Geospatial Analysis of Parental Healthcare-Seeking Behavior in the Vicinity of Multispecialty Hospital in India.

Background and Objective: The healthcare-seeking behavior of vulnerable groups, such as children under five, depends on a multitude of factors, including the caregiver's decision making. Approximately 60% of Indians seek care from private hospitals. Recent health policy in India has favored the establishment of multispecialty hospitals. However, it remains unclear to what extent this policy has changed the number of Indians seeking healthcare from these government-established multispecialty hospitals. The study aims to assess the health-seeking behavior of parents of children under five in the vicinity of a public multispecialty tertiary care hospital. Methods: This was a community-based cross-sectional survey with geospatial mapping conducted among the parents of children under five using a semi-structured questionnaire in Epi-collect mobile app. The study site was an urban slum in a catchment area [within five kilometers (km)] of a multispecialty tertiary care public hospital in the central Indian state of Chhattisgarh. The study was conducted for one year duration from February 2019 to January 2020. A questionnaire was administered to the parents of the children under five (N = 353) after their household confirmation from the nearby Anganwadi center, the community level service providing center under the Integrated Child Development Scheme by the Ministry of Women and Child Development (WCD). The questionnaire included sections for demographic characteristics, the illness pattern among their children, health-seeking decision-making, and more. Descriptive analysis was presented with numbers and percentages. Univariate analysis was used to assess the association between sociodemographic variables and health-seeking characteristics. Statistical significance was considered at p value less than 0.05. We used geospatial mapping using coordinates collected and compiled using the Microsoft Excel version 2021 and analyzed using QGIS (Quantum Geographic Information System) software. Results: Among the parents interviewed patients (N = 353), maternal literacy rates were over 85%. Approximately 54% of the families were below poverty line. Among 95.2% of the families, mothers were part of decision-making regarding their children's health-seeking. Over 92% of the families opted for consultation in a nearby private hospital or dispensary. Geospatial mapping of private hospitals was a favored place for healthcare-seeking by mothers, irrespective of their socioeconomic status or education rather than multispecialty hospital. Conclusion and Global Health Implications: The majority of the parents in the vicinity of public multispecialty hospitals seek care from private clinics for ailments for children under five. The establishment of public multispecialty tertiary care hospitals, which are mandated for tertiary level of care and research, cannot replace primary-level healthcare institutions, showed that private hospitals were the favored places healthcare seeking by mothers. These primary-level institutions are critical for the management of common ailments for children under five near home and reducing the financial burden on the family, even in the vicinity of a multispecialty hospital.

Prevalence and factors associated with cyberbullying among adolescents (15-19 years) in Gurugram District - A community based cross-sectional study.

Background: Digitalization in the form of increased Internet use through screen media has also shown its ramification like cyberbullying. They are aggressive acts with the intention or motivation to harm another person through technology. The aim is to study the prevalence of cyberbullying and its association with mental illness in the adolescent age group (15-19 years). Methods: This community-based cross-sectional study was rolled out among adolescents aged 15-19 years. A total of 387 were given a semistructured interviewer-administered questionnaire consisting of general details, cyberbullying victimization, and offending questions, PHQ-9 and GAD-7. Results: The mean (SD) age was 16.8 (1.3) years. More than half (53.2%) were males, and nearly three-fourths (74.4%) were school-going. Around 28.2% reported being cyberbullied at least once in their lifetime. About 7.0% of adolescents were cyberbullied more than once, and 0.8% more than five times in the past 30 days. The most common ways were posting a mean or hurtful picture (31.9%) and the concerned person's comments (24.2%) online. Multivariable logistic regression analysis found that adolescents attending colleges (AOR 1.9, 95% CI 1.1 to 3.4), using tobacco (AOR 2.5, 95% CI 1.4 to 4.5), and depressed (of any severity, AOR 2.0, 95% CI 1.1 to 4.3) were at significantly increased risk of being cyberbullied (P < 0.05). Conclusion: The prevalence of cyberbullying among adolescents aged 15-19 is notable, with significant associations found between cyberbullying and attending college, tobacco use, and depression. Understanding the correlates of cyberbullying can inform targeted interventions to support mental health and well-being among adolescents.

Discovery of 7-azaindole based anaplastic lymphoma kinase (ALK) inhibitors: wild type and mutant (L1196M) active compounds with unique binding mode.

We have identified a novel 7-azaindole series of anaplastic lymphoma kinase (ALK) inhibitors. Compounds 7b, 7 m and 7 n demonstrate excellent potencies in biochemical and cellular assays. X-ray crystal structure of one of the compounds (7 k) revealed a unique binding mode with the benzyl group occupying the back pocket, explaining its potency towards ALK and selectivity over tested kinases particularly Aurora-A. This binding mode is in contrast to that of known ALK inhibitors such as Crizotinib and NVP-TAE684 which occupy the ribose binding pocket, close to DFG motif.

Assessment of predictors of diabetic foot ulcers in a tertiary care hospital of Maharashtra, India: A cross-sectional comparative study.

