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Introduction: The National Health Policy, 2017, suggests pluralism in health care with the integrated delivery of AYUSH and allopathic care at public facilities. Information on unit cost of outpatient visits for both types of care at public facilities is useful to guide the policies on health-care delivery. Methods: The costs in 2019–20 were estimated for each type of care at allopathic urban primary health center (UPHC) and AYUSH facilities using top-down methodology and adding out-of-pocket expenditures (OOPE) incurred to reflect true costs. Data from national health survey, annual government budgets, and reports were used. Results: The average cost of an outpatient visit for allopathic care was ₹325 at a UPHC and ₹189 in a homeopathic dispensary and ₹692 in an Ayurvedic dispensary. While OOPE per visit at UPHC was ₹177, no OOPE was incurred at AYUSH facilities. The government expenditure per visit for allopathic care at UPHC at ₹148 was the lowest compared to any type of AYUSH care. The cost per facility for allopathic UPHC was higher than both Ayurvedic and homeopathic dispensaries. Unani dispensaries were least cost-effective, both in terms of cost per visit and cost per facility. Conclusion: Costs per visit at a facility are impacted by footfalls. For Ayurveda, despite lower facility costs as compared to UPHC, per visit costs were higher due to low utilization. Improving evidence-based utilization of AYUSH care is critical for the success of the government policy of mainstreaming AYUSH care at low cost.

IntroductionSerious bacterial neonatal infections are a major cause of global neonatal mortality. While hospitalized treatment is recommended, families cannot access inpatient treatment in low resource settings. Two parallel randomized control trials were conducted at five sites in three countries (Democratic Republic of Congo, Kenya, and Nigeria) to compare the effectiveness of treatment with experimental regimens requiring fewer injections with a reference regimen A (injection gentamicin plus injection procaine penicillin both once daily for 7 days) on the outpatient basis provided to young infants (0-59 days) with signs of possible serious bacterial infection (PSBI) when the referral was not feasible. Costs were estimated to quantify the financial implications of scaleup, and cost-effectiveness of these regimens.MethodsDirect economic costs (including personnel, drugs and consumable costs) were estimated for identification, prenatal and postnatal visits, assessment, classification, treatment and follow-up. Data on time spent by providers on each activity was collected from 83% of providers. Indirect marginal financial costs were estimated for non-consumables/capital, training, transport, communication, administration and supervision by considering only a share of the total research and health system costs considered important for the program. Total economic costs (direct plus indirect) per young infant treated were estimated based on 39% of young infants enrolled in the trial during 2012 and the number of days each treated during one year. The incremental cost-effectiveness ratio was calculated using treatment failure after one week as the outcome indicator. Experimental regimens were compared to the reference regimen and pairwise comparisons were also made.ResultsThe average costs of treating a young infant with clinical severe infection (a sub-category of PSBI) in 2012 was lowest with regimen D (injection gentamicin once daily for 2 days plus oral amoxicillin twice daily for 7 days) at US$ 20.9 (95% CI US$ 16.4-25.3) or US$ 32.5 (2018 prices). While all experimental regimens B (injection gentamicin once daily plus oral amoxicillin twice daily, both for 7 days), regimen C (once daily of injection gentamicin injection plus injection procaine penicillin for 2 days, thereafter oral amoxicillin twice daily for 5 days) and regimen D were found to be more cost-effective as compared with the reference regimen A; pairwise comparison showed regimen D was more cost-effective than B or C. For fast breathing, the average cost of treatment with regimen E (oral amoxicillin twice daily for 7 days) at US$ 18.3 (95% CI US$ 13.4-23.3) or US$ 29.0 (2018 prices) was more cost-effective than regimen A. Indirect costs were 32% of the total treatment costs.ConclusionScaling up of outpatient treatment for PSBI when the referral is not feasible with fewer injections and oral antibiotics is cost-effective for young infants and can lead to increased access to treatment resulting in potential reductions in neonatal mortality.Clinical trial registrationThe trial was registered with Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.

Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. In this paper, we review the social and economic impact of NCDs in India. We outline this impact at household, health system and the macroeconomic level. Cardiovascular diseases (CVDs) figure at the top among the leading ten causes of adult (25-69 years) deaths in India. The effects of NCDs are inequitable with evidence of reversal in social gradient of risk factors and greater financial implications for the poorer households in India. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. Study in India showed that about 25% of families with a member with CVD and 50% with cancer experience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty. The odds of incurring catastrophic hospitalization expenditure were nearly 160% higher with cancer than the odds of incurring catastrophic spending when hospitalization was due to a communicable disease. These high numbers also pose significant challenge for the health system for providing treatment, care and support. The proportion of hospitalizations and outpatient consultations as a result of NCDs rose from 32% to 40% and 22% to 35%, respectively, within a decade from 1995 to 2004. In macroeconomic term, most of the estimates suggest that the NCDs in India account for an economic burden in the range of 5-10% of GDP, which is significant and slowing down GDP thus hampering development. While India is simultaneously experiencing several disease burdens due to old and new infections, nutritional deficiencies, chronic diseases, and injuries, individual interventions for clinical care are unlikely to be affordable on a large scale. While it is clear that "treating our way out" of the NCDs may not be the efficient way, it has to be strongly supplemented with population-based services aimed at health promotion and action on social determinants of health along with individual services. Since health sector alone cannot deal with the "chronic emergency" of NCDs, a multi-sectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.

Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in many developing countries. This paper aims to assess the differential impact of OOP expenditure and its components, such as expenditure on inpatient care, outpatient care and on drugs, across different income quintiles, between developed and less developed regions in India. It also attempts to measure poverty at disaggregated rural-urban and state levels. Based on Consumer Expenditure Survey (CES) data from the National Sample Survey (NSS), conducted in 1999–2000, the share of households’ expenditure on health services and drugs was calculated. The number of individuals below the state-specific rural and urban poverty line in 17 major states, with and without netting out OOP expenditure, was determined. This also enabled the calculation of the poverty gap or poverty deepening in each region. Estimates show that OOP expenditure is about 5% of total household expenditure (ranging from about 2% in Assam to almost 7% in Kerala) with a higher proportion being recorded in rural areas and affluent states. Purchase of drugs constitutes 70% of the total OOP expenditure. Approximately 32.5 million persons fell below the poverty line in 1999–2000 through OOP payments, implying that the overall poverty increase after accounting for OOP expenditure is 3.2% (as against a rise of 2.2% shown in earlier literature). Also, the poverty headcount increase and poverty deepening is much higher in poorer states and rural areas compared with affluent states and urban areas, except in the case of Maharashtra. High OOP payment share in total health expenditures did not always imply a high poverty headcount; state-specific economic and social factors played a role. The paper argues for better methods of capturing drugs expenditure in household surveys and recommends that special attention be paid to expenditures on drugs, in particular for the poor. Targeted policies in just five poor states to reduce OOP expenditure could help to prevent almost 60% of the poverty headcount increase through OOP payments. [ABSTRACT FROM AUTHOR]

Using detailed synchrotron diffraction, magnetization, thermodynamic and transport measurements, we investigate the relationship between the mixed valence of Ir, lattice strain and the resultant structural and magnetic ground states in the geometrically frustrated triple perovskite iridate Ba 3 NaIr 2 O 9 . We observe a complex interplay between lattice strain and structural phase co-existence, which is typically not observed in this family of compounds. The low temperature magnetic ground state is characterized by the absence of long-range magnetic order, and points towards the condensation of a cluster glass state from an extended regime of short range magnetic correlations., (© 2022 IOP Publishing Ltd.)

Design and development of biocompatible, biodegradable and stable dual delivery systems for drug and gene is the need of the hour. Here, we have designed a strategy to develop carrier systems consisting of above mentioned properties by (a) incorporating an unnatural amino acid in the peptide backbone, and b) conjugating a low molecular weight cationic polymer (polyethylenimine, PEI) for incorporating cationic charge. Using this strategy, we have synthesized a small series of Boc-FΔF-AH-polyethylenimine conjugates by varying the concentration of Boc-FΔF-aminohexanoic acid, viz., PP-1, PP-2 and PP-3. These conjugates self-assembled in aqueous medium to form micelles in the size range of ~144-205 nm with zeta potential ~ +7.9-14.2 mV bearing core-shell type of conformation. Positive surface of the micelles facilitated the binding of plasmid DNA as well as transportation inside the cells. The hydrophobic core of the nanostructures helped in the encapsulation of the hydrophobic drug molecule, which was then got released in a controlled manner. DNA complexes of the conjugates were not only found non-toxic but also exhibited higher transfection efficacy than the native polymer and Lipofectamine. Altogether, these nanostructures are capable of delivering a drug and a gene simultaneously in vitro and could be used as next-generation delivery agents., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this retrospective study is to reduce the dose of heart, both lung and opposite breast and left anterior descending artery (LAD) and avoid long term complication and radiation induced secondary malignancies in radiotherapy left breast/chest wall without losing homogeneity and conformity of the Planning Target Volume (PTV), contoured using Radiotherapy Oncology Group (RTOG 1005) guideline., Materials and Methods: The treatment plans were generated retrospectively by TFIF, VMAT and Composite techniques for 30 patients. Dose-Volume Histograms (DVHs) were evaluated for PTV and organs at risk (OAR's) and analyzed in two groups BCS and MRM using Wilcoxon signed rank test., Results: The homogeneity index (HI) was improved in Composite technique by 32.72% and 21.81% of VMAT, 50.66% and 49.41% of TFIF in BCS and MRM group respectively. The Conformity Index (CI) for composite plan was statistically same as VMAT and superior by 27.94% and 41.37% of TFIF in BCS and MRM group respectively. The low dose volume V 5Gy and V 10Gy of the heart were improved in Composite plan by 47.9% and 26.1% of VMAT respectively in BCS group and in MRM group, improved by 21.2% and 45.6% of VMAT. The V 5Gy and V 10Gy of ipsilateral lung were improved in Composite plan by 16% and 13.7% of VMAT respectively in BCS and 8.4% and 3% of VMAT respectively in MRM group., Conclusion: The Composite plan consisting of VMAT and TFIF plan with an optimum selection of fractions can achieve lower low dose exposure to the OAR's without compromising coverage compared to VMAT., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2020 Turkish Federation of Breast Diseases Associations.)

