Consequences of medical negligence and litigations on health care providers - A narrative review.

Medical professionals face high stress due to the type of work they do and the prolonged working hours. Frequent burnout results due to the challenging nature of their work. Added to the stress of work, malpractice lawsuits add to their burden. In India, most doctors work in compromised settings with poor infrastructure and manpower but are expected to follow the best practices. In court, they are judged with the Bolam and Bolitho tests being essential considerations. Several tragic incidents have been reported, including depression, anger issues, and even suicide deaths of healthcare professionals (HCPs) after accusations of negligence and subsequent inquiry. Such incidents demonstrate the multitude of challenges an HCP faces in day-to-day practice. It is crucial to find ways to tackle these problems and enhance the capacity of HCP to handle such demanding circumstances. Malpractice litigation can significantly impact the mental health of HCPs. It is common to experience emotional turmoil when faced with a lawsuit. Second victim syndrome (SVS) is a term used to describe a set of symptoms experienced by HCPs who make an error leading to injury to a patient. However, it also happens if he is traumatized by the consequences of violence during healthcare services or a lawsuit or defamation article in newspaper/social media. Following a litigation crisis in their career, many HCPs go through various stages of grief, including shock, denial, anger, bargaining, depression, and acceptance. At times, death by suicide of the HCPs is well known. SVS is known to profoundly affect the personal, family, economic, professional (defensive practice), and social life of HCPs. HCPs should accept the allegations of negligence as an occupational hazard and prepare for the eventual litigation at least once in a lifetime by knowing about the medical laws, HCP's rights, becoming aware of the emotional turmoil of the lawsuit, preparing to cope with the lawsuit, and seeking help from colleagues and indemnity insurance. Frequent training of the HCPs is strongly recommended to know about the changing laws and also to undergo periodic professional competence enhancement to reduce the incidents of errors amounting to medical negligence. Medical and hospital administration should debrief after any incident and conduct internal investigations to identify systemic flaws and prevent future recurrence, resolve issues within their control at their level, and manage media (mainstream and social media) appropriately. If established, a reporting system with online and offline services will ease the internal administrative investigation process and take appropriate, timely actions. During the crisis, HCPs should have adequate and appropriate insurance or indemnity coverage and mental health support systems.

Prospective Phase II Study of Radiotherapy Dose Escalation in Grade 4 Glioma Using 68Ga-Pentixafor PET Scan.

AIMS: Local failure remains the major concern in grade 4 glioma or glioblastoma (GBM). Pilot studies have shown a radiotherapy (RT) dose-response relationship in GBM. Here we present our preliminary data of RT dose escalation using 68Ga-Pentixafor PET scan. High 68Ga-pentixafor uptake in glioma cells helps in sharp demarcation between tumour and normal brain. MATERIALS AND METHODS: This phase II prospective study was conducted from 2018 to 2020. Thirty, biopsy-proven cases of grade 4 glioma were included. All patients underwent post-operative MRI of the brain and 68Ga-Pentixafor PET scan. RT was planned in 2-phases. Phase-1 GTV (GTV1) comprised of T2/flair abnormality, PET-avid disease and post-op cavity. A margin of 2cm was given to GTV-1 to create phase-1 CTV (CTV1), which was further expanded to 0.5cm to generate phase-1 PTV (PTV1). A radiation dose of 46Gy/23fr was prescribed to PTV-1. Phase-2 GTV (GTV2) consisted of CT/MRI contrast-enhancing lesion, PET avid disease and post-op cavity. A margin of 0.5 cm was given to GTV2 to create phase-2 CTV (CTV2) which was expanded to 0.5 cm to create phase-2 PTV (PTV2). RT dose of 14 Gy/7 fr was prescribed to PTV2. PET avid disease was delineated as GTV PET and a margin of 3mm was given to generate PTV-PET which received escalated RT dose of 21 Gy/7fr by simultaneous integrated boost (SIB) in phase 2 (Total dose to PTV PET = 67 Gy/30 fr). All patients received concurrent and adjuvant temozolomide. The data was prospectively maintained in Microsoft Excel sheet. SPSS v 23 was used for statistical analysis. The primary endpoints were estimation of the overall survival (OS) and progression-free survival (PFS), and secondary endpoint was to measure the incidence of radiation necrosis. Categorical variables were reported as frequency and percentage and quantitative variables were reported as median and range. RESULTS: Data from thirty patients were analysed. A median OS of 23 months was observed with estimated 1, 2 and 3 years OS of 90%, 40% and 17.8% respectively. A significant association of OS was seen with the extent of surgery (p = 0.04) and kernofsky performance status (p = 0.007). No patient developed significant radiation necrosis. CONCLUSIONS: The index study did not show any survival benefit from dose escalation RT. However, all of the patients tolerated the treatment well and none of them developed radiation necrosis. Considering the small sample size as a limitation of the index study, the role of 68Ga-pentixafor PET scan for radiation dose escalation should be further explored. CLINICAL TRIAL NUMBER: CTRI/2019/05/019146.