BACKGROUND: The chances of nonhealing foot ulcer among the diabetic is 10-20 times more than people without diabetes. Foot ulcer among diabetes population affects more than 40-60 million globally. There is a dearth of quality data on the factor among the diabetes patients, which hastens the progression of diabetic foot. The study aims to assess the risk factors associated with foot ulcer among the diabetics. MATERIALS AND METHODS: The study was a cross-sectional comparative study in tertiary care hospital in Maharashtra, India. The study population included 200 diabetic foot ulcer patients and 200 of their age and gender matched comparator were patients with diabetes without foot ulcers. The sampling method was stratified random sampling. RESULTS: The mean age of both the groups of patients was around 54 years. Alcohol consumption, physical activity outside home, low foot care practices, irregularity of diabetic medication, and family history of diabetes among mothers were found to be factors associated with diabetes foot ulcer. CONCLUSION: There is a need to stratify the diabetes patients in regular care as per risk categories depending on the presence of above risk factors. This will not only prioritization of diabetes care in terms of future risk but also reduce the progression of complications like diabetes foot and resulting amputation through an active preventive intervention.

Need Assessment of Existing Mentorship Program Among Undergraduate Medical Students: Experience From a Medical College in Chhattisgarh, India.

Introduction While mentoring students during regular medical education has a long-standing tradition in many developed countries' medical schools, it has yet to become a standard practice in the majority of medical institutions, especially in the developing world, such as India. In institutions where mentoring programs are sparsely implemented, there is a lack of data regarding their assessment. Methodology This qualitative study involved two groups of students - nine undergraduate medical students (five male and four female) and 10 undergraduate medical students (six male and four female) who had at least three years of experience in the existing mentorship program at a tertiary care teaching hospital. We conducted two focused group discussions (FGDs) with these two groups of students using a guide, with FGDs lasting 45 and 50 minutes, respectively. We recorded the audio and it was transcripted to text. Thematic analysis of the transcripts from the 2 FGDs was conducted using Atlasti (Version 7.1.8) software to assess perceptions of the mentorship program. Results The content analysis of the discussions revealed two broad themes, namely "Current Functioning of the Programme" and "Suggestions for Improvement." These themes were further divided into multiple domains and subdomains, providing a comprehensive overview of the study's findings. Although there is a consensus among students that the mentorship program is essential, the current operational framework still has limited confidence due to biases, fears, and misinformation among the students. Conclusion The ongoing medical curriculum imparts a vast amount of scientific knowledge within a limited timeframe, with practical application occurring primarily in the last three years of the academic curriculum and minimal emphasis on ethical practice, professionalism, effective communication, handling urgent health situations, and interacting with family members, underscores the genuine need for a structured mentorship curriculum for undergraduate medical students. To enhance the program's effectiveness, the active involvement of undergraduate students must address their specific needs.

Vast gap in iodization from production to plate - Hurdles in achieving Universal Salt iodization in India.

Iodine deficiency is the most prevalent micronutrient deficiency in India and is one of the most important causes of preventable brain damage. Iodine deficiency disorders affect an individual's ability to work efficiently, which directly impacts the overall development and economic productivity of any nation. Global experiences have shown that salt fortification is the most effective way to control and reduce the burden of IDD in the community. Thirty-six years have passed since the declaration of universal salt iodization (USI) implementation in India by the Central Council of Health in 1983. However, iodine deficiency still remains a public health problem in the whole country.

Comparative assessment of factors affecting anxiety levels among adults attending online meditation sessions during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) pandemic induced the governments around the world to impose harsher preventive measures like stay at home order, lock down etc., to contain the spread of infection. This measure increased the stress of the general population through isolation of masses, loss of employment, and loss of recreation. There is a dearth of quality data showing anxiety levels among the population and association of novel nonpharmaceutical measures such as online meditation with it. MATERIALS AND METHODS: The study is a cross-sectional comparative study based on an online survey. The study population included 74 adult participants, out of which 30, included in the study group were attending structured online meditation sessions and 44 of the participants as a comparison group after matching age, gender, location of residence, and socioeconomic status. The data was collected using self-administered questionnaire. Multiple logistic regression was applied to ascertain factors contributing to the anxiety levels of the participants. RESULTS: Both the groups of participants were comparable in terms of their demographic characteristics. The mean generalized anxiety disorder (GAD 7) score among the participants of online meditation program was significantly lower as compared to those not attending any online meditation. 6.7% of the participants of online meditation had GAD 7 score more than 10 as compared to 13.6% among the comparison group (P value 0.7). CONCLUSION: "At home" mental health promotion measures such as structured online meditation can serve an important role in mitigating the mental health impact of COVID-19 pandemic on the community. Further researches are needed to assess the feasibility and effectiveness of such measures.

Discovery of MAP855, an Efficacious and Selective MEK1/2 Inhibitor with an ATP-Competitive Mode of Action.

