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1.
Indian J Med Ethics ; V(1): 49-53, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32103800

RESUMO

Diabetes care in low-resource rural areas is often compromised by access and finance barriers, leading to ethical dilemmas for physicians in diagnosis and treatment. Rural health workers should be educated on how poverty, disproportionate rural health infrastructure, and illiteracy impact diabetes care to facilitate a paradigm shift from blaming patients for poor adherence to improving health systems in order to address underlying structural care seeking barriers of cost, distance and social stigma. With these barriers urban, high resource protocols cannot be implemented and there is need for separate evidence-based protocols for rural, low resource populations. Having such set protocols coupled with continuous training and use of mobile/telemedicine technology could help shifting tasks to nurses and peripheral health workers. The National Programme For Prevention And Control Of Cancer, Diabetes, Cardiovascular Diseases & Stroke may benefit from this communitising care model by setting up PHC-level NCD clinics run by trained nurses and health workers with physician backup using technology as needed. This way of utilizing non-physician health workers to treat uncomplicated diabetes patients may not only allow physicians quality time and more resources to treat complicated diabetes patients but also provide good quality, accessible care within everyone's reach.

2.
J Microencapsul ; 36(6): 535-551, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31353993

RESUMO

Objective: An unmet need for patient friendly products can be achieved with novel, biocompatible lipidic formulations which encapsulate and prolong release of medicaments. The aim of this study was to develop a commercially scalable resveratrol-loaded solid-lipid microparticulate (SLM) topical gel for melanoma chemoprevention. Methods: Preformulation studies were conducted and drug-excipient interactions examined using infra-red spectroscopy and differential scanning calorimetry (DSC). Resveratrol-loaded SLM topical gel was prepared and evaluated by in vitro and in vivo parameters. Results: Spherical microparticles of 2.98 µm average size were obtained and DSC thermograms provide evidence of trans-resveratrol encapsulation. In vitro and ex vivo drug diffusion studies revealed sustained release profiles. Optimised SLM gel provides optimum antioxidant, tyrosinase inhibition, cytotoxicity in B16F10 melanoma cell line and apoptosis efficacy. In vivo studies on C57BL mice exhibit significant tumour reduction. Conclusion: Promising role of trans-resveratrol-loaded SLM topical gel in melanoma chemoprevention is proven.


Assuntos
Anticarcinógenos/administração & dosagem , Preparações de Ação Retardada/química , Lipídeos/química , Melanoma/prevenção & controle , Resveratrol/administração & dosagem , Administração Tópica , Animais , Anticarcinógenos/uso terapêutico , Apoptose/efeitos dos fármacos , Linhagem Celular Tumoral , Liberação Controlada de Fármacos , Géis/química , Camundongos Endogâmicos C57BL , Resveratrol/uso terapêutico
3.
Indian J Med Ethics ; 4(2): 120-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271362

RESUMO

The Government of India has passed a notification making the non-reporting of tuberculosis (TB) by a clinical establishment a punishable offence. This article examines this move from an ethical standpoint. One of the main ethical concerns relates to the violation of patient confidentiality that may result from this. Also as regards improvement in patient care, there appears to be a poor cost-benefit ratio in terms of the actionable data obtained by this There may be possible adverse consequences by a limiting of access to care due to penalising of non-reporting. In terms of the bigger picture, the notification may lead to an increased tension between the private sector and Government. Moreover, it is the position of the authors that such a step distracts attention from the more important issues that plague TB care in India today.


Assuntos
Confidencialidade/ética , Revelação/ética , Notificação de Doenças/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Notificação de Abuso/ética , Tuberculose/epidemiologia , Humanos , Índia/epidemiologia , Setor Privado/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência
4.
Indian J Med Ethics ; 3(4): 334-336, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30156558

RESUMO

The Bawaskars in their Comment "Emergency care in rural settings: Can doctors be ethical and survive?" raise a context-specific question about the sustainability of emergency care in rural, low resource areas. This could be broadened to "What efforts are needed to sustain emergency care systems run by the private sector in rural, low resource areas without catastrophically affecting patients or healthcare providers?" There are enough constitutional, legal and ethical imperatives to state that all emergency care should be available to everyone irrespective of paying capacity. The State should be responsible for providing emergency care via the public sector or for strategically purchasing it from private providers. Even if that arrangement is not viable, private sector providers cannot expect the community to underwrite the sustainability of such services and the return on investment in their training. Finally, we suggest that the principles of ethics cannot be invoked for justifying the financial viability and sustainability of the private sector in an unequal world.


