One Health intervention for elimination of anthrax in an endemic district of Odisha: A baseline and endline study

Background

This study was to compare a baseline and endline survey which were conducted to assess the changes in knowledge, attitude and practices about anthrax disease among the communities after One Health intervention for the elimination of human anthrax in an endemic district of Odisha.

Methods

A total of 2670 respondents were interviewed during the baseline and 2511 for the endline survey using a structured questionnaire by multi-stage sampling method. Descriptive statistics were used and logistic regression was performed to estimate the relationship between the variables and knowledge of anthrax.

Results

Out of the total participants in the study, males were about 76.25% in baseline and 72.08% in endline and about half of the total respondents were illiterate. Majority of the respondents had reported agriculture as their main occupation during both surveys. More than 50% of the respondents had livestock in their houses and farming was the main purpose for keeping them in both surveys. Around 20.26% of respondents knew about anthrax in baseline which raised to 53.64% after One Health intervention. Almost 21.29% of livestock owners had vaccinated their animals against anthrax disease throughout baseline, which increased to 66.5% during the endline survey.

Conclusion

This study highlights a significant surge in both knowledge and practices related to anthrax within the community after the implementation of intervention packages based on the One Health approach. The outcome of our study signified the importance of One Health interventions to address the health challenges related to zoonotic diseases in tribal communities. The data could be useful for local Governments to incorporate such an approach in their health policy to eliminate human anthrax.

The moderating effect of mental health and health insurance ownership on the relationships between physical multimorbidity and healthcare utilisation and catastrophic health expenditure in India

BACKGROUND

The current demographic transition has resulted in the growth of the older population in India, a population group which has a higher chance of being affected by multimorbidity and its subsequent healthcare and economic consequences. However, little attention has been paid to the dual effect of mental health conditions and physical multimorbidity in India. The present study, therefore, aimed to analyse the moderating effects of mental health and health insurance ownership in the association between physical multimorbidity and healthcare utilisation and catastrophic health expenditure (CHE).

METHODS

We analysed the Longitudinal Aging Study in India, wave 1 (2017-2018). We determined physical multimorbidity by assessing the number of physical conditions. We built multivariable logistic regression models to determine the moderating effect of mental health and health insurance ownership in the association between the number of physical conditions and healthcare utilisation and CHE. Wald tests were used to evaluate if the estimated effects differ across groups defined by the moderating variables.

RESULTS

Overall, around one-quarter of adults aged 45 and above had physical multimorbidity, one-third had a mental health condition and 20.5% owned health insurance. Irrespective of having a mental condition and health insurance, physical multimorbidity was associated with increased utilisation of healthcare and CHE. Having an additional mental condition strengthened the adverse effect of physical multimorbidity on increased inpatient service use and experience of CHE. Having health insurance, on the other hand, attenuated the effect of experiencing CHE, indicating a protective effect.

CONCLUSIONS

The coexistence of mental health conditions in people with physical multimorbidity increases the demands of healthcare service utilisation and can lead to CHE. The findings point to the need for multidisciplinary interventions for individuals with physical multimorbidity, ensuring their mental health needs are also addressed. Our results urge enhancing health insurance schemes for individuals with mental and physical multimorbidity.

Out-of-pocket expenditure and its correlates for institutional deliveries in private and public healthcare sectors in India: findings from NFHS 5

BACKGROUND

Increased coverage for institutional delivery (ID) is one of the essential factors for improved maternal and child health (MCH). Though, ID increased over time, out-of-pocket expenditure (OOPE) for the care-seeking families had been found to be growing, parallelly. Hence, we estimated OOPE in public and private health centres for ID, along with their sources and attributing factors and compared state and union territory-wise, so that financial risk protection can be improved for MCH related services.

METHODS

We used women's data from the National Family Health Survey, 2019-2021 (NFHS-5). Reproductive aged women (15-49 years) delivering one live child in last 5 years (n = 145,386) in any public or private institutions, were included. Descriptive statistics were presented as frequency and proportions. OOPE, was summarized as median and interquartile range (IQR). To estimate the extent for each covariate's effect, linear regression model was conducted.

RESULTS

Overall median OOPE for ID was Rs. 4066 (median OOPE: private hospitals: Rs.25600, public hospitals: Rs.2067). Health insurance was not sufficient to slash OOPE down at private facilities. Factors associated significantly to high OOPE were mothers' education, elderly pregnancy, complicated delivery, birth order of the latest child etc. CONCLUSION: A standard norm for ID should be implemented as a component of overseeing and controlling inequality. Aiding the needy is probably just one side of the solution, while the focus is required to be shifted towards reducing disparity among the health facilities, so that the beneficiaries do not need to spend on essential services or during emergencies.

What causes concordance of hypertension between spouses in India? Identifying a critical knowledge gap from a nationally representative cross-sectional sample of 63,020 couples aged 15 + years

BACKGROUND

Hypertension, a critical risk factor for cardiovascular diseases, is found to cluster between spouses due to within-couple aggregation of antecedent environmental risk factors, either through assortative mating or cohabitation. However, majority of the evidence of spousal concordance of hypertension is from Caucasoid couples from western societies, whereas marriage, partner selection, and post-marital roles of husband and wives are very different in Indian society. Therefore, we aimed to comprehensively examine the phenomenon of spousal concordance of hypertension in Indian couples.

METHOD

Couples from Longitudinal Ageing Study in India Wave 1 (n = 10,994) and National Family Health Survey Round 5 (n = 52,026) represented 15 years + Indian spouses. Hypertension was defined when systolic and/or diastolic blood pressure was > 139 and > 89 mmHg respectively, and/or if the individual was previously diagnosed or on anti-hypertensive medication. Odds Ratios (OR) estimated the within-couple concordance of hypertension while adjusting for five environmental risk factors of hypertension: individual-level body mass index, education and caste, and household-level wealth and place of residence.

