Art of breaking bad news: A qualitative study in Indian healthcare perspective.

Background: Health-care communication is essential for amiable provider-recipient relationship. This study explored various health-care experiences and expectations of service recipients and providers in private clinical establishments of West Bengal, India, while breaking difficult news, bad news, and death. Aim: The current study was framed with the following research question: What are the varying perceptions, experiences, and expectations of healthcare recipients and their providers while seeking/delivering support in situations of breaking bad news and communications on death? Materials and Methods: The data were collected through individual in-depth interviews-31 respondents that included 16 patients and their families (recipient) and 15 medical practitioners (provider). Inductive thematic analysis was used. Results: Three main themes and nine sub-themes were identified highlighting livid experiences and perceptions of respondents. The findings suggest that interpersonal communications involve language barriers, health literacy and COVID-19 pandemic, situations of sudden unexplained death, perceptual negativity surrounding healthcare, empathy as well as emotions and multiple affiliations leading to ethical moral conflicts to influence individual perception. Regarding treatment attributes, factors of inaccessibility misconceived as incompetence and waiting and contact time are involved. The behavior and personality dimensions include attitude and robustness of the patient party and capability to handle emotions that affect provider-recipient relationship during communications of bad news and death. Conclusion: This study provided a local perspective about the experiences and expectations of healthcare recipients and their providers. Understanding this critical realm shall help in bridging the gap between recipient expectations and provider practices. It will also attempt towards possible alignment to improve patient satisfaction.

Knowledge, attitude and practice survey towards COVID-19 vaccination: A mediation analysis.

BACKGROUND AND AIM: The COVID-19 pandemic has significantly impacted human lives across the world. In a country like India, with the second highest population in the world, impact of COVID-19 has been diverse and multidimensional. Under such circumstances, vaccination against COVID-19 infection is claimed to be one of the major solutions to contain the pandemic. Understanding of Knowledge, Attitude and Practice (KAP) measures are essential prerequisites to design suitable intervention programs. This paper examines the different KAP factors in Indians towards their decision of vaccine uptake. METHOD: An online questionnaire was administered to Indian respondents. (Pilot study: n = 100, Main study: n = 221) to assess their existing knowledge on COVID-19 infections and vaccination, attitude and intentions towards COVID-19 vaccines and their decision towards COVID-19 vaccine uptake. RESULT: The findings highlighted that existing knowledge on COVID-19 infections and vaccination directly impacted their attitude and intention towards vaccination. The attitude and intention towards COVID-19 vaccines directly impacted their practice of undergoing COVID-19 vaccination. Further, there was a statistically significant and considerably large indirect effect of existing knowledge on COVID-19 infections and vaccination on the practice of undergoing COVID-19 vaccination through attitude and intention towards the vaccine. There was no direct effect of Knowledge (existing knowledge on COVID-19 infections and vaccination) on Practice (decision to undergo COVID-19 vaccination). Therefore, Attitude and intention towards COVID-19 vaccine is the primary mediator between Knowledge (existing knowledge on COVID-19 infections and vaccination) and Practice (decision to undergo COVID-19 vaccination). CONCLUSION: Participants decision towards COVID-19 vaccination decisions are strongly related to their attitude and intentions that confirms the strong role of attitude towards success of COVID-19 vaccination programme. Therefore, 'person-centric' attitude based positive intervention strategies that links their prior knowledge on COVID-19 infections and vaccination must be designed for greater vaccine acceptance amongst Indians.

Risk of high-grade precancerous lesions and invasive cancers in high-risk HPV-positive women with normal cervix or CIN 1 at baseline-A population-based cohort study.

Infection with high-risk human papillomavirus (HR-HPV) is transient and clears on its own in majority of the women. Only a few women who have persistent infection may finally develop cervical intraepithelial neoplasia (CIN) or cervical cancer in later years. The risk of progression in the HR-HPV-positive women with normal cervix or low-grade lesion on colposcopy and histopathology at baseline is less studied. We performed a longitudinal study on 650 HR-HPV-positive women with colposcopy and/or histopathology-proved normal or CIN1 diagnosis at baseline to assess the cumulative risk of development of high-grade CIN. After a mean follow-up of 2.1 person years of observation (PYO) (range 0.1-5.1), the cumulative incidence of CIN2+ (6.4%; 3.0/100 PYO) was significantly higher in women who had persistent HR-HPV infection compared to those who cleared the infection (adjusted HR 6.28; 95% CI 2.87-13.73). The risk of viral persistence in women aged 50-60 years was two times higher compared to women aged 40-49 years and three times higher compared to women aged 30-39 years. The probability of having persistent infection increased progressively with higher viral load at baseline (adjusted HR 3.29, 95% CI 2.21-4.90 for RLU ≥100; adjusted HR 2.69, 95% CI 1.71-4.22 for RLU 10-100). Women with increasing viral load at follow-up had four times higher risk of developing CIN2 or worse lesions as compared to those with decreasing load (20.9% vs 4.8%; p < 0.001). In the context of developing countries where cytology or genotyping triaging is not feasible, colposcopy referral of HR-HPV-positive women with advancing age, viral persistence, and increasing viral load may be considered.

