Bridging the Gap of Skilled Surgeons in Low and Middle Income Countries Using ICT Based Tools : A Case Study in Super-Speciality Training

Introduction: Over the last two decades, advancement of super specialised surgical disciplines has shown improved health outcome, in particular quality and safety. Although medical technology has developed to meet diagnostics and therapeutic needs, there is a scarcity of trained human resources in advanced specialities in low and middle income countries (LMICs). Innovative methods are needed to educate and train people at their workplaces using collaborative technologies and networks. Methods: Over the last 15 years, two general surgeons in Cuttack have been telementored from Lucknow 1,163 km away, using collaborative technologies to develop Endocrine Surgery. This study reviews the last 11 years of the service which includes a clinical decision support system and treatment planning advice using real time videoconferencing. Results: Over the last 11 years, 199 endocrine surgeries per annum were performed with most being thyroid cases as compared with 119 surgeries per annum during the previous five years. Parathyroid and adrenal cases increased significantly during this period (p <0.001). Rates of temporary and permanent vocal cord palsy (1.7% and 0%), hypocalcaemia (5.9% and 1.1%) were comparable with high volume centres. Based on the quantum, safety and quality outcome of endocrine surgery the provincial government has approved creation of a super-speciality department of endocrine surgery in Cuttack. Conclusion: Sustained engagement using telementoring can transfer surgical skills to needy surgeons and enable them to match the expertise of mentors. This model can be replicated in other specialities in a cost effective way to develop specialised human resources for healthcare, in particular in LMICs

Indoor Air Pollution and Its Determinants in Household Settings in Jaipur, India

Individuals spend 90% of their time indoors, primarily at home or at work. Indoor environmental factors have a signifcant impact on human well-being. It was a longitudinal study that assessed the major factors that reduce indoor air quality, namely particulate matter, and bio-aerosols, using low-cost sensors and the settle plate method, respectively also to determine the effect of atmospheric parameters and land use patterns in households of commercial, industrial, residential, slum, and rural areas of the city. PM2.5 concentration levels were similar in most parts of the day across all sites. PM10.0 concentration levels increased indoors in a commercial area. PM2.5 concentration showed a negative correlation with temperature and a positive correlation with relative humidity in some areas. Very high values of PM2.5 concentration and PM10.0 concentration have been observed in this study, inside households of selected rural and urban areas. Pathogenic gram-positive cocci, gram-positive rods, Aspergillus, and Mucor species were the most common bacterial and fungal species respectively found inside households. This study examined particulate matter concentration along with bio-aerosols, as very less studies have been conducted in Jaipur the capital of Rajasthan, a state in the western part of India which assessed both of these factors together to determine the indoor air quality. Rural households surrounding the periphery of the city were found to have similar pollution levels as urban households. So, this study may form the basis for reducing pollution inside households and also for taking suitable measures for the reduction of pollution in the indoor environment

Transgenic plants for the production of edible vaccines and antibodies for immunotherapy

Vaccines and antibodies play a key role in healthcare. However, the cost of production and maintaining a chain for vaccine distribution has so far hampered realizing their full potential. Expression of antigens as vaccines, and of antibodies against antigens of pathogens in transgenic plants is a convenient and inexpensive source for these immunotherapeutic molecules. Various antigens and antibodies have already been expressed successfully in plants and have been shown to retain their native functional forms. Edible plant vaccine against diarrhoea, expressed in potato, and antibody against dental caries, expressed in tobacco, is already in pre-clinical human trials. Attempts are being made to express many proteins of immunotherapeutic use at high levels in plants and to use them as bio-reactors of the modern er

Evaluation of antidiabetic efficacy of Murraya koenigii on Streptozotocin induced diabetes in experimental rats

