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1. Photoinitiated Degradation Kinetics of the Organic UV Filter Oxybenzone in Solutions and Aerosols: Impacts of Salt, Photosensitizers, and the Medium.

Author

Cooper, Adam, Shenkiryk, Alexis, Chin, Henry, Morris, Maya, Mehndiratta, Lincoln, Roundtree, Kanuri, Tafuri, Tessa, and Slade, Jonathan

Abstract

Organic UV filters like oxybenzone (BP3) in sunscreens are seawater pollutants suspected to transfer to the atmosphere via sea spray aerosol (SSA). This study examines the photoinitiated degradation of BP3 in artificial and real seawater compared to SSA mimics containing NaCl and 4-benzoylbenzoic acid (4-BBA). We investigated pure, binary, and ternary mixtures of BP3, NaCl, and 4-BBA using solar-simulated light to isolate the effects of salt and photosensitization on BP3 degradation. Results showed significantly faster degradation in the aerosol phase (J eff,env ≈ 10-3-10-2 s-1 or t 1/2 < 10 min) compared to bulk solutions (J eff,env ≈ 10-6 s-1 or t 1/2 > 1 day). The photosensitizer enhanced BP3 photodegradation in both phases more than when mixed with salt or all three components in solutions. BP3 photodegradation was most enhanced by salt in the aerosol phase. High-resolution molecular analysis via Orbitrap LC-MS/MS revealed more acutely toxic compounds (benzophenone, benzoic acid, and benzaldehyde) in irradiated aerosols than in solution, supported by electronic structure and toxicity modeling. These findings highlight that seawater may serve as a reservoir for BP3 and other organic UV filters and that upon transfer into SSA, BP3 rapidly transforms, increasing aerosol toxicity.

Published
2024

2. Effects of Wind Speed on Size-Dependent Morphology and Composition of Sea Spray Aerosols.

Author

Madawala, Chamika, Molina, Carolina, Kim, Deborah, Gamage, Dilini, Sun, Mengnan, Leibensperger, Raymond, Mehndiratta, Lincoln, Lee, Jennie, Kaluarachchi, Chathuri, Kimble, KeLa, Sandstrom, Greg, Harb, Charbel, Dinasquet, Julie, Malfatti, Francesca, Prather, Kimberly, Deane, Grant, Stokes, M, Lee, Christopher, Slade, Jonathan, Stone, Elizabeth, Grassian, Vicki, and Tivanski, Alexei

Abstract

Variable wind speeds over the ocean can have a significant impact on the formation mechanism and physical-chemical properties of sea spray aerosols (SSA), which in turn influence their climate-relevant impacts. Herein, for the first time, we investigate the effects of wind speed on size-dependent morphology and composition of individual nascent SSA generated from wind-wave interactions of natural seawater within a wind-wave channel as a function of size and their particle-to-particle variability. Filter-based thermal optical analysis, atomic force microscopy (AFM), AFM infrared spectroscopy (AFM-IR), and scanning electron microscopy (SEM) were employed in this regard. This study focuses on SSA with sizes within 0.04-1.8 μm generated at two wind speeds: 10 m/s, representing a wind lull scenario over the ocean, and 19 m/s, indicative of the wind speeds encountered in stormy conditions. Filter-based measurements revealed a reduction of the organic mass fraction as the wind speed increases. AFM imaging at 20% relative humidity of individual SSA identified six main morphologies: prism-like, rounded, core-shell, rod, rod inclusion core-shell, and aggregates. At 10 m/s, most SSA were rounded, while at 19 m/s, core-shells became predominant. Based on AFM-IR, rounded SSA at both wind speeds had similar composition, mainly composed of aliphatic and oxygenated species, whereas the shells of core-shells displayed more oxygenated organics at 19 m/s and more aliphatic organics at 10 m/s. Collectively, our observations can be attributed to the disruption of the sea surface microlayer film structure at higher wind speeds. The findings reveal a significant impact of wind speed on morphology and composition of SSA, which should be accounted for accurate assessment of their climate effects.

