An Approach towards the synthesis of furo[3,4-c]pyrazole

Synthesis of pyrazole and its N-aryl analogues has been a subject of consistent interest because of the wide applications of such heterocycles in pharmaceutical as well as in agrochemical industry. Numerous compounds containing pyrazole moiety have been shown to exhibit antihyperglycemic, analgesic, anti-inflammatory, antipyretic, antibacterial, and sedative-hypnotic activity. The 1-phenylpyrazole motif is present in several drug candidates for treatment of various diseases such as cyclooxygenase-2 (Cox-2) inhibitors, IL-1 synthesis inhibitors, and protein kinase inhibitors etc. Similarly a few of the 1, 5-diarylpyrazole derivatives have been shown to exhibit nonnucleoside HIV-1 reverse transcriptase inhibitory activities along with Cox-2 inhibitor. Pyrazoles are usually prepared by condensation between a hydrazine derivative and a 1,3-dicarbonyl compound or by 1,3-dipolar cycloaddition of diazoalkanes or nitrile imines to olefins or acetylenes. Here, in this report our approach towards the synthesis of some polycyclic pyrazole compounds by the Diels-Alder reaction of furo[3,4-c]pyrazole and several dienophiles is disclosed. As furo[3,4-c]pyrazole is unknown till now, we want to focus our study for the synthesis of furo[3,4-c]pyrazol

Antibiotic resistance and environmental factors : focusing on the situation in Odisha, India

Background: The rise of antibiotic resistant bacteria is a major challenge to global public health. The environment has a significant impact on health and infectious diseases; however, there is a lacuna of information on the relationship between the environment and antibiotic resistance. Aim: The overall aim of this thesis was to explore the relationship between antibiotic resistance and environmental components. Methods: This study was conducted in Odisha, India. In Paper I, eight focus group discussions and ten individual interviews among community members without any healthcare background, and in Paper II, 24 interviews among healthcare professionals: allopathic doctors, veterinarians and drug dispensers from two different environmental settings were conducted. In Paper III, studies were conducted to investigate the antibiotic resistance pattern of Escherichia coli isolated from samples of children’s stool, cow-dung and drinking water from two geographical regions: non-coastal (230 households) and coastal (187 households). Paper IV investigated the association of temperature and relative humidity with occurrence of skin and soft-tissue infections (SSTIs, n=590), Staphylococcus aureus associated skin infections (SA-SSTIs, n=387) and methicillin-resistant S. aureus (MRSA, n=251) during a period of 18 months in case of outpatients in a tertiary care hospital in Bhubaneswar. Findings: Participants perceived a relationship between environmental factors, infectious diseases and antibiotic use and resistance. It was perceived that behavioural and social environmental factors, i.e. patients’ non-compliance with antibiotic use, irrational prescription by informal as well as trained healthcare providers and overthe- counter availability of antibiotics are the major contributors for antibiotic resistance development. It was also perceived that natural and physical environmental factors are associated with the occurrence and prevalence of infectious diseases and antibiotic resistance (Paper I & II). When quantitative studies were conducted, it was found that the overall prevalence of antibiotic resistance in E. coli isolated from children’s stool, cow-dung and drinking water was higher in the non-coastal than the coastal environment (Paper III). In Paper IV it was revealed that the maximum temperature above 33°C and minimum temperature above 24°C coinciding with relative humidity between 55% to 78% is a favourable combination for the occurrence of SSTIs, SA-SSTIs and MRSA infections; this combination of temperature and relative humidity is observed during late summer in Odisha. Conclusions: Although behavioural and social environmental factors are major contributors to resistance development; natural and physical environmental factors also influence antibiotic resistance development. There was geographical variation in antibiotic resistance. It was also evident that climatic factors have influence on skin and soft-tissue infections and resistant bacteria. There is a need for further research on the influence of natural and physical factors on antibiotic resistance development and for education, information dissemination and proper implementation and enforcement of legislation at all levels of the drug delivery and disposal system in order to improve antibiotic use and minimise resistance development

Traditional Treatment for Rheumatoid Arthritis

The most prevalent musculoskeletal disorder is rheumatoid arthritis (RA). The main concern with RA is extreme fatigue, pain, and weakness. Patients having severe pain are compelled to take medications containing a variety of indigenous substances. These indigenous substances, on the other hand, exacerbated illnesses and delay in seeking appropriate healthcare. Treatment is delayed due to a number of reasons, including patients’ lack of access to trained healthcare professionals, delays in referral to a rheumatologist, and patients’ belief on traditional healing practices. The choice of inappropriate healthcare providers often causes a delay in referral to a rheumatologist. Self-medication and seeking treatment from traditional healers are often compelled the patient to engage in a variety of traditional practices. Cultural values have a significant influence on care-seeking behavior. Since healthcare promotion is dictated by community demands, the healthcare system should understand the contextual phenomena behind common practices for better health education. This chapter will address the beliefs and values that underpin traditional treatment, the sources of traditional learning pathways and ethical aspects of traditional practice

Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India.