The interface of two dissimilar materials is well known for surprises in condensed matter, and provides avenues for rich physics as well as seeds for future technological advancements. We present some exciting magnetization (M) and remanence (μ) results, which conclusively arise at the interface of two highly functional materials, namely the graphitic shells of a carbon nanotube (CNT) and α-Fe 2 O 3 , a Dzyaloshinskii-Moriya interaction driven weak ferromagnet (WFM) and piezomagnet (PzM). We show that the encapsulation inside a CNT leads to a significant enhancement in M and correspondingly in μ, a time-stable part of the remanence, exclusive to the WFM phase. Up to 70% of in-field magnetization is retained in the form of μ at room temperature. The lattice parameter of the CNT around the Morin transition of the encapsulate exhibits a clear anomaly, confirming the novel interface effects. Control experiments on bare α-Fe 2 O 3 nanowires bring into the fore that the weak ferromagnets such as α-Fe 2 O 3 are not as weak, as far as their remanence and its stability with time is concerned, and encapsulation inside a CNT leads to a substantial enhancement in these functionalities.

The present article describes designing and fabrication of nanostructures from a mixed α/β-pentapeptide, Lys-βAla-βAla-Lys-βAla, which majorly contains non-natural β-alanine residues in the backbone with two α-lysine residues at 1- and 4-positions. The amphiphilic pentapeptide showed the ability to self-assemble into cationic nanovesicles in an aqueous solution. The average size of peptide nanostructures was found to be ~270 nm with a very high cationic charge of ~+40 mV. TEM micrographs revealed the average size of the same nanostructures ~80 nm bearing vesicular morphology. CD and FTIR spectroscopic studies on self-assembled pentapeptide hinted at random coil conformation which was also correlated with conformational search program using Hyper Chem 8.0. The pentapeptide nanostructures were then tested for encapsulation of hydrophobic model drug moieties, L-Dopa, and curcumin. Transfection efficiency of the generated cationic nanostructures was evaluated on HEK293 cells and compared the results with those obtained in the presence of chloroquine. The cytotoxicity assay performed using MTT depicted ~75-80% cell viability. The obtained nanostructures also gave positive results against both Gram-negative and Gram-positive bacterial strains. Altogether the results advocate the promising potential of the pentapeptide foldamer, H-Lys-βAla-βAla-Lys-βAla-OEt, for drug and gene delivery applications along with the antimicrobial activity., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Trovafloxacin is a broad-spectrum antibiotic, recently identified as an inhibitor of pannexin-1 (Panx1) channels. Panx1 channels are important conduits for the adenosine triphosphate (ATP) release from live and dying cells that enhances the inflammatory response of immune cells. Elevated extracellular levels ATP released upon injury activate purinergic pathways in inflammatory cells that promote migration, proliferation, phagocytosis, and apoptotic signals. Here, we tested whether trovafloxacin administration attenuates the neuroinflammatory response and improves outcomes after brain trauma., Methods: The murine controlled cortical impact (CCI) model was used to determine whether in vivo delivery of trovafloxacin has anti-inflammatory and neuroprotective actions after brain trauma. Locomotor deficit was assessed using the rotarod test. Levels of tissue damage markers and inflammation were measured using western blot, qPCR, and immunofluorescence. In vitro assays were used to evaluate whether trovafloxacin blocks ATP release and cell migration in a chemotactic-stimulated microglia cell line., Results: Trovafloxacin treatment of CCI-injured mice significantly reduced tissue damage markers and improved locomotor deficits. In addition, trovafloxacin treatment significantly reduced mRNA levels of several pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α), which correlates with an overall reduction in the accumulation of inflammatory cell types (neutrophils, microglia/macrophages, and astroglia) at the injury zone. To determine whether trovafloxacin exerted these effects by direct action on immune cells, we evaluated its effect on ATP release and cell migration using a chemotactic-stimulated microglial cell line. We found that trovafloxacin significantly inhibited both ATP release and migration of these cells., Conclusion: Our results show that trovafloxacin administration has pronounced anti-inflammatory and neuroprotective effects following brain injury. These findings lay the foundation for future studies to directly test a role for Panx1 channels in pathological inflammation following brain trauma.