Published
2024

3. Discovering Elementary Discourse Units in Textual Data Using Canonical Correlation Analysis

Author

Mehndiratta, Akanksha and Asawa, Krishna

Subjects
Computer Science - Computation and Language
Abstract

Canonical Correlation Analysis (CCA) has been exploited immensely for learning latent representations in various fields. This study takes a step further by demonstrating the potential of CCA in identifying Elementary Discourse Units(EDUs) that captures the latent information within the textual data. The probabilistic interpretation of CCA discussed in this study utilizes the two-view nature of textual data, i.e. the consecutive sentences in a document or turns in a dyadic conversation, and has a strong theoretical foundation. Furthermore, this study proposes a model for Elementary Discourse Unit(EDU) segmentation that discovers EDUs in textual data without any supervision. To validate the model, the EDUs are utilized as textual unit for content selection in textual similarity task. Empirical results on Semantic Textual Similarity(STSB) and Mohler datasets confirm that, despite represented as a unigram, the EDUs deliver competitive results and can even beat various sophisticated supervised techniques. The model is simple, linear, adaptable and language independent making it an ideal baseline particularly when labeled training data is scarce or nonexistent.

Published
2024

10. Visual Tracking Nonlinear Model Predictive Control Method for Autonomous Wind Turbine Inspection

Author

Amer, Abdelhakim, Mehndiratta, Mohit, Sejersen, Jonas le Fevre, Pham, Huy Xuan, and Kayacan, Erdal

Subjects
Computer Science - Robotics
Abstract

Automated visual inspection of on-and offshore wind turbines using aerial robots provides several benefits, namely, a safe working environment by circumventing the need for workers to be suspended high above the ground, reduced inspection time, preventive maintenance, and access to hard-to-reach areas. A novel nonlinear model predictive control (NMPC) framework alongside a global wind turbine path planner is proposed to achieve distance-optimal coverage for wind turbine inspection. Unlike traditional MPC formulations, visual tracking NMPC (VT-NMPC) is designed to track an inspection surface, instead of a position and heading trajectory, thereby circumventing the need to provide an accurate predefined trajectory for the drone. An additional capability of the proposed VT-NMPC method is that by incorporating inspection requirements as visual tracking costs to minimize, it naturally achieves the inspection task successfully while respecting the physical constraints of the drone. Multiple simulation runs and real-world tests demonstrate the efficiency and efficacy of the proposed automated inspection framework, which outperforms the traditional MPC designs, by providing full coverage of the target wind turbine blades as well as its robustness to changing wind conditions. The implementation codes are open-sourced., Comment: 8 pages, accepted for publication at ICAR conference

Published
2023

13. Higher Body Mass Index is Associated with Increased Oxidative Stress in Patients of Type 2 Diabetes Mellitus

Author

Edelbert A. Almeida, Mohit Mehndiratta, Sri V. Madhu, and Rajarshi Kar

Subjects
lean, mtdna content, nrf2-nqo1, obese, oxidative stress, telomere length, type 2 diabetes mellitus, Diseases of the endocrine glands. Clinical endocrinology, RC648-665, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Introduction: Type 2 diabetes mellitus (T2DM) is closely associated with the obesity; however, certain proportion of T2DM patients is non-obese or lean (BMI < 18.5 kg/m2). Obesity has long been associated with oxidative stress; however, there are no studies available documenting levels of oxidative stress in the lean patients of T2DM. Therefore, this study was done to compare the levels of makers of oxidative stress (TL, mtDNA, TAS) and their regulators (mRNA expression of TERT, Nrf2 and Nqo1) in lean and obese patients of T2DM. Methods: 60 newly diagnosed patients (treatment naïve) of T2DM were recruited and divided into lean (BMI < 18.5 kg/m2) and obese (BMI > 25 kg/m2) groups. Relative telomere length (T/S) and mtDNA content were estimated via real-time PCR. Serum total antioxidant status (TAS) was measured using a commercially available kit. mRNA expression of TERT, Nrf2 and Nqo1 was measured by real-time PCR. Results: Mean T/S and mtDNA content were lower in the obese group compared to the lean group (P = 0.16 and P = 0.06, respectively). Mean serum TAS levels were higher in obese group compared to the lean group (P = 0.001). mRNA expression of TERT and Nrf2 was increased in obese group compared to the lean group. mRNA expression of Nqo1 was similar in both the groups. Conclusion: Obese patients of T2DM are exposed to a greater degree of OS compared to the lean patients of T2DM.

