Next-generation hybrid technologies for the treatment of pharmaceutical industry effluents.

Water and industries are intangible units of the globe that are always set to meet the population's demand. The global population depends on one-third of freshwater increasing the demand. The increase in population along with urbanization has polluted the fresh water resources. The pharmaceutical industry is marked as an emerging contaminant of water pollution. The most common type of pharmaceutical drugs that are detected in the environment includes antibiotics, analgesics, NSAIDs, and pain-relieving drugs. These drugs alter the food chain of the organisms causing chaos mainly in the marine ecosystem. Pharmaceutical drugs are found only in shallow amounts (ng/mg) they have a huge impact on the living system. The consumption of water contaminated with pharmaceutical ingredients can disrupt reproduction, hormonal imbalance, cancer, and respiratory problems. Various methods are used to remove these chemicals from the environment. In this review, we mainly focused on the emerging hybrid technologies and their significance in the effective treatment of pharmaceutical wastewater. This review paper primarily elaborates on the merits and demerits of existing conventional technologies helpful in developing integrated technologies for the modern era of pharmaceutical effluent treatment. This review paper further in detail discusses the various strategies of eco-friendly bioremediation techniques namely biostimulation, bioaugmentation, bacterial degradation, mycoremediation, phytoremediation, and others for the ultimate removal of pharmaceutical contaminants in wastewater. The review makes clear that targeted and hybrid solutions are what the world will require in the future to get rid of these pharmacological prints.

Unravelling groundwater contamination and health-related implications in semi-arid and cold regions of India.

Groundwater, a vital global resource, is essential for sustaining life and various human activities. However, its quality and availability face increasing threats from both natural and human-induced factors. Widespread contamination, arising from both natural origins and human activities such as agriculture, industry, mining, improper waste disposal, and wastewater release, poses significant risks to human health and water security. India, known for its dense population and pronounced groundwater challenges, serves as a prominent case study. Notably, in most of its regions, groundwater resources have been found to be severely contaminated by various chemical, biological, and radioactive contaminants. This review presents an examination of contamination disparities across various states of semi-arid and cold regions, encompassing diverse assessment methods. The studies conducted in semi-arid regions of North, South, West, and East India highlight the consistent presence of fluorides and nitrates majorly, as well as heavy metals in some areas, with values exceeding the permissible limits recommended by both the Bureau of Indian Standards (BIS) and the World Health Organization (WHO). These contaminants pose skeletal and dental threats, methemoglobinemia, and even cancer. Similarly, in cold regions, nitrate exposure and pesticide residues, reportedly exceeding BIS and WHO parameters, pose gastrointestinal and other waterborne health concerns. The findings also indicated that the recommended limits of several quality parameters, including pH, electrical conductivity, total dissolved solids (TDS), total hardness, and total alkalinity majorly surpassed. Emphasising the reported values of the various contaminant levels simultaneously with addressing the challenges and future perspectives, the review unravels the complex landscape of groundwater contamination and its health-related implications in semi-arid and cold regions of India.

Technical and clinical assessment of latest technology SiPM integrated digital PETCT scanner.

OBJECTIVE: The aim of this study was to conduct a technical and clinical evaluation of a Silicon Photomultiplier (SiPM) integrated digital Positron Emission Tomography - Computed Tomography (PETCT) Scanner using National Electrical Manufacturers Association (NEMA) NU 2- 2018 standards. METHODS: System sensitivity was measured by using a NEMA sensitivity phantom. Scatter fraction, count-rate performance, accuracy of count loss, and timing resolution were all computed. Clinical images were acquired and image quality was assessed and compared with published studies. RESULTS: At 1 cm, tangential, radial, and axial spatial resolutions were 3.02 mm, 3.02 mm, and 2.73 mm at full width half maximum (FWHM), respectively. Sensitivity at centre and 10 cm was 10.359 cps/kBq and 9.741 cps/kBq, respectively. The timing resolution was measured at 372 ps. CONCLUSION: The digital PETCT exhibits a high-spatial resolution and a superior timing resolution, which advances the diagnostic ability to detect small lesions and boosts the diagnostic confidence. IMPLICATIONS FOR PRACTICE: Increases clinical relevance by improving the ability to detect and differentiate tiny or low-contrast lesions without compromising radiopharmaceutical dose or overall scan time.