Assuntos
Serviços Médicos de Emergência , Tratamento de Emergência , Humanos , Índia , Setor Privado , Setor Público
6.
7.
J Clin Tuberc Other Mycobact Dis ; 12: 41-47, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31720398

RESUMO

Introduction: Programmatic design affects access to healthcare and can influence tuberculosis treatment outcomes. Potential predictors of tuberculosis treatment outcomes in one rural Indian setting were examined to improve outcomes with a focus on access to care. Methods: Routinely collected tuberculosis treatment data from Jan Swasthya Sahyog, a community based healthcare system in rural Chhattisgarh, India were examined from 2003-2015. Predictors were analyzed for associations with death, loss to follow-up or failure in multivariable logistic regression models. The effect of distance from treatment on outcomes was graphed and Pearson's correlation coefficients (r2) calculated. Descriptive time to event analyses were performed for all deaths and loss to follow-up from January 2010 to September 2015. Results: 4979 patients with active TB were treated during the study period. Patients were mostly male, malnourished, diagnosed with pulmonary disease and many travelled lengthy distances. Positive treatment outcomes improved from 55% to 80% from 2003 to 2015 for all patients though positive treatment outcomes have been above 80% in the primary care setting since 2012. The annual case fatality rate was 4.4% with small yearly variation.Gender and site of treatment (primary versus secondary care facility) and also season of treatment initiation and travel time to care best predicted outcomes in both the complete model and model which included only patients with initial BMI data. No differences were found between primary and secondary care patients for initial BMI, percentage of sputum positivity among those with pulmonary disease and grade of sputum positivity among the sputum positive. Those who traveled the furthest to access care achieved the worst outcomes during the summer and, to a lesser degree, the monsoon. Distance from care was associated with treatment outcomes in a dose-response manner out to substantial distances. From 2010 to 2015, most patients who died or were lost to follow-up did so in the first week of treatment. Conclusions: The provision of care through local facilities improves the treatment of tuberculosis in rural India. Interventions addressing death or loss to follow-up should focus on the newly diagnosed. Rural Indian physicians should be aware of how access issues affect TB treatment outcomes.

8.
J Family Med Prim Care ; 7(5): 982-992, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30598944

RESUMO

Background: The cartridge-based nucleic acid amplification test (CBNAAT) Xpert MTB/RIF is more sensitive than smear microscopy for the diagnosis of tuberculosis (TB). It is also more expensive, costing 1450 INR as compared to 10 INR per smear. Objectives: We conducted a prospective study to evaluate the impact of CBNAAT results on patient management in our low-resource, high-burden Indian rural setting. Materials and Method: Between February and July 2017, clinicians were asked to complete one questionnaire at the time of CBNAAT request and another when reviewing the result. The first questionnaire, "Form 1," concerned pretest treatment status and asked clinicians to rate their confidence in the diagnosis. "Form 2" concerned postresult treatment and investigation plan. Results: Over the study period, 206 CBNAATs were requested. Form 1 was not completed for 85 patients and 21 were excluded leaving 100 in the main analysis. MTB was detected (MTB-D) in 60 of 100 (60%) of samples tested. At the time of CBNAAT request, 56 of 100 (56%) of patients were already on treatment, this being empirical in 34 of 100 (34%). Despite this, 17 of 60 (28.3%) of MTB-D results occurred in patients not yet started on treatment. Postresult treatment status was available for 94 of 100 CBNAATs (55 MTB-D and 39 MTB-ND). Following an MTB-D result, all 17 patients not on treatment started and all 38 on so already continued. Following an MTB Not Detected (MTB-ND) result, 26 of 27 (96.3%) of patients not yet on treatment remained so, but only 2 of 12 (16.7%) already on treatment stopped. Even where the clinician's pretest confidence in TB was low, 9of 30 (30%) of CBNAAT results were MTB-D. Conclusion: In a low-resource high-burden setting, CBNAAT may have greatest impact where the clinician's pretest confidence in TB is low and empirical treatment has not been started. This is because MTB-D results will lead to appropriate initiation of treatment and MTB-ND results may enable clinicians to hold-off treatment.

9.
Indian J Radiol Imaging ; 27(2): 200-206, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28744081

RESUMO

AIMS: The study was carried out to evaluate the early outcomes using Radiofrequency Ablation (RFA) for unresectable liver metastases in the management of metastatic colorectal cancer (mCRC) from an area of low endemicity. MATERIAL AND METHODS: 60 Patients with unresectable colorectal liver metastases had undergone 88 sessions of RFA from January 2007 till December 2013. The results were retrospectively analysed to evaluate the outcomes in terms of efficacy and survival rates. RESULTS: The median follow up of patients in our series was 24.8months. 35/52 (67.3%) patients had complete response at 3 months while 8 patients were lost to follow up. Of the 17 patients who had recurrence, 4 (23.5%) were at the ablated site while 13 patients (76.4%) progressed elsewhere. Abdominal pain was commonest post procedural symptom (20%). There was no procedure related mortality or any major complications. Mean disease free interval and Progression free survival was 6.7 and 13.1 months. Estimated median survival in patients with liver limited disease and those with small lesion (<3cm) was 3.79 years and 3.45 years respectively. Median survival in patients with lesion size 3-5 cms was 1.5 years. Annual survival rates would be 94.5%, 55.2% and 26.2% for 1, 3 and 5 years. CONCLUSION: Radiofrequency ablation of unresectable liver metastases is effective in treatment of mCRC. Estimated survival rates and Annual survival rates at our institute from the low endemic region also follow the global trend. Size of the lesion was an important predictor of efficacy of RFA. Presence of extrahepatic disease and lesion size >3 cm was associated with decreased survival.

