Does Being Cultured Pay? Racial and Language Concordance and its Effect on Physician Income

Issues surrounding race and ethnicity in healthcare have increased in number as racial disparities as well as minority physicians become more prevalent in the USA. One such issue is the concordance rate of race and language amongst physicians and their patients. The effect of racial concordance in physician patient relationships has been looked at to determine if it affects the perceived level of health quality. Saha et al. (1999) found that Black and Hispanic patients were more satisfied in their healthcare when treated by a physician of their own race. In this study, I establish whether or not the racial concordance has a positive effect on income. Using controls established by previous regression analyses, I measure the effect on income of racial concordance on primary care and specialty care physicians alike. The findings of this study have importance in terms of incentives for physicians to culture themselves. If racial concordance increases income, it is likely that empathy, communication skills, and teamwork is better when physicians and patients have the same race (Cooper‐Patrick et al. 1999). This suggests that physicians who are culturally competent will enjoy higher incomes, and their patients better health outcomes. Policy implications including cultural competency training in medical schools and required interpreter services may be established from these findings

Prescribing patterns of cardiovascular drugs in cardiology outpatient department in a tertiary care hospital in Western Odisha

Background: Cardiovascular morbidity plays a villainous role globally as well as countries like India. Additionally, irrational prescription incurs greater damage to health and wellbeing. Drug utilization studies scrutinize the appropriateness of treatment and provide favorable feedbacks to strengthen clinical practices. The objective of the study was to describe treatment practices in cardiology outpatient and drug utilization pattern using core prescribing indicators by World Health Organization (WHO).Methods: A cross-sectional, observational study of 4-month duration was undertaken for cardiology Outdoor patients at a tertiary care hospital. 615 prescriptions were screened and analyzed.Results: Males (59.84%) were more in number than females (40.16%). Average number of the prescribed drugs per patient were 4.32±2.7 and (3.73±1.1 for cardiovascular drugs). Generic prescription was 60.98%. Percentage encounters with antibiotics 4.11, injectables 2.92%, fixed-dose combinations (FDCs) (11.8%) were documented. Drugs from the National List of Essential Medicines were 75.89%. The most common diagnosis was ischemic heart disease (68.29%). Hypolipidemics (78.25%) followed by antiplatelets (71.14%) were toppers in cardiovascular drug. Antiulcer drugs (PPI/Antacids) comprised 58.54% of total prescriptions.Conclusions: Less adherence to EDL, less generic prescriptions, use of FDC are major shortcomings. Areas to further rationalization like optimal use of evidence based medication like beta-blockers, newer anticoagulants/anti-platelet agents and newer anti-anginal agents are identified

Signalling pathways important in human adipose tissue growth and function

Adipose tissue is a dynamic tissue which can grow and regress throughout the lifetime of an individual. The aim of this study is to understand the factors important in the regulation of adipocyte growth and function. Using human subcutaneous preadipocytes, the effects of insulin, dexamethasone, T3, and IBMX, alone and in combination, on different aspects of differentiation were examined. All 4 inducers were required in combination to induce a high level of differentiation. The PPAR$\gamma$ activator, rosiglitazone in conjunction with the 4 inducers induced the highest level of adipocyte differentiation. Inhibiting p38 MAPK and p70$^{S6K}$ reduced lipid content and lipogenic activity in differentiated preadipocytes while inhibiting p42/44 MAPK and PBK had no effect. Inhibiting p38 MAPK, p70$^{S6K}$ , p42/44 MAPK and PBK reduced leptin secretion but had no effect on protein content. Insulin and T3 caused the rapid activation of p42/44 MAPK in preadipocytes and differentiated preadipocytes, but dexamethasone, cortisol, oestrogen and rosiglitazone had no effect. Adipocytes expressed several growth factors i.e. FGF-2, VEGF, and angiopoietins. For FGF and its receptor, expression varied through differentiation. Inhibiting VEGF binding on adipocytes had no effect but inhibiting FGFR signalling and blocking angiopoietin action prevented growth and differentiation suggesting autocrine functions

Retrospective analysis of oral cavity squamous cell carcinoma treated with surgery and adjuvent radiotherapy

Background: Oral cavity cancer is one of the leading causes of cancer related deaths in developing countries. Most of the failures occur due to locoregional recurrence. The present study was conducted to find out the pattern of recurrences and factors responsible for that in oral cavity squamous cell carcinoma (SCC).Methods: The study was conducted at Gujarat cancer and research institute Ahmedabad, India. Total 260 patients were evaluated in study from year January 2013 to December 2013 retrospectively. Two year follow up was studied to find out the pattern of failure in terms of local, regional (nodal) and systemic.Results: Oral cavity SCC has high chances of local failure when removed inadequately during surgery. Perineural spread, lymphovascular involvement and perinodal spread are important prognostic factors.Conclusions: Most patients of oral cavity cancer present in advanced stages. Close margins and perineural involvement are responsible for local recurrences while perinodal spread and lymphovascular involvement contributes to nodal recurrences. Tobacco consumption is important responsible factor.