Antimicrobial peptides and proteins in mycobacterial therapy: current status and future prospects.

Tuberculosis (TB), an infectious disease caused by the pathogen Mycobacterium tuberculosis (Mtb), kills about 1.5 million people every year worldwide. An increase in the prevalence of drug-resistant strains of Mtb in the last few decades now necessitates the development of novel drugs that combat infections by both drug-sensitive and resistant Mtb. Moreover, as Mtb can persist in host cells by modulating their immune responses, it is essential that anti-TB agents be able to penetrate macrophages and kill the pathogen intracellularly without harming the host cells. In this context, antimicrobial peptides (AMPs) and proteins are being harnessed as anti-infective agents for the treatment of various diseases. Due to their direct and rapid bactericidal activity it is unlikely that pathogens acquire resistance against AMPs. Several short and potent AMP derivatives have been prepared by peptide engineering, and several of them are currently evaluated in clinical trials. The present review summarizes the role of endogenously expressed AMPs and proteins in the treatment of tuberculosis infections. In addition, mechanisms of direct anti-mycobacterial activity, manipulation of host immune responses, and future prospects of AMPs as therapeutic agents are discussed.

Topical application of zinc oxide nanoparticles reduces bacterial skin infection in mice and exhibits antibacterial activity by inducing oxidative stress response and cell membrane disintegration in macrophages.

Here we studied immunological and antibacterial mechanisms of zinc oxide nanoparticles (ZnO-NPs) against human pathogens. ZnO-NPs showed more activity against Staphylococcus aureus and least against Mycobacterium bovis-BCG. However, BCG killing was significantly increased in synergy with antituberculous-drug rifampicin. Antibacterial mechanistic studies showed that ZnO-NPs disrupt bacterial cell membrane integrity, reduce cell surface hydrophobicity and down-regulate the transcription of oxidative stress-resistance genes in bacteria. ZnO-NP treatment also augmented the intracellular bacterial killing by inducing reactive oxygen species production and co-localization with Mycobacterium smegmatis-GFP in macrophages. Moreover, ZnO-NPs disrupted biofilm formation and inhibited hemolysis by hemolysin toxin producing S. aureus. Intradermal administration of ZnO-NPs significantly reduced the skin infection, bacterial load and inflammation in mice, and also improved infected skin architecture. We envision that this study offers novel insights into antimicrobial actions of ZnO-NPs and also demonstrates ZnO-NPs as a novel class of topical anti-infective agent for the treatment of skin infections. FROM THE CLINICAL EDITOR: This in-depth study demonstrates properties of ZnO nanoparticles in infection prevention and treatment in several skin infection models, dissecting the potential mechanisms of action of these nanoparticles and paving the way to human applications.

Mutations in subunit interface and B-cell epitopes improve antileukemic activities of Escherichia coli asparaginase-II: evaluation of immunogenicity in mice.

L-Asparaginase-II from Escherichia coli (EcA) is a central component in the treatment of acute lymphoblastic leukemia (ALL). However, the therapeutic efficacy of EcA is limited due to immunogenicity and a short half-life in the patient. Here, we performed rational mutagenesis to obtain EcA variants with a potential to improve ALL treatment. Several variants, especially W66Y and Y176F, killed the ALL cells more efficiently than did wild-type EcA (WT-EcA), although nonleukemic peripheral blood monocytes were not affected. Several assays, including Western blotting, annexin-V/propidium iodide binding, comet, and micronuclei assays, showed that the reduction in viability of leukemic cells is due to the increase in caspase-3, cytochrome c release, poly(ADP-ribose) polymerase activation, down-regulation of anti-apoptotic protein Bcl-XL, an arrest of the cell cycle at the G0/G1 phase, and eventually apoptosis. Both W66Y and Y176F induced significantly more apoptosis in lymphocytes derived from ALL patients. In addition, Y176F and Y176S exhibited greatly decreased glutaminase activity, whereas K288S/Y176F, a variant mutated in one of the immunodominant epitopes, showed reduced antigenicity. Further in vivo immunogenicity studies in mice showed that K288S/Y176F was 10-fold less immunogenic as compared with WT-EcA. Moreover, sera obtained from WT-EcA immunized mice and ALL patients who were given asparaginase therapy for several weeks recognized the K288S/Y176F mutant significantly less than the WT-EcA. Further mechanistic studies revealed that W66Y, Y176F, and K288S/Y176F rapidly depleted asparagine and also down-regulated the transcription of asparagine synthetase as compared with WT-EcA. These highly desirable attributes of these variants could significantly advance asparaginase therapy of leukemia in the future.