Determinants of Bangladeshi patients' decision-making process and satisfaction toward medical tourism in India.

Objectives: The aims are to explore the factors influencing Bangladeshi patients' decision-making process and their satisfaction level toward medical tourism in India. Methods: The study used a quantitative research approach with a cross-sectional survey. Data were collected from the patients or their relatives (N = 388) who would have decided to travel to India for medical and treatment purposes at the Chittagong Indian visa center (IVAC). Data were collected using a structured, pre-tested, and facilitator-administered questionnaire, which mainly included the social demographic characteristics, health status, medical tourism information and medical tourism index. Hierarchical regression analysis was performed to explore the factors influencing their satisfaction level toward medical tourism in India. Results: More than three-fourths of the participants had visited India for self-treatment. Of the participants, 14% were cardiology patients, and 13% suffered from cancer. The relatives were the key source of information regarding medical tourism for more than one-fourth of the respondents. India's availability of well-experienced doctors, hospital/medical facilities with high standards, well-trained doctors, reputable doctors, and quality treatments and medical materials were top-ranked items. Regression results depict that facility and services appeared as the strongest factor (ß = 0.24, t = 4.71, p < 0.001) followed by tourism destination factor (ß = 0.16, t = 3.11, p = 0.002), medical tourism costs factor (ß = 0.16, t = 3.24, p = 0.001) and country environment factor (ß = 0.15, t = 2.69, p = 0.007). Conclusions: We found that the factor related to facility and services is one of the strongest predictors in our models. Therefore, home countries must strengthen the health care providers' advanced professional training, including service attitudes. Moreover, it is important to lessen the language barrier, reduce the airfare for medical tourists, and make the treatment cost more affordable for patients.

Vaccinomics strategy for developing a unique multi-epitope monovalent vaccine against Marburg marburgvirus.

Marburg virus is known to cause a severe hemorrhagic fever (MHF) in both humans and non-human primates with high degree of infectivity and lethality. To date no approved treatment is available for Marburg virus infection. A study was employed to design a novel chimeric subunit vaccine against Marburg virus by adopting reverse vaccinology approach. The entire viral proteome was retrieved from UniprotKB and assessed to design highly antigenic epitopes by antigenicity screening, transmembrane topology screening, allergenicity and toxicity assessment, population coverage analysis and molecular docking approach. Envelope glycoprotein (GP) and matrix protein (VP40) were identified as most antigenic viral proteins which generated a plethora of epitopes. The final vaccine was constructed by the combination of highly immunogenic epitopes along with suitable adjuvant and linkers. Physicochemical and secondary structure of the designed vaccine was assessed to ensure its thermostability, hydrophilicity, theoretical PI and structural behaviors. Disulfide engineering, molecular dynamic simulation and codon adaptation were further employed to develop a unique multi-epitope monovalent vaccine. Docking analysis of the refined vaccine structure with different MHC molecules and human immune TLR8 receptor present on lymphocyte cells demonstrated higher interaction. Moreover, disulfide engineering served to lessen the high mobility region of the designed vaccine in order to extend its stability. Complexed structure of the modeled vaccine and TLR8 showed minimal deformability at molecular level. Finally, translational potency and microbial expression of the modeled vaccine was analyzed with pET28a(+) vector for E. coli strain K12. However, further in vitro and in vivo investigation could be implemented for the acceptance and validation of the predicted vaccine against Marburg virus.