Search

Somen Saha,1 Apurvakumar Pandya,2 Yogini Kandre,1 Devang Raval,1 Deepak Saxena1 1Department of Public Health, Indian Institute of Public Health, Gandhinagar, Gujarat, India; 2Parul Institute of Public Health, Parul University, Vadodara, Gujarat, IndiaCorrespondence: Somen SahaDepartment of Public Health, Indian Institute of Public Health, Opp. Air Force Headquarter, Gandhinagar-Chiloda Highway, Near Lekawada Bus Stop, Gandhinagar, Gujarat, IndiaTel +91-968-7207549Email ssaha@iiphg.orgPurpose: Malnutrition status of adolescent girls remains a major public health problem in India. The present study assessed nutritional status, associated factors contributing to malnutrition and their access to health-care services in Dev Bhumi Dwarka district of Gujarat situated in western part of India.Materials and Methods: The study was carried out using descriptive cross-sectional design. A total of 1252 adolescent girls from all four blocks of Dev Bhumi Dwarka district were interviewed by field investigators. The data were collected on socio-demographic characteristics, physical activities, diet, and anthropometry. The WHO classification for body mass index (BMI) was used to assess underweight, overweight, and obesity among adolescent girls. Chi-square analyses were performed to identify significant determinants of under-nutrition.Results: Mean age of the study population was 13.82± 2.31. Of the total, around 34% of the adolescent girls were out-of-school. The prevalence of underweight (

Essential medicines or drugs are recognized as highly cost-effective components within contemporary healthcare, demonstrating significant potential for improving health outcomes. The provision of essential medicines directly impacts the functioning of healthcare facilities, resulting in financial hardship. This review aims to fill knowledge gaps by examining obstacles hindering access and utilization of essential medicines in India. This study conducted a comprehensive evidence synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to analyse articles on the availability and utilization of essential medicines in India. The search strategy included various databases and keywords. Published, peer-reviewed articles focusing on the National/ State List of Essential Medicines and meeting specific criteria were considered. Data items included essential medicines, drug availability, utilization, and challenges. Data was extracted, synthesized, and analysed using thematic framework analysis. Out of 1,129 articles, 11 were selected for review. Studies consistently highlighted the inadequate availability of essential medicines in different Indian states. Availability of essential medicines varies in the range of 17-51 percent across major states of India. Stock-outs of medicines vary from 4 to 14 weeks. Governance issues including differential procurement mechanisms across states of India, hinder seamless availability of essential medicines. Other challenges included distribution and purchasing system inefficiencies, governance-related issues, and facility/ user-level challenges impacting drug utilization. Disruptions in utilization were observed due to improper prescription practices and non-availability of affordable options. Accessibility and affordability also affected drug utilization. Issues with supply chain management and conflicting guidelines further contributed to the obstacles faced in ensuring availability and utilization of essential medicines in India. Ensuring the availability, accessibility, and affordability of essential medicines is of utmost importance. The public health system needs to strengthen its procurement and distribution management. Strengthening the logistics support for an efficient supply of essential medicines will reduce the time lag in receipt of drugs. Guidelines on essential drugs prepared by the National Health System Resource Centre need to be strictly adhered to and monitored in inventory management system. There is an urgent need to develop a sustainable model for achieving uniformity in the availability and utilization of essential medicines in India.

The generation and subsequent loss of runaway electrons (REs) during the operation sequence in a tokamak is a potent threat to the plasma-facing components and the interface of actively cooled parts. Control and mitigation of REs are of prime importance to the safe operation and machine health of a fusion device. A supersonic molecular beam injection (SMBI) system has been installed in the ADITYA-U tokamak to explore the effects of the high Mach number molecular beam on the REs and ways to mitigate the REs. In the majority of discharges in which SMBI has been injected, a burst in hard x-rays has been observed accompanying the SMBI pulse, indicating significant RE loss. This is followed by a long RE-mitigated phase in the discharge. The most plausible explanation of the mitigation of REs is minor disruption caused by SMBI. This in turn triggers field line stochastization and subsequent rapid RE loss. Finally, this leads to reorganization of the flux surfaces, resulting in bigger islands with the potential of trapping any surviving RE fraction. [ABSTRACT FROM AUTHOR]