Background: The medicinal plant Murraya koenigii shown to have a wide variety of pharmacological activities (hypoglycemic and hypolipidemic). Objective of this study is the present study was designed to evaluate Antidiabetic and Hypolipidemic property of Murraya koenigii in experimentally induced diabetes in rats.Methods: Experimental diabetes was produced with single dose of Streptozotocin (STZ): 45 mg/kg IP. The rats were randomly allocated in various groups for 37 days. After the confirmation of diabetes on 7th day (>200 mg/dl), hydroalcoholic extract of Murraya koenigii (500 mg/kg) was administered orally to experimental rats from day 7th day and continued for 37 days thereafter. Various antidiabetic (Glucose, HbA1C), metabolic (Lipid profile), safety (pancreatic lipase, Creatinine, SGPT, Histopathology of Liver and Kidney) were evaluated in various group.Results: Efficacy of Murraya koenigii was observed on various parameter of diabetes. Administration of STZ resulted in a significant decrease in diabetic changes (increase in blood glucose, HbA1C), altered lipid profile (p<0.01) in the Control group rats as compared to sham group. Murraya koenigii treatment demonstrated significant antidiabetic indicated by restoration of blood glucose, HbA1C level (p<0.01) compared to Control group. In addition, Murraya koenigii also documented hypolipidemic property of test drug. As per biochemical assessment of Pancreatic lipase, Serum creatinine, SGPT and Histopathological report, the test drug reduce the pancreatic, liver and renal marker and also showed safe to pancreas, Liver and kidney. The histopathological assessment of the liver and kidney confirmed the biochemical findings.Conclusions: The study concluded that the Murraya koenigii possess antidiabetic efficacy

Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India [version 2; peer review: 2 approved]

Introduction The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced. Intended Outcomes The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country

Physics, Astrophysics and Cosmology with Gravitational Waves

Gravitational wave detectors are already operating at interesting sensitivity levels, and they have an upgrade path that should result in secure detections by 2014. We review the physics of gravitational waves, how they interact with detectors (bars and interferometers), and how these detectors operate. We study the most likely sources of gravitational waves and review the data analysis methods that are used to extract their signals from detector noise. Then we consider the consequences of gravitational wave detections and observations for physics, astrophysics, and cosmology.Comment: 137 pages, 16 figures, Published version <http://www.livingreviews.org/lrr-2009-2

Changes in expression of monocarboxylate transporters, heat shock proteins and meat quality of Large White Yorkshire and Ghungroo pigs during hot summer period

Objective Present study explores the effect of hot summer period on the glycolytic rate of early post-mortem meat quality of Ghungroo and Large White Yorkshire (LWY) pig and comparative adaptability to high temperature between above breeds by shifting the expression of stress related genes like mono-carboxylate transporters (MCTs) and heat shock proteins (HSPs). Methods Healthy pigs of two different breeds, viz., LYW and Ghungroo (20 from each) were maintained during hot summer period (May to June) with a mean temperature of about 38°C. The pigs were slaughtered and meat samples from the longissimus dorsi (LD) muscles were analyzed for pH, glycogen and lactate content and mRNA expression. Following 24 h of chilling, LD muscle was also taken from the carcasses to evaluate protein solubility and different meat quality measurements. Results LWY exhibited significantly (p<0.01) higher plasma cortisol and lactate dehydrogenase concentration than Ghungroo indicating their higher sensitivity to high temperature. LD muscle from LWY pigs revealed lower initial and ultimate pH values and higher drip loss compared to Ghungroo, indicating a faster rate of pH fall. LD muscle of Ghungroo had significantly lower lactate content at 45 min postmortem indicating normal postmortem glycolysis and much slower glycolytic rate at early postmortem. LD muscle of LWY showed rapid postmortem glycolysis, higher drip loss and higher degrees of protein denaturation. Ghungroo exhibited slightly better water holding capacity, lower cooking loss and higher protein solubility. All HSPs (HSP27, HSP70, and HSP90) and MCTs (MCT1, MCT2, and MCT4) in the LD muscle of pigs inclined to increase more in Ghungroo than LWY when exposed to high temperature. Conclusion Effect of high temperature on the variation of HSPs and MCTs may play a crucial role in thermal tolerance and adaptation to different climatic conditions, pH regulation, muscle acidification, drip loss, protein denaturation and also in postmortem meat quality development