Social Determinants of Cardiovascular Health among Sexual Minority Adults

Cardiovascular disease (e.g., myocardial infarction, stroke, coronary artery disease) is the leading cause of death and disability worldwide. There is a growing body of literature that indicates sexual minority (e.g., gay, lesbian, bisexual, queer) adults are at a higher risk of cardiovascular disease than their heterosexual counterparts. The aim of this dissertation was to identify factors that contribute to the cardiovascular health (CVH) disparities that have been observed among sexual minority individuals. Guided by an adaptation of the minority stress model of CVH among sexual minority individuals, this dissertation includes three studies. In the first study (i.e., Chapter 2), we conducted a scoping review of the literature that investigated social determinants of cardiovascular health among sexual minority adults. Although findings were mixed, several social determinants of health were found to influence the CVH of sexual minority adults. For instance, sexual minority adults who lived in environments that were more supportive of sexual and gender minority people had lower odds of being overweight or obese. In the second study (i.e., Chapter 3), we used data from a racially and ethnically diverse sample of sexual minority women to examine the associations of family-related factors (i.e., sexual identity disclosure and family social support) with self-reported incident hypertension. Additionally, we examined whether these associations were moderated by race/ethnicity and sexual identity, or mediated by depressive symptoms. We found that higher levels of family social support were associated with lower levels of depressive symptoms among sexual minority women. However, family-related factors were not associated with self-reported incident hypertension. Further, race/ethnicity and sexual identity did not moderate the associations between family-related factors and reported incident hypertension. In the third study (i.e., Chapter 4), we used data from a nationally representative sample of adults to investigate sexual identity differences in ideal CVH (as defined by the American Heart Association’s Life Simple 7) and whether these associations were mediated by depressive symptoms. Compared to exclusively heterosexual women, mostly heterosexual and lesbian women were less likely to meet ideal criteria for tobacco use. In contrast, lesbian women were more likely to meet ideal criteria for glycosylated hemoglobin than exclusively heterosexual women. Among men, relative to exclusively heterosexual men, mostly heterosexual men were less likely to meet ideal criteria for tobacco use. Gay and bisexual men were less likely to meet ideal criteria for physical activity, whereas gay men were more likely to meet ideal criteria for body mass index compared to exclusively heterosexual men. Bisexual men were less likely to meet ideal criteria for blood pressure relative to exclusively heterosexual men. Depressive symptoms were found to partially mediate the association between sexual identity and physical activity only among mostly heterosexual women. Overall, these dissertation findings highlight CVH disparities among sexual minority adults. Clinicians should be educated about the CVH disparities that have been documented among sexual minority adults to provide personalized and culturally competent care. Results also indicate there is a need to develop behavioral interventions tailored specifically to the needs of sexual minority adults to improve their CVH outcomes and reduce CVH-related disparities

Elective versus emergency caesarean section: differences in maternal outcome

Background: Caesarean section is a life-saving surgical procedure when certain complications arise during pregnancy or labour. The use of CS worldwide has increased worldwide unprecedented levels although the gap between higher- and lower-resource settings remains. The present study evaluates the difference in maternal outcome in elective versus emergency caesarean sections in our institute.Methods: The study included first 65 cases of emergency caesarean section (group A) and during the study period, first 65 elective caesarean section (group B) if they fulfilled the inclusion criteria. Various intra operative and postoperative events were recorded which included intra operative complications, postpartum haemorrhage and transfusion indices.Results: The most common indication of caesarean section in group A was fetal distress (27.7%). In group B most caesarean sections were classified under 5 followed by class 6, the most common indication being previous caesarean section (27.6%). It was observed that pre-operative mean haemoglobin in group A was 10.6 g/dl and in group B was 11.2g/dl. A drop of 1.36 g/dl in group A and 1.10 g/dl in group B was observed in the post-op period. Cross match / transfusion ratio 1.5 in group A and  2 in group B, transfusion probability ratio was 60 % in group A and  66.7%  in group B and transfusion index was 1 in group A and  group B. There was significantly higher contraception acceptance in group B compared to group A.Conclusions: Elective caesarean section has more favourable maternal outcome as compared to emergency caesarean section as the former is done under controlled and planned circumstances.  However, there should be stringent audit to scrutinise indication of caesarean section, outcome of caesarean and blood transfusion practices

