Barriers Faced by Healthcare Providers during Home Visits of Palliative Care Patients - A Qualitative Study.

Objectives: We, the Department of Community Medicine, have been training healthcare providers for palliative care in the hospital and community setting. There were many difficulties in providing proper palliative care. The objective is to explore the various difficulties faced by Junior Residents, auxiliary nurse and midwife (ANM) and medical social workers (MSWs) during the home visits of palliative care patients and to address those difficulties in future visits. Materials and Methods: The study was conducted in our peripheral institutions such as the Rural Health Training Centre and the Urban Health Training Centre among Junior Residents, ANMs and MSWs who had provided palliative care for the patients. Qualitative study design includes participatory research action techniques such as force field analysis, cobweb diagram, and pairwise ranking, and Systematic techniques include the Delphi technique. Results: Indicators for difficulties faced by Junior Residents were derived and plotted based on priorities and joined to form a cobweb diagram. Difficulties were time constraints, lack of resources such as medications and transport facilities, need for specialist care, and non-adherence to the advice. Driving force and restraining force for palliative care were derived and plotted on the force field analysis. The favourable factors in providing palliative care services of the healthcare providers are self-satisfaction with treating the patient, satisfaction due to treatment at the doorstep, understanding the patient's psychological or social factors affecting their health, skill development and counselling of the patient. The restraining factors in providing palliative care services of the healthcare providers are time constraints, lack of resources, patient not following the advice properly, improper care by caregivers and unable to fulfill certain needs of the patient. Pairwise scoring/ranking was done for MSWs by plotting the issues faced in palliative care visits in rows and columns. The difficulties were time constraints, lack of resources, lack of proper knowledge of staff and need for specialist care. The possible potential solutions derived from the Delphi technique were proper planning to reduce time constraints and intense counseling of patients on adherence to treatment. Conclusion: It helped to identify the difficulties faced by healthcare providers and to plan for solutions in future palliative home care visits.

Effect of Self-Directed Learning Module and Assessment on Learning of National Health Programme by Medical Undergraduates - A Mixed Methods Evaluation.

Background: Competency-based medical education (CBME) curriculum in India has introduced many new concepts like a foundation course, early clinical exposure, and self-directed learning (SDL). Sometimes SDL simply means self-study. Self-directed learning as defined by Knowles is a process in which individuals take the initiative with or without the help of others in diagnosing their learning needs, setting their own learning goals, identifying appropriate learning resources, and selecting appropriate learning strategies. SDL is seen as a prerequisite for life-long learners, especially medical graduates. We found poor uptake of SDL sessions in terms of learning and attendance by students. To develop and assess the effect of the SDL module in Community Medicine for Phase -3 MBBS students. Materials and Methods: The study design was a program development and evaluation design. The program development consists of free listing and Nominal Group Technique (NGT). The evaluation design consists of a formative assessment, an end-of-module assessment, and feedback from undergraduate students, postgraduates, and faculties. Data collection procedure: SDL module was developed, agreed and implemented among undergraduates of Phase - 3 MBBS students. Results: Free listing was conducted among undergraduate students who had completed the phase 3 MBBS examination and Nominal Group Technique was conducted among the faculties (n = 7) and Postgraduates of the Department of Community Medicine (n = 2) to explore the appropriate topics for SDL in Community Medicine. The topic with the highest ranking and which was finalized for preparation of the SDL module was "National Health Programme". Three fourth 118 (75%) of the students scored ≥50% at the end of the module assessment. Manual content analysis for the feedback was categorized into three themes such as facilitating factors, challenges, and solutions. Conclusions: Effective implementation and assessment of SDL sessions are one of the new concepts in the CBME curriculum.

Exploration of Barriers and Possible Solutions for Nonutilization of Facility-based Integrated Counseling and Testing Center Using the Delphi Technique.