An in silico dosimetric evaluation of intensity-modulated radiation therapy (IMRT) vs 3-dimensional conventional radiation therapy (3D-CRT) treatment plans in postmastectomy radiation therapy (PMRT) to the chest wall and regional lymphatics was conducted. Twenty-five consecutive patients with breast cancer referred for locoregional PMRT, stages T 2-4 with N 1-3 , were planned to receive 50 Gy in 25 fractions with IMRT. Additionally, a 3D-CRT plan was generated using identical contours for the clinical target volumes (CTV), planning target volumes (PTV), and organs at risk (OAR). Treatment plans were assessed using dose-volume histogram (DVH) parameters of D 98 , D 95 , D 50 , D 2 , and homogeneity index for individual CTVs and PTVs. OARs evaluated were ipsilateral and contralateral lungs, heart, spinal cord, and opposite breast. Most DVH parameters pertaining to CTVs and PTVs significantly favored IMRT. V 20 for ipsilateral and contralateral lungs, D 33 of heart and maximum dose to spinal cord favored IMRT (all p < 0.001). The mean dose to the opposite breast was significantly lesser with 3D-CRT (5.8 ± 1.8 Gy vs 2.0 ± 1.0 Gy, p < 0.001). Thus, except for the mean dose to the opposite breast, the compliance to DVH constraints applied to PTV and OARs were significantly better with IMRT. At a median follow-up of 76 months (7-91), none had locoregional failure or pulmonary or cardiac morbidity. For PMRT, requiring comprehensive irradiation to both chest wall and regional lymphatics, IMRT offers superior dosimetric advantages over 3D-CRT. This was also corroborated by long-term outcomes in these patients treated with IMRT., (Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.)

Molecular self-assembly of biodegradable amphiphilic polymers allows rational design of biocompatible nanomaterials for drug delivery. Use of substituted polysaccharides for such applications offers the ease of design and synthesis, and provides higher biofunctionality and biocompatibility to nanomaterials. The present work focuses on the synthesis, characterization and potential biomedical applications of self-assembled polysaccharide-based materials. We demonstrated that the synthesized amphiphilic inulin self-assembled in aqueous medium into nanostructures with average size in the range of 146-486nm and encapsulated hydrophobic therapeutic molecule, ornidazole. Hydrophophic dehydropeptide was conjugated with inulin via a biocompatible ester linkage. Dehydrophenylalanine, an unusual amino acid, was incorporated in the peptide to make it stable at a broader range of pH as well as against proteases. The resulting core-shell type of nanostructures could encapsulate ornidazole in the hydrophobic core and released it in a controlled fashion. By taking the advantage of inulin, which gets degraded in the colon by colonic bacteria, the effect of enzyme, inulinase, present in the microflora of the large intestine, on inulin-peptide degradation followed by drug release has been studied. Altogether, small peptide conjugated to inulin offers novel scaffold for the future design of nanostructures with potential applications in the field of targeted drug delivery., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background and Purpose: A better understanding of appropriate sequencing and use of multimodality approach in the management and subsequent improvement in overall survival mandates a vigil on quality of life issues. Intensity modulated radiotherapy (IMRT) is a powerful tool, which might go a long way in reducing radiation doses to critical structures and thereby reduce long term morbidities. The purpose of this paper is to evaluate the impact of IMRT in reducing the dose to the critical normal tissues while maintaining the desired dose to the volume of interest for abdominal malignancies., Materials and Methods: During the period January 2002 to March 2004, 11 patients of various sites of malignancies in the abdominal region were treated using physical intensity modulator based IMRT. Plans of these patients treated with IMRT were analyzed using dose volume histograms., Results: An average dose reduction of the mean values by 50% to the liver, 57% to the right kidney, 56% to the left kidney, 66% to the cord and 27% to the bowel, with respect to the GTV could be achieved with IMRT. The two-year disease free survival was 79% and two-year overall survival was 88%. The average number of IMRT fields used was six., Conclusion: IMRT with inverse planning enabled us to achieve desired dose distribution, due to its ability to provide sharp dose gradients at the junction of tumor and the adjacent critical organs.