The Wonderful DMARD with Multiple Toxicities

Methotrexate is a type of disease-modifying anti-rheumatic drug (DMARD). It is used to reduce activity of the immune system for people who have certain conditions. Methotrexate is a chemotherapy agent and immune system suppressant. Its use may be limited by concerns regarding its adverse reactions. The occurrence of adverse drug reactions in some cases leads to the therapy discontinuation. Although adverse drug reactions (ADR) of methotrexate generally do not pose a serious threat to the health of patients and a reduction in the dose of methotrexate leads to their elimination, in some cases severe toxicities of the drug occur unpredictably. These facts explain the need for close monitoring of the patient’s condition and the identification of potential risk factors for drug toxicity on the part of different organs and functional systems. The purpose of this review is to detail about safety and tolerability of methotrexate

Violation Of Refugees’ Human Rights: Evaluating Critically Middle East Recent Migration Crisis At The External Schengen Border

On September 2, Poland introduced a state of emergency in regions at the border with Belarus. According to International Law, a state of emergency is an occurrence that threatens the nation's life. Nonetheless, migration to Poland does not meet the threshold to declare a state of emergency. Besides, International Human Rights Law strictly outlines the conditions that a state must adhere to before imposing a state of emergency that limits human rights, such as notifying significant international bodies. Accordingly, Amnesty International outlines in their findings that the Polish government did not comply with the International Human Rights Law requirements (Amnesty International, 2021) and the European Court of Human Rights decisions concerning recent events at the borders of Poland and Latvia with Belarus (R.A. and Others, 2021; Ahmed and Others, 2021)

Finding Equilibrium: Cryptocurrency And Public Policy

The growth of computer technology and the growing importance of economic globalization during the COVID-19 pandemic has drastically evolved the global economic policy. This policy has incorporated the circulation of electronic money and digital assets extensively due to the growth of these instruments in the presentday financial market. However, while this development is prosperous what we often fail to understand is that the idea of Innovation prospers based on domestic public policy. An effective public policy with a fair and equitable enforcement mechanism aligns technical innovation with human flourishment. And while the debate over legal restrictions stifling innovation, continues, the necessity of legal protection is very essential. When a legal structure is put in place, it is done so with careful consideration given to the scope of the subject matter. After a law is introduced, another aspect to consider is that the law does not go beyond what is required and all government actions must be limited to the set standards of the law

Assessment of Sleep Habits and Quality of Sleep among Elderly Residing in Rural Areas of Patiala: A Community-Based Cross-Sectional Survey

INTRODUCTION: Among the elderly, sleep problems are quite prevalent and can lead to many adverse health consequences. AIM: To assess the quality of sleep among the elderly residing in rural population and factors related to it, and provide necessary recommendations for its prevention. MATERIALS AND METHOD: In this cross-sectional study, elderly aged above 60 years residing in Patiala were taken and were interviewed separately using the modified version of the Pittsburgh Sleep Quality Index (PSQI), which was pre-tested and pre-validated prior to commencement of the study. Data recorded was divided into seven components and each component had an individual range of 0 (no difficulty) to 3 (severe difficulty) points and added to obtain a combined score of the individual with a range of 0(no difficulty)-21(severe difficulty) points. Based on the combined score,  elderly obtaining a total score of 5 or greater was classified as having  “poor sleep quality”. Statistics were applied using SPSS version 22.0, using the student’s t- test, and multivariate analysis. A p value < 0.05 was considered as significant. RESULTS: Out of 108 elderly people, most of the participants (62.9%) belonged to the age group of 60-75 years, out of which the majority (65.7%) were males. Most elderly reported having “fairly good” subjective sleep quality (53.7%, p=0.01) and was found to be significant with a global PQSI score of 7.22±4.31. Multivariate analysis revealed that significant “poor sleep quality” was observed in elderly aged above 75 years (OR:1.25, p=0.01) followed by elderly who were Immobilized (wheelchair/Bed ridden) (OR: 1.87, p=0.01). CONCLUSION: Efforts should be directed towards proper education of not only the elderly, but their children as well as colleagues and guardians to improve the sleep score of the elderly population