Comparative study of the short-range structure of α-V2O5, α-TeO2 and xV2O5-(100 - x)TeO2 glasses using X-ray diffraction, Rietveld analysis and reverse Monte Carlo simulations.

Vanadium-tellurite glasses, tetragonal TeO2 and orthorhombic V2O5 crystalline samples were characterized for their atomic structure properties by synchrotron X-ray diffraction, pair distribution function analysis, reverse Monte Carlo simulations (RMC) and Rietveld analysis. The pair correlation function, G(r), of V2O5 shows the first peak at 1.61 Å. G(r) of TeO2 shows three peaks at 1.57, 2.13 and 2.88 Šdue to Te-O linkages of three different lengths, whereas the Te-Te atomic pair correlation shows a peak at 3.85 Å. The average coordination number of V with O in crystalline V2O5 is 4.39 while that of Te with O in crystalline TeO2 is 3.71. G(r) of the vanadium tellurite glass shows the first peak at 1.90 Šdue to overlapping Te-O and V-O atomic pair correlations. The RMC analysis on diffraction data of glasses found that the V-O coordination number is in the range 5.27-5.59 and the Te-O coordination number is 5.39-5.67. However, it is found that these coordination numbers cannot be clearly defined due to short-range disorder.

Response assessment by positron emission tomography-computed tomography as compared with contrast-enhanced computed tomography in childhood Hodgkin lymphoma can reduce the need for radiotherapy in low- and middle-income countries.

INTRODUCTION: The InPOG-HL-15-01, a multicentric prospective study, used a risk-stratified and response-based approach with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) backbone to treat children and adolescents with newly diagnosed Hodgkin lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after two cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast-enhanced computed tomography (CECT) and PET-CT on treatment decisions and outcomes. METHODOLOGY: 396 patients were enrolled and 382 had an ERA at the assigned time point. Satisfactory response was defined as Deauville score 3 or less for patients undergoing PET-CT and complete response (CR)/very good partial response (VGPR) for patients undergoing CECT. Outcomes of interest incorporate 5 year event-free survival (EFS), EFS including abandonment (EFSa), and overall survival (OS). RESULTS: At ERA, satisfactory response was documented in 277 out of 382 (72.5%) participants and this was significantly higher in PET-CT (151 out of 186, 81.2%) as compared with CECT-based assessments (126 out of 196, 64.3%) respectively (p value < .001). Amongst the 203 patients with nonbulky disease (wherein the indication for RT was entirely dependent on ERA), 96 out of 114 (84.2%) and 61 out of 89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value = .008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year OS of both groups, ERA based on CECT (91.8%) versus PET-CT (94.1%) was comparable (p value = .391) and so was the 5 year EFS (86.7 vs. 85.5%, p value = .724). CONCLUSION: Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared with CECT and thereby decreases the need for RT in response-based treatment algorithm for HL-afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.

DNA protection ability, antihyperglycemic potential and in-vivo toxicity assessment of arrowleaf tearthumb (Persicaria sagittata L.), a neglected aquatic plant species of Eastern Asia.

Persicaria sagittata L. (common name arrowleaf tearthumb, American) is an herbaceous edible plant with characteristics sessile leaves mainly found in wetland areas of North America and Eastern Asia. In Eastern Himalayan Region of India, the ethnic communities consumed this plant as vegetables. The present investigation suggests the plant is endowed with bioactive compounds having potential DNA protection ability and antihyperglycemic activity. The DNA nicking assay revealed that the methanolic extract of this plant has the potential to protect plasmid DNA against hydroxyl damage. The α-glucosidase and α-amylase inhibitory assay of this methanolic extract suggest more effectiveness in inhibition of α-amylase than the α-glucosidase. Further, proximate composition, micronutrient, total phenolic and flavonoid content of this underutilised aquatic plant was determined. And lastly the in-vivo cytotoxicity study of Persicaria sagittata L. plant extract suggest that the plant is less toxic to in-vivo system.

Political stability and its effect on economy: some lessons from Sikkim Himalaya.