RESULT

OR marginally attenuated from 1.84 (95% Confidence Interval: 1.77, 1.92) to 1.75 (1.68, 1.83) after adjustment, signifying negligible explanation by environmental risk factors, and plausibility of "novel" risk factors. Concordance continued to weaken with age (OR: 2.25 (2.02, 2.52) in < 30 versus 1.36 (1.20, 1.53) in ≥ 60 years).

CONCLUSION

Our study underscores two critical knowledge gaps: first, the identity of "novel" risk factors of hypertension and second, the mechanism behind weakening of concordance with age. Future research should explore these novel risk factors rigorously and try to modify them. Also, primary healthcare policy of the country should focus on couples in addition to individuals for hypertension and cardiovascular disease screening and management.

Development, validation & pilot testing of a questionnaire to assess healthcare seeking behaviour, healthcare service utilization & out-of-pocket expenditure of Particularly Vulnerable Tribal Groups of Odisha, India

Background & objectives

Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated.

Methods

Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q.

Results

On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald's omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively.

Interpretation & conclusions

The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.

Smokeless tobacco utilization among tribal communities in India: A population-based cross-sectional analysis of the Global Adult Tobacco Survey, 2016–2017

Introduction

Evidence on smokeless tobacco use is scarce among indigenous communities, with the available literature based either on a specific tribe or on a particular region. Therefore, we aimed to estimate the prevalence of smokeless tobacco and assess its correlation among tribal communities in India.

Methods

We utilized data from the Global Adult Tobacco Survey-2 conducted in 2016–2017. A total of 12,854 tribal people aged &gt;15 years were included in this study. The utilization of smokeless tobacco was estimated using the weighted proportion, and its correlates were assessed by multivariable logistic regression reported as an adjusted odds ratio (AOR) with a 95% confidence interval.

Results

The prevalence of smokeless tobacco use was 32%. Participants aged 31–45 years [AOR: 1.66 (1.37–2.00)], who were men [AOR: 2.37 (1.94–1.90)], and who were daily wage/casual laborers [AOR: 5.32 (3.39–8.34)] were observed to have a significant association with smokeless tobacco. Willingness and attempt to quit smokeless tobacco were higher in Eastern India (31.2%) and central India (33.6%), respectively.

Discussion

We observed one-third of the tribal individuals used smokeless tobacco in India. Tobacco control policies should prioritize men, rural residents, and individuals with fewer years of schooling. Culturally appropriate and linguistically tailored messages are required for behavioral change communication.

Social determinants of tobacco use among tribal communities in India: Evidence from the first wave of Longitudinal Ageing Study in India

BACKGROUND

Evidence on tobacco use among indigenous communities is scarce with available literature based either on a specific region or a particular tribe. Considering the large tribal population in India, it is pertinent to generate evidence on tobacco use among this community. Using nationally representative data, we aimed to estimate the prevalence of tobacco use and assess its determinants and regional variations among older tribal adults in India.

METHODS

We analysed data from Longitudinal Ageing Study in India (LASI), wave-1 conducted in 2017-18. A sample of 11,365 tribal individuals aged ≥ 45 years was included in this study. Descriptive statistics was used to assess the prevalence of smokeless tobacco (SLT), smoking, and any form of tobacco use. Separate multivariable regression models were executed to assess the association of various socio-demographic variables with different forms of tobacco use, reported as adjusted odds ratio (AOR) with 95% confidence interval.

RESULTS

The overall prevalence of tobacco use was around 46%, with 19% of smokers and nearly 32% smokeless tobacco (SLT) users. Participants from the lowest MPCE quintile group had a significantly higher risk of consuming (SLT) [AOR: 1.41 (95% CI: 1.04-1.92)]. Alcohol was found to be associated with both smoking [AOR: 2.09 (95% CI: 1.69-2.58)] and (SLT) [AOR: 3.05 (95% CI: 2.54-3.66)]. Relatively higher odds of consuming (SLT) were associated with the eastern region [AOR: 6.21 (95% CI: 3.91-9.88)].

CONCLUSION

This study highlights the high burden of tobacco use and its social determinants among the tribal population in India, which can help tailor anti-tobacco messages for this vulnerable population to make tobacco control programs more effective.

Effectiveness of the BBV-152 and AZD1222 vaccines among adult patients hospitalized in tertiary hospitals in Odisha with symptomatic respiratory diseases: A test-negative case-control study

Two vaccines, namely BBV-152 (COVAXIN^®) and AZD1222 (COVISHIELD™), were deployed against SARS-CoV-2 in India from January 16, 2021. Frontline health care workers were vaccinated first, followed by the adult population. However, limited data on vaccine effectiveness are available for the population of India. Therefore, we aimed to evaluate the effectiveness of two doses of each of these two common vaccines against COVID-19 infection among hospitalized patients with pulmonary conditions. We adopted a test-negative case-control design and recruited a sample of adults who were admitted to one of six tertiary care hospitals in Odisha. All participants were hospitalized patients with COVID-19-like pulmonary signs and symptoms. Participants who tested positive for SARS CoV-2 via RT-PCR were treated as cases, and those who tested negative were treated as controls. Logistic regression, adjusted for participants' age, sex, and number of comorbidities, was used to calculate the effectiveness of the two vaccines, using the formula: 100^*(1 - adjusted odds ratio). Between March and July of 2021, data were collected from 1,614 eligible adults (864 cases and 750 controls). Among all participants, 9.7% had received two doses of one of the two COVID-19 vaccines. Vaccine effectiveness was 74.0% (50.5%-86.0%) for two doses of BBV-152 and 79.0% (65.4%-87.2%) for two doses of AZD1222. Thus, two doses of either BBV-152 or AZD1222 nCoV-19 vaccine were found to be substantially effective in protecting against COVID-19-related infection.

