Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study.

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Acute Methemoglobinemia Due to Crop-Flowering Stimulant (Nitrobenzene) Poisoning: A Case Report.

Nitrobenzene poisoning is an uncommon but serious form of intoxication. Nitrobenzene is used in dyes, paints, lubricating oils, and crop-flowering stimulants. Ingestion produces acute methemoglobinemia and cyanosis, which fails to produce improvement in high-flow oxygen therapy. We present here a case of a 25-year-old male presenting with diffuse headache, fatigue, and cyanosis after attempting suicide by consumption of 15 mL of 20% nitrobenzene. Oxygen saturation (SpO2) was 85% on room air and was not improving on oxygen therapy. Serum methemoglobin level was 22% of hemoglobin. The patient was treated with IV methylene blue and oral ascorbic acid along with supportive management. He attained recovery by day three and was subsequently discharged. Acute methemoglobinemia following nitrobenzene poisoning is of grave concern and demands timely identification and diligent management with methylene blue and ascorbic acid alongside supportive measures.

Retaliation of Alstonia scholaris (L.) R.Br. to caesium and strontium in hydroponics: effect on morpho-physiology and induction of enzymatic defence.

The habitation and environment are affected by the stable isotopes of caesium (Cs) and strontium (Sr), as well as by their radioactive isotopes. The current work gives insight on Alstonia scholaris' capacity to phytoextract stable caesium (Cs) and strontium (Sr), as well as the plant's ability to protect against the toxicity of both elements. Experiments with Cs [0-5 mM (CsCl)] and Sr [0-3 mM (SrCl2. 6H2O)] dosing in controlled light, temperature, and humidity condition in greenhouse for 21 days were undertaken. Cs and Sr accumulation in different plant parts was quantified with atomic absorption spectroscopy (AAS) and inductively coupled plasma-optical emission spectrometry (ICP-OES) respectively. Hyper-accumulation capacity for Cs and Sr was estimated with indices like transfer factor (TF) and translocation factors (TrF). The uptake pattern of caesium in Alstonia scholaris is 5452.8-24,771.4 mg/kg DW (TF = 85.2-57.6) and in the case of Sr is 1307.4-8705.7 mg/kg DW (TF = 85.3-1.46). The findings demonstrated the plant's ability to transfer Cs and Sr to aboveground biomass on the basis of dry weight, with the majority of the metals being deposited in the shoot rather than the root portion of the plant. For Cs and Sr, with increasing concentration, the plants exhibited the enzymatic expression for defence against metal toxicity by free radicals compared to control. Field emission electron microscopy with energy-dispersive spectroscopy (FESEM with EDS) was employed to assess the spatial distribution of Cs and Sr in plant leaf, indicating the accumulation of Cs, Sr, and their homologous components.

Assessing the Effect of the Anti-tuberculosis Drug Rifampicin on Known Hypertensive Patients With Tuberculosis in a Tertiary Care Center.

Background Epidemiological evidence suggests an indirect link between hypertension and tuberculosis, and several studies have reported that rifampicin has potentially diminished the hypotensive effects of many anti-hypertensive agents by inducing cytochrome P450. This study investigates rifampicin's effect on the target blood pressure in known hypertensive patients whose blood pressure had been previously controlled with anti-hypertensive drugs. Methodology This prospective observational study was conducted at the Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, from June 2021 to December 2022. A total of 160 patients with known hypertension on anti-hypertensive drugs were recruited for this study. All these patients had been recently diagnosed with tuberculosis and had been treated with rifampicin-based anti-tuberculosis therapy (ATT). Results The maximum number of patients were under 50 years of age and predominantly male (67%). A total of 91 (57%) patients were hypertensive for less than five years, and the remaining patients were hypertensive within 6-10 years or more than 10 years. However, these patients had other comorbidities such as diabetes mellitus (32%) and coronary artery disease (27%). Before ATT, the mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was recorded to be 130/80 mmHg. The last six months' course of ATT showed mean values around 154/96 mmHg even after adding additional/multiple anti-hypertensive drugs. After discontinuation of ATT, the mean SBP/DBP was effectively 130/80 mmHg at four weeks. Conclusions Rifampicin significantly diminishes the hypotensive effects of many well-established anti-hypertensives such as calcium channel blockers, beta-blockers, and diuretics to maintain blood pressure.

Phytoremediation of 137Cs: factors and consequences in the environment.

Radionuclide contamination is a concerning threat due to unexpected nuclear disasters and authorized discharge of radioactive elements, both in the past and in present times. Use of atomic power for energy generation is associated with unresolved issues concerning storage of residues and contaminants. For example, the nuclear accidents in Chernobyl 1986 and Fukushima 2011 resulted in considerable deposition of cesium (Cs) in soil, along with other radionuclides. Among Cs radioactive variants, the anthropogenic radioisotope 137Cs (t½ = 30.16 years) is of serious environmental concern, owing to its rapid incorporation into biological systems and emission of ß and γ radiation during the decaying process. To remediate contaminated areas, mostly conventional techniques are applied that are not eco-friendly. Hence, an alternative green technology, i.e., phytoremediation, should in future be considered and implemented. This sustainable technology generates limited secondary waste and its objectives are to utilize hyper-accumulating plants to extract, stabilize, degrade, and filter the radionuclides. The review highlights plant mechanisms for up-taking radionuclides and influences of different environmental factors involved in the process, while considering its long-term effects.