Recent developments in enzymatic and microbial biosynthesis of flavor and fragrance molecules.

Flavors and fragrances are an important class of specialty chemicals for which interest in biomanufacturing has risen during recent years. These naturally occurring compounds are often amenable to biosynthesis using purified enzyme catalysts or metabolically engineered microbial cells in fermentation processes. In this review, we provide a brief overview of the categories of molecules that have received the greatest interest, both academically and industrially, by examining scholarly publications as well as patent literature. Overall, we seek to highlight innovations in the key reaction steps and microbial hosts used in flavor and fragrance manufacturing.

Harnessing biocatalysis to achieve selective functional group interconversion of monomers.

Polymeric materials are ubiquitous to modern life. However, reliance of petroleum for polymeric building blocks is not sustainable. The synthesis of macromolecules from recalcitrant polymer waste feedstocks, such as plastic waste and lignocellulosic biomass, presents an opportunity to bypass the use of petroleum-based feedstocks. However, the deconstruction and transformation of these alternative feedstocks remained limited until recently. Herein, we highlight examples of monomers liberated from the deconstruction of recalcitrant polymers, and more extensively, we showcase the state-of-the-art in biocatalytic technologies that are enabling synthesis of diverse upcycled monomeric starting materials for a wide variety of macromolecules. Overall, this review emphasizes the importance of functional group interconversion as a promising strategy by which biocatalysis can aid the diversification and upcycling of monomers.

Fabrication of Mesoporous Materials Based on Supramolecular Self-Assembly of Guanosine Monophosphonate-Nickel Chloride (GMP-Ni) for High-Performance Hybrid Supercapacitors.

Supramolecular self-assembly of nickel chloride and guanosine mono-phosphonate (GMP) and nickel (Ni)-based GMP-Ni and their calcinated mesoporous electrode materials GMP-Ni-500 and GMP-Ni-700 at 500 and 700 °C, respectively, have been fabricated. GMP-Ni, GMP-Ni-500, and GMP-Ni-700 are examined for their supercapacitor performance in a three-electrode configuration. The electrochemical tests demonstrate the mesoporous battery-type nature of GMP-Ni-500 which exhibited a specific capacity (Cs) of about 289 C g-1 at 0.5 A g-1 current density. In addition, a cost-effective and simple asymmetric supercapacitor device has been fabricated with battery-type GMP-Ni-500 as a cathode material and capacitive-type activated carbon (AC) as an anodic material. In an operating voltage window of 0 to 1.5 V, hybrid supercapacitors (HSCs) based on GMP-Ni-500//AC exhibited a remarkable performance with a specific capacity (Cs) of 144 C g-1 at 0.5 A g-1. For the HSC device, the maximum of 66% capacity retention has been observed after 5000 charging/discharging cycles at 5 A g-1. Furthermore, the HSC device demonstrates a high energy density of 24 W h kg-1 at a power density of 297 W kg-1. The molecular transformation was established by employing theoretical calculations. These results suggest that our HSC has outstanding potential in technology development for next-generation commercial applications.