Mutations in MEK1/2 have been described as a resistance mechanism to BRAF/MEK inhibitor treatment. We report the discovery of a novel ATP-competitive MEK1/2 inhibitor with efficacy in wildtype (WT) and mutant MEK12 models. Starting from a HTS hit, we obtained selective, cellularly active compounds that showed equipotent inhibition of WT MEK1/2 and a panel of MEK1/2 mutant cell lines. Using a structure-based approach, the optimization addressed the liabilities by systematic analysis of molecular matched pairs (MMPs) and ligand conformation. Addition of only three heavy atoms to early tool compound 6 removed Cyp3A4 liabilities and increased the cellular potency by 100-fold, while reducing log P by 5 units. Profiling of MAP855, compound 30, in pharmacokinetic-pharmacodynamic and efficacy studies in BRAF-mutant models showed comparable efficacy to clinical MEK1/2 inhibitors. Compound 30 is a novel highly potent and selective MEK1/2 kinase inhibitor with equipotent inhibition of WT and mutant MEK1/2, whose drug-like properties allow further investigation in the mutant MEK setting upon BRAF/MEK therapy.

Covid-19 chemoprophylaxis: Ethics of prevention based on anecdotal evidence.

The ongoing pandemic of Covid-19 caused by the SARS-CoV-2 virus has infected more than 6 million all over the world and has caused more than 3.8 lakh fatalities till date(1) Health workers are the frontline responders and are exposed to a plethora of health hazards. Recently, an advisory by the Indian Council of Medical Research for the use of hydroxychloroquine as post-exposure prophylaxis was hailed as an outstanding initiative for the protection of healthcare workers and high risk contacts of patients. But the evidence of effectiveness available is only from in vitro studies and non-randomised control trials of insufficient sample size. Several ongoing large scale clinical trials are focused on the same research questions, the preliminary results of which are still awaited. The present study discusses the ethics of the introduction of therapeutic or preventive interventions based on limited available evidence during the ongoing pandemic of Covid-19.

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Leprosy-A raging persistent enigma.

Leprosy or Hansen's disease despite having achieved the elimination target across the world, the decrease in detection of new cases has almost stagnated for the last 10 years. Southeast Asia is having the highest prevalence of leprosy among all regions in the world. The review focuses on the programmatic laggards' post-achievement of elimination target in India, the most significant contributors to leprosy caseload in the world, and a way forward.

X-ray structure of PTP1B in complex with a new PTP1B inhibitor.

Protein tyrosine phosphatase 1B (PTP1B) is a prototype non receptor cytoplasmic PTPase enzyme that has been implicated in regulation of insulin and leptin signaling pathways. Studies on PTP1B knockout mice and PTP1B antisense treated mice suggested that inhibition of PTP1B would be an effective strategy for the treatment of type II diabetes and obesity. Here we report the X-ray structure of PTP1B in complex with compound IN1834-146C (PDB ID 4I8N). The crystals belong to P3121 space group with cell dimensions (a = b = 87.89 Å, c = 103.68 Å) diffracted to 2.5 Å. The crystal structure contained one molecule of protein in the asymmetric unit and was solved by molecular replacement method. The compound engages both catalytic site and allosteric sites of PTP1B protein. We described the molecular interaction of the compound with the active site residues of PTP1B in this crystal structure report.

Diphenylether derivative as selective inhibitor of protein tyrosine phosphatase 1B (PTP1B) over t-cell protein tyrosine phosphatase (TCPTP) identified through virtual screening.

Even though protein tyrosine phosphatase has been identified as a validated therapeutic target over a decade for type II diabetes and obesity, developing a selective inhibitor to protein tyrosine phosphatase 1B (PTP1B) over other cellular PTPases has been a complicated task owing to the highly conserved and polar nature of the PTP1B catalytic site. Virtual screening study of in-house chemical depository resulted in the prioritization of few low molecular weight compounds as PTP1B inhibitors. The in-vitro pNPP assays were carried out on prioritized compounds in both PTP1B and T-cell protein tyrosine phosphatase (TCPTP). From this we identified four low molecular weight compounds as PTP1B inhibitors, of which the compound AU-2439 has shown 5 fold selectivity towards PTP1B over highly homologous TCPTP. In this short communication selectivity of AU-2439 is explained based on interaction with critical active site residues in both proteins using docking models.

Self-circularizing 5'-ETS RNAs accumulate along with unprocessed pre ribosomal RNAs in growth-stressed Entamoeba histolytica.

The primary transcript of rRNA genes is a large pre rRNA which is precisely processed to release the mature rRNAs. The 5'-external transcribed spacer (ETS) of rRNA genes contains important sites for pre rRNA processing. Once the processing is accomplished the ETS is rapidly degraded. We show that in growth-stressed cells of the human parasitic protist Entamoeba histolytica the A'-A(0) sub-fragment of the 5'-ETS accumulates to high levels as a family of RNA molecules of size 666 to 912 nt. These etsRNAs are circular in vivo and can spontaneously self-circularize in vitro. The accumulation of etsRNAs is accompanied by accumulation of unprocessed pre rRNA, indicating a possible role of etsRNAs in inhibition of processing during growth stress. Our data shows for the first time that processed etsRNA is not a mere by-product destined for degradation but is stabilized by circularization and could play a regulatory role as noncoding RNA.