Published
2024
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14. Fisetin-loaded nanoemulsion ameliorates lung cancer pathogenesis via downregulating cathepsin-B, galectin-3 and enolase in an in vitro setting

Author

Ayeh Bani Saeid, Keshav Raj Paudel, Gabriele De Rubis, Samir Mehndiratta, Sofia Kokkinis, Sukriti Vishwas, Stewart Yeung, Gaurav Gupta, Sachin Kumar Singh, and Kamal Dua

Subjects
lung cancer, fisetin-loaded nanoemulsion, cathepsin-b, galectin-3, enolase, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282, Biology (General), QH301-705.5
Published
2024
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15. Reproducibility of spatial penalty-based methodologies for intravoxel incoherent motion analysis with diffusion MRI

Author

Esha Baidya Kayal, Shuvadeep Ganguly, Devasenathipathy Kandasamy, Kedar Khare, Raju Sharma, Sameer Bakhshi, and Amit Mehndiratta

Subjects
Intravoxel incoherent motion, Precision, Reproducibility, Spatial penalty based IVIM method, Quantitative comparison, Medicine, Science
Abstract

Abstract Objective was to assess the precision and reproducibility of spatial penalty-based intravoxel incoherent motion (IVIM) methods in comparison to the conventional bi-exponential (BE) model-based IVIM methods. IVIM-MRI (11 b-values; 0–800 s/mm2) of forty patients (N = 40; Age = 17.7 ± 5.9 years; Male:Female = 30:10) with biopsy-proven osteosarcoma were acquired on a 1.5 Tesla scanner at 3 time-points: (i) baseline, (ii) after 1-cycle and (iii) after 3-cycles of neoadjuvant chemotherapy. Diffusion coefficient (D), Perfusion coefficient (D*) and Perfusion fraction (f) were estimated at three time-points in whole tumor and healthy muscle tissue using five methodologies (1) BE with three-parameter-fitting (BE), (2) Segmented-BE with two-parameter-fitting (BESeg-2), (3) Segmented-BE with one-parameter-fitting (BESeg-1), (4) BE with adaptive Total-Variation-penalty (BE + TV) and (5) BE with adaptive Huber-penalty (BE + HPF). Within-subject coefficient-of-variation (wCV) and between-subject coefficient-of-variation (bCV) of IVIM parameters were measured in healthy and tumor tissue. For precision and reproducibility, intra-scan comparison of wCV and bCV among five IVIM methods were performed using Friedman test followed by Wilcoxon-signed-ranks (WSR) post-hoc test. Experimental results demonstrated that BE + TV and BE + HPF showed significantly (p

Published
2024
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17. Applications and advancements of nanoparticle-based drug delivery in alleviating lung cancer and chronic obstructive pulmonary disease

Author

De Rubis, Gabriele, Paudel, Keshav Raj, Corrie, Leander, Mehndiratta, Samir, Patel, Vyoma K., Kumbhar, Popat S., Manjappa, Arehalli Sidramappa, Disouza, John, Patravale, Vandana, Gupta, Gaurav, Manandhar, Bikash, Rajput, Rashi, Robinson, Alexandra Kailie, Reyes, Ruby-Jean, Chakraborty, Amlan, Chellappan, Dinesh Kumar, Singh, Sachin Kumar, Oliver, Brian Gregory George, Hansbro, Philip Michael, and Dua, Kamal

Published
2024
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19. Duodenal obstruction: A rare complication of langerhans cell histiocytosis

Author

Vaishnavi Sreenivasan, Anmol Aatli, Saahiti Andhavaram, Apoorva Sharma, Rashmi Dandriyal, Shyam S. Meena, Nidhi Sugandhi, Sumit Mehndiratta, Nidhi Chopra, and Amitabh Singh

Subjects
Histiocytosis, Malnutrition, Gastrointestinal, Pediatrics, RJ1-570
Abstract

Background: Langerhans cell histiocytosis (LCH) has a variable presentation. Gastrointestinal involvement is rare and portends a poor prognosis in LCH. Case report: Herein, we describe the presentation, progression, management, and outcome of an 11-month-old female infant with LCH. The patient presented with severe acute malnutrition, hepatosplenomegaly, and gastrointestinal involvement in the form of persistent vomiting. She was managed with chemotherapy initially and subsequently developed complete duodenal narrowing. She underwent Kimura's duodenojejunostomy and improved. Hence, chemotherapy was restarted. Two months later, she developed features of intestinal obstruction with intraoperative findings of ileal gangrene requiring adhesiolysis, ileal resection, and ileostomy. Subsequently, she succumbed to sepsis. Conclusion: This case report aims to highlight the atypical gastrointestinal manifestations of LCH and the challenges faced in managing such a case.

