Diffusion of CCTs from Latin America to Asia: the Philippine 4Ps case / Difusión de los PTC de América Latina en Asia: el caso del programa 4Ps en Filipinas / Difusão dos PTCs da América Latina para a Ásia: o caso do programa 4Ps nas Filipinas

Abstract The purpose of this study is to understand the role of international and domestic actors, ideas and processes in the diffusion of public policies. It argues that existing studies on the subject do not provide an adequate explanation of the mechanisms through which diffusion takes place, nor do they sufficiently address the roles of actors affecting the policy transfer process. We address these shortcomings by studying the diffusion of conditional cash transfer (CCT) programs from Brazil and Mexico to the Philippines over the past decade. We use the concept of an 'instrument constituency' to delineate and trace the various actors and channels involved in the diffusion of CCTs. The case study shows that these groups of actors dedicated to the articulation, adoption and expansion of particular policy instruments are central players in transnational diffusion of policies and offer a robust explanation of the phenomenon.

Resumen El objetivo de este estudio es comprender el papel de actores, ideas y procesos nacionales e internacionales en lo que respecta a la difusión de políticas públicas. Se observa que los estudios existentes sobre ese tema no ofrecen una explicación adecuada sobre los mecanismos por los cuales se da esa difusión; asimismo, no abordan definitivamente los papeles de los actores involucrados en el proceso de transferencia de políticas. En virtud de ese panorama, este trabajo se propone contribuir mediante el estudio del proceso de difusión - durante la última década - de los programas de transferencia monetaria condicionada (PTC) de Brasil y de México en las Filipinas. Además, usamos el concepto de "grupo de defensa de instrumento de política pública" para delinear y comprender los diversos actores y canales involucrados en la difusión de los PTC. El estudio de caso muestra que esos grupos de actores dedicados a la articulación, adopción y expansión de políticas específicas son centrales para su difusión en otros países y para explicar ese fenómeno con más propiedad.

Resumo O objetivo deste estudo é compreender o papel de atores, ideias e processos nacionais e internacionais no que diz respeito à difusão de políticas públicas. Observa-se que os estudos existentes sobre esse tema não oferecem uma explicação adequada sobre os mecanismos pelos quais essa difusão ocorre, bem como não abordam definitivamente os papéis dos atores envolvidos no processo de transferência de políticas. Em virtude desse quadro, este trabalho busca contribuir por meio do estudo do processo de difusão, ao longo da última década, de programas de transferência condicionada de renda (PTCs) do Brasil e do México para as Filipinas. Ainda, usamos o conceito de "grupo de defesa de instrumento de política pública" para delinear e compreender os diversos atores e canais envolvidos com a difusão dos PTCs. O estudo de caso mostra que esses grupos de atores dedicados a articulação, adoção e expansão de políticas específicas são centrais para sua difusão para outros países e para explicar esse fenômeno com maior propriedade.

Association of genetic markers with cardiomyopathy.

Background: Cardiomyopathy is an anatomic and pathologic diagnosis associated with muscle or electrical dysfunction of the heart. Cardiomyopathies represent a heterogeneous group of diseases that often lead to progressive heart failure with significant morbidity and mortality. Cardiomyopathy and myocarditis resulted in 443,000 deaths in 2013 up from 294,000 in 1990. Objective: The main objective of the present study is to observe the association of cardiomyopathy and genetic markers such as red cell enzymes namely, Esterase D [ESD] and Super oxide dismutase [SOD] and plasma proteins namely, Haptoglobin [HP] and Group specific component [GC] systems. Methods: In the present study, fifty cases presenting cardiomyopathy and fifty cases of age and sex matched healthy controls were included. Red cell enzymes were determined by standard agarose gel electrophoresis. Plasma samples were typed using PAGE electrophoresis. The statistical significance of differences between patients and controls were tested. Analysis of the data was carried out using Epi Info 5 software. Relative risk was calculated by the random-effects method. For odds ratio, confidence interval was calculated. The significance level was 5%. Results: The inter group heterogeneity for ESD and SOD of red cell enzymes and GC system of plasma proteins was found to be a significant value (ESD: χ2 =10.2564; d.f. = 2; 0.01>p>0.001; SOD: χ2 = 11.1120; d.f. = 2; 0.01>p>0.001; GC: χ2 = 15.5044; d.f. = 2; p>0.001), when observed between cardiomyopathy patients and controls. Thus, all the examined groups were deviating from Hardy-Weinberg equilibrium indicating a significant association between cardiomyopathy and these red cell enzymes and plasma protein markers. There was a predominant occurrence of Haptoglobin 2 phenotype in patients when compared to controls. Risk estimates show significant association with both ESD and GC systems with an increased risk of 100% and more, indicating that individuals with ESD (2-2 and 2-1) and GC (2-1) phenotypes are more likely to get the disease when compared with the other phenotypes of the ESD and GC systems. Conclusions: Out of seven genetic markers, four markers (ESD, SOD, HP and GC) are found to be significant i.e. they show some relation with the cardiomyopathy which influences the disease. Furthermore studies on genetic markers, to be attempted in future, would certainly enlighten us to assess the role of these polymorphic systems in different cardiomyopathies.

