Extracellular vesicle-mediated drug delivery in breast cancer theranostics.

Breast cancer (BC) continues to be a significant global challenge due to drug resistance and severe side effects. The increasing prevalence is alarming, requiring new therapeutic approaches to address these challenges. At this point, Extracellular vesicles (EVs), specifically small endosome-released nanometer-sized EVs (SEVs) or exosomes, have been explored by literature as potential theranostics. Therefore, this review aims to highlight the therapeutic potential of exosomes in BC, focusing on their advantages in drug delivery and their ability to mitigate metastasis. Following the review, we identified exosomes' potential in combination therapies, serving as miRNA carriers and contributing to improved anti-tumor effects. This is evident in clinical trials investigating exosomes in BC, which have shown their ability to boost chemotherapy efficacy by delivering drugs like paclitaxel (PTX) and doxorubicin (DOX). However, the translation of EVs into BC therapy is hindered by various challenges. These challenges include the heterogeneity of EVs, the selection of the appropriate parent cell, the loading procedures, and determining the optimal administration routes. Despite the promising therapeutic potential of EVs, these obstacles must be addressed to realize their benefits in BC treatment.

Road accidents on Indian National highways, ambulance reachability and transportation of injured to trauma facility: Survey-based introspection of golden hour.

Background: The transportation system plays a crucial role in the context of socioeconomic development, whereas the highway infrastructure acts as a base for the transportation system. In recent years, a rich impetus has been given to the development of road infrastructure by Indian governance. There is a need to introspect how well the prevailing highway infrastructure is equipped with emergency rescue management during road accidents. Lack of ambulance service and trauma facilities along the highways results in a steady loss of lives and injuries and increases people's exposure to risks. Objective: This study aims to determine the response time of ambulance reachability to the accident spot on Indian national highways associated with heavy commercial transportation. Also, determining the time to transport the injured to the nearest trauma facility is another factor included as an objective in this investigation. Methods: The study adopted survey-based research, whereby the variables in the questionnaire were designed to record and assess the time for an ambulance to reach the accident spot and, from there, to transport the injured to the trauma management facility on Indian highways. Two hundred twenty-five participants who were either victims/relatives of victims or those involved in the rescue of the injured have participated in the survey. The dates of the accident events were 2017 and 2022. Results: The survey resulted in the identification of two categories of highway accidents. The first category of accidents happened on the highways near city limits/dense settlements, and the second category occurred on the core highways. The percentage of accidents caused on the highways either adjacent to or passing through the city limits/dense settlements was reported to be higher than the accidents on the core highways. Ninety percent of the participants reported successful contact with the ambulance call/service centre, but only ~75% success rate exists for ambulances to reach the accident scene. On the core highways, the time taken for the ambulance to arrive at the accident scene is 25-35 minutes. The results from the survey ascertained that the patients were prioritised for treatment in the nearest hospitals (irrespective of having a trauma facility) at a distance of ~12-20 km, for which the time taken is ~15-25 minutes. Importantly, from the interviews, it is understood that in many cases, these hospitals have further referred to specialty hospitals located in nearby cities or trauma centres with greater facilities. Occasions exist where the injured were taken directly to hospitals 30-40 km from the accident spot, for which the time was more than 40 minutes. Conclusions: The results provide evidence that in either of the accident cases on the highways that are adjacent to/passing through the city limits or on the core highways, the total time for emergency care accessibility is nearly 60 minutes or greater; this implies that in the majority of cases, there is very meagre time left to provide emergency medical care to the needy and injured on the Indian highways to abide by the concept of golden hour. Plausible reforms backed by technology for enabling highways into 'emergency rescuable highways' are highly needed to guarantee a safer and more sustainable transportation system in India.

The Critical Need for Disaster Medicine in Modern Medical Education.

