Correction: Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers.

[This corrects the article DOI: 10.1371/journal.pone.0157831.].

Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers.

OBJECTIVE: A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures. METHODS: Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster) were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a) experienced illness in the past 30 days, (b) had illness lasting longer than 30 days, (c) were hospitalized in the past 365 days, or (d) had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles. RESULTS: The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2). Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was 16.6% less for acute care, 15% less for hospitalization and 50% less for childbirth than in the private healthcare facilities. Out-of-pocket expenditure was mostly on medicines followed by diagnostic and laboratory tests. Among households experiencing hospitalization, 56.5% had incurred catastrophic expenditures, which was significantly higher in the poorest compared to richest household expenditure quartile (p <0.002). CONCLUSIONS: Expenditure on healthcare remains high in Punjab state of India. Efforts to increase utilization of the public sector could decrease out-of-pocket healthcare expenditure.

Synthesis, antifungal and antibacterial activity of novel 1,2,4-triazole derivatives.

A large number of 1,2,4-triazole-containing ring system have been incorporated into a wide variety of therapeutically interesting drug candidates including anti-inflammatory, central nervous system stimulants, antianxiety, and antimicrobial agents. To overcome the rapid development of drug resistance, new agents should preferably have chemical characteristics that clearly differ from those of existing agents. Thus led to the design and synthesize the new antimicrobial agents. A novel series of Schiff bases based on of 4-(benzylideneamino)-5-phenyl-4H-1,2,4-triazole-3-thiol scaffold was prepared by heating thiocarbohydrazide and substituted benzoic acid and subsequently, treating with substituted benzaldehydes. Seventeen derivatives were synthesized and were biologically screened for antifungal and antibacterial activity. The newly synthesized derivatives of triazole showed antifungal activity against fungal species, Microsporum gypseum; and antibacterial activity against bacterial species, Staphylococcus aureus. It was observed that none of the compounds tested showed positive results for fungi Candida albicans fungi Aspergillus niger, nor against bacterial strain Escherichia coli. Strong antifungal effects were obtained for the synthesized compounds against M. gypseum and were superior or comparable to standard drug ketoconazole. Similarly, all of the synthesized compounds exhibit strong antibacterial activity against S. aureus and were superior or comparable to standard drug streptomycin. It was found that among the triazole derivatives so synthesized, six of them, showed antifungal activity superior to ketoconazole while one of them, showed antibacterial activity superior to streptomycin. Thus, these can be the potential new molecule as an antimicrobial agent.

Chalcone derivatives as potential antifungal agents: Synthesis, and antifungal activity.

Much research has been carried out with the aim to discover the therapeutic values of chalcone derivatives. Chalcones possess wide range of pharmacological activity such as antibacterial, antimalarial, antiprotozoal, antitubercular, anticancer, and antifungal agents etc. The presence of reactive α,ß-unsaturated keto group in chalcones is found to be responsible for their biological activity. The rapid developments of resistance to antifungal agents, led to design, and synthesize the new antifungal agents. The derivatives of chalcones were prepared using Claisen-Schmidt condensation scheme with appropriate tetralone and aldehyde derivatives. Ten derivatives were synthesized and were biologically screened for antifungal activity. The newly synthesized derivatives of chalcone showed antifungal activity against fungal species, Microsporum gypseum. The results so obtained were superior or comparable to ketoconazole. It was observed that none of the compounds tested showed positive results for fungi Candida albicans nor against fungi Aspergillus niger. Chalcone derivatives showed inhibitory effect against M. gypseum species of fungus. It was found that among the chalcone derivatives so synthesized, two of them, that is, 4-chloro derivative, and unsubstituted derivative of chalcone showed antifungal activity superior to ketoconazole. Thus, these can be the potential new molecule as antifungal agent.

Peptide based macrocycles: selective histone deacetylase inhibitors with antiproliferative activity.