Dobbs V. Jackson Women's Health Organization (2022): A Case Comment

In June 2022, the US Supreme Court, in Dobbs v. Jackson with a 6:3 majority, overruled Roe and Casey and took away the constitutional right to abortion. The right was implicitly based on, among other things, the Liberty interest protected by the Fourteenth Amendment's Due Process Clause. In denying the right, the Supreme Court reasoned that to bring a new component of right into liberty, one must show that it was reasonably accepted as a right when the Fourteenth Amendment was adopted and ratified. Any other interpretation, the court held, would not be faithful to the constitutional text. In this commentary, it is argued that the court's historical analysis is a rudimentary method for interpreting abstract concepts like liberty which was envisaged for eternity. The case comment demonstrates that historically chained understanding of the constitutional text, especially its rights, is not instance best way to show fidelity to the constitutional text. The difference between "original meaning" and "original expected application" is significant. The comment further shows the judgment's possible unintended—but still cruel—consequence. Finally, it is concluded with a proposed alternative method of Reflective Equilibrium with an aspiration of visualising a seamless web of the components of the liberty principle

An Examination Of The Right To Private Defence In The Indian Penal Code

Every person in India has the right to self-defend against any external force that may cause harm or injury to them. It is using otherwise illegal means to protect oneself or another person, safeguard property or prevent any other crime. The provisions of Sections 96 to 106 of the Indian Penal Code 1860 govern every person in India's right to self-defence. Citizens of any free society should have the right to self-defence to protect themselves from any impending harm when governmental assistance is unavailable or unworkable. This right should be understood in conjunction with the state's obligation to safeguard its citizens and their property. It was granted to every citizen of India as a right to self-defence, but many people abuse it by using it as an excuse to commit any crime or offence. As a result, this right to private defence is subject to some limitations and restrictions. Though the right to private defence was granted to Indian individuals as a weapon for self-defence, it is frequently utilised for ill or unlawful reasons by many people. The court has the duty and obligation to evaluate whether the right was exercised in good conscience or not. Keywords- self-defence, safeguard, unlawful, section

Safety and effectiveness of intravenous iron sucrose versus standard oral iron therapy in pregnant women with moderate anaemia in India

Background: Aim of the study was to diagnose and treat pregnant females with iron deficiency anaemia, to reduce the complications associated with anaemia in pregnancy and to compare the efficacy, safety and side effects of iron sucrose with ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy. Methods: The subjects for study were enrolled on fulfilling the inclusion and exclusion criteria. After detailed history, examination and investigations of patient the dose of intravenous iron sucrose was calculated by using the following formula: dose of iron: 2.4 x Hb deficit (11-patient’s actual Hb) x body weight in kg + 500. The following investigations were done on day 1: (a) complete blood count (CBC)- Hb, MCV, MCH, MCHC and PCV; (b) urine examination. Patients was randomly allocated into two groups. Group-A: oral group- containing 150 pregnant females. Group-B: intravenous group- containing 150 pregnant females. Results: Majority of women (48%) were from lower middle class and lower class (30%). Only 5.3% were from higher socioeconomic class (p value 0.0001). Maximum women (60%) were primigravida and 40% were multigravida. which indicates that most ladies enter pregnancy with poor iron reserves. Improvement in the mean haemoglobin levels after 4 weeks of treatment was statistically significant in both the groups (p value 0.0001). Similarly rise in the mean PCV levels after 4 weeks of the treatment was significantly associated in both the groups (p value 0.0001). There was slight rise in the mean MCV and MCH after 4 weeks. Peripheral blood film had changed from microcytic hypochromic to normocytic normochromic after 4 weeks of the treatment in both the group (p value 0.004). Presence of side effects with the oral and parenteral treatment were 81.3% and 12% respectively (p value 0.0001). Conclusions: From our study, it can be concluded that intravenous iron sucrose has lesser side effects along with better absorption

Section 29 Of The Limitation Act Vis-A-Vis Portuguese Laws

Confusion on the applicability of the special law and then sudden repeal of it leads to denial of the suit where a valid cause of action arises. The judiciary has to be cautious of the measures while taking the action of repealing a special law. If the purpose of the code is to preserve the encompass diversity in the field, then the approach should be taken in a holistic manner rather being blind-sighted on a particular approach for repealing and not weighing the other one possible which saves the law