Satisfaction Level of Patients Visiting Outpatient Department in a Tertiary Care Hospital of Delhi - A Cross-Sectional Study

Introduction: Patient satisfaction is considered to be one of the important parameters in the assessment of quality of healthcare and overall performance of a healthcare facility.Objectives: To assess the utilization of health services and patient satisfaction for services provided by this tertiary care center.Material and Methods: The present study was a hospital-based, cross-sectional study conducted in a tertiary care center situated in South Delhi from March 9 to June 8, 2016 (3 months). Patients of age >18 years visiting the OPD who gave their informed written consent were interviewed by using a pre-tested, semi-structured questionnaire. The responses of patients were divided into three categories-satisfied, uncertain and dissatisfied.Statistical Analysis: The surveyed questionnaires were collected and coded in an MS Excel database and analyzed by using the SPSS statistical package, version 21.0. Descriptive statistics were performed on the sociodemographic data.Results: A total of 313 patients had participated in the present study. Most (53.4%) of the patients were of age group 21-40 years. Majority (60.1%) of them were male. Nearly 80% were literate. It was found that 89.9% patients were satisfied with the overall behavior of hospital staff. It was revealed that 87.4% of the patients were satisfied with the good healthcare services provided by the hospital. 7.1% patients were dissatisfied with the healthcare services. They found insufficient healthcare facilities in this hospital. 5.2% patients were uncertain.Conclusion: Dissatisfaction among some patients triggers an alarm for hospital management to work on those components so that quality health services can be provided to all patients to make them satisfied. Periodic patient satisfaction survey should be institutionalized to provide feedback for continuous quality improvement

Awareness of consequences of obesity on reproductive health problems among women in an urban area in South India

Background: Obesity is a well-known risk factor for number of non-communicable diseases. There is paucity of data however with regard to awareness of its consequences on reproductive health hazards.Methods: Data was collected from 208 women aged ≥18 years from households chosen by systematic random sampling in an urban area.Results: The mean age of participants was 41.4±14.2 years. Majority of them completed their graduation [109(52.4%)] and were housewives [80(38.5%)]. Most of them were married [167(80.3%)]. Out of 208 study participants, 166(79.8%) knew that obesity adversely affects reproductive health causing problems like PIH [156(75.0%)], GDM [150(72.1%)], menstrual irregularities [130(62.5%)], infertility [117(56.2%)], decreased efficacy of hormonal contraception [84(40.4%)], premature delivery [67(32.2%)], miscarriages [66(31.7%)] and fetal malformations [55(26.4%)] during pregnancy. Difficulties during delivery [137(65.9%)], higher chances of caesarean section [130(62.4%)], infections [36(17.3%)] and PPH [33(15.9%)] in the intra and post natal period were also known to participants. Majority of women [158(76%)] had average awareness level regarding consequences of obesity on their reproductive health. Only 21(10.1%) had good awareness. Source of information among majority of participants was media [116(55.8%)]. Good awareness level was significantly more among those aged ≤ 25 years (p=0.03), with higher level of education (p=0.038), nulligravida (p=0.037) and professionals (p=0.02).Conclusions: Awareness generation on consequences of obesity on reproductive health is required to bring about behavioral change regarding obesity prevention among women in the setting.

Clean coal technology to improve environmental qualtiy and energy efficiency

Coal is the world’s most abundant and widely distributed fossil fuel source. It is a major source of commercial energy in the present scenario. Coal currently supplies over one third of the world’s electricity and 23% of global primary energy needs. Conventional power generation system, though one of the cheapest means of production of electricity in the world, have energy efficiency only 30-35%. However, it has enormous environmental impact which includes emission of large amount of gases like CO2, SO2, NOx, and Hg, particulate matter which primarily includes fly ash. This is responsible for global warming and air and water pollution. To reduce this environmental impact due to emissions from thermal power plant and to meet the quality requirements of the coal consumers, it is imperative to adopt clean coal technologies. “Clean coal” is a term used in the promotion of the use of coal as an energy source by emphasizing methods being developed to reduce its environmental impact. This paper addresses advanced power generation systems like integrated gasification combined cycle (IGCC) system and underground coal gasification (UCG) which claim to have energy efficiency in the rage of 45-50%. Carbon capture and storage (CCS) technology for capturing emitted CO2 and storing it in geological formation appears to be one of the efficient means to reduce CO2 in the atmosphere. This technology has also been enumerated in this paper. An account for global and Indian initiatives for clean coal technology is given. Clean coal mining operation along with coal preparation technology practiced in India is also discussed in brief