Histone deacetylase inhibitors (HDACi) have been enthusiastically investigated as a novel generation of chemotherapeutics for cancers usually called as epigenetic therapeutics. Histone deacetylases have been found to influence cellular function by catalyzing the removal of acetyl groups from ε-N-acetylated lysine residues of several protein substrates including histones, transcription factors, α-tubulin, and nuclear importers. Cyclic peptides represent the most structurally complicated and diverse class of histone deacetylase inhibitors. Each subtype of the Histone Deacetylase (HDAC) family perform a distinct role in the gene expression and cyclic peptides with their plentiful set of surface contacts, zinc binding group and macrocyclic cap, can target enzyme precisely through adequate modulation of the amino acid configurational and structural assortment. The present article summarizes current status of different peptide based macrocyclic compounds being developed as HDACi for the treatment of cancer.

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures.

BACKGROUND: To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity. METHODS: From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months. RESULTS: Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3-16) cm and the operation time 170 (140-210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications. CONCLUSIONS: Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.

Modulation of drug release from nanocarriers loaded with a poorly water soluble drug (flurbiprofen) comprising natural waxes.

In this study, flurbiprofen (FLB) Solid Lipid Nanoparticles (SLN) composed from a mixture of beeswax and carnauba wax, Tween 80 and egg lecithin as emulsifiers have been prepared. FLB was incorporated as model lipophilic drug to assess the influence of matrix composition in the drug release profile. SLN were produced by microemulsion technique. In vitro studies were performed in Phosphate Buffered Saline (PBS). The FLB loaded SLN showed a mean particle size of 75 +/- 4 nm, a polydispersity index approximately 0.2 +/- 0.02 and an entrapment efficiency (EE) of more than 95%. Suspensions were stable, with zeta potential values in the range of -15 to -17 mV. DSC thermograms and UV analysis indicated the stability of nanoparticles with negligible drug leakage. Nanoparticles with higher beeswax content in their core exhibited faster drug release than those containing more carnauba wax.

Do the dimensions of the distal phalanges allow suture anchor fixation of the flexor digitorum profundus? A cadaver study.

This study was done to identify whether the dimensions of the distal phalanges allow suture anchor fixation of the flexor digitorum profundus tendon. Forty pairs of hands were dissected to measure the anteroposterior and lateral dimensions of distal phalanges of all digits. The mean anteroposterior depth of the distal phalanx at the insertion of the tendon was found to be 4.7 mm for the little finger, 5.4 mm for the ring finger, 5.9 mm for the middle finger, 5.4 mm for the index finger and 6.9 mm for the thumb respectively. The commonly available anchors and drill bits for fingers were found to be suboptimal for anchoring the flexor digitorum profundus tendon to the distal phalanx of the little finger. The drill bits used for these anchors were found to be too long for the little fingers and some ring and index fingers.

In Vitro Anti-oxidant Effect of Vitamin E on Oxidative Stress Induced due to Pesticides in Rat Erythrocytes.

An attempt was made to study the antioxidant property of vitamin E in endosulfan and chlorpyrifos toxicity. Erythrocytes were collected from healthy rats and exposed to 1 ppm endosulfan and chlorpyrifos pesticides individually and also along with vitamin E treatment. Results showed that endosulfan was more toxic in comparison of chlorpyrifos. Activities of superoxide dismutase and catalase were significantly decreased, while lipid peroxidation and glutathione-S-transfarase were increased in comparison to the control values. The results of the present study suggest that vitamin E acts as an effective antioxidant for endosulfan and chlorpyrifos pesticide toxicity, in reducing oxidative stress burden.

TB control in India--efforts, challenges and priorities.