Published
2024
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21. Connecting the Dots: Unveiling the Power of Sensors in IoT

Author

Mehndiratta, Vandana, Gupta, Varuna, Garg, Aakansha, Chakravorty, Antorweep, Series Editor, Verma, Ajit Kumar, Series Editor, Bhattacharya, Pushpak, Series Editor, Pant, Millie, Series Editor, Ghosh, Shubha, Series Editor, Arya, Rajeev, editor, Sharma, Subhash Chander, editor, and Iyer, Brijesh, editor

Published
2024
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22. Building Smart Campuses: Integrating AI in Higher Education

Author

Tyagi, Swati, Gupta, Varuna, Mehndiratta, Vandana, Chakravorty, Antorweep, Series Editor, Verma, Ajit Kumar, Series Editor, Bhattacharya, Pushpak, Series Editor, Pant, Millie, Series Editor, Ghosh, Shubha, Series Editor, Arya, Rajeev, editor, Sharma, Subhash Chander, editor, and Iyer, Brijesh, editor

Published
2024
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23. Wireless Charging for Electric Vehicles: A Review

Author

Mehndiratta, Tushar, Kumar, Rakesh, Angrisani, Leopoldo, Series Editor, Arteaga, Marco, Series Editor, Chakraborty, Samarjit, Series Editor, Chen, Jiming, Series Editor, Chen, Shanben, Series Editor, Chen, Tan Kay, Series Editor, Dillmann, Rüdiger, Series Editor, Duan, Haibin, Series Editor, Ferrari, Gianluigi, Series Editor, Ferre, Manuel, Series Editor, Jabbari, Faryar, Series Editor, Jia, Limin, Series Editor, Kacprzyk, Janusz, Series Editor, Khamis, Alaa, Series Editor, Kroeger, Torsten, Series Editor, Li, Yong, Series Editor, Liang, Qilian, Series Editor, Martín, Ferran, Series Editor, Ming, Tan Cher, Series Editor, Minker, Wolfgang, Series Editor, Misra, Pradeep, Series Editor, Mukhopadhyay, Subhas, Series Editor, Ning, Cun-Zheng, Series Editor, Nishida, Toyoaki, Series Editor, Oneto, Luca, Series Editor, Panigrahi, Bijaya Ketan, Series Editor, Pascucci, Federica, Series Editor, Qin, Yong, Series Editor, Seng, Gan Woon, Series Editor, Speidel, Joachim, Series Editor, Veiga, Germano, Series Editor, Wu, Haitao, Series Editor, Zamboni, Walter, Series Editor, Zhang, Junjie James, Series Editor, Tan, Kay Chen, Series Editor, Goyal, Sunil Kumar, editor, Palwalia, Dheeraj Kumar, editor, Tiwari, Rajiv, editor, and Gupta, Yeshpal, editor

Published
2024
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27. Effect of Preoperative Oral Carbohydrate Intake on Perioperative Hyperglycemia in Indian Patients Undergoing Hip Fracture Fixation

Author

Evelyn Eliza Minz, Rashmi Salhotra, Asha Tyagi, Aditya N. Aggarwal, Mohit Mehndiratta, S. V. Madhu, Venu George Toppo, and Edelbert Anthonio Almeida

Subjects
blood glucose, carbohydrate loading, diet, enhanced postsurgical recovery, hip fractures, preoperative care/methods, Anesthesiology, RD78.3-87.3
Abstract

Objective: Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. Methods: This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Results: Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Conclusion: Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care.

Published
2024
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28. A review based study on emotional distress and physical pain in oral and head and neck cancer patients pre- and post-chemotherapy