Current escalation of natural disasters, pandemics, and humanitarian crises underscores the pressing need for inclusion of disaster medicine in medical education frameworks. Conventional medical training often lacks adequate focus on the complexities and unique challenges inherent in such emergencies. This discourse advocates for the integration of disaster medicine into medical curricula, highlighting the imperative to prepare health-care professionals for an effective response in challenging environments. These competencies encompass understanding mass casualty management, ethical decision-making amidst resource constraints, and adapting health-care practices to varied emergency contexts. Therefore, we posit that equipping medical students with these specialized skills and knowledge is vital for health-care delivery in the face of global health emergencies.

Lest we forget: Dr Paul Farmer (1959-2022) 'A Global Health Leader at Harvard'.

In the chronicles of medical advancement, Dr Paul Farmer stands out as a transformative figure whose unwavering commitment to healthcare equity has reshaped treatments for the disenfranchised. An American anthropologist and physician, Farmer has had a profound impact on global health which encapsulates a legacy driven by the steadfast belief that healthcare is an inalienable human right. This article explores Farmer's monumental contributions, showcasing how his dedication has revolutionized the landscape of healthcare, particularly for those marginalized and underserved. As the architect of Partners In Health and a guiding force at Harvard Medical School, he fostered a novel paradigm of enduring, community-focused medical care. His unyielding advocacy from Haiti to Rwanda confronted entrenched health disparities and galvanized support for increased access to primary and secondary care. His poignant critiques and policy recommendations during the COVID-19 crisis highlighted his relentless pursuit of health justice - advocating for equitable vaccine distribution and tackling racial health disparities. His scholarly works on overlooked health dilemmas and the urgency of global healthcare reflect a legacy that transcends his lifetime. While his passing is deeply felt, Farmer's visionary ethos continues to inspire, beckoning us toward a more equitable healthcare horizon.

Evolving perspectives in reverse cardio-oncology: A review of current status, pathophysiological insights, and future directives.

Cardiovascular disease (CVD) and cancer are leading causes of mortality worldwide, traditionally linked through adverse effects of cancer therapies on cardiovascular health. However, reverse cardio-oncology, a burgeoning field, shifts this perspective to examine how cardiovascular diseases influence the onset and progression of cancer. This novel approach has revealed a higher likelihood of cancer development in patients with pre-existing cardiovascular conditions, attributed to shared risk factors such as obesity, a sedentary lifestyle, and smoking. Underlying mechanisms like chronic inflammation and clonal hematopoiesis further illuminate the connections between cardiovascular ailments and cancer. This comprehensive narrative review, spanning a broad spectrum of studies, outlines the syndromic classification of cardio-oncology, the intersection of cardiovascular risk factors and oncogenesis, and the bidirectional dynamics between CVD and cancer. Additionally, the review also discusses the pathophysiological mechanisms underpinning this interconnection, examining the roles of cardiokines, genetic factors, and the effects of cardiovascular therapies and biomarkers in cancer diagnostics. Lastly, it aims to underline future directives, emphasising the need for integrated healthcare strategies, interdisciplinary research, and comprehensive treatment protocols.

Nanoremediation strategies to address environmental problems.

A rapid rise in population, extensive anthropogenic activities including agricultural practices, up-scaled industrialization, massive deforestation, etc. are the leading causes of environmental degradation. Such uncontrolled and unabated practices have affected the quality of environment (water, soil, and air) synergistically by accumulating huge quantities of organic and inorganic pollutants in it. Environmental contamination is posing a threat to the existing life on the Earth, therefore, demands the development of sustainable environmental remediation approaches. The conventional physiochemical remediation approaches are laborious, expensive, and time-consuming. In this regard, nanoremediation has emerged as an innovative, rapid, economical, sustainable, and reliable approach to remediate various environmental pollutants and minimize or attenuate the risks associated with them. Owing to their unique properties such as high surface area to volume ratio, enhanced reactivity, tunable physical parameters, versatility, etc. nanoscale objects have gained attention in environmental clean-up practices. The current review highlights the role of nanoscale objects in the remediation of environmental contaminants to minimize their impact on human, plant, and animal health; and air, water, and soil quality. The aim of the review is to provide information about the applications of nanoscale objects in dye degradation, wastewater management, heavy metal and crude oil remediation, and mitigation of gaseous pollutants including greenhouse gases.