TB control is a long battle. Since after the discovery of Mycobacterium tuberculosis by Robert Koch in 1882, endeavours have been made at different levels in the form of control measures like establishment of open-air sanatorium in Tilonia (Ajmer) in 1906, Tuberculosis Dispensary in Mumbai (1917), Tuberculosis Association of India (1939), Mass BCG campaign (1951), Establishment of Chemotherapy centre (TRC Chennai), National Sample Survey (1955-58), National Tuberculosis Institute Bangalore (1961), Developments of National Tuberculosis Programme (1962), Review of NTP by GOI, SIDA & WHO (1992), pilot testing of RNTCP (1993), implementation/expansion of RNTCP across the country (1997-2006). Shopping for health, marketing for TB diagnosis and treatment, MDR-TB, XDR-TB, TB-HIV combination and partnership related challenges are crucial and needs to be addressed .Universal access to DOTS for cutting the chain of transmission of bacilli, reducing the morbidity and mortality and reversing the TB epidemic in line with Millennium Development Goals, surveillance of notification, drug resistance, TB/HIV coinfection, operation researches, development of vaccines, immune therapeutic agents against tuberculosis and expansion of package of care to MDR-TB and XDR-TB would be the priorities for eradicating TB as a public health problem.

A comparative study of kinetic and connectionist modeling for shelf-life prediction of Basundi mix.

A ready-to-reconstitute formulation of Basundi, a popular Indian dairy dessert was subjected to storage at various temperatures (10, 25 and 40 °C) and deteriorative changes in the Basundi mix were monitored using quality indices like pH, hydroxyl methyl furfural (HMF), bulk density (BD) and insolubility index (II). The multiple regression equations and the Arrhenius functions that describe the parameters' dependence on temperature for the four physico-chemical parameters were integrated to develop mathematical models for predicting sensory quality of Basundi mix. Connectionist model using multilayer feed forward neural network with back propagation algorithm was also developed for predicting the storage life of the product employing artificial neural network (ANN) tool box of MATLAB software. The quality indices served as the input parameters whereas the output parameters were the sensorily evaluated flavour and total sensory score. A total of 140 observations were used and the prediction performance was judged on the basis of per cent root mean square error. The results obtained from the two approaches were compared. Relatively lower magnitudes of percent root mean square error for both the sensory parameters indicated that the connectionist models were better fitted than kinetic models for predicting storage life.

Can IMA-RNTCP stop TB by 2050?

Tuberculosis has been with mankind since time immemorial. No other disease has so much sociological, economic and health significance as tuberculosis. In the poorly functioning tuberculosis control programme, the ratio of incidence to prevalence may be as high as 1: 3.5. Experience and observations from both developed and developing countries have demonstrated that if case detection and cure rates in smear positive cases are consistently achieved to 70 % and 85 % respectively, the incidence would decline to 5% annually while prevalence decline very rapidly, being reduced to less than half of its previous level within three years. Since RNTCP India is based on scientific principles of DOTS strategy, its effective clinical and public health management, committed and co-ordinated efforts of public and private partners (IMA) would certainly lead to decline the prevalence (already declined from 586/1,00,000 in 1990 to 185/1,00,000 population in 2008 - 68 % reduction), mortality rate from 42/ 1,00,000 in 1990 to 21/1,00,000 in 2015 (already reduced to 24/1,00,000 in 2008 - 43 % reduction) as target set under indicator 23 of TB-related Millennium Development Goal. This kind of impact would result in halting and reversing TB Incidence to pave way for future effective control of TB, which may not remain a public health problem by 2050. Thus, TB control is a winnable battle.

Phytochemical investigation and evaluation of in vitro free radical scavenging activity of Tabernaemontana divaricata Linn.

We evaluate the in vitro free radical scavenging activity of the leaves of Tabernaemontana divaricata Linn. Petroleum ether, ethanol and aqueous extracts of T. divaricata were prepared with successive extraction in a soxhlet apparatus. Each extract was selected to study the free radical scavenging activity by superoxide scavenging assay method. It was found that the aqueous extract contained carbohydrates, glycosides, amino acids, flavonoids, tannins, alkaloids, and steroids, and the ethanolic extract contained glycosides, amino acids, flavonoids, tannins, alkaloids and steroids. The ethanolic extract of T. divaricata showed 58.7 +/- 0.62% inhibition in the superoxide scavenging model. The aqueous extract also showed almost similar activity (54.9 +/- 0.53% compared to the ethanolic extract), while petroleum ether extract showed poor inhibition of superoxide scavenging activity. All extracts showed the dose- and time-dependent inhibition of the superoxide scavenging activity.

A rare complication of a metacarpophalangeal joint replacement in a rheumatoid hand: a case report.