The Himalayan state of Sikkim has a unique political culture and social environment that could be replicated. Unlike other north-eastern states of India where ethnic identities have been intensely used for electoral politics and state developmentalism, the collective Sikkimese identity has taken precedence over narrow ethnic identity politics in Sikkim. As a result, the state has evolved as one of the most politically stable and better-governed states in India, resulting in rapid economic growth. This has been made possible by the charismatic quality of its political leadership, and the peoples' collective vision of an inclusive Sikkimese identity.

Identification of Health Systems Science in a Problem-Based Learning Clinical Reasoning Exercise.

The creation of developmentally appropriate and meaningfully complex clinical reasoning exercises in the pre-clerkship curriculum is a common challenge for many medical schools. We provide an overview of one component of the pre-clerkship clinical reasoning curriculum at Case Western Reserve University School of Medicine, and present evidence that inclusion of Health Systems Science in this exercise facilitates integrated thinking in a Problem-Based Learning curriculum.

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines.

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.

The Hindi Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment.

BACKGROUND: Despite the cultural sanctity and elevation of breastfeeding practices, nearly one in two Indian women nationwide are unable to practice exclusive breastfeeding (EBF). Early identification of mothers at risk of reduced breastfeeding through a suitable instrument can enable targeted interventions for breastfeeding support. OBJECTIVES: We conducted this study with the objectives of translation into Hindi and to psychometrically test the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and to ascertain the sociodemographic and other correlates of breastfeeding self-efficacy. METHODS: The BSES-SF was translated into Hindi using a back and forth translation process to ensure linguistic validity. We enrolled a total of 210 married women who were mothers of infants at an urban primary health center in Delhi, India. RESULTS: The Cronbach's alpha for the Hindi translation of the BSES-SF was 0.87 with all except one correlation coefficient <0.3. We conducted an exploratory factor analysis using principal component analysis that revealed a two-component solution, which explained 47.9% and 16.7% of the total variance, respectively. Mothers perceiving higher social support registered significantly higher mean BSES-SF scores, indicating a greater confidence in their breastfeeding abilities (P = 0.01). However, breastfeeding self-efficacy was unrelated to the mother's age, parity, and education. The women planning to breastfeed partially had lower BSES-SF scores compared to the woman adhering to EBF norms (P < 0.001). CONCLUSION: The Hindi version of the BSES-SF demonstrates good reliability and validity and can also explain previous and planned breastfeeding behavior in mothers of infants.

Cost-effectiveness of a novel strategy of HIV/AIDS care in Armed Forces: A stochastic model with Monte Carlo simulation.

BACKGROUND: Despite the initial success of HIV/AIDS policy, an increasing number of patients are failing the first-line antiretroviral therapy (ART) each year and the failure rates are increasing. There is a need for identification of novel strategies to reduce failure rates. The aims of the study are (1) to design a novel strategy to reduce ART failure rates and (2) to create a stochastic model using Monte Carlo (MC) simulation comparing the novel strategy with existing strategy. METHODS: A novel strategy based on annual plasma viral load testing and resistance testing for HIV treatment at baseline and at the time of failure was designed. A cohort of 1000 patients each was created for the existing strategy and a novel strategy. Assumptions were included from Indian studies and own data. The two strategies were compared over 20 years of follow-up using stochastic modeling and MC simulation was done for death rates, failure rates, and cost-effectiveness analysis. SimVoi add-in software for MS Excel was used for simulations. Student's t-tests were performed for comparing continuous variables, and the cumulative rates for various outcomes were plotted using Kaplan-Meier analysis. RESULTS: The novel strategy resulted in lower mortality over a 20-year period (279.9 + 7.13 deaths vs 130.43 + 6.03 deaths) with incremental cost per life saved at Rs 32,925 per year. Incremental cost-effectiveness ratio cost per quality-adjusted life year was Rs 1.33 lakhs/annum at constant rate of discounting and just under Rs 90,000 per annum using differential discounting. CONCLUSION: Armed Forces are likely to benefit by adopting the novel strategy that is cost-effective with a significant mortality benefit.

The determinants of out-of-pocket health-care expenses for diabetes mellitus patients in India: An examination of a tertiary care government hospital in Delhi.