Dermatological adverse reactions to cancer chemotherapy.

The new targeted anticancer drugs as well as the older traditional chemotherapy agents are associated with adverse effects on skin, hair, nails and mucosa. These toxic effects can cause great distress to the patient leading to decreased quality of life and interruption in treatment. Aims: To study the mucocutaneous adverse effects of both single and combined chemotherapy regimens in cancer patients. Materials and Methods: We studied 53 cancer patients attending the oncology outpatient department or those admitted in the oncology ward of Father Muller Medical College Hospital, Mangalore between October 2012 and September 2013. The adverse effects of chemotherapy on skin, hair, nails and mucosa were noted. Results: The most common adverse effects observed in the study were nail changes in 33 (62.2%) patients, followed by hair changes in 20 (37.7%) patients, skin changes in 19 (33.9%) patients, and mucosal changes in 2 (3.7%) patients. The skin changes were acneiform rash in 5 (27.7%) patients, xerosis in 4 (22.2%) patients, hyperpigmentation in 4 (22.2%) patients, and toxic epidermal necrolysis, hand foot syndrome, extravasation, erythema nodosum, and supravenous hyperpigmentation in 1 patient each. The most common nail fi nding was melanonychia seen in 26 (78.7%) patients. Hair changes were in the form of anagen effl uvium seen in 20 (37.7%) patients. Mucosal changes seen were pigmentation of tongue and stomatitis in one case each. Limitations: Sample size is small. Conclusions: While these side effects are generally not life-threatening, they can be a source of signifi cant morbidity. Knowledge about the adverse effects of anti-cancer drugs will help in accurate diagnosis and management, thereby improving the quality of life.

Nature Heals: Spontaneous Resolution of Liver Abscess through Hepato-colic Fistula.

Rupture of a liver abscess is a fairly common phenomenon in surgical practice. It is commoner in developing countries like India. Sites of rupture often predict the clinical course of the patient and affect the natural history of the disease, more common being the pleural and peritoneal cavity. Rupture into the bowel with fistulization is a rare phenomenon in liver abscess. Hepato-colic fistulae are being encountered following radiofrequency ablation for hepato cellular carcinoma. This occurring in the setting of liver abscess is highly uncommon. We report the first ever case in English literature, wherein an amoebic liver abscess was complicated by the occurrence of a hepato-colic fistula. The patient was a 48-year-old male who had a liver abscess in a background of alcoholic liver disease. On further investigation, he was found to have abnormal communication between the abscess cavity and the hepatic flexure of the colon. He was managed conservatively followed by spontaneous closure of the fistula.

Study of morbidity pattern and occupational hazards in sweepers working at a municipal teaching hospital in Mumbai.

Background: The International Labour Organization (ILO) estimates that more than 125 million workers are victims of occupational accidents and diseases in a single year. The important morbid conditions detected in the workers include the diseases of the respiratory system and eye, accidents, injuries, cuts and wounds, skin infections, animal bites, etc. Health Care Workers (HCWs) are attributed to the group at highest risk of occupationally acquired blood borne diseases as the result of contact with blood and body fluids. The present study was conducted to assess the morbidity pattern and occupational hazards in the sweepers working at the tertiary care teaching hospital in Mumbai. Methods: A cross-sectional epidemiological study was carried out in the various wards of Lokmanya Tilak municipal medical college & general hospital, Mumbai during the period of January 2008 to May 2009. Total 267 sweepers were interviewed. A pre-designed and pre-tested questionnaire was used to get information regarding the morbidity pattern and occupational hazards in the sweepers. Results: Out of 267, history of acute illness was elicited from 64 (23.97%) employees. 52 (19.47%) sweepers had history of chronic illness. Among the sweepers, 160 (59.9%) had some sort of morbidity present. The morbid conditions found in the sweepers were musculoskeletal disorders 55 (20.6%), hypertension 46 (17.2%), gastrointestinal problem 26 (9.7%), eye disorders 23 (8.6%) and respiratory system diseases 21 (7.9%). The present study showed that, 226 (84.6%) sweepers used some form of personal protective devices regularly and 41 (15.4%) didn’t use regularly. 113 (42.3%) sweepers had needle prick or sharp injury. 74 (65.5%) sweepers had single needle prick or sharp injury & 39 (34.5%) sweepers had repeated needle prick or sharp injury. Conclusions: Periodic examination should be done annually & immediate corrective measures should be taken to protect the health of employees at risk. Stress management principles must be implemented in the sweepers to enhance physical and mental health. There is need for safety training programme for all health workers including sweepers in the hospitals.

