Opioid substitution therapy in manipur and nagaland, north-east india: operational research in action

<p>Abstract</p> <p>Background</p> <p>There is good evidence for the effectiveness of opioid substitution therapy (OST) for injecting drug users (IDUs) in middle and high-income countries but little evidence regarding the provision of OST by non-government organisations (NGOs) in resource-poor settings. This paper reports on outcomes of an NGO-based OST program providing sub-lingual buprenorphine to opiate dependent IDUs in two north-east Indian states (Manipur and Nagaland), a region where conflict, under-development and injecting of heroin and Spasmoproxyvon (SP) are ongoing problems. The objectives of the study were: 1) to calculate OST treatment retention, 2) to assess the impact on HIV risk behaviours and quality of life, and 3) to identify client characteristics associated with cessation of treatment due to relapse.</p> <p>Methods</p> <p>This study involves analysis of data that were routinely and prospectively collected from all clients enrolled in an OST program in Manipur and Nagaland between May 2006 and December 2007 (n = 2569, 1853 in Manipur and 716 in Nagaland) using standardised questionnaires, and is best classified as operational research. The data were recorded at intake into the program, after three months, and at cessation. Outcome measures included HIV risk behaviours and quality of life indicators. Predictors of relapse were modelled using binary logistic regression.</p> <p>Results</p> <p>Of all clients enrolled in OST during the month of May 2006 (n = 713), 72.8% remained on treatment after three months, and 63.3% after six months. Statistically significant (p = 0.05) improvements were observed in relation to needle sharing, unsafe sex, incidents of detention, and a range of quality of life measures. Greater spending on drugs at intake (OR 1.20), frequently missing doses (OR 8.82), and having heroin rather than SP as the most problematic drug (OR 1.95) were factors that increased the likelihood of relapse, and longer duration in treatment (OR 0.76) and regular family involvement in treatment (OR 0.20) reduced the likelihood of relapse.</p> <p>Conclusion</p> <p>The findings from this operational research indicate that the provision of OST by NGOs in the severely constrained context of Manipur and Nagaland achieved outcomes that are internationally comparable, and highlights strategies for strengthening similar programs in this and other resource-poor settings.</p

PATHOPHYSIOLOGY OF SHWASROGA W.S.R. DYSPNOEA

Respiratory system is divided in two parts, as upper and the lower respiratory tract. The upper respiratory tract is consists the part like the nose, nasal cavity, nasopharynx, oral cavity, while the lower respiratory tract contains larynx, pharynx, trachea, lungs, and alveoli. Major functions of respiratory system are like conduction of the air, gaseous exchange, pulmonary circulation, excretion of the metabolic waste in the form of carbon dioxide. It directly correlates with Pranavaha srotas in Ayurveda. Pranavaha Srotas plays a vital role in maintaining the vitality of the body, not only due to movement of vital Prana in this Srotas but also as it is the major route through which the pathogens enters inside the body. Dyspnoea is the one of most important common clinical feature in respiratory disorders. It is a subjective awareness of the sensation of uncomfortable breathing. It may be of physiological, pathological or environmental origin. The pathophysiology of dyspnoea is strenuous and involves the activation of various pathways that lead to increased work of breathing, stimulus of the receptors of the upper or lower airway, lung parenchyma, or chest wall and excessive stimulation of the respiratory centre. In Ayurveda dyspnoea is directly correlates with Shwaskruchchhta. The pathophysiology, etiology and clinical presentation of dyspnoea are reviewed in this article. This definitely will help to have a comprehensive Ayurvedic view in modern medicine context and to get success in diagnosis and treatment of Shwasaroga

Stability analysis for grain yield and some quality traits in bread wheat (Triticum aestivum L.

The present study was conducted to assess the genetic diversity and stability for grain yield (GY), 1000- grain weight (TGW), protein content (PC), grain iron (Fe) and grain zinc (Zn) concentration under three varied environmental locations using 28 diverse wheat genotypes (including three checks i.e., WH1105, DPW621-50, and HD2967 ). The material was sown at three locations during Rabi 2015-2016. Pooled analysis of variance revealed highly significant variance due to environments for all the traits studied indicating differential response of the genotypes. The genotype BWL 3584 exhibited stable performance across the environments for grain yield and grain zinc concentration under un-favorable environment also shows potential for high grain yield and high grain zinc concentration. After further confirmation, genotype BWL 3584 could be utilized as potential donor in hybridization programme to improve grain yield and grain zinc concentration. Further, genotype SABW 225 showed consistent performance across the environments for TGW and PC content. Whereas, PBW 744 was found to be suitable for GY (6142 kg/ha), coupled with PC (12.09%) and Zn (52.18ppm) across the locations followed by PBW 725 (6094, 12.26 and 46.96) and BWL 3584 (5219, 12.63 and 50.23) GY, PC and Grain Zn, respectively)and BWL 3584 (5219, 12.63 and 50.23) could be utilized as a donor in routine breeding programme to improve grain yield and quality traits in bread wheat

