Preliminary analysis of claims data to understand relationship between disease patterns and quality of care and its implications for health insurance in India

This paper provides preliminary analysis of claims data of Mediclaim insurance scheme to understand the relationship between disease pattern and the quality of health care. We use length of stay (LOS) and average length of stay (ALS) as one of the indicators of quality of care. We use the Diagnostic Related Grouping (DRG) based ALS as the benchmark to make this evaluation and comparison. It is observed that the reimbursements in insurance system are tied to hospital inputs and resource use and not to diagnostic related groups or outputs. Therefore the current system of reimbursements and provider payment system influences the length of stay and there is significant variation in ALS observed across disease groups and its sub-groups. There is no consistency observed in ALS as the severity of diseases under each group increases. This reflects lack of standards/protocols and unintended consequences of current practice of provider payment system. Implementing systems like Diagnosis Related Grouping would be an attempt to link it with outcomes. The paper provides insights into whether there is a significant mismatch in the premium that insurance companies charge in comparison to the risk insurer undertake while issuing policies. It was also found that after adjusting for the purchasing power parity, the claims data suggest that healthcare costs reimbursed for medical insurance to private providers in India are actually higher than healthcare costs reimbursed to providers of healthcare in the US under DRG system. The paper argues that under less regulated private healthcare providers market and health insurance market, cost based reimbursement is highly undesirable. The regulators should put in place a system of pre-determined rates for reimbursements in health insurance.

MDA-7/IL-24 suppresses human ovarian carcinoma growth in vitro and in vivo

BACKGROUND: Previous studies showed that the human melanoma differentiation-associated gene-7 (mda-7), also known as interleukin-24 (IL-24), has potent antitumor activity against human and murine cancer cells. However, the majority of these studies were limited to in vitro testing. In the present study, we investigated the antitumor activity of mda-7/IL-24 against human ovarian cancer cells both in vitro and in vivo. RESULTS: In vitro, treatment of ovarian cancer cells with an adenoviral vector carrying the mda-7 gene (Ad-mda7) resulted in inhibition of cell proliferation and induction of cell cycle arrest, leading to apoptosis. We did not observe inhibitory activity in Ad-mda7-treated normal cells. In vivo, treatment of subcutaneous tumor xenografts with Ad-mda7 resulted in significant tumor growth inhibition when compared with that in control groups (p < 0.001). Molecular analysis of ovarian tumor tissue lysates treated with Ad-mda7 showed that MDA-7 protein expression was associated with activation of the caspase cascade. CONCLUSION: Our results show that treatment of ovarian cancer cells with mda-7/IL-24 results in growth suppression both in vitro and in vivo

Efficacy of fungicide ‘Kavach’ against Beauveria bassiana L. in silkworm Bombyx mori L.

Silkworm Bombyx mori L. is prone to be attacked by pathogen and more notably Beauveria bassiana L. Bed disinfectant Kavach was inoculated in different dosages (0.2%-1.6%) to IV and V instar silkworms of both bivoltine and cross breeds. Potency of disinfectant was assessed for the parameters such as survivability, larval duration, physiological, chemo and bio-assay tests. It was revealed that, bivoltine (NB4D2) silkworms were highly susceptible to diseases compared to cross breeds (PMxNB4D2). In bivoltine silkworms, survivability was found to be 61.15% at 1.6% of Kavach, when dusted twice during IV and V instar and crossbreed silkworms exhibited better resistance of 63.10% with the same treatments. Kavach treated silkworms showed decreased larval duration compared to control worms. Crossbreed silkworms were capable of maintaining high level of soluble proteins in spite of infection on 3rd day (17.40%), 4th day (20.50%) and 5th day (21.55%) whereas in bivoltine silkworms soluble protein level was brought down on 3rd day (19.30%), 4th day (22.40%) and 5th day (23.40%). Total soluble sugarsvaried from third day till fifth day in both the races. Kavach dusted twice at 1% proved to be very useful in the improvement of various commercial cocoons characters

Does pamidronate enhance the osteogenesis in mesenchymal stem cells derived from fibrous hamartoma in congenital pseudarthrosis of the tibia?

AbstractNeurofibromatosis type 1 (NF1) is a commonly occurring genetic disorder in children. Mutation in the NF1 gene has its implication in poor osteoblastic capabilities. We hypothesised that pamidronate will enhance the osteoblastic potential of the mesenchymal stem cells (MSCs) derived from lipofibromatosis tissue of children with congenital pseudarthrosis tibia (CPT) associated with NF1. In this study, bone marrow MSCs (BM MSCs) and CPT MSCs were obtained from three patients undergoing salvage surgeries/bone grafting (healthy controls) and those undergoing excision of the hamartoma and corrective surgeries respectively. The effects of pamidronate (0, 10nM, 100nM and 1μM) on cell proliferation, toxicity and differentiation potential were assessed and the outcome was measured by staining and gene expression. Our outcome showed that CPT MSCs had more proliferation rate as compared to BM MSCs. All 3 doses of pamidronate did not cause any toxicity to the cells in both the groups. The CPT MSCs showed less differentiation with pamidronate compared to the healthy control MSCs. This was quantitated by staining and gene expression analysis. Therefore, supplementation with pamidronate alone will not aid in bone formation in patients diagnosed with CPT. An additional stimulus is required to enhance bone formation