BACKGROUND: A major group of the population, especially antenatal checkup (ANC) mothers and their spouses, people admitted for surgery, and people attending STI clinics, are reluctant to pretest counseling. OBJECTIVES: This study has been taken up to explore the barriers and possible solutions to improve the utilization of Facility based integrated counseling and testing center (F-ICTC) counseling services. MATERIALS AND METHODS: Phase 1: In-depth interview and ranking with stakeholders from the F-ICTC center (n = 13) were conducted to identify the barriers to utilization of F-ICTC and solution for the same. Phase 2. A: Delphi panel with experts (n = 17) was invited through mail to find out the potential solution to improve the utilization of F-ICTC counseling services. RESULTS: Possible barriers from the stakeholders' perspectives were fear of the disease, violate the privacy, unacceptance, gender bias, fear of social stigma and discrimination, and neglect attached to the disease. At third round of Delphi experts had arrived at a consensus regarding of following possible potential solutions: 1. Those who refuse pretest counseling they should be asked to answer a set of questions(which are usually told during counseling), only those questions not answered correctly by them can be corrected, 2.conducive hospital environment, 3.zero discrimination policy, 4. group counseling for ANC mothers and patients in waiting area of the hospital,5. phone counseling for unwilling patients and relocation of testing center and health education camping. CONCLUSION: Context-specific proactive evidence-based intervention will help in improving the proper utilization of the F-ICTC center.

Effect of plasma sericin glutaraldehyde treatments on the low stress mechanical properties of micro denier polyester/cotton blended fabric.

This study aimed to see how different treatments affect the low-stress mechanical properties of micro-denier polyester/cotton (MDP/C-65/35) fabrics. This blend was chosen for the study because it is the most popular blend used in polyester/cotton blended material. The results of fabric properties treated with sericin revealed that fabrics treated with sericin and glutaraldehyde as a cross-linking agent had higher bending rigidity, regardless of how it was tested. Concerning the blend fabrics, it was noticed that there was deterioration in tensile resilience following sericin treatment. Shear rigidity, accompanied by shear hysteresis, showed an increase in sericin-treated fabrics. Compression properties were affected by the treatment, and in general, the fabric suffered deterioration in those the samples were hard. Surface properties such as coefficient of friction, mean deviation of friction and mean deviation of surface contour were found to be higher than those of the control and sericin-treated fabrics in a few cases.

An exploratory mixed method study on the follow up status and quality of life among recurrent tuberculosis patients in South India.

INTRODUCTION: After completion of treatment of Tuberculosis (TB), many patients can have long-term physical sequelae, which in some cases results in life-long impairment and further stigma. OBJECTIVES: To determine the follow up status and quality of life of post-treatment among Category 2 TB patients under RNTCP and to explore the factors affecting the Quality of Life. MATERIAL AND METHODS: The present study was done in urban area of Villupuram district of Tamil Nadu using Exploratory mixed methods study design. In the first phase case-control study was conducted with 100 post treatment category 2 TB patients (cases) and 100 non-TB patients (controls) matched for age and gender. The quality of life of the respondents was assessed by (WHOQOL-BREF) questionnaire (Quantitative), followed by five in-depth interviews among cases with extreme scores (Qualitative). RESULTS: The mean scores of "perceived physical health" and "perceived psychological health" among cases after completion of treatment was significantly lower than the mean scores in controls. The determinants for perceived physical health were age, years of education and marital status. The determinants for psychological health were age, marital status and associated comorbidities. In-depth interview explored that major perspectives of cases affecting quality of life were side effects of drugs, loss of social support, loss of employment and psychological factors like anxiety, depression. CONCLUSIONS: HR-QOL among post treatment TB patients was reduced. Efforts should be made to counsel TB patients, family members, relatives and their workplace regarding their care, support and challenges to have a reasonable QOL.

Risk Factors for Kidney Stones in Rural Puducherry: Case-Control Study.