Family-Level Multimorbidity among Older Adults in India: Looking through a Syndemic Lens

Most evidence on multimorbidity is drawn from an individual level assessment despite the fact that multimorbidity is modulated by shared risk factors prevailing within the household environment. Our study reports the magnitude of family-level multimorbidity, its correlates, and healthcare expenditure among older adults using data from the Longitudinal Ageing Study in India (LASI), wave-1. LASI is a nationwide survey amongst older adults aged ≥45 years conducted in 2017-2018. We included (n = 22,526) families defined as two or more members coresiding in the same household. We propose a new term, "family-level multimorbidity", defined as two or more members of a family having multimorbidity. Multivariable logistic regression was used to assess correlates, expressed as adjusted odds ratios with a 95% confidence interval. Family-level multimorbidity was prevalent among 44.46% families, whereas 41.8% had conjugal multimorbidity. Amongst siblings, 42.86% reported multimorbidity and intergenerational (three generations) was 46.07%. Family-level multimorbidity was predominantly associated with the urban and affluent class. Healthcare expenditure increased with more multimorbid individuals in a family. Our findings depict family-centred interventions that may be considered to mitigate multimorbidity. Future studies should explore family-level multimorbidity to help inform programs and policies in strategising preventive as well as curative services with the family as a unit.

Multimorbidity and Complex Multimorbidity in India: Findings from the 2017-2018 Longitudinal Ageing Study in India (LASI)

Complex multimorbidity refers to the co-occurrence of three or more chronic illnesses across >2 body systems, which may identify persons in need of additional medical support and treatment. There is a scarcity of evidence on the differences in patient outcomes between non-complex (≥2 conditions) and complex multimorbidity groups. We evaluated the prevalence and patient outcomes of complex multimorbidity and compared them to non-complex multimorbidity. We included 30,489 multimorbid individuals aged ≥45 years from the Longitudinal Ageing Study in India (LASI) from wave-1 conducted in 2017−2018. We employed a log link in generalised linear models (GLM) to identify possible risk factors presenting the adjusted prevalence−risk ratio (APRR) and adjusted prevalence−risk difference (APRD) with 95% confidence interval. The prevalence of complex multimorbidity was 34.5% among multimorbid individuals. Participants residing in urban areas [APRR: 1.10 (1.02, 1.20)], [APRD: 0.04 (0.006, 0.07)] were more likely to report complex multimorbidity. Participants with complex multimorbidity availed significantly higher inpatient department services and had higher expenditure as compared to the non-complex multimorbidity group. Our findings have major implications for healthcare systems in terms of meeting the requirements of people with complicated multimorbidity, as they have significantly higher inpatient health service utilisation, higher medical costs, and poorer self-rated health.

Multimorbidity Among Urban Poor in India: Findings From LASI, Wave-1

Background

Multimorbidity has become a norm in low-and middle-income countries such as India requiring notable health system improvements to combat. Urban population is a heterogeneous group where poor are at a risk of facing inequity in accessing healthcare services which can jeopardize our efforts to attain universal health coverage (UHC). We aimed to estimate the prevalence, assess correlates and patterns of multimorbidity among urban poor. Further, we assessed the outcomes of multimorbidity such as healthcare utilization, expenditure and self-rated health.

Methods

Longitudinal Aging Study in India (LASI), wave-1 is a nationally representative survey conducted amongst participants aged ≥45 years in 2017–18. We included 9,327 participants residing in urban areas, categorized as poor based on monthly per capita expenditure. Descriptive statistics computed prevalence with 95% uncertainty interval. Multivariable logistic regression was executed to assess the association between multimorbidity and various correlates, expressed as adjusted odds ratio. An ordinal regression model was run between self-rated health and number of chronic conditions.

Results

The prevalence of multimorbidity was 45.26% among the urban poor. Hypertension and oral morbidities were the most commonly observed dyad. Respondents who were poorer [AOR: 1.27 (1.06–1.51)] had higher chances of having multimorbidity than the poorest. Respondents with a health insurance [AOR: 1.40 (1.14–1.70)] had a higher risk of having multimorbidity. In-patient admission was significantly higher among participants having multimorbidity. Out of pocket expenditure increased while self-rated health deteriorated with each additional morbid condition.

Conclusion

Multimorbidity is found to be increasingly prevalent among urban poor and individuals having health insurance which demonstrates the need to expand healthcare insurance schemes such as Ayushman Bharat for urban poor to achieve UHC.

Impact of internet addiction during COVID-19 on anxiety and sleep quality among college students of Bhubaneswar city

BACKGROUND

COVID-19 initiated in December 2019 in Wuhan, China, and over a period of time, the infection outspread across the world in a rapid pace. To protect the people and to further limit the spread of infection, lockdown was declared in most parts of the world including India. As all people were forced to stay indoors during this pandemic, internet was the only source of entertainment whose overuse has side effects on anxiety and sleep quality. This study is aimed to know the impact of Internet addiction during COVID-19 on anxiety and sleep quality among college students of Bhubaneswar city.

MATERIALS AND METHODS

This was a web-based cross-sectional, questionnaire study. It administered 475 students from six colleges. The students were assessed by a proforma containing demographic details, patterns of internet use, Youngs Internet Addiction Test, Generalised Anxiety disorder score, and the Pittsburgh Sleep Quality Index. Statistical analysis was done using SPSS version 21.0 using Chi-square test and Wilcoxon signed-rank test.

RESULTS

The mean age of the study group was 18.81 ± 1.189. Out of 475 students, 60.6% were female and 39.4% were male. 23.6% and 13.4% of recruited students had severe internet addiction and anxiety disorder, respectively. The mean global PSQI score in the study was 6.356 ± 1.88. About 84.6% of the students had poor global sleep quality score. All components of sleep quality were significantly associated (P = 0.000) with different degrees of internet addiction except sleep duration (P = 0.589) and efficiency (P = 0.767).

CONCLUSION

Females were highly addicted than males. The study findings specified that students' excessive internet usage leads to anxiety, and affects mental health. Monitoring and controlling students' internet addiction through informative sessions on how to use the Internet adequately is useful.

Is multimorbidity associated with higher risk of falls among older adults in India?

BACKGROUND

Fall, a multifaceted health condition, is one of the major causes of mortality among older adults. Rapid ageing and increased multimorbidity in low-and middle-income countries (LMICs), including India, might elevate the risk of fall. Although, fall is associated with significant healthcare utilization, it still remains an under-recognized public health issue. This accentuates a need for evidence on fall to integrate it into existing healthcare programs, a gap in geriatric care. The present study aimed to assess the association of fall with multimorbidity among older adults in India.