Author

Sanya Mehndiratta, Ravindra Singh, Saanjli Bhandari, and Mansha Dadhich

Subjects
Emotional distress, Chemotherapy, Physical pain, Head and neck cancer, Oral cancer, Cancer management, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Emotional distress is a psychological response that occurs in the form of mental suffering to an experience that arises from the any negative event or condition. It commonly occurs in patients who suffer from cancer-related physical pain throughout the treatments. Cancer patients face a lot of exhaustion which makes them physically and mentally dysfunctional in their daily lives. However, the Head and Neck Cancer (HNC) patients face some serious issues due to the site of tumour or surgery itself. The current study aims to describe how chemotherapy and physical pain cause emotional distress in HNC patients. Furthermore, the study aims to determine the association between all three factors (Emotional distress, pain, and chemotherapy) and highlight the relevance of care and remediation needs for HNC patients. The literature related to the concerned topic was investigated including empirical research papers, review papers. In total, the authors identified and reviewed 42 articles related to the above-mentioned variables. These articles were obtained from different databases, such as Google Scholar, PubMed, JSTOR and Research Gate. The authors then assessed the full texts of the selected articles for eligibility and extracted data from them. The study revealed that cancer patients who have tolerated physical pain and witnessed the long-term treatment of the process of chemotherapy experience extremely high emotional distress throughout the course. It was also observed that psychological distress is more common in HNC patients than in patients with cancer in other body parts. The main findings of the result indicated that emotional distress was much higher in females. Psychosocial support and palliative care should be integrated to encourage and improve the abilities of cancer-affected patients.

Published
2024
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29. Establishing national hospital costing systems: insights from the qualitative assessment of cost surveillance pilot in Indian hospitals

Author

Shankar Prinja, Abha Mehndiratta, Yashika Chugh, Lorna Guinness, Deepshikha Sharma, Basant Garg, and Shuchita Sharma

Subjects
Medicine
Abstract

Objective The Indian Government launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world’s largest health insurance scheme, in 2018. To reform pricing and gather evidence on healthcare costs, a hospital cost-surveillance pilot was initiated among PM-JAY empanelled hospitals. We analysed the process and challenges from both healthcare providers and payer agency’s perspectives and offer recommendations for implementing similar systems in lower- and middle-income countries.Design We employed an open-ended, descriptive and qualitative study design using in-depth interviews (IDI) as the data collection strategy.Settings The interviews were conducted in both virtual and face-to-face modes depending on the convenience of the participants. The IDIs for the National Health Authority (NHA) officials and all providers in Kerala were conducted virtually, while face-to-face interviews were conducted and in Haryana and Chhattisgarh.Participants Staff from 21 hospitals in three states (Haryana, Chhattisgarh and Kerala), including officials from State Health Agency (n=5) and NHA (n=3) were interviewed.Results The findings highlight significant challenges in reporting cost data at the hospital level. These include a shortage of trained staff, leading to difficulties in collecting comprehensive and high-quality data. Additionally, the data collection process is resource-intensive and time-consuming, putting strain on limited capacity. Operational issues with transaction management system, such as speed, user-friendliness and frequent page expirations, also pose obstacles. Finally, current patient records data has gaps, in terms of quantity and quality, to be directly put to use for pricing.Conclusion Accurate cost data is vital for health policy decisions. Capacity building across healthcare levels is needed for precise cost collection. Integration into digital infrastructure is key to avoid burdening providers and ensure quality data capture.

Published
2024
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30. Human Telomerase Reverse Transcriptase and Metallothionein 1A Expressions in Relation with Telomere Length in Healthy Individuals

Author

Parul Gupta, Mohit Mehndiratta, Edelbert Anthonio Almeida, Seema Garg

Subjects
Healthy individuals, hTERT, MT1A, Telomere length, Medicine
Abstract

Introduction: Telomere length (TL), the marker of cellular aging, is regulated by a reverse transcriptase complex that contains reverse transcriptase (hTERT). Oxidative stress (OS) generated by environmental and genetic reasons can alter the TL in the blood. Metallothionein (MT) is a metal-binding protein with a low molecular weight and a high cysteine content found in all eukaryotes. Studies using animal models have provided evidence supporting the antioxidant function of MT. Since TL and MT both can be altered by oxidative stress, the present study was conducted to find association between them. Methodology: A total of 40 healthy volunteers in the age group of 18-45 years were enrolled in the study. mRNA expression of hTERT and Metallothionein (MT1A) and estimation of telomere length (TL) was done by qPCR and compared. Result: Comparison of groups based on quartiles of TL (groups A-D) revealed an increased expression of hTERT in groups with shorter TL. Expression of MT1A was similar in these groups. Comparison of groups based on quartiles of ∆Ct of MT1A (Groups 1-4) revealed lower TLin groups with low expression of MT1A. Correlation analysis revealed a significant negative correlation between mRNA expression of hTERT with TL (r = - 0.84, p =0.04) and a positive non-significant association between mRNAexpression of MT1Aand TL(r = 0.76, p = 0.2). Conclusion: Our study has documented an increase in expression of hTERT in groups with shorter TL in healthy individuals, reinforcing the role of hTERT in maintenance of telomeres. Caution needs to be maintained when comparing TL/hTERT expression in normal versus diseased individuals. Though our study has documented a possible link between MT1A and TL, the exact role of MT1A with regard to telomere biology needs to be elucidated further.