INTRODUCTION: Renal stone is a distressing chronic condition which is getting common across the world. The rigorous evidence on multiple risk factors of kidney stone from a single study is limited. AIM: To find out the social and dietary risk factors responsible for the occurrence of kidney stone in a local community in rural Puducherry, India. MATERIALS AND METHODS: It was a hospital-based unmatched case-control study. Based on existing information, a sample of 70 cases and 140 controls was calculated and considered adequate. The exposure information on recent cases was uniformly collected by interview and review of radiologic records and exposure information for controls was collected through interviews. Associations between the occurrence of renal stone as a dependent variable and multiple independent variables such as age, sex, socioeconomic status, type of family, religion, the source of drinking water and dietary practices were studied by using multiple logistic regression analysis. RESULTS: We found associations of occurrence of kidney stone with genetic predisposition (OR:16.98, CI;3.02-95.25), less frequency of urine per day (OR:5.95, CI;1.03-34.19) and dietary habit of eating red meat once a week (OR:32.28, CI; 9.7-143.2) and even once a month (OR:5.20, CI;1.44-18.77). CONCLUSION: The risk of kidney stone was found high among those who had genetic predisposition, less frequency of urination per day and those who consumed red meat once a month or more. Patients and local community should be educated to reduce the red meat consumption and increase the consumption of water and fluid, especially during the hot climates.

Nimbolide inhibits androgen independent prostate cancer cells survival and proliferation by modulating multiple pro-survival signaling pathways.

BACKGROUND: Prostate cancer is the most prominent cancer in men, experiencing a relapse in disease often express high serum TNF-α levels. It has been correlated with increased cell survival and proliferation of prostate cancer cells. Previous studies reported that nimbolide, a terpenoid derived from the leaves and flowers of neem tree inhibits cancer growth through selective modulation of cell signaling pathways linked to inflammation, survival, proliferation, angiogenesis and metastasis. METHODS: The present study aimed to examine the effect of nimbolide at 1 and 2µM concentrations on TNF-α/TNFR1 mediated signaling molecules involved in cell survival and proliferation in PC-3 cell line via NF-κB and MAPK pathways by real time PCR and western blot. Protein and compound interaction were performed by Molecular docking analysis. RESULTS: Our results indicate that nimbolide treatment suppressed expression of TNF-α, SODD, Grb2, SOS mRNA and modulated TNF-α/TNFR1 regulated NF-κB and MAPK signaling molecules in PC-3 cells. Additional molecular dynamics simulation studies confirmed the stability of nimbolide and signaling molecules binding interactions. Binding pose analysis revealed the significance of hydrogen bond interactions for effective stabilization of virtual ligand protein complexes. CONCLUSION: Nimbolide inhibited prostate cancer cell survival and proliferation via NF-κB and MAPK pathways.

Unidirectional growth of benzil crystal from solution by Sankaranarayanan-Ramasamy method and its characterization.

Good quality <100> benzil single crystal with a diameter 18 mm and length 75 mm was successfully grown from solution by the unidirectional growth method of Sankaranarayanan-Ramasamy (SR) for the first time in the literature. The seed crystals have been harvested from conventional solution growth technique and subsequently used for unidirectional growth. The grown crystal was subjected to various characterization studies. The results of UV-vis spectral analysis, photoluminescence, etching and microhardness studies were compared with conventional solution grown crystal to that of SR method grown crystal. The quality of SR method grown benzil crystal is better than conventional solution grown crystal.

Synthesis, growth, thermal, optical and mechanical properties of 2-Aminopyridinium 4-methylbenzoate Dihydrate.

Organic NLO material of 2-Aminopyridinium 4-methylbenzoate Dihydrate (2A4M) was synthesized using 2-Aminopyridinium and 4-methylbenzoic acid as starting materials. Single crystals of 2A4M were grown by the slow evaporation solution growth technique at room temperature using water as a solvent. The grown crystal was characterized by single crystal XRD to confirm the crystal system and lattice parameters. From the optical studies the optical band gap and the refractive index of the material are found to be 2.9 eV and 1.40 at 1200 nm. Functional groups of the crystallised material were confirmed by FTIR vibrational spectrum. Thermal behaviour of the title compound was studied using thermogravimetric (TG) and differential thermal analyses (DTA). The initial weight loss is found up to 125°C, which corresponds to 13.2% i.e. presence of 2 mole of water in the lattice. The grown crystal was subjected to Vickers hardness test and the brittleness index, fracture toughness, yield strength were estimated. The etching studies reveal the growth pattern and dislocations present in the grown crystal. The second harmonic generation (SHG) behaviour of 2A4M was tested by Kurtz-Perry powder technique. The relative SHG efficiency of 2A4M is found to be 3.03 times that of the reference material KDP.

