Concordance and Discordance of Orthopedicians with Revised National Tuberculosis Control Program with Reference to Musculoskeletal Tuberculosis: A Qualitative Inquiry.

BACKGROUND: Musculoskeletal tuberculosis (TB) continues to share the major burden of extrapulmonary TB. This burden up to some extent may be attributed to the implementation gap which is reasonably broadest at the level of the immediate point of care. As an orthopedic physician is an important stakeholder at this juncture, it is imperative to recognize their experiences, perceptions, and anticipations to fill this gap. This qualitative inquiry tries to explore these attributes in the context of the recent development at the policy level in Revised National Tuberculosis Control Program. METHODOLOGY: Type of Study Qualitative inquiry with framework approach. SETTINGS: Orthopedic surgeons working in different work settings. SAMPLING METHOD: Purposive sampling. An iterative topic guide for an in-depth interview was prepared by reviewing the literature and expert opinions. The questions were contextual, diagnostic, evaluative, and strategic. This study adopted a framework approach as the issue was near to evaluative and strategic policy research. The recorded interviews were transcribed and coded into axial and serial codes. A framework matrix was created and thematic mapping was done to understand the phenomena and to offer the solution framework. RESULTS: The investigators detected an element of unawareness of the current context coupled with the perceived previous stringency of the program. This is in conjunction with already multifaceted diagnostic and prognostic complexity. This leads to mutual dissociation and skepticism. CONCLUSION: This qualitative inquiry explored an element of dissociation between programmatic objectives and individualistic concerns of the caregivers. An integrated ecosystem which may take care of synergistic reciprocation among the two is imperative for successful implementation.

Atypical Presentation of Fibrodysplasia Ossificans Progressiva: A Case Report and Review of Literature.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease characterized by widespread areas of abnormal bone formation in muscles, ligaments, tendons and joint capsules. Typically, the symptoms begin in the first decade of life with episodes of painful inflammatory soft tissue swellings. Gradually, there occurs restriction of motion at various joints, severely limiting the activities of daily living and the quality of life of such patients by the third decade of life. There is no definite cure available for the disease and the current treatment options target symptomatic and palliative management. We describe the case of a 10-year-old child who presented to our institute with a severe disability of upper limbs due to joint contractures along with several bony masses at various locations of the body but without having any prior complaints of painful soft tissue lesions or the characteristic flare-ups of the disease ever. Identification of typical soft tissue ossified masses in the specific anatomic pattern, along with the presence of short and malformed great toes helped us in reaching the diagnosis. Surgical procedures including biopsies should be strictly avoided in such patients to prevent triggering the development of more lesions, which occurred in our patient after inadvertent removal of the first swelling by an orthopaedic specialist.

Development of oxaliplatin encapsulated in magnetic nanocarriers of pectin as a potential targeted drug delivery for cancer therapy.

Superparamagnetic iron oxide nanoparticles (SPIONs) and oxaliplatin (OHP) were in-situ encapsulated in pectin cross-linked with Ca(2+) forming 100-200 nm sized magnetically functionalized pectin nanocarriers, referred here as MP-OHP nanocarriers. The scanning electron microscopy (SEM) and transmission electron microscopy (TEM) studies revealed formation of spherical nanostructures. The magnetic measurements by vibration sample magnetometer (VSM) revealed high saturation magnetization (M s=45.65 emu/g). The superparamagnetic property of MP-OHP was confirmed from the blocking temperature (T B) determined from field cooled and zero field cooled magnetization, measured by superconducting quantum unit interference device (SQUID) magnetometry. The stability of the aqueous dispersion of MP-OHP nanocarriers was confirmed from its high zeta potential (-30.5 mV). The drug encapsulation efficiency (55.2±4.8% w/w) and the drug loading content (0.10±0.04 wt%) in MP-OHP nanocarriers were determined from corresponding platinum contents in OHP and MP-OHP batches measured by inductively coupled plasma mass spectrometry (ICPMS). These nanocarriers exhibited a sustained release of OHP in phosphate buffer solution maintained at pH 5.5 and 7.4, where the drug release profile satisfied a combination of diffusion and swelling controlled mechanism. The cytotoxicity effect of MP-OHP nanocarriers was studied on MIA-PaCa-2 (pancreas) cancer cell line, where the GI50 values were more than 5 mg/mL and it exhibited 10 folds higher cytoxicity than the equivalent concentration of free drug.

Development of diclofenac sodium loaded magnetic nanocarriers of pectin interacted with chitosan for targeted and sustained drug delivery.

A novel spherical magnetic nanocarrier of 100-150 nm dimensions made of pectin interacted with chitosan (MPCh-DS0.05) resulted in 99.5% encapsulation efficiency of diclofenac sodium (DS) as a model drug. Similarly, magnetic nanocarrier made of only pectin crosslinked with Ca(2+) (MPDS-0.05) resulted in only 60.6% encapsulation efficiency of DS. The increase in drug encapsulation efficiency (%) in MPCh-DS0.05 batch was due to synergistic drug encapsulation properties of pectin and chitosan. The structural and morphological features of these magnetic nanocarriers were studied by X-ray diffractometry (XRD), Fourier transform infrared-spectrometry (FT-IR), thermogravimetry, electron microscopy and dynamic light scattering (DLS) measurements. The magnetic properties were measured by vibrating sample magnetometer (VSM) and superconducting quantum unit interference device measurements (SQUID). The in vitro drug release was pH sensitive and exhibited sustained release sequentially in simulated gastric fluid (negligible release in 0-2h), simulated intestinal fluid (~69% release in 2-5h), simulated colonic fluid (5-60 h) and also in phosphate buffer at pH 7.4 (0-48 h). The drug release profile in phosphate buffer solution at pH 7.4 was in good agreement with swelling controlled mechanism on the basis of Korsemeyer-Peppas model.

Development of a novel probe sonication assisted enhanced loading of 5-FU in SPION encapsulated pectin nanocarriers for magnetic targeted drug delivery system.

A novel probe sonication method is developed to enhance loading of 5-fluorouracil (5-FU) in SPION encalsulated pectin nanocarriers of 100-150 nm size (referred here as MP-5FU nanocarriers). Probe sonication at 20 kHz for 60 min resulted in 5-FU loading efficiency of 33.2 ± 2.5%w/w and corresponding drug loading content of 18.2 ± 1.1 wt%. These are two folds higher than literature report of 5-FU loading in pectin. The enhanced loading is attributed to increase in the rate of dissolution of 5-FU in pectin due to transmission of kHz order sonic waves which increases temperature and pressure in the medium due to formation and collapsing of cavitation bubbles. The fabricated MP-5FU nanocarriers with saturation magnetization (43.13 emu/g) exhibited pH responsive, swelling controlled in vitro release of 5-FU in simulated gastric fluid at pH 1.2, in simulated intestinal fluid at pH 6.8, in simulated colonic fluid at pH 5.5, and in phosphate buffer solution at pH 7.4. The cytotoxicity of MP-5FU was measured by sulforhodamine B (SRB) assay and its GI(50) was more than 5mg/mL for cancer cells of HT-29 (colon) and Hep G2 (liver), while it was 3.7 mg/mL for cancer cells of MIA-PaCa-2 (Pancreas).