Synthesis of 2, 5 Dimethyl Furan from Renewable Lignocellulosic Biomass

Renewable biomass resources could reduce the dependency on the fossil fuels by conversion of its lignocellulose into bio-fuels and other valuable chemicals. Depolymerisation of lignocellulose, hydrolysis of cellulose to monomer glucose and its subsequent dehydration results 5-hydroxymethyl furfural (HMF). HMF is an important platform chemical for fuels and various other applications. The hydrogenation of HMF results 2, 5-dimethylfuran (DMF), which may be a biofuel with 40 per cent greater energy density than that of ethanol. The homogeneous catalytic method is preferred for lignocellulosic biomass conversion to cellulose, its hydrolysis and further dehydration to HMF. The Cu-Ru/C and related catalysts are preferred for hydrogenation of HMD to 2, 5-dimethylfuran. This review is an attempt to summarise the current research and developments in the field of lignocellulose derived HMF and further conversion to DMF as a potential biofuel

Opioid substitution treatment with sublingual buprenorphine in Manipur and Nagaland in Northeast India: what has been established needs to be continued and expanded

Manipur and Nagaland in northeast India report an antenatal HIV prevalence of > 1% and the current HIV prevalence among injecting drug users is 24% and 4.5% respectively. Through support from DFID's Challenge Fund, Emmanuel Hospital Association (EHA) established thirteen drop-in-centres across the two states to deliver opioid substitution treatment with sublingual buprenorphine for 1200 injecting drug users. Within a short span of time the treatment has been found to be attractive to the clients and currently 1248 injecting opioid users are receiving opioid substitution treatment. The project is acceptable to the drug users, the families, the communities, religious as well as the militant groups. The treatment centres operate all days of the week, have trained staff members, utilize standardized protocols and ensure a strict supervised delivery system to prevent illicit diversion of buprenorphine. The drug users receiving the substitution treatment are referred to HIV voluntary counselling and testing. As this treatment has the potential to change HIV related risk behaviours, what has been established in the two states needs to be continued and expanded with the support from the Government of India

Isolated single coronary artery (RII-B type) presenting as an inferior wall myocardial infarction: A rare clinical entity

AbstractIsolated single coronary artery without other congenital cardiac anomalies is very rare among the different variations of anomalous coronary patterns. The prognosis in patients with single coronary varies according to the anatomic distribution and associated coronary atherosclerosis. If the left main coronary artery travels between the aorta and pulmonary arteries, it may be a cause of sudden cardiac death. We present multimodality images of a single coronary artery, in which the whole coronary system originated by a single trunk from the right sinus of Valsalva with inter-arterial course of left main coronary artery. This rare type of single coronary artery was classified as RII-B type according to Lipton's scheme of classification. A significant flow-limiting lesions were found in the right coronary artery that was successfully treated with percutaneous coronary intervention

Imaging resemblance but diagnostic disparity in cervix cancer: a rare case report

F-18 FDG PET-CT is an establish modality for staging of cervical cancer. The high uptake value in PET with no evidence of necrosis in CECT is generally understood malignant pathology in known cancer patients. A 47 year-old-female with cervix carcinoma underwent staging FDG PET-CT. It showed FDG avid primary lesion in cervix with FDG avid pelvic, retroperitoneal, mediastinal and supraclavicular lymph nodes. USG guided FNA from the supraclavicular lymph node revealed tuberculosis. Now patient scheduled for ATT and chemotherapy

