The potential for bi-lateral agreements in medical tourism: A qualitative study of stakeholder perspectives from the UK and India

BACKGROUND: Globalisation has prompted countries to evaluate their position on trade in health services. However, this is often done from a multi-lateral, rather than a regional or bi-lateral perspective. In a previous review, we concluded that most of the issues raised could be better addressed from a bi-lateral relationship. We report here the results of a qualitative exercise to assess stakeholders' perceptions on the prospects for such a bi-lateral system, and its ability to address concerns associated with medical tourism. METHODS: 30 semi-structured interviews were carried out with stakeholders, 20 in India and 10 in the UK, to assess their views on the potential offered by a bi-lateral relationship on medical tourism between both countries. Issues discussed include data availability, origin of medical tourists, quality and continuity of care, regulation and litigation, barriers to medical tourism, policy changes needed, and prospects for such a bi-lateral relationship. RESULTS: The majority of stakeholders were concerned about the quality of health services patients would receive abroad, regulation and litigation procedures, lack of continuity of care, and the effect of such trade on the healthcare available to the local population in India. However, when considering trade from a bi-lateral point of view, there was disagreement on how these issues would apply. There was further disagreement on the importance of the Diaspora and the validity of the UK's 'rule' that patients should not fly more than three hours to obtain care. Although the opinion on the prospects for an India-UK bi-lateral relationship was varied, there was no consensus on what policy changes would be needed for such a relationship to take place. CONCLUSIONS: Whilst the literature review previously carried out suggested that a bi-lateral relationship would be best-placed to address the concerns regarding medical tourism, there was scepticism from the analysis provided in this paper based on the over-riding feeling that the political 'cost' involved was likely to be the major impediment. This makes the need for better evidence even more acute, as much of the current policy process could well be based on entrenched ideological positions, rather than secure evidence of impact

Zinc Status in the Soils of Karnataka and Response of Horticultural Crops to Zinc Application : A Meta-analysis

Zinc is considered as the fourth important yield limiting nutrient in India, after N, P, and K. From the regular soil analysis data, Indian soils (50%) are found to be deficient in Zn and the zinc deficiency is likely to increase in future. Areas with low soil available Zn are often regions with widespread zinc deficiency in humans. Zinc malnutrition and deficiency in human is alarming and is gaining attention in recent years. Application of zinc to soil and crops is one of the simple and easiest ways to mitigate or alleviate Zn deficiency in human. Moreover Zn uptake, its translocation and yield response of various crops to applied Zn are need to be focused for finding sustainable solutions to the problem of zinc deficiency in crops and humans. In this manuscript, importance of Zn to plants and human, Zn malnutrition problems in India and global level, soil Zn status of Karnataka, various factors that responsible for Zn deficiency in the soils of Karnataka and the response of various horticultural crops to Zn application in the region is discussed. Soil maps are believed to be an important tool to delineate and manage nutrient deficient areas. It also elaborates the effective Zn management strategies to improve crop productivity and farm income

Groundwater Decline and Prolonged Drought Could Reduce Vigour, Enhance Vulnerability to Diseases and Pests and Kill Perennial Horticultural Crops: Needs Urgent Policy Intervention

Perennial horticulture in India has undergone a change from rainfed system to drip fertigation systems and from isolated hedge and bund trees to high intensity orchard systems with enhanced number of trees per unit area. In several parts, particularly in the Deccan plateau, the system has now become completely dependent on water pumped from tube wells. Severe competition for water from tube wells makes farmers to devote more water for cash rich annual crops and even sell water for city dwellers nearby. As a consequence, the groundwater level in the past three decades has fallen from few feet to above thousand feet. At several places it has crossed the “peak water”. Frequent and prolonged exposure of fruit trees and nuts to drought coupled with ground water depletion has led to soil profile drying leading to reduced vigour and enhanced vulnerability to diseases and pests. This has led to withering of fruit and nut trees. Perennial crops are likely to become increasingly maladapted to their environment, particularly in the earlier period of climate change they are more likely to be attacked by diseases and insects. Coconuts, areca nuts and mango trees have died in several places and the government constituted committees have recommended compensation to the farmers. As a country, we have dramatically increased our reliance on groundwater. 175 million Indians are now fed with food produced with the unsustainable use of groundwater. This increase has dried up rivers and lakes, because there is a hydrologic connection between groundwater and surface water. Yet the legal rules governing water use usually ignore the link between law and science. The issue needs thorough examination and needs policy interventions to come out of this vicious circle