Published
2024
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38. The impact of facial disfigurement and self-image anxiety on the quality of life of head and neck cancer patients

Author

Saanjli Bhandari, Ravindra Singh, Sanya Mehndiratta, and Mansha Dadhich

Subjects
Quality of life of cancer patients, Head and neck cancer, Facial disfigurement, Body image disturbance, Self-image anxiety, Psychological distress, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Quality of life is a concept referring to the physical, psychological and emotional well-being of individuals. It is affected by various aspects of one’s life including physical health, interpersonal relationships, psychological well-being and other environmental factors. Head and neck cancer patients undergo surgery and chemotherapy which could lead to changes in their facial appearance as well as voice and speech, resulting in self-image anxiety. It impacts the patients’ self-esteem, perception and confidence negatively. This research aims to study how facial disfiguration and self-image anxiety affects the overall quality of life of head and neck cancer patients. The relationship between cancer and the quality of life of cancer patients is complex, as they face various challenges such as the disease itself, its treatment and the impact it has on their self-image. The existing literature related to the subject was examined, including various articles, review papers and research papers. Altogether, we identified and reviewed 20 articles. The inclusion criteria focused on papers on the quality of life of cancer patients, facial disfigurement post-surgery, self-image anxiety among head and neck cancer patients. The studies indicate that head and neck cancer patients experienced negative body image due to facial disfigurement from surgery and chemotherapy. This resulted in increased self-image anxiety among the cancer patients. It is observed that the physical pain, distress, facial disfiguration and self-image anxiety impacted their quality of life and overall well-being negatively.

Published
2024
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39. Understanding the extent of economic evidence usage for informing policy decisions in the context of India’s national health insurance scheme: Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY)

Author

Shankar Prinja, Abha Mehndiratta, Akashdeep Singh Chauhan, Lorna Guinness, Deepshikha Sharma, Malkeet Singh, and Anamika Dhiman

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world’s largest tax-funded insurance schemes. The present study was conducted to understand the decision-making process around the evolution (and revision) of health benefit packages (HBPs) and reimbursement rates within PM-JAY, with a specific focus on assessing the extent of use of economic evidence and role of various stakeholders in shaping these policy decisions.Methods A mixed-methods study was adopted involving in-depth interviews with seven key stakeholders involved in HBP design and reimbursement rates decisions, and a survey of 80 government staff and other relevant stakeholders engaged in the implementation of PM-JAY. The data gathered were thematically analysed, and a coding framework was developed to explore specific themes. Additionally, publicly available documents were reviewed to ensure a comprehensive understanding of the decision-making processes.Results Findings reveal a progressive transition towards evidence-based practices for policy decisions within PM-JAY. The initial version of HBP relied heavily on key criteria like disease burden, utilisation rates, and out-of-pocket expenditures, along with clinical opinion in shaping decisions around the inclusion of services in the HBP and setting reimbursement rates. Revised HBPs were informed based on evidence from a national-level costing study and broader stakeholder consultations. The use of health economic evidence increased with each additional revision with consideration of health technology assessment (HTA) evidence for some packages and reimbursement rates based on empirical cost evidence in the most recent update. The establishment of the Health Financing and Technology Assessment unit further signifies the use of evidence-based policymaking within PM-JAY. However, challenges persist, notably with regard to staff capacity and understanding of HTA principles, necessitating ongoing education and training initiatives.Conclusion While substantial progress has been made in transitioning towards evidence-based practices within PM-JAY, sustained efforts and political commitment are required for the ongoing systematisation of processes.

