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Background: Children with intellectual and developmental disabilities are at a higher risk of developing dental caries. Few scoping reviews have been conducted in India to understand their issues. We aimed to summarise the distribution and risk factors of dental caries among children and adolescents with intellectual disabilities in India. Methods: A scoping review was conducted based on the Arksey O Malley framework. Quality assessment of studies, descriptive and thematic analyses were also conducted. Results: We charted, collated, and summarised from four databases. Thirty-one studies met the study criteria consisting of children and adolescents with intellectual disabilities. Median caries prevalence was 70%, decayed missing and fIlled permenant teeth (DMFT) was 2.4, decayed missing and filled decidous teeth (dmft) was 2.36, and DMFS was 3.7. Major determinants were the severity of disability, socioeconomic status and parents' education. Oral care and dental visits were inadequate. Conclusion: Further exploration is required to improve access and reduce caries experience and prevalence among children with intellectual and developmental disabilities in India.

Introduction: Chemotherapy in an integral part of cancer treatment, either administered alone or in combination with radiation. However, the cost of these drugs is often prohibitively high for most patients. To address this issue, the Government of India has established Jan Aushadhi (JAS) stores across the country, where affordable generic medicines are available. In the current study, we performed a cost minimization analysis comparing JAS drugs with branded chemotherapeutic drugs used in various cancer treatment regimens., Objectives: This study was to conduct a cost-minimization analysis by comparing the costs of different regimens when using JAS drugs, the most expensive branded drugs, and the least expensive branded drugs in the treatment of cancer in India., Materials and Methods: The study focused on conducting a cost minimization analysis of various chemotherapy drugs used in the treatment of different cancers, considering the availability of anticancer drugs at JAS stores. The costs for different chemotherapy regimens, including both anticancer and supportive drugs, were calculated for single and complete cycles. The costs of the most expensive and least expensive branded drugs were noted from the Current Index of Medical Stores. The cost difference (CD) was calculated by subtracting the cost of the cheaper drug from that of the costliest brand. The cost ratio (CR) and the percentage of cost variation (PCV) were calculated for India-specific conditions., Results: The study analyzed the CD for various regimens using JAS drugs for chemotherapy treatment of breast, esophagus, rectal, colon, stomach, prostate, ovary, endometrial, cervical, head and neck, lung, multiple myeloma, testicular, and lymphoma cancers. It also considered chemoirradiation regimens for brain, head and neck, anorectal, esophageal, and uterine cervical cancers. Significant CDs were observed when both anticancer and supportive drugs were obtained from JAS stores., Conclusion: To the best of the authors' knowledge, this is the first study to consider the CD, CR, and PCV for various regimens using JAS drugs, as well as the costliest and cheapest branded drugs in standard cancer treatment regimens. The results of this study are expected to assist healthcare professionals and pharmacists in understanding the cost-saving benefits of substituting expensive branded drugs with more affordable chemotherapeutic drugs for the treatment of cancer. This substitution can provide financial benefit for socioeconomically marginalized population., (Copyright © 2024 Copyright: © 2024 Journal of Cancer Research and Therapeutics.)

Background and Purpose: Very few large scale multicentric stroke clinical trials have been done in India. The Indian Council of Medical Research funded INSTRuCT (Indian Stroke Clinical Trial Network) as a task force project with the objectives to establish a state-of-the-art stroke clinical trial network and to conduct pharmacological and nonpharmacological stroke clinical trials relevant to the nation and globally. The purpose of the article is to enumerate the structure of multicentric stroke network, with emphasis on its scope, challenges and expectations in India., Methods: Multiple expert group meetings were conducted by Indian Council of Medical Research to understand the scope of network to perform stroke clinical trials in the country. Established stroke centers with annual volume of 200 patients with stroke with prior experience of conducting clinical trials were included. Central coordinating center, standard operating procedures, data and safety monitoring board were formed., Discussion: In first phase, 2 trials were initiated namely, SPRINT (Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India) and Ayurveda treatment in the rehabilitation of patients with ischemic stroke in India (RESTORE [Rehabilitation of Ischemic stroke Patients in India: A Randomized controlled trial]). In second phase, 4 trials have been approved. SPRINT trial was the first to be initiated. SPRINT trial randomized first patient on April 28, 2018; recruited 3048 patients with an average of 128.5 per month so far. The first follow-up was completed on May 27, 2019. RESTORE trial randomized first patient on May 22, 2019; recruited 49 patients with an average of 3.7 per month so far. The first follow-up was completed on August 30, 2019., Conclusions: In next 5 years, INSTRuCT will be able to complete high-quality large scale stroke trials which are relevant globally., Registration: URL: http://www.ctri.nic.in/; Unique Identifier: CTRI/2017/05/008507.