OBJECTIVE: To assess the determinants of out-of-pocket (OOP) expenses on diabetes-related treatment incurred in patients attending outpatient clinics in a tertiary care hospital in Delhi, India. STUDY DESIGN: A cross-sectional analysis of baseline data from a quasi-experimental study was conducted over 8 months in 2016 in a major tertiary care hospital in Delhi. METHODS: The study included 375 diabetes patients up to 65 years of age on treatment for at least a year without significant complications. Data were collected through a patient interview schedule. RESULTS: Of the previous six scheduled appointments, at least two missed appointments were seen in 267 (71.2%) patients. The average patient's OOP expenditure on diabetes-related medicines was ₹63.5 a month, a similar amount was spent on traveling to and from health facilities. Sixty-four (17.1%) patients took antidiabetic medication for <85% of the days in the previous 3 months. CONCLUSION: There exists a high burden of missed clinic appointments among diabetes patients in tertiary care government health settings in India. This appears to be related to the high cost in terms of both time and money involved in attending appointments for the modest benefit of a dispensation of a 15-day drug refill. Health policy measures focused on strengthening medication coverage need to explore the balance of costs and benefits when determining the frequency of clinical appointments in these settings.

Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings.

Improving patient survival and quality of life in chronic diseases requires prolonged and often lifelong medication intake. Less than half of patients with chronic diseases globally are adherent to their prescribed medications which preclude the full benefit of treatment, worsens therapeutic outcomes, accelerates disease progression, and causes enormous economic losses. The accurate assessment of medication adherence is pivotal for both researchers and clinicians. Medication adherence can be assessed through both direct and indirect measures. Indirect measures include both subjective (self-report measures such as questionnaire and interview) and objective (pill count and secondary database analysis) measures and constitute the mainstay of assessing medication adherence. However, the lack of an inexpensive, ubiquitous, universal gold standard for assessment of medication adherence emphasizes the need to utilize a combination of measures to differentiate adherent and nonadherent patients. The global heterogeneity in health systems precludes the development of a universal guideline for evaluating medication adherence. Methods based on the secondary database analysis are mostly ineffectual in low-resource settings lacking electronic pharmacy and insurance databases and allowing refills without updated, valid prescriptions from private pharmacies. This significantly restricts the choices for assessing adherence until digitization of medical data takes root in much of the developing world. Nevertheless, there is ample scope for improving self-report measures of adherence. Effective interview techniques, especially accounting for suboptimal patient health literacy, validation of adherence questionnaires, and avoiding conceptual fallacies in reporting adherence can improve the assessment of medication adherence and promote understanding of its causal factors.

Performance, carcass characteristics and economics of broiler chickens fed dietary enzymes and probiotic.

BACKGROUND: Researchers are challenged with identification of possible feed additives with the ability to increase the efficiency of feed utilization. AIMS: The present work aimed at studying growth pattern and carcass traits in broiler fed on dietary enzymes (Enzymex) and probiotic (Yeamark) over a period of six weeks. METHODS: A completely randomized design, including 8 treatments, 3 replications and 15 birds in each experimental unit was applied. Results: The results showed that feed intake decreased significantly (P<0.05) which might be due to the birds fulfilling their nutrient requirements by taking less amount of feed with improved digestibility of energy sources and amino acids. The results of present study also demonstrate the beneficial effects on performance and dressed yield in the treated groups in broiler. CONCLUSION: Enzymes and probiotic are, therefore, suggested to be used as feed additives in broiler rations for higher profitability.

An Epidemiological Study on Burden of Hearing Loss and Its Associated Factors in Delhi, India.

