Developing Standard Treatment Workflows—way to universal healthcare in India

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80–90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC

Optimization of Culture Parameters for Improved Production of Bioactive Metabolite by Endophytic Geosmithia pallida (KU693285) Isolated from Brucea mollis Wall ex. Kurz, An Endangered Medicinal Plant

The present study envisaged to optimise the culture parameters for improved bioactive secondary metabolite production by Geosmithia pallida (KU693285), a potent endophytic fungi, isolated from endangered medicinal plant Brucea mollis Wall ex. Kurz. G. pallida was isolated from healthy, surface sterilized leaf, bark and root tissues of B. mollis. Sporulation was induced in sterile G. pallida by growing it on modified PDA media. Identification of G. Pallida was confirmed by ITS r-DNA sequence analysis. The culture parameters were optimized for enhanced production of metabolites. Maximum metabolite production was observed at 25°C incubation temperature and 6.5 pH on 28th day of inoculation, when lactose and yeast extract were added in the basal medium respectively as carbon and nitrogen source along with 3.5 g/l NaCl. The inhibition zone showed by G. pallida was significantly higher during the optimum culture conditions than that of the control (basal media). From the present study, it is concluded that for the maximum production of bioactive metabolite the culture parameters need to be optimized. These results would steer the authors to carry out further studies on purification, characterization, and identification of bioactive metabolites produced by G. pallida (KU693285) for pharmaceutical as well as agricultural applications

Antibacterial potential of Actinobacteria from a Limestone Mining Site in Meghalaya, India

This work attempts to assess the antimicrobial potential of actinobacteria isolated from limestone mining sites which hitherto, is an under-explored niche for exploring novel bioactive metabolites. Actinobacteria were selectively isolated from Mawsmai, Meghalaya, India, a limestone mining area, using different pretreatment methods. Forty-seven isolates were obtained, which were identified based on their morphological, biochemical and chemotaxonomical characteristics. Streptomyces was the dominant cultivable genera which constituted 76% of the isolates cultivated. All the isolates were screened for antimicrobial activity against three Gram-negative viz. Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae, and three Gram-positive bacteria viz. Staphylococcus aureus, Bacillus subtilis and Micrococcus luteus and besides, two candidal species viz. Candida albicans and C. tropicalis. 19% of the total isolates showed antibacterial activity against at least one of the test bacterial strains used. The identity of the four bioactive isolates viz. LD-21, LD-29, LD-34 and LD-39 was confirmed as Streptomyces sp. on the basis of their 16S rDNA sequence and 16S rRNA secondary structure analysis. These isolates showed antibacterial activity against at least two Gram-positive bacteria and all the four harbored at least one of the three biosynthetic gene clusters viz. type-I and type-II polyketide synthases and non-ribosomal peptide synthetase which are related to synthesis of bioactive metabolites

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease