of kynurenines in pathogenesis of cataract formation in tryptophan-deficient regimen in Wistar rats.

L-Tryptophan (Trp) is an essential amino acid and its deficiency is involved in various pathologies. In this present investigation an attempt was made to study the role of tryptophan and its metabolites in cataract formation in wistar rats. Rats were divided and maintained in 3 groups, Group A--control; Group B--marginal-tryptophan and Group C--Tryptophan-deficient diet for 3 months. Slit lamp microscope observations indicated lenticular opacities in Group-C (tryptophan-deficient) rats. In the rats that were maintained on tryptophan deficient diet, a decrease in protein content, kynurenines, reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione-s-tranferase (GSTs) and tryptophan-fluorescence intensities and an increase in lipid peroxidation indicative of oxidative stress have been observed. The above changes were normalized in the rats on supplementation of 0.05% tryptophan (Group-B) in their diets. These results suggest that tryptophan-deficiency in the diet leads to an overall significant decrease in kynurenines and levels of antioxidant enzymes (except SOD) in ocular tissue with a concomitant lenticular opacification. The results suggest that diet with adequate tryptophan has protective influence and is of immense benefit in mitigating the changes that may otherwise contribute to the lenticular opacities.

Cumulative antioxidant defense against oxidative challenge in galactose-induced cataractogenesis in Wistar rats.

Natural dietary ingredients are known for their antioxidant activity. Of such, curcumin, the active principle of turmeric, at 0.01% in the diet proved as pro-oxidative in galactose-induced cataract in vivo. The purpose of this study was to investigate the effect of vitamin E (VE), a well-known antioxidant, in combination with curcumin on the onset and maturation of galactose induced cataract. Periodic slit-lamp microscope examination indicated that in combination with vitamin-E, 0.01% curcumin (G-IV) delayed the onset and maturation of galactose-induced cataract. Biochemical analyses revealed that combined treatment of 0.01% curcumin and vitamin-E diet exhibited an efficient antioxidant effect, as it inhibited lipid peroxidation and contributed to a distinct rise in reduced glutathione content. The results indicate that natural dietary ingredients are effective in combination rather than the individual administration as they are complementing each other in reducing the risk of galactose induced cataract.

Expression of nestin--a stem cell associated intermediate filament in human CNS tumours.

BACKGROUND & OBJECTIVES: Nestin is an intermediate filament protein expressed in undifferentiated cells during the development of brain and is considered as a marker for neuroepithelial stem cells. Expression of this protein in various CNS tumour cells suggests the possibility of existence of tumour stem cell modulating the evolution. We carried out an immunohistochemical study to demonstrate the expression of nestin and its co-expression with neuronal and glial intermediate filament and correlate with the grade of malignancy. METHODS: Formalin fixed, paraffin processed sections from two human foetuses, 16 brain tumours of both neuronal and glial lineage and two metastatic tumours were immunostained with polyclonal antibody to nestin. Serial sections from primary brain tumours were also stained with monoclonal antibody to neurofilament (NF) and glial fibrillary acidic protein (GFAP). Fluorescent double labeling was carried out on four cases using laser confocal microscopy, to document co-localization of nestin with other intermediate filaments in the tumour cells. RESULTS: Nestin expression was observed along the paraventricular zone of human foetuses and in brain tumours of both glial and neuronal lineage, of both high and low grades of malignancy. In addition, mature dysplastic spinal motor neurons adjacent to tumour and cerebellar Purkinje cells also expressed nestin along with neurofilament. INTERPRETATION & CONCLUSION: Nestin expression was noted in both low and high grade brain tumours and dysplastic neurons and did not parallel the malignant grade of the tumour. The expression of nestin in tumour cells and dysplastic neurons suggests aberrant expression of antigenically primitive proteins in cells to facilitate remodelling of the cell and migration. More studies are needed to elucidate the concept.

Pulmonary functions in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a common disabling and progressive neuro-degenerative disorder. Morbidity and mortality are frequently associated with pulmonary dysfunction in patients with PD. AIM: To investigate characteristics of pulmonary function test (PFT) abnormalities in patients with PD and to study the effect of levodopa on the PFT findings. METHODS: Pulmonary function testing was performed in 35 patients with PD during 'off' and 'on' state while on levodopa; and 35 matched healthy controls. RESULTS: The forced vital capacity (FVC) (P < 0.001), maximum voluntary ventilation (MVV) (p < 0.001), maximum expiratory pressure (MEP) (p < 0.001), and maximum inspiratory pressure (MIP) (p < 0.001) were significantly reduced in patients with PD compared to controls. There was significant improvement in the PFT values in 'on' state compared to 'off' state. CONCLUSIONS: A restrictive pattern of pulmonary dysfunction is present in patients with PD, which improves significantly with levodopa. The evaluation and rehabilitation of respiratory disturbances should be routinely included in the management of patients with Parkinson's disease.

Protective effect of curcumin during selenium induced toxicity on dehydrogenases in hepatic tissue.

Selenium administration resulted in a marked decrease in the activity levels of the liver succinate dehydrogenase, malate dehydrogenase, and lactate dehydrogenase while pyruvate dehydrogenase increased significantly (P<0.001) in the wistar rat. The degree of decrease of these enzymes was significantly less (P<0.001) when rats were treated with curcumin, a natural constituent Curcuma longa. Curcumin seems to prevent oxidative damage mediated through selenium and protect the dehydrogenases possibly through its anti-oxidative property.

Antioxidant effect of curcumin in selenium induced cataract of Wistar rats.

Wistar rat pups treated with curcumin, a natural constituent of Curcuma longa before being administered with selenium showed no opacities in the lens. The lipid peroxidation, xanthine oxidase enzyme levels in the lenses of curcumin and selenium co-treated animals were significantly less when compared to selenium treated animals. The superoxidase dismutase and catalase enzyme activities of curcumin and selenium co-treated animal lenses showed an enhancement. Curcumin co-treatment seems to prevent oxidative damage and found to delay the development of cataract.

Effect of arsenite on certain aspects of protein metabolism in fresh water teleost, Tilapia mossambica (Peters).

The sublethal toxicity of sodium arsenite on protein metabolism was investigated in teleost fish, Tilalpia mossambica at the end of 24, 48, 72 and 96 h of exposure. Total protein content, free amino acid content and activities of the enzymes aspartate amino transferase (AAT) and alanine amino transferase (ALAT) in liver, gill, brain and muscle exhibited significant (P<0.05) alterations throughout the investigation in relation to that of control. It is suggested that the fish is able to respond to the stressful situations by gearing up the metabolic activity as revealed by the elevated protein, amino acid content and the activities of AAT and ALAT.

Long-term effects of postnatal aluminium exposure on acetylcholinesterase activity and biogenic amine neurotransmitters in rat brain.

The long-term effects of early postnatal exposure to aluminium on acetyl choline esterase (AChE) activity and on biogenic amines were studied in different brain regions. The subjects were eight days old male Wistar rat pups. They were grouped into normal control and aluminium exposed groups. For aluminium exposure, the pups were gastric intubated with aluminium chloride (40 mg/Kg body weight) for two weeks. Control rats were given equal volumes of distilled water. After the treatment, they were rehabilitated for forty days. On the sixtieth day, the rats from both the groups were sacrificed and AChE activity, levels of dopamine, noradrenaline and serotonin were estimated in the cerebral cortex, hippocampus, septum, brainstem and striatum. In the aluminium exposed group: the AChE activity was significantly decreased in the hippocampus, septum, striatum and brainstem; serotonin levels were reduced by 20% in the cortex, hippocampus, septum and striatum; in brain stem, the serotonin level was decreased by 40%. A 60% reduction in noradrenaline levels was observed in the striatum whereas it was reduced by 25% in other regions except in hippocampus. Though dopamine levels were not altered in the cortex, septum and brainstem, they were reduced by 40% in the striatum. The study documents the long-term consequences of exposure to aluminium during the developmental periods.

Symptomatic human rotavirus subgroups, serotypes & electropherotypes in Hyderabad, India.

A total of 352 stool specimens obtained from children under 2 yr of age with acute diarrhoea, between January 1998 and March 1999, were screened for the presence of rotavirus by RNA-PAGE. Symptomatic human rotaviruses were detected in 57 of 352 (16.19%) specimens by RNA-PAGE. These 57 samples were tested for rotavirus double stranded RNA pattern and among these, 46 samples were tested for subgroup and serotype specificities. Among the 46 strains tested, 29 strains were found to be subgroup II and remaining 17 strains were subgroup I, indicating that subgroup II strains are more predominant than subgroup I strains. Subgroup I and II strains were circulating concurrently throughout the study period. Seventeen strains with 'short' RNA pattern and subgroup I specificity could not be assigned as serotype 2 strains as they exhibited cross-reactivity to MAbs specific for more than one serotype. Of the 29 subgroup II strains with 'long' RNA pattern, 16 (55.17%) were serotype 1, 8 (27.58%) were serotype 4. Five (17.24%) showed dual reactivity to serotypes 1 and 3. Our results indicated that serotype 1 and G2-like strains are predominant in Hyderabad. None of the virus strains showed an unusual RNA pattern.

A study of structure of phenomenology of consciousness in meditative and non-meditative states.

Twelve senior Kundalini (Chakra) meditators were assessed during meditation session and non-meditation or control session using Phenomenology of Consciousness Inventory. The data has been analyzed using structural analysis to measure the altered state of consciousness and the identity state by comparing meditative state with non-meditative state. The structural analysis of pattern of consciousness during the meditative state revealed altered experience in perception (percentile rank PR = 90), meaning (PR = 82) and time sense (PR = 87), while positive affect dimension showed increased joy (PR = 73) and love (PR = 67). The imagery vividness (PR = 72), self-awareness (PR = 77), rationality (PR = 73) and arousal (PR = 69) were found to be structurally different from the ordinary state. With regards to identity state meditative experience was found to produce statistically significant changes in terms of intensity in meaning (P < 0.05), time sense (P < 0.05), joy (P < 0.05), love (P < 0.05) and state of awareness (P < 0.01). Our results indicate that long term practice of meditation appears to produce structural as well as intensity changes in phenomenological experiences of consciousness.