While sanitation interventions have focused primarily on child health, women's unique health risks from inadequate sanitation are gaining recognition as a priority issue. This study examines the range of sanitation-related psychosocial stressors during routine sanitation practices in Odisha, India. Between August 2013 and March 2014, we conducted in-depth interviews with 56 women in four life stages: adolescent, newly married, pregnant and established adult women in three settings: urban slums, rural villages and indigenous villages. Using a grounded theory approach, the study team transcribed, translated, coded and discussed interviews using detailed analytic memos to identify and characterize stressors at each life stage and study site. We found that sanitation practices encompassed more than defecation and urination and included carrying water, washing, bathing, menstrual management, and changing clothes. During the course of these activities, women encountered three broad types of stressors-environmental, social, and sexual-the intensity of which were modified by the woman's life stage, living environment, and access to sanitation facilities. Environmental barriers, social factors and fears of sexual violence all contributed to sanitation-related psychosocial stress. Though women responded with small changes to sanitation practices, they were unable to significantly modify their circumstances, notably by achieving adequate privacy for sanitation-related behaviors. A better understanding of the range of causes of stress and adaptive behaviors is needed to inform context-specific, gender-sensitive sanitation interventions

Epidemiology of multimorbidity in Nepal:A systematic review and meta-analysis

BACKGROUND: Multimorbidity is rising in low-and middle-income countries such as Nepal, yet the research has not gained pace in this field. We aimed to systematically review the existing multimorbidity literature in Nepal and estimate the prevalence and map its risk factors and consequences.METHODS: We reviewed data collated from PubMed, Embase and CINAHL by including original studies that reported prevalence of multimorbidity in Nepal. The quality of included studies was assessed using the Appraisal Tool for Cross-sectional Studies. The summary of the review is presented both qualitatively as well as through meta-analysis to give pooled prevalence. We prospectively registered in PROSPERO (CRD42024499598).RESULTS: We identified 423 studies out of which seven were included in this review. All studies were conducted in a community setting except one which was hospital based. The prevalence reported across various studies ranged from 13.96% to 70.1%. The pooled prevalence of multimorbidity was observed to be 25.05% (95% CI: 16.99 to 34.09). The number of conditions used to assess multimorbidity ranged from four to nine. The major risk factors identified were increasing age, urban residence, and lower literacy rates.CONCLUSION: A wide variance in the prevalence of multimorbidity was observed. Moreover, multimorbidity assessment tool/conditions considered for assessing multimorbidity were heterogeneous.</p

Universal health coverage in India and health technology assessment: current status and the way forward

In India, there is a renewed emphasis on Universal Health Coverage (UHC). Alongside this, Health Technology Assessment (HTA) is an important tool for advancing UHC. The development and application of HTA in India, including capacity building and establishing institutional mechanisms. We emphasized using the HTA approach within two components of the Ayushman Bharat programme, and the section concludes with lessons learned and the next steps. The UHC has increased the importance of selecting and implementing effective technologies and interventions within national health systems, particularly in the context of limited resources. To maximize the use of limited resources and produce reliable scientific assessments, developing and enhancing national capacity must be based on established best practices, information exchange between different sectors, and collaborative approaches. A more potent mechanism and capacity for HTA in India would accelerate the country’s progress toward UHC

Identifying Risk Factors for Lower Reproductive Tract Infections among Women Using Reusable Absorbents in Odisha, India.