The cytokine gene polymorphisms (TNF-α, IL-10 And IFN-γ) and the role of inflammatory cytokines in diabetic neuropathy.

Background: One of the most frequently-occurring micro vascular complications is diabetic neuropathy (DN). Diabetic nephropathy (DN) affects approximately one third of people with type 1 or type 2 diabetes mellitus The objective of the study is an attempt to examine functional SNPs primarily at the position on gene of TNF-α (-308 G/A, rs 1800629), IL-10 (-1082 G/A, rs 1800896) and IFNγ (+874 A/T, rs 62559044) in order to establish their association with peripheral neuropathy patients with type 2 diabetes. Methods: 150 cases presenting Diabetic neuropathy and 160 cases of age and sex matched healthy controls were included in the study. ARMS PCR was done for genotyping of TNF-α (-308), IL-10 (1082 G/A) and IFNγ (+874) polymorphism using allele specific primers for detection of single nucleotide polymorphisms. Analysis of the data was carried out using Epi Info 5 software. In addition, the gene frequencies were estimated and goodness of fit between the observed and expected phenotype frequencies was tested. Multifactor Dimensionality Reduction (MDR) analysis was performed to study case-control data and gene-gene interactions. Results: The results revealed that the chi- square test for heterogeneity for IL-10 system was found to be significant (χ² = 16.2380; d.f = 2; p >0.001) between patients and controls, indicating a significant departure from the HWE. Thus, the test of association of both homogeneity and heterogeneity of IL-10 showed a significant difference, indicating an association of IL-10 with diabetic neuropathy.SNPs at position −308 promoter gene of TNF-α and IFNγ (+874) were not significantly associated with development of Diabetic Neuropathy. Conclusion: This case-control study suggests that IL-10-1082G/G polymorphism is associated with the susceptibility to diabetic neuropathy in type 2 DM patients. IL-10 serves as an important bio marker in Indian population for their susceptibility to Diabetic Neuropathy as it may play a role in alteration of IL-10 production and the inflammatory responses.

Granulomatous cheilitis with granulomatous vulvitis: A rare association.

Granulomatous cheilitis and granulomatous vulvitis are rare disorders characterized by painless swelling of lips and vulva, respectively. Histopathology of both conditions show non-caseating epithelioid cell granulomas in the dermis. Both disorders have been associated with Crohn’s disease rarely. Occurrence of the two conditions in the same patient is extremely infrequent. We hereby report, the association of granulomatous cheilitis with granulomatous vulvitis in a 30-year-old female.

Region-wise gray matter volume alterations in brain of adolescents with attention deficit hyperactive disorder : A voxel based morphometric analysis.

Attention Deficit Hyperactive Disorder (ADHD) is a behavioral neuropsychiatric disorder affecting an estimated 5% of school-age children worldwide with symptoms persisting into adulthood in 80% of cases. Presently clinical diagnosis and treatment of ADHD relies on behavioral disturbances than on detecting underlying defective brain regions. Therapeutic outcome in treatment of ADHD may be more positive if defective brain region in clinically diagnosed ADHD is detected by voxel based morphometric (VBM) analysis that measures voxel-wise global and regional focal volume differences in structural magnetic resonance images (sMRI) of brain. This study was designed to detect any region-specific gray matter (GM) volume defects in sMRI of ADHD adolescents by VBM analysis. Thirty sMRI datasets matched for sex, handedness of adolescents aged between 11.66 and 20.47 years (mean age 16.27±2.48 years) obtained from NeuroImage webpage, were selected (Control n=15; ADHD combined type n=15). These sMRI were analyzed by VBM technique and compared using statistical parametric mapping (SPM). Significant regional GM volume deficits (P<0.05) was specifically identified in left cuneus and middle occipital gyrus in ADHD, after voxel-wise false discovery rate correction over the whole brain compared to matched controls. Deficit of GM volume in occipital cortex detected by VBM analysis in ADHD children, suggests defects of visual processing affecting attention mechanisms.

