Multilevel population and socioeconomic variation in health insurance coverage in India.

OBJECTIVES: This study explores population-level variation in different types of health insurance coverage in India. We aimed to estimate the extent to which contextual factors at community, district, and state levels may contribute to place-based inequalities in coverage after accounting for household-level socioeconomic factors. METHODS: We used data from the 2015-2016 National Family Health Survey in India, which provides the most recent and comprehensive information available on reports of different types of household health insurance coverage. We used multilevel regression models to estimate the relative contribution of different population levels to variation in coverage by national, state, and private health insurance schemes. RESULTS: Among 601,509 households in India, 29% reported having coverage in 2015-2016. Variation in each type of coverage existed between population levels before and after adjusting for differences in the distribution of household socioeconomic and demographic factors. For example, the state level accounted for 36% of variation in national scheme coverage and 41% of variation in state scheme coverage after adjusting for household characteristics. In contrast, the community level was the largest contextual source of variation in private insurance coverage (accounting for 24%). Each type of coverage was associated with higher socioeconomic status and urban location. CONCLUSIONS: Contextual factors at community, district, and state levels contribute to variation in household health insurance coverage even after accounting for socioeconomic and demographic factors. Opportunities exist to reduce disparities in coverage by focusing on drivers of place-based differences at multiple population levels. Future research should assess whether new insurance schemes exacerbate or reduce place-based disparities in coverage.

Robotic Kidney Transplantation-an Update.

PURPOSE OF REVIEW: Over the last decade, there have been advances in kidney transplantation with introduction of minimally invasive surgery. Robotic surgery is becoming increasingly common across the specialities. There is now increasing experience in robotic kidney transplantation, though it remains a niche procedure. Initial reports suggest that this is a safe, feasible operation when performed by teams familiar with robotic surgery. There have been a few modifications to the initially described procedure, as a result of increasing experience. RECENT FINDINGS: There is no significant difference in graft and patient survival when compared with open surgery and laparoscopic kidney transplantation. It is a safe procedure and therefore represents a viable alternative to open surgery in selected patients particularly the obese. The advantages include less postoperative pain and fewer wound complications such as surgical site infections and hernia, which could be particularly advantageous in the obese. Robotic kidney transplantation is procedure that has been developed over the last decade and could have applicability in kidney transplantation in the obese. Its main benefit is in enabling surgery in less accessible spaces due to body habitus, combined with those of using a smaller incision with less associated morbidity, with no inferiority in the reported primary outcomes of graft and patient survival. There are capital costs associated with this procedure, but further studies on the cost-effectiveness of robotic kidney transplantation are needed before it can be adopted widely.

Trans-2-Acetoxycyclobutyltrimethylammonium iodide, a cyclobutane analog of "trans-ACTM".

The (+/-) title compound was prepared to evaluate prior observations that certain acetylcholine congeners derived from cyclobutane are devoid of muscarinic effects. It was prepared by a multistep sequence from trans-2-carbomethoxycyclobutyl methyl ketone. In a guinea pig ileum assay, it was 0.02 times as active as AcCh, and in a dog blood pressure assay, it was 0.09 times as active. In these assays, its (+/-)-cyclopropane congener and AcCh were equally active. This is the first cyclobutane-derived AcCh congener possessing significant muscarinic effect.

Synthesis and carcinogenic activity of 5-fluoro-7-(oxygenated methyl)-12-methylvenz[a]anthracenes.

Treatment of 7,12-benz[a]anthraquinone (2) with methylmagnesium iodide or methyllithium yields mixtures of cis- and trans-7,12-dihydro-7,12-dihydroxy-7,12-dimethylbenz[a]anthracenes (3a,b), in which the ratio of cis to trans lies in the 3--4:1 region. Each isomer afforded high yields of 7-chloromethyl-12-methylbenz[a]anthracene (5) on treatment with hydrogen chloride in ethyl acetate. Similarly, 5-fluoro-7,12-benz[a]anthraquinone (8) afforded a mixture of cis- and trans-5-fluoro-7,12-dihydro-7,12-dihydroxy-7,12-dimethylbenz[a]anthracenes (9) which yielded 7-chloromethyl-5-fluoro-12-methylbenz[a]anthracene (10) on treatment with HCl. The chloromethyl compounds, 5 and 10, yielded 7-acetoxymethyl-12-methylbenz[a]anthracene (6) and 7-acetoxymethyl-5-fluoro-12-methylbenz[a]anthracene (11) on treatment with acetate ion. Hydrolysis of 6 and 11 yielded 7-hydroxymethyl-12-methylbenz[a]anthracene (7) and 5-fluoro-7-hydroxymethyl-12-methylbenz[a]anthracene (12), respectively. Since neither 11 nor 12 is appreciably carcinogenic, the carcinogenic metabolism of 7,12-dimethylbenz[a]anthracene (DMBA) probably does not involve attack at the 7-methyl group.

