EFFECT OF NIRGUNDI (VITEX NEGUNDO LINN.) PATRA ARKA AS ASCHOTHANA (EYE DROPS) IN CATARACT-A CLINICAL STUDY

Purpose: Age-related cataract is one of the leading causes of blindness and avoidable visual impairment in the world. There is no time-tested, FDA-approved, or clinically proven medical treatment exists till date to delay, prevent, or reverse the progression of senile cataract. Nirgundi (Vitex negundo) is a Chakshushya single drug mentioned in Ayurvedic classics. Various animal experimental study and invitro studies in recent years using flavonoids extracted from leaves of Vitex negundo on selenite induced cataract models proved to be beneficial in arresting the progression of cataract. Hence a clinical study with Vitex negundo eye drops in the form of Arka was planned with primary objective to assess the effect of Nirgundi patra arka as Aschotana (eye drops) in pre senile cataract. Methods: The study design was interventional pre and post evaluation without control. Patients were advised to instill Nirgundi patra arka two drops thrice daily i.e. 6 am, 12 pm and 6pm for a period of 6months. Log mar visual acuity score and contrast sensitivity score were recorded before treatment, 3rd month of treatment, after treatment, 9th month (1st follow up) and 12th month (2nd follow up). Slit lamp photographs were recorded before treatment and 12th month. Study and follow up were done in 31 eyes. Result: The intervention is statistically significant while considering visual acuity and contrast sensitivity. All the 27 cases of nuclear cataract responded to the intervention, while only 83.3% of posterior sub capsular cataract and 60% of cortical cataract showed response. But the change was not significant statistically. Conclusion: The intervention was effective in improving visual acuity and contrast sensitivity in all types of pre senile cataract. Clinical assessment revealed the study was effective in preventing the progression of pathogenesis in early stage of nuclear cataract

Complex interventions to implement a diabetic retinopathy care pathway in the public health system in Kerala: the Nayanamritham study protocol

Introduction: Using a type 2 hybrid effectiveness-implementation design, we aim to pilot a diabetic retinopathy (DR) care pathway in the public health system in Kerala to understand how it can be scaled up to and sustained in the whole state. Methods and analysis: Currently, there is no systematic DR screening programme in Kerala. Our intervention is a teleophthalmology pathway for people with diabetes in the non-communicable disease registers in 16 family health centres. The planned implementation strategy of the pathway will be developed based on the discrete Expert Recommendations for Implementing Change taxonomy. We will use both quantitative data from a cross-sectional study and qualitative data obtained from structured interviews, surveys and group discussions with stakeholders to report the effectiveness of the DR care pathway and evaluation of the implementation strategy. We will use logistic regression models to assess crude associations DR and sight-threatening diabetic retinopathy and fractional polynomials to account for the form of continuous covariates to predict uptake of DR screening. The primary effectiveness outcome is the proportion of patients in the non-communicable disease register with diabetes screened for DR over 12 months. Other outcomes include cost-effectiveness, safety, efficiency, patient satisfaction, timeliness and equity. The outcomes of evaluation of the implementation strategies include acceptability, feasibility, adoption, appropriateness, fidelity, penetration, costs and sustainability. Addition of more family health centres during the staggered initial phase of the programme will be considered as a sign of acceptability and feasibility. In the long term, the state-wide adoption of the DR care pathway will be considered as a successful outcome of the Nayanamritham study. Ethics and dissemination: The study was approved by Indian Medical Research Council (2018-0551) dated 13 March 2019. Study findings will be disseminated through scientific publications and the report will inform adoption of the DR care pathway by Kerala state in future

Dual institutional embeddedness and home country CSR engagement : evidence from Indian MNEs

This study contributes to the international corporate social responsibility (CSR) literature and emerging market multinationals research by examining the influence of dual institutional embeddedness on home country CSR engagement in the understudied context of Indian multinational enterprises (MNEs). Specifically, we study the role of internationalization, depth of involvement in stringent CSR contexts, and implementation of mandatory CSR regulation in the home country on the domestic CSR engagement of Indian MNEs. Our results indicate that heterogeneous institutional pressures experienced by firms embedded in dual institutional contexts encourage greater home country CSR engagement

Corporate investments in tax havens : evidence from India

Little is known about the drivers of corporate investments in tax havens from emerging markets. This paper offers extensive descriptive statistics and regression analysis to illustrate the patterns and motivations for tax haven investments by Indian firms over the 2007-2017 period. We find that the motivations for Indian firms to invest in tax havens are not only driven by the benefits of tax avoidance and secrecy of these jurisdictions, but also to seek strategic advantage and efficiency gains in global markets