Citizens' perception towards landfill exposure and its associated health effects: a PLS-SEM based modeling approach.

Around 90% of municipal solid waste in India is treated improperly at open dumps and landfills, posing a severe threat to public health. Landfills are an annoyance whose presence causes uncertainty, stress, and dissatisfaction in neighboring residential areas. This research investigates the perceived impact of exposure to landfills on health in terms of environmental quality, general living status, and defensiveness. To meet the current study's objective, "Case of exposed population" to landfill, i.e., 384 participants dwelling near 1 km of the dump site in Siliguri municipality, West Bengal, India, were considered using a purposive sample approach. The present study adopted Partial Least Square-Structural Equation Modeling (PLS-SEM) approach to prove the hypothesis related to the residential perception of landfills and their impact on health. The findings reveal that all three constructs, namely environmental quality (ß = .997, t = 19.607, and ρ < 0.001), general life status (ß = .116, t = 2.475 and ρ < 0.05), and people's defensive attitude (ß = .150, t = 2.526 and ρ < 0.001), significantly affect the health condition of those exposed to a landfill site. The results suggest that by understanding the impact of landfills on resident health, policymakers and bureaucrats can promote reliable and effective measures linked to sustainable solid waste disposal facilities. The administration must create a policy to protect citizens who live near landfills by improving the ambient environment, establishing health management facilities, and raising awareness through public participation.

Reduction in concentration of PM2.5 in India's top most polluted cities: with special reference to post-lockdown period.

Lockdown in India begins from 25 March and continues until 31 May 2020 due to the COVID-19 pandemic situation. Due to such an extended period of lockdown for about more than 2 months resulted in 1.38 billion populations restricted themselves from mass activities that contribute to air pollution. Thus, through our quantitative approach and trend analysis, the study aims to evaluate the changes in the level of PM2.5 as a major pollutant for the top ten polluted cities in India, with a special emphasis on finding what happened to its concentration after the lockdown ended. Thus, to better understand the nature of variation in PM2.5, we divide the entire 7 months into three periods for our analysis, i.e., before lockdown (1 January to 24 March), during lockdown (25 March to 31 May), and post-lockdown or unlock 1 and 2 (1 June to 31 July). Our investigation reveals that before lockdown, all the top polluted cities of India violating the national standard of PM2.5, as the lockdown begins interestingly, all cities show a momentous reduction in PM2.5 concentration. Further, surprisingly we found that after the post-lockdown period, the concentration of PM2.5 was reduced to minimal, as the average concentration of PM2.5 for all the cities is below the National Ambient Air Quality Standard (NAAQS). The study reveals that the lockdown has a consequence in improving overall air quality for the top polluted cities in India and further lockdown in the future with proper planning should be considered an alternative approach to restrain excessive emissions.

Prevalence of Steroid-Induced Cataract and Glaucoma in Chronic Obstructive Pulmonary Disease Patients Attending a Tertiary Care Center in India.

PURPOSE: Exposure to corticosteroids is known to be associated with an increased risk of cataract and glaucoma. This study was undertaken to determine the prevalence of steroid-induced cataract and glaucoma in patients with chronic obstructive pulmonary disease (COPD) and to assess a dose-response relationship between them. DESIGN: This was a prospective observational study. METHODS: We identified all COPD patients aged 50 years or older, with minimum steroid exposure of 4 months and on inhaled corticosteroids from March 2014 to March 2015. Average daily dose of inhaled corticosteroids was defined as low (1-250 µg), medium (251-500 µg), and high (501-1000 µg) using fluticasone propionate equivalents. RESULTS: We screened 405 COPD patients, of which 48 were dropouts. We identified 58 cataract and 14 glaucoma patients with a prevalence of 16.24% and 3.92%, respectively. We also observed a dose-response relationship with the highest prevalence of cataract (39.6%) and glaucoma (42.8%) at daily doses of 501-1000 µg fluticasone propionate equivalents. CONCLUSIONS: It is evident that higher doses and longer duration of inhaled corticosteroid in COPD patients are associated with a higher prevalence of cataract and glaucoma.