Published
2024
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40. Higher oxidative stress and inflammation in obese compared to lean patients with type 2 diabetes mellitus

Author

Mohit Mehndiratta, Edelbert Anthonio Almeida, Diwesh Chawla, S.V. Madhu, Seema Garg, and Rajarshi Kar

Subjects
Type 2 diabetes mellitus, Inflammation, Lean, Obese, Oxidative stress, Medicine
Abstract

Aim: To compare mRNA [messenger RNA] expression of RELA, NFκB1, TNF-α, IL-6 and MCP-1 in whole blood & serum Total Antioxidant status [TAS] in newly diagnosed lean and obese patients with T2DM. Methods: Newly diagnosed treatment naïve patients of T2DM were enrolled in this study. The patients were divided into two groups of 30 patients each, lean (BMI< 18.5 kg/m2) and obese (BMI >25 kg/m2) groups. mRNA expression of RELA, NFκB1, TNF-α, IL-6 and MCP-1 was measured by real time PCR. Serum TAS was measured using a commercially available kit. Results: There was a 2.7-fold increase in mRNA expression of RELA in obese group compared to the lean group. There was a 1.3-fold increase in mRNA expression of NFκB1, a 3.24-fold increase in mRNA expression of TNF-α, a 4.7-fold increase in mRNA expression of IL 6 and a 3.8-fold increase in mRNA expression of MCP-1 in obese group compared to the lean group. Mean fasting serum insulin levels were 16.07 ± 8.39 μIU/mL in the lean group and 27.11 ± 4.91μIU/mL in the obese group (p = 0.001). Mean TAS level was 5.39 ± 2.28 μM Trolox Equivalents in the obese group and 3.85 ± 3.33 μM Trolox Equivalents in the lean group (p = 0.001). Conclusion: Inflammation and OS is higher in obese patients of T2DM compared to lean patients of T2DM. This could be the result of excess adipokines production or resistance to the anti-inflammatory effects of insulin with multiple explanations. Our study suggests a difference in the pathogenic mechanism in lean patients when compared with obese T2DM patients.

Published
2024
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41. Expression of hTERT and Lp-PLA(2) genes is increased in primary hypothyroidism.

Author

Seema Garg, Parul Gupta, Satyam Wahi, Mohit Mehndiratta, S.V. Madhu, Edelbert Almeida, and Rajarshi Kar

Subjects
Hypothyroidism, hTERT, Lp-PLA(2), Inflammation, Longevity, Telomere length, Medicine
Abstract

Objective: Sightly low serum free T4 levels are associated with longer life expectancy. However, hypothyroidism is associated with increased risk of inflammation and vascular complications. Therefore, relation of thyroid hormones (THs) with life expectancy seems to be complex. This study was carried out in an effort to understand the contribution of THs in inflammation and aging. Methodology: 15 cases of treatment naïve primary hypothyroidism and 15 age and sex matched euthyroid controls were recruited. mRNA expression of Telomerase (hTERT), leucocyte telomere length (LTL) and Lipoprotein associated phospholipase A2 (Lp-PLA2), a marker of vascular inflammation and risk predictor of cardiovascular events were measured by qPCR in whole blood. Result: Expression of hTERT was found to be 6.95 times higher in the cases as compared to the controls. mRNA expression of Lp-PLA(2) was also 3.3 times higher in cases. LTL in euthyroid was approximately 81% of the length in hypothyroid patients. Conclusion: A higher expression of hTERT indicates that hypothyroidism confers better cell survival in peripheral leucocytes inspite of the presence of vascular inflammation. However causal relationship cannot be ascertained with these results.

Published
2024
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42. Ghosal hematodiaphyseal dysplasia – A remediable cause of refractory anemia: A case report

Author

Vaishnavi Sreenivasan, Apoorva Agarwal, Amitabh Singh, Sumit Mehndiratta, and Nidhi Chopra

Subjects
Anemia, Steroids, Skeletal, Hereditary, Pediatrics, RJ1-570
Abstract

Background: The cardinal features of Ghosal hematodiaphyseal dysplasia (GHDD) include severe myelopathic anemia with increased density of long bones with or without deformities. Early diagnosis helps in the institution of corticosteroid therapy, improving hematological parameters and bone changes. Case report: We report a 6-year-old girl of consanguineous birth who presented with progressive anemia and thrombocytopenia without bony deformities, lymphadenopathy, or organomegaly. The skeletal survey was normal. Bone marrow was severely hypocellular. She had a homozygous point mutation in exon 12 of the TBXAS1 gene and was diagnosed with GHDD. She was started on oral corticosteroids and is on follow-up, with reduced transfusion needs. Conclusion: GHDD, although rare, must be considered a differential diagnosis for difficult-to-treat anemia as it is simple to diagnose and easy to treat. Even without an obvious abnormality in the skeletal survey, one needs to keep this possibility in mind.

Published
2023
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48. Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author

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2024
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