METHODS

We included 28,567 participants aged ≥ 60 years from Longitudinal Ageing Study in India (LASI), wave-1 conducted during 2017-19. Descriptive statistics were used to compute the prevalence of self-reported falls along with 95% confidence interval as a measure of uncertainty. The association between falls and multimorbidity was assessed by multivariable logistic regression and presented as an adjusted odds ratio (AOR).

RESULTS

The prevalence of falls was 12.5%, being higher among women (13.6% vs. 11.4%) than men. The major determinants of fall were females, rural residents and smokeless tobacco use. We observed multimorbidity [AOR: 1.29 (1.14-1.46)] to be significantly associated with falls.

CONCLUSION

Falls are commonly prevalent among older adults having multimorbidity as its important predictor. Existing health programs should incorporate falls as an important part of geriatric care. Additionally, primary health care facilities should be strengthened to provide comprehensive care for injuries sustained due to falls.

Packing a flexible fiber into a cavity

The insertion of an elastic rod or fiber into a confining cavity is studied. Such an insertion is a feature of a variety of problems, including packing and unpacking of DNA in viral capsids and the insertion of catheters during surgery. We consider a simplified geometry in which the container is a smooth (frictionless) circular cylinder of radius a. The fiber is pushed through a hole in the curved surface of the cylinder and is then assumed to stay in a cross-sectional plane perpendicular to the cylinder axis. A solution is found for the fiber shape in which most of the fiber lies against the curved interior surface of the cylinder, apart from the final end section of the fiber, of length 2.0888a, which crosses the interior of the cylinder before ending at the opposite side, which it meets at an angle 1.15 rad to the normal. The force required to push the fiber into the cylinder is EI/2a^{2}, where E is the fiber's Young's modulus and I its cross-sectional moment of inertia. The shape of the final end section of the fiber is confirmed by experiment.

Declining trends in smokeless tobacco use among Indian women: findings from global adult tobacco survey I and II

BACKGROUND

Smokeless Tobacco (SLT) use is culturally rooted and more acceptable among women in India. SLT is a significant risk for oral cancers and has other adverse health outcomes on women's general as well as reproductive health. This study aimed to estimate and compare the prevalence and correlates of SLT among adult females in India using Global Adult Tobacco Survey (GATS), 2009-2010 (GATS 1) and 2016-2017 (GATS 2).

METHODS

Data from a nationally representative cross-sectional study GATS 1 (n = 35,529) and GATS 2 (n = 40,265) were analysed for adult female smokeless tobacco users. Correlates of SLT exposure were assessed separately using binary logistic regression. Multivariable logistic regression analysis was done for the variables which computed p < 0.1. The association was expressed as Adjusted Odds ratio with 95% confidence intervals.

RESULTS

There was a reduction in prevalence of SLT use among women in India between GATS 1 (18.4%) and GATS 2 (12.8%). SLT use was highest among the North-Eastern women in both rounds [AOR: 4.567 (3.942-5.292) during GATS-1 and 9.149 (7.722-10.839) during GATS-2]. Odisha had highest prevalence of 56.53% while Himachal Pradesh had lowest 0.14% during the recent GATS 2 survey. 33.3% vs. 34.80% of the participants were willing to quit tobacco in Central region across both rounds of survey.

CONCLUSIONS

Although, smokeless tobacco prevalence among females has reduced between 2009 and 2016 in India, yet tobacco control strategies need further pace. Hence, more focused gender-based tobacco control programs and policies are the need of time.

Exclusion-Enrichment Effect in Ionic Transistors

A simple model of a nanofluidic transistor consisting of a uniformly charged central section between a pair of plane parallel walls is considered. The linearized Poisson-Boltzmann equation corresponding to weak surface charge is solved exactly, and the solution is presented as an infinite series. The problem is characterized by three dimensionless parameters, namely the normalized surface charge, the ratio of the channel width to the Debye length, and the length-to-width aspect ratio of the charged section. The first of these parameters is presumed small, but the other two are arbitrary. The dependence of the exclusion-enrichment effect on these three parameters is discussed.

Effect of Nonzero Solid Permittivity on the Electrical Repulsion between Charged Surfaces

The electrical repulsion between two charged solid surfaces separated by an electrolyte is studied as a function of the permittivity ϵ_s of the solid in the limit in which potentials are small, and the gap between the plane solid surfaces is small compared to the Debye length κ^-1 within the electrolyte. The solid surfaces are uniformly charged in a central region |x|< L outside which they are uncharged. When ϵ_s = 0, ions from the charge cloud between the charged surfaces spill out into regions of length O(κ^-1) beyond x = ± L, thereby reducing the pressure between the surfaces from that predicted by Derjaguin-Landau-Verwey-Overbeek theory for infinite, uniformly charged surfaces. When ϵ_s>0, ions spill out over much larger O(L) regions, thereby reducing still further both the electrical potential between the solid surfaces and the repulsive force between them. However, this reduction becomes smaller as κL becomes large.

Weak correlation of bleeding scores to platelet electron microscopy: A retrospective chart review of pediatric patients with delta-storage pool disorder

BACKGROUND

Delta granule storage pool deficiency (δ-SPD) is a rare platelet disorder in which a deficiency of platelet granules leads to poor aggregation, resulting in varying clinical bleeding phenotypes. Children with δ-SPD have variable laboratory results, making the proper diagnosis and evaluation controversial.

OBJECTIVES

To describe the demographic and laboratory trends of this population and to assess the value of electron microscopy in diagnostic evaluation and its correlation to bleeding symptoms.

METHODS

We performed a retrospective review of 109 pediatric patients diagnosed with δ-SPD. We collected demographic information and bleeding scores using a validated bleeding assessment tool. A descriptive and exploratory analysis was performed.