Multi-location supervised field trials in India were conducted with a combination pesticide formulation (iprovalicarb 5.5% + propineb 61.25%, 66.75% WP) in tomato to study dissipation behavior at single (iprovalicarb 137.5 g a.i. ha -1 + propineb 1531.25 g a.i. ha -1 ) and double (iprovalicarb 275 g a.i. ha -1 + propineb 3062.5 g a.i. ha -1 ) dose. The samples were processed using a modified QuEChERS method for iprovalicarb and acid hydrolysis followed by carbon disulfide estimation for propineb and confirmation of their respective residues by LC-MS/MS and GC-MS. Both the fungicides in tomato fruits obey first-order kinetics irrespective of location and doses. Half-life (t 1/2 ) values at all the four locations ranged from 1.08 to 4.67 days for iprovalicarb and 3.36 to 11.41 days for propineb in tomato. The Food Safety and Standards Authority of India (FSSAI) has set MRL of 1 mg kg -1 for propineb, but no MRL is yet fixed for iprovalicarb. Using OECD MRL calculator, the calculated MRL for iprovalicarb and propineb was found to be 2 and 4 mg kg -1 , respectively. The hazard quotient (HQ) < 1, theoretical maximum daily intake (TMDI) < acceptable daily intake (ADI), TMDI < maximum permissible intake (MPI), percent acute hazard index (% aHI) ≤ 1, and percent chronic hazard index (% cHI) < 1 for both the fungicides indicated that the combination formulation will not pose any dietary risk and thus considered safe for human health.

Background: In elderly people, the body's metabolic processes are not optimal and pharmacokinetics and pharmacodynamic profile of drugs are compromised or reduced. Under these conditions, the concomitant use of diverse classes of drugs can potentially increase the risk of adverse reactions and drug interactions. This will consequentially affect the already debilitated organ system. As far as the authors are aware, there are no studies addressing the drug-drug interactions and adverse drug reactions due to polypharmacy in older patients with cancer and therefore, we conducted this study., Methods: This was an observational chart-based study and was carried out in a tertiary care cancer hospital. The data concerning prescription of all prescribed medications were noted down from the medication chart of the patient in the wards., Results: The most common drug-to-drug interaction that could have happened was due to the combination of theophylline with budesonide (26.10%). Adverse drug reactions were noted during the course of time, the most common being nausea and vomiting (71.9%)., Conclusions: As the geriatric population is increasing, the need to address medical problems among aged patients with cancer is the need of the hour. The adverse drug reactions and drug interactions that have occurred were lesser when compared to published observations., Competing Interests: None

Background & Objectives: : Acute kidney injury (AKI) has been identified as an independent risk factor for mortality in intensive care units. This retrospective study was conducted to determine the effect of AKI on in-hospital mortality in a general medical ward of a tertiary care hospital and risk factors for mortality in patients with AKI., Methods: : Demographic and clinical details, and outcome data were collected from case records of patients. In all hospitalized patients, factors associated with increased in-hospital mortality, such as AKI, inotrope requirement, mechanical ventilation and primary disease were compared between patients who died during their hospital stay and those who were discharged alive. Among the hospitalized patients, who had AKI, likely predictors of in-hospital mortality were compared between dead and alive patients at discharge. Factors that were significant in univariate analysis were tested by multivariate regression analysis to identify those that independently predicted poor outcomes., Results: : Of the 1150 patients admitted in a general medical ward in a year, 220 patients were identified to have AKI. In-hospital mortality rate among patients with AKI was 19.09 per cent as compared to 1.8 per cent without AKI [adjusted odds ratio (OR) 5.7 (95% CI: 1.56-20.74)]. The presence of AKI was an independent risk factor for death, with an adjusted OR of 6.0 [95% CI: 1.67-21.6]. Among patients with AKI, the presence of haematological malignancy, adjusted OR 25.86 (95% CI: 1.81-369.58), requirement of inotrope, adjusted OR 126.5 (95% CI: 19.39-825.93) and serum creatinine at admission (P<0.001) were found to be independent predictors of death. The presence of underlying chronic kidney disease and hospital-acquired AKI were not found to have an association with mortality., Interpretation & Conclusions: : The study showed the in-hospital mortality rate among patients with AKI in a general medical ward was 19.09 per cent. The occurrence of AKI was an independent risk factor for death, with haematological malignancy, use of vasopressors and higher serum creatinine at admission, significantly associated with death among patients with AKI. Large prospective studies need to be done to better understand the outcomes in AKI and the ways to present and manage AKI., Competing Interests: None