Bis(tetra-ethyl-ammonium) bis-(hydrogen l-tartrate) l-tartaric acid monohydrate.

In the title compound, 2C(8)H(20)N(+)·2C(4)H(5)O(6) (-)·C(4)H(6)O(6)·H(2)O, the presence of the two tetra-ethyl-ammonium cations is balanced by two hydrogen l-tartrate anions. Also present in the asymmetric unit are a mol-ecule of l-tartaric acid and a water mol-ecule. The various components are linked by O-H⋯O hydrogen bonds. In the crystal, two-dimensional networks are formed via O-H⋯O hydrogen bonds and C-H⋯O inter-actions involving the water mol-ecule, the hydrogen l-tartrate anions and the l-tartaric acid mol-ecules. These layers, which stack along [001], are separated by tetra-ethyl-ammonium cations. The latter are also involved in C-H⋯O inter-actions with the anions and the l-tartaric acid and water mol-ecules participating in the two-dimensional network.

Dietary administration of Bacillus thuringiensis on the cellular innate immune response of African catfish (Clarias gariepinus) against Aeromonas hydrophila.

AIM: An experiment was conducted to evaluate the use of Bacillus thuringiensis (Bt) as a probiotic to enhance the cellular innate immune response of the African catfish (Clarias gariepinus) challenged with a bacterial fish pathogen, Aeromonas hydrophila. MATERIALS AND METHODS: The bacterium (Bt) was administered orally at three different dietary doses of 0.5 x 10(7) (T2), 1.0 x 10(7) (T3) and 1.5 x 107 (T4) cfu/g feed to the fingerlings of African catfish twice daily for 15 days. The positive control group (T1) and negative control group (T5) was fed without Bt for the same period. On the 16th day, blood and serum samples were withdrawn to determine the differential leukocyte count (DLC) and serum bactericidal activity. After 15 days feeding, the treatment groups (T2, T3 and T4) and positive control (T1) were challenged intraperitoneally with the bacterial suspension of 0.2 ml (1 x 10(8) cfu/ml). The negative control group (T5) was injected intraperitoneally with phosphate buffered saline (PBS). On the 3rd day of post challenge, the DLC was assessed in all the treatment groups. RESULTS: The fish fed with Bt incorporated diet showed significantly higher (P < 0.05) bactericidal activity during the pre-challenge compared with the control groups. The highest serum bactericidal activity was observed in T4, the group fed with diet containing highest concentration of Bt. Highest survival rates (90%) were recorded in fish fed with Bt supplemented group (T3 and T4). Granulocyte counts on the other hand were higher in treatment groups compared to the control in both pre and post challenge. CONCLUSIONS: The result demonstrates that Bt can enhance certain innate immune responses in African catfish.

Physical growth in children with reflux nephropathy with normal or mildly impaired renal function.

Ten children aged 11 months to 10 years (means 5.7 years) with reflux nephropathy, vesicoureteric reflux (VUR) and normal or mildly impaired renal function having GFR more than 50 ml/min/1.72 m(2), were included in the study. The hematological and biochemical parameters were within normal limits. Height standard deviation score (HZ score) was reduced at entry and, decreased further during follow-up (-2.2 and -2.6 at 0 and 12 months, respectively). Weight for height index (WHI) improved significantly (p=0.0004) during follow-up. The basal and stimulated peak growth hormone levels of these patients were found to be elevated, 18.53 +/- 11.36 microg/L and 34.20 +/- 5.86 microg/L, respectively. The IGF-1 levels were low ranging from 45.00 to 84.40 ng/dl (mean +/- SD 61.54 +/- 10.21 ng/dl) compared to 51.80 to 247.50 ng/dl (mean +/- SD111.20 +/- 70.24 ng/dl) in age and sex matched controls, indicating partial insensitivity to growth hormone.

Insulin mimetic impact of Catechin isolated from Cassia fistula on the glucose oxidation and molecular mechanisms of glucose uptake on Streptozotocin-induced diabetic Wistar rats.