Background: Induction with cyclophosphamide (CYC) and glucocorticoids in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) has a relapse of 30%–50%. Studies show that rituximab (RTX) is superior to CYC in refractory/relapsed AAV. We prospectively analyzed efficacy and safety of RTX in CYC-failed cases of AAV. Methods: Patients with AAV who relapsed or were refractory to CYC therapy were given RTX 1 gm at 0 and 15 days, followed by maintenance with 500 mg every 4–6 months. All patients received oral prednisolone. Disease activity was defined by Birmingham Vasculitis Activity Score/Wegener's granulomatosis (BVAS/WG). Remission was defined by the European League Against Rheumatism criteria. Results: From August 2012 to July 2018, 67 patients with AAV were seen at our center; 21 patients who relapsed after inductions with CYC or were refractory to CYC received RTX; 8 (38%) were refractory and 13 (62%) were relapsed AAV; 20 were anti-proteinase 3 positive and 1 was anti-myeloperoxidase positive. All were granulomatosis with polyangiitis (GPA). Mean time to relapse was 12.04 ± 7.8 months. Most common indication for RTX was lung followed by ophthalmic, renal, ear nose throat, and nervous system involvement. Median follow-up after induction with RTX was 24 months. Mean BVAS/WG was 11.2 at baseline, 0.66 at the end of 3 months, 0.16 at the end of 6 months, and remained stable at that value at 18 months. At 24 months, 16 patients (76.19%) remained in remission. One was refractory to RTX treatment even after 2 years. Two patients died and two were still under follow-up. Conclusion: In our experience, RTX is a good induction and maintenance strategy for relapsed/refractory AAV.

Current political, institutional and societal expectations have challenged the meaning of medical professionalism. This article summarizes the debates concerning what constitutes medical professionalism, how professionalism develops in doctors and the critical importance of professionalism within good medical practice. [ABSTRACT FROM AUTHOR]

An analysis of clinical response and plasma indomethacin concentration was performed on 10 small (less than or equal to 1000 g) and 12 large (greater than 1000 g) premature infants who had symptomatic ductus arteriosus and required intravenous indomethacin therapy (0.3 mg/kg per day). The postnatal age, daily fluid intake, and cardiopulmonary status of the two groups at time of study were comparable, The small premature infants had a significantly lower peak plasma indomethacin concentration and lower concentration in the first four hours after infusion, and lower plasma concentration X time integral than that of the larger premature infants. There was a significant difference between the groups in proportion of response (2/10 vs 9/12) after one dose of indomethacin; this difference was not seen after two to three doses. The results of the study suggest that small premature infants do respond to indomethacin treatment, but compared to the larger infants may require repeated doses. [ABSTRACT FROM PUBLISHER]

The renal effects of frusemide treatment in infants with respiratory distress syndrome shortly after birth and during the first three postnatal days were evaluated. Eighty five infants were randomly assigned to two groups. Forty two received three doses of intravenous frusemide (1 mg/kg) starting at age, mean (SD) 7.5 (4.1) hours and given at approximately 24 hour intervals. Forty three control infants were treated similarly but were not given frusemide. The groups were comparable in birthweight, gestational age, and Apgar score and in pulmonary status, blood gases, serum electrolytes, and postnatal age. Infants who received frusemide had significantly higher fractional excretion of sodium and chloride at 12 to 24, 24 to 48, and 48 to 72 hours, and higher calcium excretion at 24 to 48 and 48 to 72 hours after entry into the study than control infants. The study group had a significantly higher urine output and greater weight loss than the control group at 48 to 72 hours after entry into the study. There was no significant difference between groups in serum sodium, potassium, and calcium and in fractional excretion of potassium and the glomerular filtration rate. Infants with an Apgar score of more than 3 had higher urine output and had a better diuretic response to frusemide than those with a lower score. The results suggest that perinatal hypoxia may play an important role in renal function and in diuretic response to frusemide shortly after birth and early in the postnatal life of infants with respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Background: Indoor residual spray (IRS), with appropriate insecticide, is an effective weapon for the control of malaria. Two rounds of indoor residual spray, with synthetic pyrethroid, are given in highly malaria endemic areas. It aims to prevent transmission of malaria by adult vector mosquitoes. Aims : To assess the impact of indoor residual spray in the highly malaria-endemic villages of Kalol taluka in Gandhinagar district. Design : High risk population for malaria, based on last three-year malaria situation. Setting: Malaria endemic rural areas in Gandhinagar district where indoor residual spray was undertaken with synthetic pyrethroid in 2006 and 2007. Study Variables: Exploratory - Rural areas; Outcome - coverage, acceptance. Analysis: Percentage and proportions. Results: Prior to the introduction of synthetic pyrethroid, in 2005, the annual parasitic incidence of the sprayed villages was 33.4. It came down to 8.8 in 2006. Continuation of this strategy in the same villages further brought down the annual parasitic incidence to 1.5 in 2007. A similar trend of steady decline was observed in actual numbers of cases and other malariometric indices as well. Conclusion: IRS, it still has a major role in the control of malaria if implemented with proper supervision, better coverage and community participation.