RESULTS

The majority of patients were female, with an average age at diagnosis of 11.61 years. Females were diagnosed at a significantly older age presenting most often with menorrhagia, while males presented most commonly with epistaxis. The majority showed normal lumiaggregometry, the mean platelet electron microscopy (PEM) value was 2.37, and the mean bleeding score was 6. Bleeding assessment tool and PEM had a significantly weak correlation.

CONCLUSIONS

Patients with more dense granules per platelet had higher bleeding scores than those with fewer dense granules per platelet. The current body of evidence does not favor the use of PEM in routine clinical practice, and results are difficult to interpret. In patients with severe mucocutaneous bleeding symptoms and normal platelet aggregation studies, consideration should be given to an alternative diagnosis and further evaluation is warranted.

Neuropharmacology of the mesolimbic system and associated circuits on social hierarchies

Most socially living species are organized hierarchically, primarily based on individual differences in social dominance. Dominant individuals typically gain privileged access to important resources, such as food, mating partners and territories, whereas submissive conspecifics are often devoid of such benefits. The benefits associated with a high social status provide a strong incentive to become dominant. Importantly, motivational- and reward-related processes are regulated, to a large extent, by the mesolimbic system. Consequently, several studies point to a key role for the mesolimbic system in social hierarchy formation. This review summarizes the growing body of literature that implicates the mesolimbic system, and associated neural circuits, on social hierarchies. In particular, we discuss the neurochemical and pharmacological studies that have highlighted the contributions of the mesolimbic system and associated circuits including dopamine signaling through the D1 or D2 receptors, GABAergic neurotransmission, the androgen receptor system, and mitochondria and bioenergetics. Given that low social status has been linked to the emergence of anxiety- and depressive-like disorders, a greater understanding of the neurochemistry underlying social dominance could be of tremendous benefit for the development of pharmacological treatments to dysfunctions in social behaviors. This article is part of the Special Issue entitled 'The neuropharmacology of social behavior: from bench to bedside'.

Liraglutide and Dulaglutide therapy in addition to SGLT-2 inhibitor and metformin treatment in Indian type 2 diabetics: a real world retrospective observational study

Background

Therapy for Type 2 diabetes (T2D) has been transformed by the introduction of newer agents like Glucagon like Peptide Receptor Agonists (GLP-1RA) and Sodium-glucose linked transporter inhibitors (SGLT2i). However with co-initiation of SGLT2i and GLP-1RA in the DURATION 8 trial an improvement in HbA1c was noted but the beneficial effect was not equal to the sum of its parts. In view of this we proceeded to test the hypothesis that sequential addition of GLP-1RA therapy to metformin and SGLT-2i may be more beneficial.

Methods

A retrospective real world observational case note study conducted in two diabetes care centres in India analyzed the first 60 consecutive T2D patients who could afford this therapy and had not achieved their glycaemic target (HbA1c < 7%)on metformin and SGLT2i. All these patients were additionally treated with either Dulaglutide or Liraglutide and followed up for 13 weeks.

Results

Across the entire 13-week study period, both liraglutide and dulaglutide proved to be an excellent add on to metformin and SGLT-2 inhibitor. There was significant reduction in HbA1c and body weight. Liraglutide had an additional significant impact on systolic blood pressure reduction in contrast to the dulaglutide arm. Comparatively, liraglutide and dulaglutide achieved similar metabolic control. However, a larger proportion of patients achieved HbA1c below 7.0% in the liraglutide arm (63.3%) compared to the dulaglutide arm (30%) and this difference was statistically significant.

Conclusion

In this retrospective study in Indian type 2 diabetic patients poorly controlled with metformin and SGLT-2 inhibitor we found a meaningful impact of adding a GLP-1 RA on all metabolic parameters. There were additional advantages seen with liraglutide as far achieving target HbA1c of less than 7% and also on the quantum of weight loss and systolic blood pressure reduction.

Electrically generated eddies at an eightfold stagnation point within a nanopore

Electrically generated flows around a thin dielectric plate pierced by a cylindrical hole are computed numerically. The geometry represents that of a single nanopore in a membrane. When the membrane is uncharged, flow is due solely to induced charge electroosmosis, and eddies are generated by the high fields at the corners of the nanopore. These eddies meet at stagnation points. If the geometry is chosen correctly, the stagnation points merge to form a single stagnation point at which four streamlines cross at a point and eight eddies meet.

Electroosmosis in a finite cylindrical pore: simple models of end effects

A theoretical model of electroosmosis through a circular pore of radius a that traverses a membrane of thickness h is investigated. Both the cylindrical surface of the pore and the outer surfaces of the membrane are charged. When h ≫ a, end effects are negligible, and the results of full numerical computations of electroosmosis in an infinite pore agree with theory. When h = 0, end effects dominate, and computations again agree with analysis. For intermediate values of h/a, an approximate analysis that combines these two limiting cases captures the main features of computational results when the Debye length κ(-1) is small compared with the pore radius a. However, the approximate analysis fails when κ(-1) ≫ a, when the charge cloud due to the charged cylindrical walls of the pore spills out of the ends of the pore, and the electroosmotic flow is reduced. When this spilling out is included in the analysis, agreement with computation is restored.

Early evaluation of voice quality in glottic cancer (T1, T2) following curative radiotherapy

BACKGROUND

This is prospective study analyzing the subjective and objective quality of voice and voice related quality of life in patients of early glottic cancer (T1, T2 disease) before and after receiving curative radiotherapy.

METHODS

Fifteen patients of early glottic carcinoma (T1, T2) underwent voice assessment using multidimensional voice protocol based on recommendation by European Laryngological Society which included Perceptual analysis of voice by speech therapist and otolaryngologist, acoustic analysis; aerodynamic efficiency analysis-Maximum phonation time; patient's self perception of voice analysis--Voice handicap index; and videolaryngostroboscopy. Assessment was done prior to commencement of radiation therapy and at 1 month and 3 months following radio- therapy.

