ABSTRACT
Background: To determine the superiority of the combination of endoscopic retrograde cholangiopancreatography (ERCP) and digital single-operator cholangioscopy (DSOC) in the same sitting over the individual modality alone in patients with indeterminate biliary strictures. Materials and Methods: A randomized study enrolled 60 adult patients with biliary strictures who were randomized into two groups: ERCP + DSOC and ERCP/DSOC. Histopathologic or cytologic assessment was performed in terms of benign, indeterminate, or malignant nature of the strictures. Procedural adverse events were documented. Accuracy in terms of sensitivity (Sn), specificity (Sp), and predictive value [positive (PPV) and negative (NPV)] were noted. Results: As per final diagnosis, in ERCP/DSOC group, there were 12 (40%) benign cases and 18 (60%) malignant cases, and in group ERCP + DSOC, there were 8 (26.67%) benign cases and 22 (73.33%) malignant cases. ERCP/DSOC labeled 16 (53.33%) patients as benign, 8 (26.67%) as malignant, and 6 (20%) as indeterminate, while ERCP + DSOC labeled 8 (26.67%) as benign, 17 (56.67%) as malignant, and 5 (16.67%) as indeterminate. The Sn, Sp, PPV, and NPV of ERCP/DSOC were 44.4%, 75%, 100%, and 56.25%, and for ERCP + DSOC was 77.27%, 62.50%, 100%, and 62.5%, respectively (P = 0.033). Side effects were statistically similar in both the groups (P > 0.05). Conclusion: To conclude, the combination of ERCP with DSOC is safe and effective with higher diagnostic sensitivity (77.27%) in comparison to standard ERCP or DSOC alone (44.4%) for the diagnosis of biliary strictures.
ABSTRACT
Various nanostructures of ZnO such as nanowires, sea urchin like and nano needles were grown using rapid thermal chemical vapor deposition technique (RTCVD), in oxygen ambient. For the growth of such structures, oxygen pressure was kept as 0.1 Torr whereas the chamber base pressure was 10(-5) Torr. The growth temperature was varied from 600 degrees C to 850 degrees C, which resulted in morphological variations. X-ray diffraction measurement revealed the hexagonal wurtzite structure of ZnO preferably oriented in [001] direction, which was further confirmed by high-resolution transmission electron microscopic (HRTEM) observations. X-ray photoelectron spectroscopy (XPS) analysis suggests the presence of Zn 2p and O 1s. Raman E2 high peaks at approximately 434 cm(-1) has the highest intensity compared to other modes supports XRD results. Presence of low E2 peaks at approximately 330 cm(-1) indicates defects and oxygen vacancies.
ABSTRACT
BACKGROUND: Under the National Vector Borne Disease Control Program, the Enhanced Malaria Control Project (EMCP) with World Bank assistance was implemented in India, in the eastern state of Orissa. AIMS: This article tries to analyze the possible reasons for the poor performance of EMCP in a few states of India. SETTINGS AND DESIGN: The eastern state of India is taken as a case study for looking into systemic, human resource, and logistics related issues that could explain the poor performance of EMCP in a few states of India. MATERIALS AND METHODS: Field visits were made to some selected EMCP areas in the state of Orissa. Operational issues-related implementation of various components of the project were scrutinized. STATISTICAL ANALYSIS: Not Applicable. RESULTS: While the project was highly successful in a few states of India, it had limited success in some states. It was learnt that the honorarium meant for Fever Treatment depot [FTD] work was divided among all the malaria workers. In high-risk areas, presumptive radical treatment was being carried on by malaria workers for every case of fever. Using Rapid Diagnostic Tests (RDTs) in such areas seemed to have no relevance. The laboratory technician ignored malaria work, due to a high work load and no additional incentive. In the Primary Health Centers (PHCs) the Medical officers had either not visited the village under indoor residual spray or symbolically visited only five to six houses. Cement tanks had to be built for larvivorus fish breeding. However, they had not been mad. CONCLUSIONS: The success of a public health program is dependent more on project implementation, management, monitoring, and evaluation of project activities than the volume of financial resource allocation.