2, 4-dichloro phenoxy acetic acid alters monoamine levels, acetylcholinesterase activity & operant learning in rats.

2, 4-Dichloro phenoxy acetic acid (2, 4-D) was given at 100 mg/kg body weight per day by oral intubation from postnatal days 2 to 25 to assess its effect on the levels of norepinephrine (NE), dopamine (DA) and 5-hydroxytryptamine (5-HT) in olfactory bulb (OB), hippocampus (HI), visual cortex (VC), cerebellum (CB) and brainstem (BS). NE levels were increased in OB, HI, VC and BS at 10 days of age. However, by 25 days, NE levels were decreased in OB, HI and VC. DA levels were also increased in OB, HI, VC and CB at 10 days of age and again decreased by 25 days in OB, HI and VC. 5-HT levels were increased in HI, CB and BS at 10 days and in VC and CB at 25 days of age. Reduced acetylcholinesterase (AChE) activity in OB and HI and monoamines in different brain regions at 25 days of age might be responsible for the observed deficits in both acquisition and rate of pedal press response when animals were exposed chronically to 2, 4-D during postnatal brain development.

Subordination induced decrease in 5-hydroxytryptamine and dopamine levels in the frontal cortex--a study using worker-parasite relationship in rats as a model.

Competition for a limited resource appears to be an important factor in natural selection. Such competition when elicited experimentally, leads to the establishment of dominant-subordinate (D-S) relationship between the competitors. The present study was carried out to analyse the effect of D-S relationship on the levels of monoamines, namely, dopamine (DA), 5-hydroxytryptamine (5-HT) and norepinephrine (NE) in various brain regions. The model of D-S relationship selected for this work was a modified worker-parasite paradigm in adult male Wistar rats. The levels of monoamines were estimated in the frontal cortex, the entorhinal cortex, the hippocampus and the septum of the two competitors and a non-competitor control, using high pressure liquid chromatography (HPLC). Levels of DA and 5-HT, but not NE, were found to be lower (P < 0.05) only in the frontal cortex of the subordinate as compared to that of the dominant or the control. These findings are comparable with similar neurochemical changes reported to be caused by some of the known stressors.

Dose-response functions of apomorphine, SKF 38393, LY 171555, haloperidol and clonidine on the self-stimulation evoked from lateral hypothalamus and ventral tegmentum.

The experimental animals were implanted with two bipolar electodes, one in the lateral hypothalamus including medial forebrain bundle (LH-MFB) and other in ipsilateral ventral tegmental area-substantia nigra (VTA-SN) and were trained to press a pedal for self-stimulation. This provided the scope to compare directly the effect of a given dose of a drug on the two reward regions in the same animal in the same testing situation. The current intensity was set to produce intracranial self-stimulation (ICSS) response rates of 50% less than the maximal shaping response rates for the respective animals (M60). Following systemic (intraperitoneal) administration of apomorphine (a dopamine receptor D1/D2 mixed agonist), SKF 38393 (D1 > D3 > D2 agonist), LY 17155 or quinpirole (D3 > D2 and D1) agonist), haloperidol (a DA-D2 antagonist), and clonidine (noradrenaline receptor alpha 2 agonist), the ICSS response rates evoked from LH-MFB and VTA-SN were compared with vehicle or saline-treated animals on the basis of dose-response functions. A dose-dependent inhibitory effect at M50 was observed with apomorphine (0.01-1.00 mg/kg) and haloperidol (0.05-0.30 mg/kg) for both the sites of stimulation. These doses of haloperidol did not produce any motor deficits like catalepsy and muscular rigidity. The dose-response and time-effect functions of SKF 38393 and LY 171555 at M50 showed the facilitation and suppression of ICSS of VTA-SN and LH-MFB respectively. Clonidine (0.05-0.25 mg/kg) also produced inhibitory effect on ICSS rates, but this suppression was of different magnitude with respect to the site of stimulation. These doses of clonidine were in the range that did not prevent active pedal pressing responses. ED50 (the dose required to reduce the ICSS response rate 50% of the rate after administration of vehicle) for LY 171555 was 0.8 and 4.4 mg/kg for the ICSS of VTA-SN and LH-MFB respectively and thus statistically different ED50 for apomorphine was 0.27 and 0.36 mg/kg; and for haloperidol was 0.75 and 0.90 mg/kg for LH-MFB and VTA-SN respectively and thus not different significantly. ED50 for clonidine was 0.25 and 0.08 mg/kg for VTA-SN and LH-MFB respectively and thus statistically different. The two-way analysis of variance (ANOVAR) of interaction of dose-response function of alpha 2 agonist with respect to LH-MFB and VTA-SN showed significant independence in their suppressive effects.