RESULTS

There was significant improvement in majority of the voice parameters post radiotherapy. Perceptual analysis showed significant improvement in GRBAS score following radiotherapy. Perturbation measures (jitter, shimmer, SNR, HNR) showed improvement post radiotherapy though remained inferior compared to controls. Mean fundamental frequency (Mean F0) and habitual frequency (habitual F0) decreased post radiotherapy. Intensity of voice increased following radiotherapy which was statistically significant (p < 0.05). There was significant improvement in the patient's perception of their quality of voice and voice related quality of life post radiotherapy. Maximum phonation time showed statistically significant improvement post-radiotherapy. Perceptual analysis of voice by professional observer correlated well with patients self perception of his own voice.

CONCLUSION

Voice quality improves following radiotherapy but not all the patients regain normal voice. Improvement in voice quality improves quality of life of patients shown by improved voice handicap index.

Effect of lycoriside, an acylglucosyloxy alkaloid, on mast cells

The effect of lycoriside, an acylglucosyloxy alkaloid from Crinum asiaticum Linn, (family Amaryllidaceae), with or without sitosterol-3-O-β-D-glucoside, was studied on the rate of degranulation of peritoneal mast cells of albino rats. Lycoriside, at lower concentrations (1-20 µg/ml), in vitro, produced statistically significant protection against Tween 80-induced degranulation, as also to sensitized mast cells challenged with an antigen (horse serum). It also provided protection against compound 48/80-induced degranulation of mast cells when administered in vivo (1-5 mg/kg, po). At higher concentrations (100 µg/ml and above), in vitro, however, it had a mast-cell degranulation effect per se. The addition of sitosterol-3-O-β-D-glucoside to lycoriside did not modify the effect of the latter compound. The mechanism of the dual response elicited by lycoriside is appraised in view of a concentration-dependent anti- or prerelease effect on mast-cell mediators.

Attenuated stress-evoked anxiety, increased sucrose preference and delayed spatial learning in glucocorticoid-induced receptor-deficient mice

The glucocorticoid-induced receptor (GIR) is a stress-responsive gene that is abundantly expressed in forebrain limbic regions. Glucocorticoid-induced receptor has been classified as a Neuropeptide Y-like receptor, however, physiological attributes have not been investigated. In this study, mice lacking GIR (-/-) were screened in various paradigms related to stress, anxiety, activity, memory, fear and reward. GIR -/- mice elicited behavioral insensitivity to the anxiogenic effects of restraint stress. However, hypothalamic pituitary adrenal axis response to stress was not impacted by GIR deficiency. Increased preference for sucrose was observed in GIR -/- mice suggestive of modulation of reward-associated behaviors by the receptor. A delayed acquisition of spatial learning was also observed in GIR -/- mice. There were no effects of genotype on the modulation of anxiety-like behavior, activity, fear-conditioning and extinction. Our data extend previous studies on GIR regulation by glucocorticoids and provide novel evidence for a role of GIR in reward, learning and the behavioral outcomes of stress.

Multiscale Simulations of the RF Diode Sputtering of Copper

The morphology and microstructure of RF diode sputter deposited materials is a complicated function of many parameters of the reactor operating conditions. Using a combination of computational fluid dynamics (CFD), RF plasma, molecular dynamics (MD) sputter, and direct simulation Monte Carlo (DSMC) transport models, a multiscale approach has been used to analyze the RF diode sputtering of copper. The CFD model predicts the velocity and pressure distribution of the working gas flows in the deposition chamber. The plasma model uses these CFD results to compute ion energies and fluxes at the target and substrate. The MD model of sputtering is used to determine the initial energy distribution of sputtered atoms and reflected neutral working gas atoms and both of their angular distributions. A DSMC transport model then deduces the target atom deposition efficiency, the spatial distribution of the film thickness, the target and reflected neutral atoms energy and impact angle distributions given reactor operating input conditions such as background pressure, temperature, gas type, together with the reactor geometry. These results can then be used in atomistic growth models to begin a systematic evaluation of surface morphology, nanoscale structure, and defects dependences upon the reactor design and its operating conditions.

Effect of fish oil on offensive and defensive factors in gastric ulceration in rats

The effect of fish oil (FO) derived from Scomberoides commersonianus containing omega-3 polyunsaturated fatty acids was studied on gastric ulcers and as well as on offensive and defensive factors in gastric mucosal damage, following experimental gastric ulceration. FO significantly reduced the severity of ulceration in gastric ulcers induced by aspirin, cold-restraint stress (CRS), alcohol, and pylorus ligation. The results also indicated the potentiality of FO in maintaining the integrity of gastric mucosa by virtue of its effect on both offensive and defensive gastric mucosal factors. It decreased the offensive acid-pepsin secretion and augmented the defensive factors like mucin secretion, cellular mucus and life span of mucosal cells following pylorus ligation. FO significantly increased activity of anti-oxidant enzymes (catalase and glutathione peroxidase) and decreased lipid peroxidation in gastric mucosa of CRS rats. The study indicates the beneficial role of FO in gastric ulceration by inhibition of offensive mucosal factors and oxidative stress, and augmentation of defensive mucosal factors.

Effect of bioactive tannoid principles of Emblica officinalis on ischemia-reperfusion-induced oxidative stress in rat heart

The tannoid principles of the fruits of Emblica officinalis have been reported to exhibit antioxidant activity in vitro and in vivo. In the present study, an emblicanin-A (37%) and -B (33%) enriched fraction of fresh juice of Emblica fruits (EOT) was investigated for antioxidant activity against ischemia-reperfusion (IRI)-induced oxidative stress in rat heart. Vitamin E (VE) was used as the standard antioxidant agent. IRI was induced in isolated rat heart by perfusing it with modified Kreb-Hensleitt's solution for 5 min, followed by a period of ischemia (stoppage of perfusion) for 10 min and then restoring the perfusion (reperfusion) for 15 min. IRI induced a significant decrease in the activities of cardiac superoxide dismutase, catalase and glutathione peroxidase, with a concomitant increase in lipid peroxidation. These IRI-induced effects were prevented by the administration of EOT (50 and 100 mg/kg body wt.) and VE (200 mg/kg body wt.) given orally twice daily for 14 days prior to the sacrifice of the animals and initiation of the perfusion experiments. The study confirms the antioxidant effect of E. officinalis and indicates that the fruits of the plant may have a cardioprotective effect.