11.
Recent Pat Drug Deliv Formul ; 10(2): 141-55, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26927413

RESUMO

BACKGROUND: The development and progression of atherosclerosis is known to occur at a sluggish pace and the lesions remain concealed for a long duration before the factual situation of the complex atherosclerotic etiology affecting various organ gets apprehended. The root cause mainly involves an imbalance or malfunction of the cholesterol metabolizing pathway. The till date therapeutic alternatives include oral hypo-lipidemic agents along with advances made in biotechnology/tissue engineering and surgical procedures for management purpose. However, with the advent and upsurge of nanotech delivery systems, along with meticulous indulgence and identification of the causative genes in the etiology of disease have opened a new therapeutic area that has far reaching application potential for effective management of such chronic disease requiring lifelong therapy. METHODS: Various genes that have implication in atherosclerosis were reviewed along with research in delivery vectors that have been employed for gene therapeutics and hurdles in successful delivery were elaborated. Relevant patents are discussed systematically to clearly support and highlight the developments made. RESULTS: Patenting activity in the delivery of genes for atherosclerosis so far primarily covers use of viral vectors. With the identification of new targets, a list of candidate genes are available that can be potentially exploited for therapeutic purpose. Though the delivery of candidate genes using viral vectors has been well explored, the limitation of viral vectors have seized the much needed clinical success. Non-viral vectors can prove to be the key for conquering this limitations and offer a vast area for exploration for achieving an effective control and remission to the disease and increasing the assortment of patents as reviewed in this article. CONCLUSION: In view of the many limitations in employing viral vectors for delivery, designing non-viral vectors for successful delivery of therapeutic gene in atherosclerosis should be realized and focused for effective management of the disease.


Assuntos
Aterosclerose/terapia , Terapia Genética/métodos , Animais , Aterosclerose/diagnóstico , Aterosclerose/genética , Difusão de Inovações , Técnicas de Transferência de Genes , Marcadores Genéticos , Predisposição Genética para Doença , Terapia Genética/tendências , Vetores Genéticos , Humanos , Patentes como Assunto , Fenótipo
12.
Indian J Med Res ; 141(5): 663-72, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-26139787

RESUMO

Tribals are the most marginalised social category in the country and there is little and scattered information on the actual burden and pattern of illnesses they suffer from. This study provides information on burden and pattern of diseases among tribals, and whether these can be linked to their nutritional status, especially in particularly vulnerable tribal groups (PVTG) seen at a community health programme being run in the tribal areas of Chhattisgarh and Madhya Pradesh States of India. This community based programme, known as Jan Swasthya Sahyog (JSS) has been serving people in over 2500 villages in rural central India. It was found that the tribals had significantly higher proportion of all tuberculosis, sputum positive tuberculosis, severe hypertension, illnesses that require major surgery as a primary therapeutic intervention and cancers than non tribals. The proportions of people with rheumatic heart disease, sickle cell disease and epilepsy were not significantly different between different social groups. Nutritional levels of tribals were poor. Tribals in central India suffer a disproportionate burden of both communicable and non communicable diseases amidst worrisome levels of undernutrition. There is a need for universal health coverage with preferential care for the tribals, especially those belonging to the PVTG. Further, the high level of undernutrition demands a more augmented and universal Public Distribution System.


Assuntos
Hipertensão/epidemiologia , Neoplasias/epidemiologia , Grupos Populacionais , Tuberculose/epidemiologia , Promoção da Saúde , Humanos , Índia , Saúde Pública , Características de Residência , População Rural , Escarro/microbiologia
13.
Conf Proc IEEE Eng Med Biol Soc ; 2007: 3737-40, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18002810

RESUMO

Assessment of opioid dependent patients in a replacement program has traditionally relied on conventional methods such as urine testing or face to face examination with a physician. We are introducing new assessment techniques based on pupillometry, reaction time and slurring of speech. The pupillometry test uses a webcam, controlled lighting and customized software to measure pupil parameters. The reaction time test uses a push-button to detect time to respond to a visual stimulus. The slurred speech test involves detection of slurring of a set of individual test words. These three tests will be combined to provide the physician with an objective "sedation index" for patients. These techniques will be used with remote dispensing technology currently under development.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Diagnóstico por Computador/métodos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Exame Físico/métodos , Software , Interface Usuário-Computador , Humanos , Design de Software , Medida da Produção da Fala/métodos , Testes Visuais/métodos
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