Metacarpophalangeal joint replacement is one of the most common surgery performed for rheumatoid hand deformities. The systemic and progressive nature of rheumatoid arthritis and other inflammatory arthritis make isolated assessment and treatment of metacarpophalangeal joint joints challenging.Extensive joint involvement and systemic nature of the illness has an impact in the prognosis of the illness. The long term outcome of the surgical procedure depends on how best the illness is controlled. Technical aspects of the surgery in patients with rheumatoid arthritis can be widely variable and can make implant arthroplasty challenging. We present a case report of an unusual presentation of a rare complication following metacarpophalangeal joint replacement performed 17 years ago.

Increased yield of smear positive pulmonary TB cases by screening patients with > or =2 weeks cough, compared to > or =3 weeks and adequacy of 2 sputum smear examinations for diagnosis.

BACKGROUND: RNTCP recommends examining three sputum smears for AFB from Chest Symptomatics (CSs) with cough of > or =3 weeks for diagnosis of Pulmonary TB (PTB). A previous multi-centric study from Tuberculosis Research centre (TRC) has shown that the yield of sputum positive cases can be increased if duration of cough for screening was reduced to > or =2 weeks. Other studies have shown that two smear examinations are adequate for diagnosis of smear positive PTB . To validate the above findings, a cross sectional multi-centric study was repeated in different settings in five geographical areas in India. METHODS: Three primary and secondary level health facilities with high out-patient attendance were selected from two Tuberculosis Units (TU) in each of the 15 selected districts to screen about 10,000 new adult outpatients from each state. For patients who did not volunteer history of cough, symptoms were elicited using a structured simple questionnaire. All the CSs were referred for sputum examination. RESULTS: A total of 96,787 out-patients were registered. Among them 69,209 (72%) were new adult out-patients. Using > or =2 weeks of cough instead of 3 weeks as the criterion for screening, there was an overall increase of 58% in CS and 23% increase in the detection of smear-positive cases. Among 211 patients, 210 were positive at least by one smear from the initial two specimens. Increase in the work-load if 2 smears were done for patients with cough of > or =2 weeks cough were 2 specimens (i.e. 13 to 15) per day for an adult OPD of 150. CONCLUSION: The yield of sputum positive PTB cases can be improved by screening patients with > or =2 weeks cough and two specimens are adequate for diagnosis.

Treatment of keloids and hypertrophic scars using bleom.

BACKGROUND: Numerous treatments have been attempted with unsatisfactory results using either single or combination modalities for treatment of keloids and hypertrophic scars. The aim of our study was to determine the effectiveness and safety of bleomycin in the treatment of hypertrophic scars and keloids. METHODS: This study included 50 patients with keloids and hypertrophic scars. Bleomycin was administered through multiple superficial puncture technique. Three applications were given at intervals of 15 days each, followed by a fourth and final application 2 months after the last application. Final results were read 2 months after the last application. Results were evaluated according to change in size as follows: Group Response. a. Complete flattening (100% regression). b. Significant flattening (75-99% regression). c. Adequate flattening (50-74% regression). d. Inadequate flattening (less than 50%). Patients were assessed for any complication of bleomycin (systemic as well as local) and recurrence of keloids and hypertrophic scars. Regular follow-up for side-effects was done for 18 months. RESULTS: Out of 50 patients, complete flattening was observed in 22 cases (44%); significant flattening in 11 cases (22%); and adequate flattening was observed in 7 cases (14%). Only 10 cases (20%) did not show any satisfactory flattening. Pruritus was relieved completely in 40 patients (88.88%). Recurrence was seen in seven patients. CONCLUSION: Bleomycin is easy to administer, is cheap, shows high regression rate, and has minimum complication and recurrence. Thus, it can be used as the first-line treatment modality for management of keloids and hypertrophic scars.

Estimation of BCL-2 protein in carcinoma of the breast and its clinical correlation in locally advanced breast cancer.