Effect of organic and inorganic fertilizers on plant height, spread and flower diameter of gaillardia (gaillardia pulchella).

An experiment was conducted to study the effect of organic and inorganic fertilizers on plant height, plant spread and flower diameter of Gaillardia (Gaillardia pulchella). In Gaillardia the plant maximum height was recorded in the plot treated with 100 per cent recommended dose of NPK + press mud at 10 tones ha-1 followed by 75 per cent recommended dose of NPK + press mud at 10 t ha-1 at 45 days and 75 per cent recommended dose of NPK + press mud at 5 tones ha-1 at 15, 30 and 60 days. Highest plant spread was obtained at 30 and 45 days after planting in the treatments which involved 100 per cent recommended dose of NPK + press mud at 10 t ha-1 and at 60 days no significant differences were recorded. The combination of recommended dose of NPK + press mud at 10 t ha-1 produced maximum diameter of flower.

Geriatric Injuries among Patients Attending a Regional Hospital in Shinyanga Tanzania

Abstract:Geriatric injuries pose a major challenge to surgeons and general practitioners in developing countries. The objective of this study was to determine the prevalence; injury characteristics and outcomes of geriatric injury among patients at Shinyanga Regional Hospital in Tanzania. Data was collected using a pre-tested; coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7 of all trauma admissions were studied. The male to female ratio was 1.4:1. Their mean age was 68.5 years (ranged 60-98 years). Premorbid illness was reported in 38.3 of patients. Most injuries were intentional in fifty-three (56.4) patients. Assaults; falls and road traffic crashes were the mechanism of injuries in 52.1; 19.1and 11.7 of cases; respectively. The majority of cases of assault were females accounting for 64.6. The majority of injuries (81.9) occurred at home. Pre-hospital care was recorded in 5.3 of cases. The musculoskeletal (72.3) and head (66.0) regions were commonly affected. Soft tissue injuries (wounds) (89.4) and fractures (52.2) were the most common type of injuries. The majority of patients (90.4) underwent surgical treatment of which wound debridement was the most common procedure performed in 91.8 of cases. Complication rate was 39.4. The mean length of hospital stay was 28.6 days (ranged 1 - 124 days). The length of hospital stay was significantly longer in patients with co-morbidities; long bone fractures and those with complications (P0.05). Mortality rate was 14.9 and it was significantly related to advanced age; presence of pre-morbid illness; high injury severity score; severe head injuries and the need for ventilatory support (P 0.05). In conclusion; traumatic injuries in elderly constitute a major but preventable public health problem in Shinyanga region and contribute significantly to high morbidity and mortality. Urgent preventive measures focusing at the root causes of the injuries and early appropriate treatment is highly needed to reduce the occurrence; morbidity and mortality associated with these injuries

Histiocytosis Syndromes of Childhood: A report of four cases.

Histiocytosis Syndromes of Childhood (HSC) are a group of rare and diverse disorders characterized by aggressive proliferation or accumulation of cells of monocyte - macrophage system of bone marrow. The clinical spectrum of this syndrome is distinctly varied. The exact pathophysiology of HSC is yet to be determined; however, evidence suggests that one of the subtypes, Hemophagocytic Lymphohistiocytosis, is due to decreased Natural Killer cell activity, resulting in increased activation of other T cell subtypes and production of cytokines. We present four cases of HSC managed at our center between October 2008 & February 2010.

Efficient in vitro plant regeneration via leaf base segments of indica rice (Oryza sativa L.).

A reliable and reproducible protocol has been developed for high frequency plant regeneration from 4-5 mm long leaf base segments of 4 days old in vitro germinated seedlings of indica rice (Oryza sativa) cultivar Rasi. The effect of age of seedlings, position of leaf base segments and optimum concentration of 2,4-D on callus induction frequency was investigated with a future aim to use leaf bases for biolistic and Agrobacterium-mediated transformation experiments. Friable, nodular and white to pale yellow embryogenic callus cultures (206 mg fresh weight /explant) were obtained from the first basal segments of rice seedlings on Linsmaier and Skoog (LS) medium supplemented with 2,4-D (11.3 microM) and 3.0 microM thiamine-HCL. Plant regeneration was achieved after the transfer of 54 days old embryogenic callus cultures to Murashige and Skoog (MS) medium supplemented with BAP (2.2 microM) and NAA (0.27 microM). In vitro regenerated plants with multiple shoots and roots transferred to sterile soil in growth chamber and maintained in greenhouse exhibited normal growth and were phenotypically similar to plants germinated from seeds.