Low dose oral hydroxyurea prophylaxis improves all clinico: haematological parameters among sickle cell disease patients

Background: Sickle cell disease (SCD) an inheritable disorder of haemoglobin structure resulting from substitution of valine for glutamic acid at 6th position of β-globin chain of haemoglobin(HbS), which polymerizes on deoxygenation and undergoes to sickle shaped RBC causing vaso-occlusive painful crisis, chronic haemolysis, anaemia, frequent blood transfusions, frequent hospitalizations with increased morbidity and acute chest syndrome leading to mortalities. Presence of foetal haemoglobin (HbF) prevent sickling and use of drugs like Hydroxyurea (HU) results in increased production of HbF to prevent complications of SCD. Aims and objectives was to know the various effect of low dose HU on clinical and haematological parameters among SCD patients.Methods: Total 100 S HbSS patients were consecutively selected, with indication for HU in 10mg/kg + 5mg folic acid/day. Baseline haemoglobin, HbF, HbS, haematocrit (HCT), TRBC, MCV, MCH, MCHC, and HbS, TPC, TWBCs, ANCs and other relevant tests as needed. Follow up haematological tests were done at 1 month and then every 3 month up to 24 months with monitoring of clinical status, hepatic, renal, and myelotoxicities. Data were collected and analyzed.Results: There were 31 paediatric cases with mean age of 8.47±4.1 years and 69 adults with mean age of 25.9±8.2 years presented with or history of various complications. HU improves all clinical and haematological parameters significantly (Hb, HCT, HbF, MCV, MCH, MCHC,) with mild myelotoxicities (decreased ANC, TPC, WBCs).Conclusions: HU improves all clinical and haematological parameters with mild myelotoxicities among SCD patients

Utilization trends of drugs in patients admitted with ischemic heart disease in a tertiary care teaching hospital

Background: Coronary artery disease (CAD) takes the highest toll of lives across the world as well as India. Prompt diagnosis and effective treatment is lifesaving. Drug utilization studies scrutinize the appropriateness of treatment and provide favourable feedbacks to strengthen clinical practices. Several other studies have reported underuse of four evidence-based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD. Polypharmacy, injection overuse is some of the shortcomings. The objectives of this study was to describe treatment practices in terms of different disease spectrum and drug utilization (group-wise and individually) for inpatients with CAD using core prescription indicators by WHO.Methods: A cross-sectional study of 4-month duration was undertaken for patients with CAD admitted to cardiology indoor of a tertiary care hospital. A total no of 143 prescriptions was screened and analyzed.Results: Males (67.13%) were more in number than females (32.87%). Age group from (57-66) topped in frequency (61.05%) ahead of (67 to 76) group (38.46%). Average no of drugs per patient were 8.056±1.97 and 5.86±0.14 for cardiovascular drugs. Prescription in generics (45.49%), antibiotics (0.61%), fixed-dose combinations (FDCs) (0.52%) and injectables (28.47%) were noted. The most common categories of CAD were ST-segment elevated myocardial infarction (69.23%) followed by chronic stable angina (17.48%). Antiplatelets (100%), hypolipidemics (99.3%), antianginals (60.14%), β-blockers (37.06%) and ACE-I/ARBs (27.97%) were utilized. Drugs from the national list of essential medicines were 66.49%.Conclusions: Among four evidence-based drugs, use of β-blockers and ACE-I/ARBs were inappropriately low. Polypharmacy and overuse of Injectable drugs are noted

Development of a porous layer-by-layer microsphere with branched aliphatic hydrocarbon porogens

Porous polymer microspheres are employed in biotherapeutics, tissue engineering, and regenerative medicine. Porosity dictates cargo carriage and release that are aligned with the polymer physicochemical properties. These include material tuning, biodegradation, and cargo encapsulation. How uniformity of pore size affects therapeutic delivery remains an area of active investigation. Herein, we characterize six branched aliphatic hydrocarbon-based porogen(s) produced to create pores in single and multilayered microspheres. The porogens are composed of biocompatible polycaprolactone, poly(lactic-co-glycolic acid), and polylactic acid polymers within porous multilayered microspheres. These serve as controlled effective drug and vaccine delivery platforms

Multipolymer microsphere delivery of SARS-CoV-2 antigens

Effective antigen delivery facilitates antiviral vaccine success defined by effective immune protective re- sponses against viral exposures. To improve severe acute respiratory syndrome coronavirus-2 (SARS-CoV- 2) antigen delivery, a controlled biodegradable, stable, biocompatible, and nontoxic polymeric micro- sphere system was developed for chemically inactivated viral proteins. SARS-CoV-2 proteins encapsulated in polymeric microspheres induced robust antiviral immunity. The viral antigen-loaded microsphere sys- tem can preclude the need for repeat administrations, highlighting its potential as an effective vaccine