Diabetes mellitus is the most common and serious metabolic disorder among people all over the world. Many plants have successfully been used to overcome this problem. Cassia fistula, an ethnomedicnal plant, is widely used in Indian medicine to treat diabetes. Methanol extract of stem of plant, reduced the blood glucose levels in Streptozotocin-induced diabetic rats. Bioassay guided fractionation was followed to isolate Catechin from methanol extract. Catechin was administered to Streptozotocin (60mg/kg b.w.)-induced diabetic male Wistar rats at different doses (5, 10, 20mg/kg b.w.) for 6 weeks to assess its effect on fasting plasma glucose. The plasma glucose was significantly (p<0.05) reduced when compared to the control. Oral administration of Catechin (20mg/kg b.w.) markedly increased tissue glycogen, and (14)C-glucose oxidation without any change in plasma insulin and C-peptide. Catechin restored the altered Glucokinase, glucose-6 Phosphatase, Glycogen Synthase and Glycogen Phosphorylase levels to near normal. GLUT4 mRNA and protein expression were enhanced after Catechin treatment. The results of this experimental study indicated that Catechin possesses hypo-glycemic, Glucose oxidizing and insulin mimetic activities and hence it could be used as a drug for treating diabetes.

HIV/AIDS patient's satisfactory and their expectations with pharmacy service at specialist antiretroviral therapy (ART) units.

A cross-sectional descriptive study was conducted to determine HIV/AIDS patient's level of satisfaction and their expectations with pharmacy service at specialist antiretroviral therapy (ART) unit's in the government hospitals of Addis Ababa, Ethiopia. The present investigation clearly revealed that 82.5% of HIV/AIDS patients indicated long waiting time was a major reason for their dissatisfaction with pharmacy service. Majority of patients indicated few more other issues are also responsible for their dissatisfaction with pharmacy service such as lack of description about antiretroviral therapy drugs (45.20%), staffs impoliteness (22.40%), and shortage of drugs (4.20%). 93.33% of the respondents prefer to get their pharmacy service within a shorter span, 18.02% wanted comfort waiting hall, 14.32% expecting staffs politeness, 5.18% insisted sufficient number of ART units, 8.88% adequate supply of ART drugs and 21.48% cleanliness. In addition, 20.98% of the patients call for personal interaction with their pharmacist and 4.44% ask for information on ARTs side effects. Chi-square test results showed that patient's level of satisfaction and length of waiting time to get pharmacy service was inter related and statistically significant (p < 0.002). Therefore, the concern ART units must provide better pharmacy service within shorter span to enhance the patient's satisfaction. At the end of the day, improving health care services to persons living with HIV/AIDS in our community is all of our duty and responsibility too. Ultimately, increasing HIV/AIDS patient's level of satisfaction and fulfilling their expectations is extremely essential and inevitable to diminish the unbearable burden of HIV/AIDS pandemic in the near future.

Effects of levonorgestrel butanoate alone and in combination with testosterone buciclate on spermatogenesis in the bonnet monkey.

The spermatogenic effects of levonorgestrel butanoate were studied in adult male bonnet monkeys when administered alone and in combination with testosterone buciclate. Levonorgestrel butanoate (0.25, 1.0 and 2.5 mg kg(-1)) given as two injections on days 0 and 60 (groups II, III, IV) resulted in thickening and folding of the basement membrane and disruption of cell associations in groups III and IV (on day 120). In group II, no apparent changes in testicular histology were observed. When these doses of levonorgestrel butanoate were combined with 40 mg of testosterone buciclate (groups V, VI, VII), maximum changes were seen in group VI in which all stages of spermatogenesis were absent on day 120 except for a small number of spermatogonia. The changes caused by lower dose (group V) and higher dose (group VII) of levonorgestrel butanoate were less prominent than in group VI. A significant decrease in the number of dark A (Ad) and B spermatogonia was observed in all groups except for Ad spermatogonia on day 120 in group V, B spermatogonia on day 60 in group IV and B spermatogonia on day 120 in group III. A significant decrease in pachytene spermatocytes was seen on day 120 in groups V only. Early spermatids showed a significant decrease only in groups V and VII on day 120 of treatment. Advanced spermatids were suppressed significantly in group IV on day 60 and in groups IV and V on day 120. These data indicate that levonorgestrel butanoate (1.0 mg kg(-1)) in combination with 40 mg of testosterone buciclate was the most effective treatment in suppressing spermatogenesis. The site of action of this combination regimen is at the level of renewing Ad spermatogonia.

