How to improve public health systems : lessons from Tamil Nadu

Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems’ broad capacity to reduce exposure to disease. Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialists—with its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. They also discuss the system’s shortfalls. Tamil Nadu’s public health system is replicable, offering lessons on better management of existing resources. It is also affordable: compared with the national averages, Tamil Nadu spends less per capita on health while achieving far better health outcomes. There is much that other states in India, and other developing countries, can learn from this to revitalize their public health systems and better protect their people’s health.Health Monitoring&Evaluation,Disease Control&Prevention,Health Systems Development&Reform,Population Policies,Health Economics&Finance

Factors regulating the transcription of eukaryotic protein coding genes and their mechanism of action- a review

Protein factors play a crucial role in establishing gene-specific and cell-specific regulation of the process of transcription. These include general transcription factors which recognize TATA and CCAAT boxes and which form components of the RNA polymerase II system. Specific transcription factors interact with characteristic promoter elements of individual genes. Some of the examples are SP1, glucocorticoid receptor, GCN4, GAL4 and many others. Transcription factors have a DNA binding domain demarcated from the transcription activation domain. Some factors may have an additional ligand (small molecule) binding domain. Typical structural features such as helix-turn-helix motif, zinc finger and leucine zipper have been recognized in the DNA binding domain of the transcription factors. The acidic domain of the protein factors is involved in the transcription activation process. It appears that activation is the result of the combined action of several regulatory proteins binding at different regions of the promoter. Interaction between proteins bound to DNA but seperated by long stretches of nucleotides is facilitated by DNA bending. Functional specificity as well as diversity are feasible with a limited number of transcription factors through alterations in the architecture of interaction between a group of proteins bound to promoter elements

In Silico, In Vitro and In Vivo Hepatoprotective Activity of Senna Auriculata L. Flowers against D-Galactosamineinduced Liver Toxicity Using Rats

Liver is one of the most important organs in the human body. It plays a supreme role in the metabolism of xenobiotics, detoxification and excretion of many endogenous and exogenous compounds. However, liver is one of the most frequently injured organs in the body. A number of hepatotoxins such as viruses, bacteria, chemicals, medicines and alcohol target the liver and cause liver injury. The magnitude of liver hepatotoxins is generally measured by the levels of serum enzyme biomarkers and antioxidants. These antioxidants are rich in natural sources of drugs, especially plants. Natural remedies from traditional plants and their derivatives are still used all over the world in one from another as they are effective and safe alternate treatments for hepatotoxicity. In this aspect, plants that were chosen for the study are the flowers of Senna auriculata L. The study investigated the in silico, in vitro and in vivo hepatoprotective activities of flowers of Senna auriculata L. Phytochemical screening of various plant extracts viz, aqueous and ethanol was carried out. In vitro hepatoprotective activity was based on the protection of liver cells from d-galactosamine cytotoxicity in liver slice culture. The aqueous extract showed good activity than ethanolic extract. In vivo hepatoprotective activity of various extracts of the plant at two different doses (lower and higher) was determined. AESA and EESA at doses of 100mg/kg and 200mg/kg possessed significant (P<0.01) hepatoprotective activity. The results of the present study revealed that the AESA and EESA can protect the liver in a dose dependent manner from damaging effects of d-galactosamine by considerably decreasing the serum marker enzymes. The decreased serum levels of these enzymes were further accompanied by the improvement of liver histology in AESA and EESA at higher doses (200mg/kg) which remarkably exhibited the hepatoprotective effect of flowers Senna auriculata L. The presence of active constituents (flavonoids, tannins, triterpenoids and phenolics) in these plants might be responsible for the hepatoprotective activity. Therefore, AESA and EESA at high dose (200mg/kg) proposed to protect the liver against dgalactosamine- induced oxidative damage in rats. The in vivo hepatoprotective properties of the plants can consequently propose a liver protection to the population whoever consumes it and prevent liver damage

Regulation of Heme Biosynthesis in Neurospora crassa

The mold Neurospora crassa does not accumulate porphyrins in iron deficiency but instead accumulates the sideramine desferricoprogen. In iron deficiency there is an accumulation of &#948;-aminolevulinic acid and the &#948;-aminolevulinic acid dehydratase level is very low. A similar situation exists in cobalt toxicity and zinc deficiency. The &#948;-aminolevulinic acid synthetase and ferroprotoporphyrin chelatase comparatively show only marginal changes under these conditions. Addition of iron and zinc to the respective metal-deficient cultures results in an induction of &#948;-aminolevulinic acid dehydratase. The induction of &#948;-aminolevulinic acid dehydratase is repressed by protoporphyrin and less effectively by hemin and hemoglobin. Iron deficiency, zinc deficiency, and cobalt toxicity have been found to interfere with the conversion of protoporphyrin into heme, thus rendering protoporphyrin available to repress the enzyme. This repression can be counteracted by iron and much more effectively by coprogen. A model has been proposed in which protoporphyrin has been visualized as the corepressor for the enzyme &#948;-aminolevulinic acid dehydratase. It is held that iron in the form of coprogen converts protoporphyrin to heme, the latter having a lesser affinity for the aporepressor. Coprogen can inhibit heme binding to the aporepressor and thus render the repressor nonfunctional. This will lead to a derepression of the enzyme &#948;-aminolevulinic acid dehydratase

Innovations and Challenges in Reducing Maternal Mortality in Tamil Nadu, India

Although India has made slow progress in reducing maternal mortality, progress in Tamil Nadu has been rapid. This case study documents how Tamil Nadu has taken initiatives to improve maternal health services leading to reduction in maternal morality from 380 in 1993 to 90 in 2007. Various initiatives include establishment of maternal death registration and audit, establishment and certification of comprehensive emergency obstetric and newborn-care centres, 24-hour x 7-day delivery services through posting of three staff nurses at the primary health centre level, and attracting medical officers to rural areas through incentives in terms of reserved seats in postgraduate studies and others. This is supported by the better management capacity at the state and district levels through dedicated public-health officers. Despite substantial progress, there is some scope for further improvement of quality of infrastructure and services. The paper draws out lessons for other states and countries in the region

Validity of the diagnosis of pneumonia in hospitalised patients with COPD.

Rationale: Exacerbations of chronic obstructive pulmonary disease (COPD) and pneumonia are two of the most common reasons for acute hospital admissions. Acute exacerbations and pneumonia present with similar symptoms in COPD patients, representing a diagnostic challenge with a significant impact on patient outcomes. The objectives of this study were to compare the prevalence of radiographic consolidation with the discharge diagnoses of hospitalised COPD patients. Methods: COPD patients admitted to three UK hospitals over a 3-year period were identified. Participants were included if they were admitted with an acute respiratory illness, COPD was confirmed by spirometry and a chest radiograph was performed within 24 h of admission. Pneumonia was defined as consolidation on chest radiograph reviewed by two independent observers. Results: There were 941 admissions in 621 patients included in the final analysis. In 235 admissions, consolidation was present on chest radiography and there were 706 admissions without consolidation. Of the 235 admissions with consolidation, only 42.9% had a discharge diagnosis of pneumonia; 90.7% of patients without consolidation had a discharge diagnosis of COPD exacerbation. The presence of consolidation was associated with increased rate of high-dependency care admission, increased mortality and prolonged length of stay. Inhaled corticosteroid use was associated with recurrent pneumonia. Conclusions: Pneumonia is underdiagnosed in patients with COPD. Radiographic consolidation is associated with worse outcomes and prolonged length of stay. Incorrect diagnosis could result in inappropriate use of inhaled corticosteroids. Future guidelines should specifically address the diagnosis and management of pneumonia in COPD