A large proportion of women in Odisha, India, use reusable absorbents to manage their menstruation. Yet, the risk factors for lower reproductive tract infections (RTIs) related to menstrual hygiene management (MHM) have not been studied among reusable absorbent users. Women of reproductive age attending one of two hospitals from two different cities in Odisha during two separate study intervals were recruited for the study. Laboratory diagnosis of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) were conducted. A questionnaire was used to collect information on MHM practices, water, sanitation, and socio-demographic factors. Among the 509 women who used reusable absorbents, 71.7% were diagnosed with at least one infection. After adjusting for confounders, women with BV were more likely to identify as being a housewife (aOR: 1.8 (1.1-2.9)). Frequent absorbent changing was protective against BV (aOR: 0.5 (0.3-0.8)), whereas frequent body washing increased the odds of BV (aOR: 1.5 (1.0-2.2)). Women with VVC were more likely to be older (aOR: 1.6 (1.0-2.5)), live below the poverty line (aOR: 1.5 (1.1-2.2)), have a non-private household latrine (aOR: 2.2 (1.3-4.0)), dry their absorbents inside the house (aOR: 3.7 (2.5-4.5)), and store absorbents in the latrine area (aOR: 2.0 (1.3-2.9)). Washing absorbents outside the house was protective against VVC (aOR: 0.7 (0.4-1.0)). This study highlights the importance of improving MHM practices among reusable absorbent users to prevent lower RTIs among women reusing menstrual materials in Odisha

From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India.

Women face greater challenges than men in accessing water, sanitation, and hygiene (WASH) resources to address their daily needs, and may respond to these challenges by adopting unsafe practices that increase the risk of reproductive tract infections (RTIs). WASH practices may change as women transition through socially-defined life stage experiences, like marriage and pregnancy. Thus, the relationship between WASH practices and RTIs might vary across female reproductive life stages. This cross-sectional study assessed the relationship between WASH exposures and self-reported RTI symptoms in 3,952 girls and women from two rural districts in India, and tested whether social exposures represented by reproductive life stage was an effect modifier of associations. In fully adjusted models, RTI symptoms were less common in women using a latrine without water for defecation versus open defecation (Odds Ratio (OR) = 0.69; Confidence Interval (CI) = 0.48, 0.98) and those walking shorter distances to a bathing location (OR = 0.79, CI = 0.63, 0.99), but there was no association between using a latrine with a water source and RTIs versus open defecation (OR = 1.09; CI = 0.69, 1.72). Unexpectedly, RTI symptoms were more common for women bathing daily with soap (OR = 6.55, CI = 3.60, 11.94) and for women washing their hands after defecation with soap (OR = 10.27; CI = 5.53, 19.08) or ash/soil/mud (OR = 6.02; CI = 3.07, 11.77) versus water only or no hand washing. WASH practices of girls and women varied across reproductive life stages, but the associations between WASH practices and RTI symptoms were not moderated by or confounded by life stage status. This study provides new evidence that WASH access and practices are associated with self-reported reproductive tract infection symptoms in rural Indian girls and women from different reproductive life stages. However, the counterintuitive directions of effect for soap use highlights that causality and mechanisms of effect cannot be inferred from this study design. Future research is needed to understand whether improvements in water and sanitation access could improve the practice of safe hygiene behaviors and reduce the global burden of RTIs in women

Geographical Variation in Antibiotic-Resistant Escherichia coli Isolates from Stool, Cow-Dung and Drinking Water

Little information is available on relationships between the biophysical environment and antibiotic resistance. This study was conducted to investigate the antibiotic resistance pattern of Escherichia coli isolated from child stool samples, cow-dung and drinking water from the non-coastal (230 households) and coastal (187 households) regions of Odisha, India. Susceptibility testing of E. coli isolates (n = 696) to the following antibiotics: tetracycline, ampicillin/sulbactam, cefuroxime, cefotaxime, cefixime, cotrimoxazole, amikacin, ciprofloxacin, norfloxacin and nalidixic acid was performed by the disk diffusion method. Ciprofloxacin minimum inhibitory concentration (MIC) values were determined for ciprofloxacin-resistant isolates (n = 83). Resistance to at least one antibiotic was detected in 90% or more of the E. coli isolates. Ciprofloxacin MIC values ranged from 8 to 32 µg/mL. The odds ratio (OR) of resistance in E. coli isolates from children’s stool (OR = 3.1, 95% CI 1.18–8.01), cow-dung (OR = 3.6, 95% CI 1.59–8.03, P = 0.002) and drinking water (OR = 3.8, 95% CI 1.00–14.44, P = 0.049) were higher in non-coastal compared to coastal region. Similarly, the co-resistance in cow-dung (OR = 2.5, 95% CI 1.39–4.37, P = 0.002) and drinking water (OR = 3.2, 95% CI 1.36–7.41, P = 0.008) as well as the multi-resistance in cow-dung (OR = 2.2, 95% CI 1.12–4.34, P = 0.022) and drinking water (OR = 2.7, 95% CI 1.06–7.07, P = 0.036) were also higher in the non-coastal compared to the coastal region