Stem cell therapy is applicable for repair and replacement of damaged cells and tissues. Apart from transplanting cells to the body, the stem cell therapy directs them to grow new and healthy tissues. Stem cells in the area of regenerative medicines hold tremendous promise that may help to regenerate the damaged tissues and heal various diseases like multiple sclerosis, heart diseases, Parkinson's disease, and so on. To prove the safety, efficacy, and for the requirement of a licence for manufacturing and sale, all the stem cell therapies should pass the required criteria and undergo certain examinations of the regulatory agencies. The regulatory authorities review the manufacturing procedures of products to assure its purity and potency. This review summarizes the comparative critical evaluations of existing regulations and developments on the stem cells research in India, USA, EU and Asian regions and also discusses the challenges that have to be overcome and the important points that should be understood to position India as a source of the perspective nation in stem cells around the world., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: Drug wastage is a major concern in oncology where costs of antineoplastic drugs are exorbitant, and the disposal of toxic drugs increases the chances of occupational hazards to healthcare and sanitary workers and environmental pollution at the site of disposal. The principal objective of this study was to ascertain the extent of drug wastage and calculate its financial costs., Materials and Methods: This was a prospective pilot study conducted to ascertain the quantity of drug wastage in a tertiary care hospital. This pilot study was conducted in day care and inpatient facilities in February 2016. The prescription of cytotoxic drugs, recommended dose, the quantity used, and remainder (waste) left were recorded from the nurses and pharmacy files of the hospital. Cost evaluation of the actual use and the waste was undertaken and an audit was conducted to understand in which anticancer drug the maximum wastage was generated., Results: The results of this study indicated that 6.1% of the total amount of reconstituted drugs was wasted. The highest drug wastage was observed in trastuzumab (29.55%), followed by etoposide (20.4%), dacarbazine (17.14%), daunorubicin (16.67%), and carboplatin (11.29%). Cost analysis showed that the total cost of the drug issued during the study period was Rs. 1,294,975 and the cost of drug wastage amounted to Rs. 143,820 (11.1%)., Conclusion: To the best of authors' knowledge, this is the first study from India and the results indicate that the financial impact of anticancer drug wastage was substantial. Attempts should be directed at minimizing the wastage and cost savings without risking patients' treatment regimen and administering effective dose schedule., Competing Interests: None

Background: Scrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reports., Methods: A retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness--a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits., Results: Sixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol., Conclusion: Meningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.

Human suffering speaks differently to different lived contexts. In this paper, I have taken a metaphoric representation of suffering, Ishvara, from the lived context of a Hindu immigrant woman to show that suffering is experienced and expressed within one's lived context. Further, a dominant narrative from her world is presented to show that the same lived context can be a resource for spiritual care that could reconstruct her world that has fallen apart with a suffering experience. Having argued that suffering is experienced and expressed within one's lived context, and that lived context could be a resource, in this paper I present that spiritual care is an intervention into the predicaments of human suffering and its mandate is to facilitate certain direction and a meaningful order through which experiences and expectations are rejoined. Finally, I observe that spiritual care is an engagement between the lived context where suffering is experienced and the spiritual experience and orientation of the caregiver.

Introduction: Endoprosthetic replacement is a popular method of treatment for fracture neck of femur in the elderly. Unipolar, bipolar and total hip endoprosthesis are all used. The aim of this paper is to compare the functional results of bipolar arthroplasty with that of total hip arthroplasty in a South Asian population., Materials and Methods: Sixty-one patients who underwent prosthetic replacement for fracture neck of femur between May 1997 and Dec 2002 were followed-up prospectively. Twenty-nine patients were treated with total hip replacement and thirty-two were treated with bipolar arthroplasty. At the time of the last follow-up, twenty-four patients had expired and seventeen could not be traced. The results in the remaining twenty are presented., Results: The period of follow up ranged from 24 months to 90 months, with a mean of 58.5 months. The mean Harris Hip Score for the bipolar group was 86.93, and for the total hip group was 83.82. More than a third of our patient population died within 5 years of endoprosthetic replacement., Conclusion: The functional outcome is equally good whether bipolar or total hip replacement is used, in the elderly, in a South Asian population. More than a third of our patient population expired within 5 years of prosthetic replacement; therefore it may be wise to choose the less expensive treatment modality in resource poor countries.

A study was conducted of the experience of menopause among middle-aged women in a fishing village on the southwest coast of India. These women live in a harsh environment with a standard of living that would be considered economically deprived by an outsider. The women have established their identity as fish sellers. Although they reported experiencing some of the physiological symptoms of menopause typically reported in Western literature, the symptoms were not cause for complaint, and none of them sought medical treatment for them. Nor did these women go through an identity crisis at midlife; they continued to identify themselves as well-established fish sellers, not as redundant, aging housewives. Furthermore, menopause gave them much more time and freedom to pursue their fish-selling business. This paper posits that their continuity in identity accounts for their freedom from the psychological symptoms some Western women experience at midlife.

This paper presents an analysis and interpretation of the reasons that older immigrant Sikh women in a Canadian city perceive menopause as a positive event in their lives. Traditional psychological and psychosomatic symptoms ascribed to menopause in the literature were notably absent in this group of women. The positive attitude that the women displayed toward the menopausal experience was investigated within the ecology of their particular lives. Prior to and after immigration to Canada, participants lived in a traditional Indian/Sikh ideological setting. Only within this ideological system and world view could the cultural symbolism and the meaning ascribed to menopause be understood. The physical/biological symptoms and the meaning ascribed to them was not addressed (George T. There is a time for everything: A study of the menopausal/climacteric experience of Sikh women in Canada. Doctoral dissertation, University of Utah, 1985).