Tumor Suppressor Gene-Based Nanotherapy: From Test Tube to the Clinic

Cancer is a major health problem in the world. Advances made in cancer therapy have improved the survival of patients in certain types of cancer. However, the overall five-year survival has not significantly improved in the majority of cancer types. Major challenges encountered in having effective cancer therapy are development of drug resistance by the tumor cells, nonspecific cytotoxicity, and inability to affect metastatic tumors by the chemodrugs. Overcoming these challenges requires development and testing of novel therapies. One attractive cancer therapeutic approach is cancer gene therapy. Several laboratories including the authors' laboratory have been investigating nonviral formulations for delivering therapeutic genes as a mode for effective cancer therapy. In this paper the authors will summarize their experience in the development and testing of a cationic lipid-based nanocarrier formulation and the results from their preclinical studies leading to a Phase I clinical trial for nonsmall cell lung cancer. Their nanocarrier formulation containing therapeutic genes such as tumor suppressor genes when administered intravenously effectively controls metastatic tumor growth. Additional Phase I clinical trials based on the results of their nanocarrier formulation have been initiated or proposed for treatment of cancer of the breast, ovary, pancreas, and metastatic melanoma, and will be discussed

Functional outcome following conservative management of acetabular fractures

Background: Acetabular fractures are complex injuries caused due to high velocity injury and constitutes about 18 % of Pelvic fractures. To obtain articular congruency and anatomical reduction is the gold standard in treating these fractures. In this study we have studied about the functional outcome in acetabular fractures managed conservatively with the long-term follow.Methods: A retrospective study with prospective analysis done between 2011-2020 involved 39 patients with acetabular fractures who were treated conservatively at St John’s Medical college Hospital. Patients were followed up at 6 months, 1 year, 2 years and at the end of 5 years for functional evaluation and assessment with the clinical outcome scores with Merle d’Aubigne and Postel score &amp; Harris Hip Score.Results: Study included 39 patients with the average age of 41.3 years with 31 male and 8 female patients. Functional outcome score showed good to excellent results in 80%, fair to satisfactory results in 18%, 0.5 to 2% had poor result in the patient analyzed with both Merle d’Aubigne and Postel score and Harris Hip Score. 80 % of the patients were able to sit cross legged, 90% had returned to regular work and 10% of the patients changed their occupation to desk jobs.Conclusions: Conservative management of acetabular fractures gives a good long-term result following congruent reduction of the fracture, good early rehabilitation and gradual weight bearing. Return to activity of daily living was good even in congruently reduced acetabular dome fractures with good to excellent functional outcome scores

Razvoj samoemulzifirajućeg sustava za isporuku albendazola (SEDDS) s pojačanom sistemskom apsorpcijom

The aim of the study was to develop and evaluate a self-emulsifying drug delivery system (SEDDS) formulation to improve solubility and dissolution and to enhance systemic exposure of a BCS class II anthelmetic drug, albendazole (ABZ). In the present study, solubility of ABZ was determined in various oils, surfactants and co-surfactants to identify the microemulsion components. Pseudoternary phase diagrams were plotted to identify the microemulsification existence area. SEDDS formulation of ABZ was prepared using oil (Labrafac Lipopfile WL1349) and a surfactant/co-surfactant (Tween 80/PEG-400) mixture and was characterized by appropriate studies, viz., microemulsifying properties, droplet size measurement, in vitro dissolution, etc. Finally, PK of the ABZ SEDDS formulation was performed on rats in parallel with suspension formulation. It was concluded that the SEDDS formulation approach can be used to improve the dissolution and systemic exposure of poorly water-soluble drugs such as ABZ.Cilj rada bio je razvoj i evaluacija samoemulzifirajućeg sustava za isporuku lijekova (SEDDS) povećane topljivosti i oslobađanja, te povećane sistemske apsorpcije anthelmintika albendazola (ABZ), lijeka iz klase BCS II. Odabir sastojaka za pripravu mikroemulzija izvršen je na temelju topljivosti albendazola u različitim uljima, surfaktantima i kosurfaktantima. Kako bi se odredilo područje u kojem dolazi do mikroemulzifikacije izrađeni su pseudoternarni fazni dijagrami. SEDDS formulacija albendazola pripravljena je pomoću smjese ulja (Labrafac Lipopfile WL1349) i surfaktanta/kosurfaktanta (Tween 80/PEG-400). Dobivenom pripravku određena su mikroemulzifirajuća svojstva, veličina kapljica, oslobađanje in vitro, itd. Osim toga, određeni su farmakokinetički parametri za ABZ SEDDS u štakora i uspoređeni sa suspenzijom albendazola. Zaključeno je da se pomoću SEDDS-a može povećati topljivost i sistemska apsorpcija lijekova slabo topljivih u vodi kao što je ABZ