Building to Building Communication over Wireless Sensor Networks

The smartphone usage in the low-income sections of India, which form over 70% of the population, is relatively small in comparison to urban areas. Recent reports says that India’s mobile penetration is at 73% (up from 30% in 2009), fast catching up to the global average of 93%. India is the fastest growing country for mobile Internet users with the latest predictions at 20% growth every quarter. This growth is mainly driven by low-cost smartphones, which are particularly interesting due to their enhanced capabilities and potential to enable services for the masses. With the advent of affordable smart-phones (Rs 3,000 - Rs 10,000) designed for the Indian user from indigenous manufacturers such as Miromax, Karbonn, etc., more people are shifting to smartphones. Other factors contributing to this shift includes the fact that 98.9% of India currently has no access to fixed-line broadband connectivity options and industries like banking, retail, entertainment, health and education have begun to introduce compelling mobile services. Due to these factors, smartphone sales have begun to cannibalize the traditional feature phone market, while the overall market grew by 12% last year, the smartphone market grew by 229%. At this rate, the smartphone market will overtake feature phones in terms of number of units sold, by 2017

Ethnopharmacology of Some Important Medicinal Plants of Nanda Devi National Park (NDNP) Uttarakhand, India

Abstract: Ethnopharmacology deals with the applied aspects of plants and has been emerged as an important discipline of traditional botany with modern sciences. With the increasing demands of vegetational resources in developing world, it has been attracted much attention in recent past. The paper presents few of the important medicinal plants present in alpine and sub alpine regions of core and buffer zone of Nanda Devi National Park (NDNP), district Chamoli, Uttarakhand. Since inhabitants and tribal communities have strong faith and belief in Indigenous Health Care system, they have been interviewed along with herbal practitioners, priests and shepherds during the entire study. Establishing small scale industry on medicinal plants may be helpful in capacity building of unprivileged inhabitants of this remote region. [Nature and Science 2010;8(11):9-14]. (ISSN: 1545-0740). Key words: medicinal plants; folk recipes; NDNP, U.K. Introduction The Nanda Devi National Park is the first and foremost highly valued core of the Nanda Devi Biosphere Reserve. It has an area of 624.6 sq. km. and has an average altitude exceeding 4500 m asl surrounded by high mountain ridges and peaks on all sides. Some of the important peaks encircling the National Park are Dunagiri (7066 m), Rishi Pahar (6992 m), Mangraon (6765 m), Nanda Khat (6631 m), Maiktoli (6803 m), Mrigthuni (6655 m), Trishul I-II (7120-6319m), Nanda Devi (7817 m), Devisthan I-II (6529 -6678 m) and Hanuman Peaks (6070 m), situated in the park. The park is situated in the form of a cup, with lush-green meadows, cluttering white water falls, and rich wild flora and fauna Ethno-medicinal plants, as a group, comprise approximately 8000 species and account for about 50% of all the higher flowering plant species in India. A large number of the country&apos;s rural population depends on medicinal plants for treating various illnesse

Utilisation, availability and price changes of medicines and protection equipment for COVID-19 among selected regions in India : findings and implications

Background: COVID-19 has already claimed a considerable number of lives worldwide. However, there are concerns with treatment recommendations given the extent of conflicting results with suggested treatments and misinformation, some of which has resulted in increased prices and shortages alongside increasing use and prices of personal protective equipment (PPE). This is a concern in countries such as India where there have been high patient co-payments and an appreciable number of families going into poverty when members become ill. However, balanced against pricing controls. Community pharmacists play a significant role in disease management in India, and this will remain. Consequently, there is a need to review prices and availability of pertinent medicines during the early stages of the COVID-19 pandemic in India to provide future direction. Objective: Assess current utilisation and price changes as well as shortages of pertinent medicines and equipment during the early stages of the pandemic. Our Approach: Multiple approach involving a review of treatments and ongoing activities across India to reduce the spread of the virus alongside questioning pharmacies in selected cities from early March to end May 2020. Our Activities: 111 pharmacies took part, giving a response rate of 80%. Encouragingly, no change in utilisation of antimalarial medicines in 45% of pharmacies despite endorsements and for antibiotics in 57.7% of pharmacies, helped by increasing need for a prescription for dispensing. In addition, increased purchasing of PPE (over 98%). No price increases were seen for antimalarials and antibiotics in 83.8 and 91.9% of pharmacies respectively although shortages were seen for antimalarials in 70.3% of pharmacies, lower for antibiotics (9.9% of pharmacies). However, price increases were typically seen for PPE (over 90% of stores) as well as for analgesics (over 50% of pharmacies). Shortages were also seen for PPE (88.3%). Conclusion: The pandemic has impacted on utilisation and prices of pertinent medicines and PPE in India but moderated by increased scrutiny. Key stakeholder groups can play a role with enhancing evidenced-based approaches and reducing inappropriate purchasing in the future