Alcohol expectancy responses from first year medical students: Are they prone to alcoholism?

CONTEXT: Modern life style and affluence lead to changes in people's outlook on various habits, including alcohol intake. Some of them will fall prey to the addictive nature of the drink. AIMS: Present study was done to evaluate the responses to comprehensive alcohol expectancy questionnaire (comprehensive effects of alcohol - CEOA) in order to test the tendency towards alcohol intake among the First Year Medical (MBBS) students of our college - that is, to assess the positive or negative reinforcement they would expect if they consumed alcohol. SETTINGS AND DESIGN: The study was done by giving a set of questionnaires to be answered by the students. MATERIALS AND METHODS: Questionnaires of CEOA had 38 responses, in which both negative and positive feelings were represented. All questions were again grouped into four groups of positive and three groups of negative responses. Each question was rated to what degree they agreed, by 4-point Likert-type scale (1 = disagree, 2 = slightly disagree, 3 = slightly agree, 4 = agree). The positive and negative responses were analyzed to group them into agreeing or disagreeing type. STATISTICAL ANALYSIS USED: Analysis of responses by Student 't' test and 2-way ANOVA was done to analyze the results. 'P' RESULTS: Results showed that negative expectancies outweighed positives significantly (2.8017 +/- 0.58554 vs. 2.3055 +/- 0.67604, t = 7.526; P< 0.001.). Females rated the negatives more firmly (P< 0.001). However, there was no statistically significant difference with respect to different religious beliefs, places of origin or incomes of the respondents. An experience of alcohol had a significant effect on the responses where they had stronger positive expectancy, which is an important point revealed in this study. CONCLUSIONS: In this study, we have observed a general acceptance that alcohol could provide positive reinforcement, especially among those who have had a prior experience of intake of alcohol. Thus, this study throws light on whether there is likelihood of youngsters falling into addiction in the later part of their life; hence it can act as a useful predictor for parents, health professionals, social counselors and the society as a whole so that they can take preventive measures against alcohol addiction.

Changes in selected biomarkers in freshwater teleost fish, Cyprinus carpio var. communis exposed to sublethal concentrations of chromium sulphate toxicity.

The toxicity of chromium sulphate on plasma electrolytes (Na+, K+, Cl-) level and Na+, K(+)-ATPase activity of an economically important fish, Cyprinus carpio var. communis was evaluated. During sublethal treatment, plasma sodium level was increased, whereas plasma chloride level decreased throughout the experimental period. Plasma potassium level increased upto 10th day and then declined in the rest of the study period. The Na+, K(+)-ATPase activity decreased upto 15th day of treatment and slowly recovered showing significant increase upto 25th day of treatment. The significant changes in the plasma electrolytes levels and Na+, K(+)-ATPase activity can serve as a valuable biomarker of pollutant exposure and effects.

Management of pyoderma gangrenosum--an update.

Pyoderma gangrenosum is a neutrophilic dermatosis with distinctive clinical manifestations. It is frequently associated with systemic diseases like inflammatory bowel disease, rheumatoid arthritis and myeloproliferative diseases. The etiopathogenesis of pyoderma gangrenosum is still not well understood. Clinically it is classified into ulcerative, pustular, bullous and vegetative types. The diagnosis mainly depends on the recognition of evolving clinical features as there are no specific investigations for the diagnosis. It is essential to exclude other infectious diseases before therapy is initiated as corticosteroids and immunosuppressant therapy are the mainstays in the treatment of this disease. Recently, drugs like tacrolimus, mycophenolate mofetil and infliximab have shown promising results in this condition. Recent concepts regarding the various types of pyoderma gangrenosum and its management are reviewed.

Sparfloxacin induced toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a life-threatening cutaneous adverse drug reaction. TEN is known to occur with the fluoroquinolone class of antibiotics, but only four cases of sparfloxacin induced TEN have been reported to the WHO database. This is another case report of sparfloxacin induced TEN.