Effect of Withania somnifera glycowithanolides on a rat model of tardive dyskinesia

Withania somnifera glycowithanolides (WSG) were investigated for their preventive effect on the animal model of tardive dyskinesia (TD), induced by once daily administration of the neuroleptic, haloperidol (1.5 mg/kg, i.p.), for 28 days. Involuntary orofacial movements (chewing movements, tongue protusion and buccal tremors) were assessed as TD parameters. WSG (100 and 200 mg, p.o.), administered concomitantly with haloperidol for 28 days, inhibited the induction of the neuroleptic TD. Haloperidol-induced TD was also attenuated by the antioxidant, vitamin E (400 and 800 mg/kg, p.o.), but remained unaffected by the GABA-mimetic antiepileptic agent, sodium valproate (200 and 400 mg/kg, p.o.), both agents being administered for 28 days like WSG. The results indicate that the reported antioxidant effect of WSG, rather than its GABA-mimetic action, may be responsible for the prevention of haloperidol-induced TD.

Antidepressant activity of hyperforin conjugates of the St. John's wort, Hypericum perforatum Linn.: an experimental study

Nine extracts of H. perforatum, containing hyperforin in conjugated forms, but devoid of free hyperforin and adhyperforin, were subjected to antidepressant screening using the forced swim test (FST). The observed activity was compared with that of SJW extracts containing hyperforin and adhyperforin (in free form). Results indicate that hyperforin conjugates exhibit significant antidepressant activity as evidenced by the reduced immobility period in the FST in rats.

Effects of Shilajit on the development of tolerance to morphine in mice

Effects of concomitant administration of Processed Shilajit (PS, 0.1 and 1 mg/kg, i.p.), in Swiss mice were evaluated on the development of tolerance to morphine induced analgesia in the hot plate test. Chronic administration of morphine (10 mg/kg, i.p., b.i.d.) to mice over a duration of 10 days resulted in the development of tolerance to the analgesic effect of morphine. Concomitant administration of PS with morphine, from day 6 to day 10, resulted in a significant inhibition of the development of tolerance to morphine (10 mg/kg, i.p.) induced analgesia. Processed Shilajit per se, in the doses used, did not elicit any significant analgesia in mice; nor did the chronic concomitant administration of Processed Shilajit alter the morphine-induced analgesia. These findings with Processed Shilajit indicate its potential as a prospective modifier of analgesic tolerance to morphine.

Anti-oxidant effect of Withania somnifera glycowithanolides in chronic footshock stress-induced perturbations of oxidative free radical scavenging enzymes and lipid peroxidation in rat frontal cortex and striatum

The antioxidant activity of Withania somnifera (WS) glycowithanolides was assessed in chronic footshock stress induced changes in rat brain frontal cortex and striatum. The stress procedure, given once daily for 21 days, induced an increase in superoxide dismutase (SOD) and lipid peroxidation (LPO) activity, with concomitant decrease in catalase (CAT) and glutathione peroxidase (GPX) activities in both the brain regions. WS glycowithanolides (WSG), administered orally 1 h prior to the stress procedure for 21 days, in the doses of 10, 20 and 50 mg/kg, induced a dose-related reversal of the stress effects. Thus, WSG tended to normalise the augmented SOD and LPO activities and enhanced the activities of CAT and GPX. The results indicate that, at least part of chronic stress-induced pathology may be due to oxidative stress, which is mitigated by WSG, lending support to the clinical use of the plant as an antistress adaptogen.

Anxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental study

The roots of Withania somnifera (WS) are used extensively in Ayurveda, the classical Indian system of medicine, and WS is categorized as a rasayana, which are used to promote physical and mental health, to provide defence against disease and adverse environmental factors and to arrest the aging process. WS has been used to stabilize mood in patients with behavioural disturbances. The present study investigated the anxiolytic and antidepressant actions of the bioactive glycowithanolides (WSG), isolated from WS roots, in rats. WSG (20 and 50 mg/kg) was administered orally once daily for 5 days and the results were compared by those elicited by the benzodiazepine lorazepam (0.5 mg/kg, i.p.) for anxiolytic studies, and by the tricyclic anti-depressant, imipramine (10 mg/kg, i.p.), for the antidepressant investigations. Both these standard drugs were administered once, 30 min prior to the tests. WSG induced an anxiolytic effect, comparable to that produced by lorazepam, in the elevated plus-maze, social interaction and feeding latency in an unfamiliar environment, tests. Further, both WSG and lorazepam, reduced rat brain levels of tribulin, an endocoid marker of clinical anxiety, when the levels were increased following administration of the anxiogenic agent, pentylenetetrazole. WSG also exhibited an antidepressant effect, comparable with that induced by imipramine, in the forced swim-induced 'behavioural despair' and 'learned helplessness' tests. The investigations support the use of WS as a mood stabilizer in clinical conditions of anxiety and depression in Ayurveda.

Effect of Withania somnifera glycowithanolides on iron-induced hepatotoxicity in rats

Glycowithanolides, consisting of equimolar concentrations of sitoindosides VII-X and withaferin A, isolated from the roots of Withania somnifera Dunal, have been reported to have an antioxidant effect in the rat brain frontal cortex and striatum. In the present study, the effect of 10 days of oral administration of these active principles, in graded doses (10, 20 and 50 mg/kg), was noted on iron overload (FeSo(4), 30 mg/kg, i.p.) induced hepatotoxicity in rats. Apart from hepatic lipid peroxidation (LPO), the serum enzymes, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase, were assessed as indices of hepatotoxicity. Silymarin (20 mg/kg, p.o.) was used for comparison. Iron overload induced marked increase in hepatic LPO and serum levels of the enzymes, which was attenuated by WSG in a dose-related manner, and by silymarin. The results indicate that the reported use of WS in Ayurveda for hepatoprotection against heavy metals and other environmental toxins, may be due the antioxidant action of WSG.