INTRODUCTION: Hearing loss is the second most common cause of years lived with disability (YLD). The present study was conducted with an objective to determine the prevalence, severity, and sociodemographic correlates of hearing loss among people aged 3 months and above in selected areas of Delhi, India. MATERIAL AND METHODS: A community-based cross-sectional study was conducted in selected rural and urban areas of Delhi among population aged 3 months and above. Of the total sample size of 664, 85 study subjects (17 households) were taken from the rural area, and 579 (116 households) were taken from urban areas. The hearing test and ear examination was carried out using handheld oto-acoustic emission (OAE) in children <5 years of age and pure tone audiometry in individuals above 5 years of age. SPSS software was used for data analysis. Chi-square test was used to analyze difference between proportions. RESULTS: Overall prevalence of hearing loss was 25.1%. Conductive hearing loss was present among 61 (10.3%) subjects, mixed hearing loss was found among 5 (0.8%) subjects, and sensorineural hearing loss among 94 (15.8%) subjects. On OAE, 62 (89.9%) children passed the test, and 7 (10.1%) were referred. Increasing age, female gender, and low education were significantly associated with hearing loss. CONCLUSION: There was high prevalence of hearing loss in the study sample. Urgent interventions are required to identify individuals with hearing loss so that its serious complications can be reduced.

Influence of hatch time and access to feed on intramuscular adipose tissue deposition in broilers.

The effect of hatch time and subsequent access to feed on intramuscular adipose tissue deposition was studied in the pectoralis major muscle of male Ross 308 broiler chickens. Based on their hatch time chicks were classified as early (EH), midterm (MH), or late (LH) hatchers, with an average incubation duration of 497.7 h for EH, 508.8 h for MH, and 514.5 h for LH birds. Chicks were provided access to feed either immediately at hatch, or 24 h after the conclusion of the hatch window. Expression of the adipogenic regulatory genes peroxisome proliferator-activated receptor gamma (PPARγ), and stearoyl-CoA desaturase (SCD), were measured at the time of hatch, and zero, one, 4, 7, 28, and 40 d. Intramuscular adipocyte cell width and visualization of adipose tissue deposition was observed at 28 and 40 d. Expression of PPARγ was increased in the pectoralis major of LH birds at the time of hatch, zero, and one d. The expression of PPARγ at one and 7 d, and SCD at 7 d were increased in all birds that received delayed access to feed. At 28 d, adipocyte cell width was increased in LH birds with delayed access to feed, compared to EH and MH birds with delayed access to feed and LH birds with immediate access to feed. At 40 d, adipocyte cell width was increased in all birds that received delayed access to feed. Also at 40 d, there was a trend (P = 0.078) for more extensive intramuscular adipose tissue deposition in LH than EH birds, and in birds with delayed access to feed (P = 0.075). These data indicate delayed access to feed increases intramuscular adipose tissue deposition in the pectoralis major muscle, and suggest that hatch time influences this regulation.

To address emerging infections, we must invest in enduring systems: The kinetics and dynamics of health systems strengthening.

Clinical pharmacology uses foundational principles of pharmacokinetics (PK) and pharmacodynamics (PD) to address medication use spanning a continuum from molecules to the masses. In the realm of infectious diseases, PK/PD attributes are considered especially important, because subtherapeutic dosing of antibiotics has been associated with poorer clinical outcomes in patients and increased incidences of drug resistance in populations. In consideration of these PK/PD principles, we will describe the analogous relationship between health systems strengthening, including for educating healthcare providers about emerging infections, and the tenets of therapeutic drug monitoring.

ATPase 8/6 GENE BASED GENETIC DIVERSITY ASSESSMENT OF SNAKEHEAD MURREL, Channa striata (Perciformes, Channidae).

The mitochondrial DNA (mtDNA) ATPase 8/6 gene has been used in phylogenetic as well as in phylogeographic studies along with other mtDNA markers. In this study, ATPase gene sequences were used to assess the genetic structuring and phylogeographic patterns in Channa striata. Out of 884 nucleotide positions generated in ATPase 8/6 genes, 76 were polymorphic. The study suggested 23 unique haplotypes from 67 individuals of nine populations collected from different riverine systems of India. The ATPase 8/6 sequence revealed highest haplotype as well as nucleotide diversities in Imphal River population and lowest diversities in Tapti River population. The pattern of genetic diversity and haplotype network indicated distinct mitochondrial lineages for Chaliyar population, whereas mismatch distribution strongly suggested a population expansion in mid pleistocene epoch (0.4 Mya) with distinct genetic structuring in C. striata. The baseline information on genetic variation and the population sub-structuring would facilitate conservation and management of this important snakehead murrel.