Spectroscopic characterization of nanocrystalline chromium nitride (CrN).

Nanocrystalline chromiuim nitride has been synthesised by direct gas phase nitridation of nanocrystalline chromia at 1100 degrees C in ammonia-atmosphere. XRD of this material showed formation of single phase CrN with particle size around 20 nm. AFM studies showed particle distribution along with some soft agglomerated nanostructures. Nanocrystalline Cr2O3 and partially-as well as fully--converted nanocrystalline CrN were also investigated using various spectroscopic techniques like XPS, FT-IR, and Raman for gaining insight into the conversion pathways. Spectroscopic investigations of these materials clearly indicate that complete conversion of CrN occurs by nitriding at 1100 degrees C for 4 hrs. The salient spectroscopic features of these nanocrystalline materials with respect to their microcrystalline counterparts are discussed.

Obstructive infertility: changes in the histology of different regions of the epididymis and morphology of spermatozoa.

In the present study, the effects of prolonged obstruction in different regions of the human epididymis on its histology and on the spermatozoa retained at the site of obstruction were assessed. Men who were confirmed of having obstruction of the epididymis underwent vasoepididymostomy (VEA) for surgical correction of the obstruction. At the time of surgery, fluid from the epididymal tubule above the site of obstruction was aspirated and examined for sperm profile. Epididymal tissue, collected at the site of obstruction, was processed for assessment of histological changes and also used to identify the site of obstruction. Prolonged obstruction of the epididymis has caused degeneration of the epididymal epithelium, gradual decrease in the diameter of the tubule and tubular lumen and increase in the intertubular connective tissue. Sperm aspirated from the caput epididymal fluid showed sluggish pattern of motility only in one out of the six subjects, whereas spermatozoa collected from the cauda epididymal fluid showed rapid linear progressive motility in one of three subjects. A major percentage of spermatozoa in the aspirated fluid showed various types of morphological abnormalities, irrespective of the site of obstruction. These results are discussed in relation to the role of the epididymis in investing spermatozoa with motility and fertilizing capacity.

Semen quality and sperm functional parameters in fertile Indian men.

The reports of a decline in the reproductive health of men worldwide prompted the present study to be undertaken so that baseline semen parameters could be established in Indian men. Semen profile and sperm function parameters were evaluated in 368 Indian men of proven fertility, settled in Delhi. The results of the study were compared with available published information from Indian men. The mean sperm concentration and semen volumes were 68.22 +/- 15.14 x 10(6) ml(-1) and 3.20 +/- 0.94 ml, respectively. Rapid, linear progressive motility and sluggish linear motility were 40.95 +/- 9.15% and 24.95 +/- 7.01%, respectively. A comparison of the results of the present study with earlier published data did not support the contention of a decrease in the semen quality in Indian men.

Male contraception: expanding reproductive choice.

The development of steroid-based oral contraceptives had revolutionized the availability of contraceptive choice for women. In order to expand the contraceptive options for couples by developing an acceptable, safe and effective male contraceptive, scientists have been experimenting with various steroidal/non-steroidal regimens to suppress testicular sperm production. The non-availability of a long-acting androgen was a limiting factor in the development of a male contraceptive regimen since all currently tested anti-spermatogenic agents also concurrently decrease circulating testosterone levels. A combination regimen of long-acting progestogen and androgen would have advantage over an androgen-alone modality since the dose of androgen required would be much smaller in the combination regimen, thereby decreasing the adverse effects of high steroid load. The progestogen in the combination regimen would act as the primary anti-spermatogenic agent. Currently, a number of combination regimens using progestogen or GnRH analogues combined with androgen are undergoing trials. The side effects of long-term use of androgens and progestogens have also undergone evaluation in primate models and the results of these studies need to be kept in view, while considering steroidal regimens for contraceptive use in men. Efforts are also being made to popularize non-scalpel vasectomy and to develop condoms of greater acceptability. The development of contraceptive vaccines for men, using sperm surface epitopes not expressed in female reproductive tract as source, still requires considerable research efforts.