Antioxidant activity of tannoid principles of Emblica officinalis (amla) in chronic stress induced changes in rat brain

Effect of tannoid principles emblicanin A, emblicanin B, punigluconin, and pedunculagin of E. officinalis was assessed on chronic unpredictable footshock-induced stress-induced perturbations in oxidative free radical scavanging enzymes in rat brain frontal cortex and striatum. Chronic stress, administered over a period of 21 days, induced significant increase in rat brain frontal cortical and striatal superoxide dismutase (SOD) activity, concomitant with significant reduction in catalase (CAT) and glutathione peroxidase (GPX) activity. The changes in the enzyme activities was accompanied by an increase in lipid peroxidation, in terms of augmented thiobarbituric acid-reactive products. Administration of Emblica tannoids (10 and 20 mg, po) for 21 days, concomitant with the stress procedure, induced a dose-related alteration in the stress effects. Thus, a tendency towards normalization of the activities of SOD, CAT and GPX was noted in both the brain areas, together, with reduction in lipid peroxidation. The results indicate that the reported antistress rasayana activity of E. officinalis may be, at least partly due to its tendency to normalize stress-induced perturbations in oxidative free radical scavenging activity, in view of the postulate that several stress-induced diseases, including the process of aging, may be related to accumulation of oxidative free radicals in different tissues.

Antioxidant activity of Bacopa monniera in rat frontal cortex, striatum and hippocampus

The effect of a standardized extract of Bacopa monniera Linn. was assessed on rat brain frontal cortical, striatal and hippocampal superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) activities, following administration for 7, 14 or 21 days. The effects induced by this extract (bacoside A content 82% +/- 0.5%), administered in doses of 5 and 10 mg/kg, orally, were compared with the effects induced by (-) deprenyl (2 mg/kg, p. o.) administered for the same time periods. Bacopa monniera (BM) induced a dose-related increase in SOD, CAT and GPX activities, in all the brain regions investigated, after 14 and 21 days of drug administration. On the contrary, deprenyl induced an increase in SOD, CAT and GPX activities in the frontal cortex and striatum, but not in the hippocampus, after treatment for 14 or 21 days. The results suggest that BM, like deprenyl, exhibits a significant antioxidant effect after subchronic administration which, unlike the latter, extends to the hippocampus as well. The results suggest that the increase in oxidative free radical scavenging activity by BM may explain, at least in part, the cognition- facilitating action of BM, recorded in Ayurvedic texts, and demonstrated experimentally and clinically.

Effect of bioactive tannoid principles of Emblica officinalis on iron-induced hepatic toxicity in rats

The tannoid principles of the fruits of the plant Emblica officinalis Gaertn comprising of emblicanin A. emblicanin B, punigluconin and pedunculagin, have been reported to exhibit antioxidant activity in vitro and in vivo. In the present study, an emblicanin A (37%) and B (33%) enriched fraction of fresh juice of Emblica fruits (EOT), administered prophylactically (10, 20 and 50 mg/kg, p.o.) for 10 consecutive day, was found to inhibit acute iron overload (30 mg/kg, i.p.) hepatic lipid peroxidation and the increase of serum levels of alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase, used as markers of the induced hepatic dysfunction. A similar effect was produced by silymarin (20 mg/kg, p.o.), an antioxidant hepatoprotective agent. The results support the use of Emblica fruits for hepatoprotection in Ayurveda.

3'-deoxyribonucleosides and their derivatives as anti-amoebic agents

In general nucleoside analogues were found to possess in vitro amoebicidal property against trophozoites of Entamoeba histolytica. The acid-labile nature of these compounds completely destroyed their ability to cure caecal amoebiasis of rats. However the therapeutic efficacy of one of these compounds yielded most promising results, with 10% cures when it was administered as enteric coated formulation.

Sodium channel blockers and uridine triphosphate: effects on nasal potential difference in cystic fibrosis mice

Sodium channel inhibitors block the enhanced Na+ reabsorption in cystic fibrosis (CF). Extracellular nucleotides facilitate Cl- secretion via Ca2+ gated Cl- channels. A combination of these effects may produce less viscid secretions in CF which are easier to expectorate. This study examined the effects of combining sodium channel blockers with uridine triphosphate (UTP) on nasal membrane potential difference (PD) in CF insertional null mutant mice (cftr(tm1HGU)), deltaF508 homozygous mice (cftr(tm1Cam)) and matched control animals. Median basal PD in the insertional CF mice and deltaF508 CF mice were -28 and -34 mV respectively. These values were significantly different to the control animals (-20 mV). Amiloride and loperamide reduced the PD in cftr(tm1HGU) CF mice (deltaPD 13 mV & 15 mV respectively) suggesting Na+ blockade. The subsequent addition of UTP in a chloride-free vehicle increased the PD (deltaPD -8- -12.5 mV). DeltaF508 mice showed significantly greater responses compared with CF insertional null mutant mice (p<0.05). The action of UTP was brief and not prolonged by the addition alpha-beta-methylene-adenosine 5' diphosphate. Suramin, a competitive antagonist of P2 purinoceptors blocked the action of UTP. In conclusion, this study demonstrated dose dependant nasal membrane potential changes in differences mice with uridine triphosphate in the presence of sodium channel blockers suggestive of chloride secretion. More stable analogues of uridine triphosphate in combination with long acting sodium channel blockers such as loperamide may have therapeutic potential in cystic fibrosis.

A chemically labeled cytotoxic agent: two-photon fluorophore for optical tracking of cellular pathway in chemotherapy

Chemotherapy is commonly used in the treatment of cancers. However, the mechanism of action of many of these agents is not well understood. We present the synthesis of a two-photon fluorophore (C625) and its biological application when chemically linked to a chemotherapeutic agent (AN-152). By using two-photon laser-scanning microscopy, the drug:fluorophore conjugate can be observed directly as it interacts with receptor-positive cell lines. The results of this project visually show the receptor-mediated entry of AN-152 into the cell cytoplasm and subsequently into the nucleus. These observations will allow for better understanding of the drug's therapeutic mechanism, which is a subject of ongoing research aimed at improving present methods for cancer therapy.