Fetomaternal outcome in pregnancy with HELLP syndrome

Background: HELLP Syndrome is a serious complication of pregnancy induced hypertensive disorders. It is defined as a triad of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Objectives of this study was to find out incidence of HELLP syndrome in pre-eclampsia, eclampsia and its overall incidence. To analyse the clinical profile of HELLP syndrome. To study maternal and perinatal outcome including morbidity and mortality.Methods: A retrospective study was conducted from July 2017 to September 2019 at a tertiary care center with inclusion criteria of abnormal peripheral blood smear, elevated liver enzymes (LDH, aspartate aminotransferase), and low platelet count.Results: HELLP syndrome was more common in younger age group (45%) and in primigravida (52.5%). Most of the patients presented at >36 weeks of gestation (40%) and most of the patients delivered by caesarean section (67.5%). Maternal complications were acute renal failure (27.5%), DIC (22.5%), maternal mortality (7.5%). Neonatal complications associated were intrauterine death (27.5%), prematurity (25%) and intrauterine growth retardation (15%).Conclusions: Thus, HELLP syndrome requires an early diagnosis and early initiation of treatment at tertiary care center with all the medical facilities available

Study on fetomaternal outcome in antepartum haemorrhage

Background: Any bleeding from or into the genital tract after the period of viability, but before the birth of the baby is termed as antepartum haemorrhage (APH).Methods: 110 cases of bleeding per vaginal (pv) after 28 weeks of gestation were studied retrospectively from August 2018 to June 2019 and were grouped as placenta previa, placental abruption and indeterminate.Results: 35.45% cases were of placenta previa, 53.63% cases were of placental abruption and 10.90% cases were of indeterminate. Majority were delivered by lower segment caesarean section (LSCS) and most of the cases required blood transfusion.Conclusions: APH cannot reliably be predicted .It is major cause of maternal and perinatal mortality and morbidity. Multidisciplinary approach and senior input is necessary in making decision about timing and mode of delivery. Presently increase in use of ultrasonography (USG) for placental localisation and to diagnose abruption, improved obstetrical and anesthetic facilities, increase in use in blood products to correct anemia and advanced neonatal care facilities, all of these have played important role in decreasing perinatal as well as maternal mortality and morbidit

Fetomaternal outcome in patients with diabetes mellitus in pregnancy

Background: Diabetes mellitus (DM) is defined as increased blood glucose level due to defect in insulin secretion, insulin action or both. Undiagnosed or inadequately treated diabetes mellitus during pregnancy can lead to significant maternal and fetal complications. The study was conducted to review feto-maternal outcome in pregnancy with diabetes and to plan management of pregnancy with diabetes and to study the modalities for treatment of DM in pregnancy.Methods: A prospective case study was conducted from July 2015 to December 2018 at a tertiary care center. Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis.Results: GDM (85%) was more common than overt diabetes (15%) and in younger age group (53.75%) and Multiparous patients (18.2%). Most of patients required insulin (81.2%) for treatment of DM during pregnancy along with medical nutrition therapy and exercise. Most common association in this patient was hypertension (41%). Rate of caesarean section (60%) was more common. Average birth weight was of >3.5 kg, intrauterine death (4.2%), preterm delivery (14.2%) and admission to NICU were also common.Conclusions: There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduces the fetomaternal outcome

Statistical Analysis and Deep Learning Associated Modeling for Early stage Detection of Carinoma

The high death rate and overall complexity of the cancer epidemic is a global health crisis. Progress in cancer prediction based on gene expression has increased in light of the speedy advancement using modern high-throughput sequencing methods and a wide range of machine learning techniques, bringing insights into efficient and precise treatment decision-making. Therefore, it is of significant interest to create machine learning systems that accurately identify cancer patients and healthy people. Although several classification systems have been applied to cancer prediction, no single strategy has proven superior. This research shows how to apply deep learning to an optimization method that uses numerous machine learning models. Statistical analysis has helped us choose informative genes, and we've been feeding those to five different categorization models. The results from the five different classifiers are ensembled in the next step using a deep learning technique. The three most common types of adenocarcinoma are those of the lungs, stomach, and breasts. The suggested deep learning-based inter-ensembles model was tested with deep learning-based algorithms on Carcinoma data. The results of the tests show that relative to using only one set of classifiers or the simple consensus algorithm, it improves the precision of cancer prognosis in every analyzed carcinoma dataset. The suggested deep learning-based inter-ensemble approach is demonstrated to be reliable and efficient for cancer diagnosis by entirely using diverse classifiers

Integrated genetic and metabolic landscapes predict vulnerabilities of temozolomide resistant glioblastoma cells.

Metabolic reprogramming and its molecular underpinnings are critical to unravel the duality of cancer cell function and chemo-resistance. Here, we use a constraints-based integrated approach to delineate the interplay between metabolism and epigenetics, hardwired in the genome, to shape temozolomide (TMZ) resistance. Differential metabolism was identified in response to TMZ at varying concentrations in both the resistant neurospheroidal (NSP) and the susceptible (U87MG) glioblastoma cell-lines. The genetic basis of this metabolic adaptation was characterized by whole exome sequencing that identified mutations in signaling pathway regulators of growth and energy metabolism. Remarkably, our integrated approach identified rewiring in glycolysis, TCA cycle, malate aspartate shunt, and oxidative phosphorylation pathways. The differential killing of TMZ resistant NSP by Rotenone at low concentrations with an IC50 value of 5 nM, three orders of magnitude lower than for U87MG that exhibited an IC50 value of 1.8 mM was thus identified using our integrated systems-based approach