UNLABELLED: The change in expression of apoptotic markers (Bcl-2 and Bax proteins) brought about by various chemotherapeutic regimens is being used for its predictive value for assessing response to neoadjuvant chemotherapy (NACT) in locally advanced breast carcinoma (LABC). AIMS: (1) Estimation of Bcl 2 expression in LABC, (2) Any change in Bcl 2 expression following chemotherapy in LABC, (3) Any relation of Bcl 2 estimation to changes in size of tumor, nodal status, age, and menopausal status. SETTINGS AND DESIGN: This was a prospective study of 120 cases of LABC. MATERIALS AND METHODS: All cases were subjected to biopsy and the tissue was evaluated immunohistochemically for apoptotic marker Bcl-2 family protein. Three cycles of NACT were given at three-weekly intervals. Modified radical mastectomy was performed and the specimens were re-evaluated for any change in the Bcl-2 family protein. The clinical response and immunohistochemical response were correlated and compared. STATISTICAL ANALYSIS: Coefficient of correlation was calculated by Pearson correlation coefficient (P-value). RESULTS: Clinical response, as measured by reduction in the tumor size, was observed in 81 (67.5%) patients while immunohistochemical response was observed in 67 (55.8%) patients. Correlation between immunohistochemical and clinical response was found to be statistically significant (P = 0.02). Nodal response was seen in 72 (60%) patients. There were no patients in the N o group; 22 (53.7%) of the N 1 patients were down-staged to N o , while 19 (46.3%) remained N 1 . In patients with N 2 disease, 11 (13.9%) were down-staged to N o status, 39 (49.4%) were down-staged to N 1 status, and 29 (36.7%) did not show any response. Immunohistochemical response was observed in 67 (55.8%) patients. Correlation between immunohistochemical and nodal responses was also found to be statistically significant (P = 0.03). CONCLUSIONS: This significant positive correlation between clinical and immunohistochemical responses highlights the importance of apoptotic marker Bcl-2 family protein in predicting the response of LABC to NACT.

Outcome of Dorsal Onlay Buccal Mucosa Substitution Urethroplasty in Long Strictures of Anterior Urethra.

BACKGROUND: The surgical treatment of adult anterior urethral strictures is constantly evolving. Controversy exists over the best means of reconstructing the anterior urethra. METHODS: Twelve patients underwent buccal mucosal urethroplasty for long segment anterior urethral stricture between 2003 and 2005 . Eleven patients with a salvageable urethral plate were treated with one stage dorsal onlay urethroplasty, using a perineal or circumcoronal incision. One patient with a severely scarred urethral plate underwent two-stage urethroplasty. RESULTS: At a mean follow up of 14.2 months (range 2 to 26) one (8.3%) patient had short recurrent stricture, which was treated with optical urethrotomy. The mean maximal urine flow rate improved from 8.3 ml/sec to 18.1 ml/sec after the surgery. There were no donor site complications. All patients had a normal slit like meatus and none had chordee or erectile dysfunction. CONCLUSION: In long stricture of anterior urethra, dorsal onlay buccal mucosa urethroplasty provides excellent intermediate term results with a normal, wide caliber urethra.

Dextrans--potential polymeric drug carriers for suprofen.

Dextrans are clinically useful biodegradable polysaccharide macromolecules and have been utilized as carriers for suprofen. Conjugates of suprofen were synthesized by preparing their acylimidazol derivatives which were condensed in situ with dextrans of different molecular weights (40000, 60000, 110000 and 200000). The structures of the synthesized conjugates were confirmed by IR and NMR spectroscopy. The degrees of substitution obtained were between 7.5 and 9.0%. The molecular weight was determined by the Mark-Howin Sakurada viscosity equation. Hydrolysis was studied in different buffer solutions (pH 1.2, 7.4, 9.0) and 80% human plasma (pH 7.4) and followed first order kinetics. Much faster hydrolysis was observed at pH 9.0 compared to pH 7.4 buffer solution and 80% human plasma (pH 7.4). Biological evaluation for acute and chronic anti-inflammatory activity was performed and the results were found to be comparable with the parent drug. The ulcerogenic index of conjugates showed a remarkable reduction compared to the parent suprofen.