Birefringence measurement of rapid structural changes during collagen denaturation.

Linear birefringence, an optical property that results from a material's structure and composition, can be used to study dynamic changes in tissue structure. Single, 200 microseconds-long pulses from a Ho:YAG laser emitting 2.1 microns radiation were used to induce changes in the linear birefringence of rat tail tendon. Such changes were measured on a millisecond timescale. The measured rate coefficients describing the denaturation are not predicted by previous studies of collagen denaturation induced by slower, lower-temperature heating. Two types of laser-induced collagen denaturation can be differentiated: thermal denaturation, which appears rate-limited, and thermomechanical denaturation, which is observed at higher laser radiant exposures. Neither process is described by standard Arrhenius-type kinetic models.

Giant broad ligament leiomyoma.

Giant fibroids are known to arise from the uterus, but occasionally from the broad ligament also. A case of giant broad ligament fibroid is reported for its rarity, and the diagnostic difficulties it posed are discussed.

Genital amebiasis.

Five cases of amebiasis of the genital tract involving the cervix, vulva and penis are described. All presented as an ulcerating mass and were clinically suspected to have a tumor. In two cases the amebiasis co-existed with a carcinoma, an association which is extremely rare. The spouse of a patient with penile amebiasis was found to have amebiasis of the cervix suggesting a sexually transmitted mode of infection. The need for histopathological confirmation of all suspected genital malignancies is emphasised due to the striking resemblance of genital amebiasis to a carcinoma. The co-existence of amebiasis with carcinoma is of interest and suggests a possible etiological relationship.

Fine-needle aspiration cytology in the diagnosis of superficial lymphadenopathy: an analysis of 2,418 cases.

During a period of 5 yr, 2,418 fine-needle aspirations (FNA) were performed on 2,216 patients with superficial lymphadenopathy. Chronic nonspecific lymphadenitis was the commonest inflammatory lesion followed by tuberculosis. Among malignant lesions, metastatic tumors were most common followed by non-Hodgkin's lymphoma. The FNAC findings were correlated with subsequent histopathological diagnosis in 1,041 cases. The sensitivity rates of FNAC in tuberculosis, metastatic tumors, Hodgkin's disease, and non-Hodgkin's lymphoma were found to be 83.3, 97, 30, and 80.3%, respectively, the specificity being 94.3, 98.9, 98.6, and 95.4% in the same order. Immunocytochemical tests performed on the aspirated material helped in classifying the metastatic poorly differentiated tumors and confirming the diagnosis of non-Hodgkin's lymphomas. Effects of FNA on subsequent biopsy in 81 lymph nodes with benign hyperplasia were studied and showed that aspiration does not interfere with subsequent histologic assessment. Thus FNAC is a simple, inexpensive procedure, and when complemented by appropriate immunocytochemical studies is accurate and reliable for routine diagnosis of lymphadenopathy.

Histological and immunological analysis of gastric and intestinal lymphomas.

Immunophenotyping of 28 gastrointestinal non-Hodgkin's lymphomas was done using specific antibodies. Twenty six of these were successfully classified using this technique.

Early detection of Rickettsia tsutsugamushi in peripheral monocyte cultures derived from experimentally infected monkeys and dogs.

Rickettsia tsutsugamushi organisms were identified in Giemsa and fluorescent antibody stained monocyte cell cultures derived from experimentally infected monkeys and dogs. The identification of organisms in monocyte cell cultures compared favorably with the standard technique of mouse inoculation.

Application of the AgNOR method to distinguish pseudoepitheliomatous hyperplasia from squamous cell carcinoma.

The AgNOR stain was performed on seventeen cases of pseudoepitheliomatous hyperplasia of the oral cavity and genital tract, seventeen cases of squamous cell carcinomas of the same regions, and nineteen cases of squamous cell carcinoma of the cervix, to determine whether the stain could help to distinguish pseudoepitheliomatous hyperplasia from squamous cell carcinoma. No constant relationship of the AgNOR score to the grade of the lesion could be determined. Follow up of some of the cases was possible. Here, too, it was seen that the AgNOR score could not reliably predict which cases of pseudoepitheliomatous hyperplasia would progress to squamous cell carcinoma, and which cases of squamous cell carcinoma would suffer a relapse.

MicroRNAs in erythroid and megakaryocytic differentiation and megakaryocyte-erythroid progenitor lineage commitment.

MicroRNAs (miRNAs) are a class of small regulatory noncoding RNAs that modulate the expression of their target genes through either mRNA degradation or inhibition of protein translation. In recent years, miRNAs have been shown to be critical regulators of hematopoiesis and have important roles in the differentiation of specific lineages. Here, we summarize our current understanding of miRNAs involved in hematopoiesis with a focus on the role of miRNAs in regulating erythroid and megakaryocytic differentiation and megakaryocyte-erythroid progenitor lineage commitment.