Pure Foamy Gland Carcinoma of Prostate - A Series of Rare Cases

Foamy gland carcinoma (FGC) is a distinct histological variant of prostatic acinar adenocarcinomas. It was first described by Epstein and Nelson in 1996. It is characterized by abundant xanthomatous cytoplasm, pyknotic nuclei, and intermediate Gleason grade. However, FGC with a high Gleason grade exists. FGC is found admixed with conventional acinar adenocarcinoma in 17 to 22% of needle biopsies and 13 to 22% of radical prostatectomy specimens and only rarely found in pure form. We report six cases of pure foamy gland carcinoma of prostate. The mean age in our study was 62.83 years and 5 out of the 6 cases presented with an elevated serum PSA level. Histopathological examination of our cases showed tumor cells with abundant foamy cytoplasm and low nucleo-cytoplasmic ratio. This deceptively benign-looking morphology can mimic nonneoplastic prostatic glands, Cowper’s gland, mucinous metaplasia, and xanthomatous prostatitis and hence often pose diagnostic challenges, especially in core needle biopsies. PNI was detected in two of our cases. PSA and AMACR staining was positive in all our cases (100%). p63 Staining was negative in all four cases where it was performed. Three, two, and one of our cases had a Gleason score of 7, 8, and 6 respectively. The prognosis depends on the Gleason score and the presence or absence of PNI or extraprostatic extension. Three of the cases presented with bony metastasis. We report this case series in view of the rarity and also to raise awareness of this entity which is often missed on small biopsies. Keywords: Foamy gland carcinoma, Gleason score, Prostat

Recent Trends in In-silico Drug Discovery

A Drug designing is a process in which new leads (potential drugs) are discovered which have therapeutic benefits in diseased condition. With development of various computational tools and availability of databases (having information about 3D structure of various molecules) discovery of drugs became comparatively, a faster process. The two major drug development methods are structure based drug designing and ligand based drug designing. Structure based methods try to make predictions based on three dimensional structure of the target molecules. The major approach of structure based drug designing is Molecular docking, a method based on several sampling algorithms and scoring functions. Docking can be performed in several ways depending upon whether ligand and receptors are rigid or flexible. Hotspot grafting, is another method of drug designing. It is preferred when the structure of a native binding protein and target protein complex is available and the hotspots on the interface are known. In absence of information of three Dimensional structure of target molecule, Ligand based methods are used. Two common methods used in ligand based drug designing are Pharmacophore modelling and QSAR. Pharmacophore modelling explains only essential features of an active ligand whereas QSAR model determines effect of certain property on activity of ligand. Fragment based drug designing is a de novo approach of building new lead compounds using fragments within the active site of the protein. All the candidate leads obtained by various drug designing method need to satisfy ADMET properties for its development as a drug. In-silico ADMET prediction tools have made ADMET profiling an easier and faster process. In this review, various softwares available for drug designing and ADMET property predictions have also been listed

When Silent Actors Talk: Bodies as Learning Infrastructure in the Post-Pandemic World

This paper is based on a qualitative research study that explored the lived experiences of 25 high school students when they first transitioned to online learning during the Covid-19 lockdown. The objectives of the study were to describe the lived experiences of high school students who transitioned to online learning during the lockdown in terms of their learning, and their mental and physical wellbeing; and to map the resources and strategies deployed by the students to navigate difficult circumstances of studying during a global public health crisis. The study employs actor network theory in education, a sociomaterial approach, in identifying the silent taken-for-granted human and non-human actors that constitute learning infrastructures whose presence and effects become visible only during infrastructural breakdowns such as the pandemic. The findings are organized into four themes each of which identify different aspects of the resources, that is, learning infrastructures needed for high school students to learn well. The first theme describes how learners are affected by the shift in the responsibility of providing learning infrastructure from private schools to private homes. While the second theme focuses on how historically developed classroom surveillance mechanisms play out when the body is no longer visible, the third theme explores how bodies can be envisioned as technologies of engagement. The last theme explores how students as integral beings respond physically and emotionally to the learning process. The findings of the study have implications for policymakers, school leadership, and educators to expand their understandings of learning infrastructures needed for learning in post-pandemic online and offline contexts

A multicentric evaluation of dipstick test for serodiagnosis of visceral leishmaniasis in India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain

Author Correction: A multicentric evaluation of dipstick test for serodiagnosis of visceral leishmaniasis in India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain PMID: 33574485Visceral leishmaniasis (VL) is one of the leading infectious diseases affecting developing countries. Colloidal gold-based diagnostic tests are rapid tools to detect blood/serum antibodies for VL diagnosis. Lack of uniformity in the performance of these tests in different endemic regions is a hurdle in early disease diagnosis. This study is designed to validate a serum-based dipstick test in eight centres of six countries, India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain with archived and fresh sera from 1003 subjects. The dipstick detects antibodies against Leishmania donovani membrane antigens (LAg). The overall sensitivity and specificity of the test with 95% confidence intervals were found to be 97.10% and 93.44%, respectively. The test showed good sensitivity and specificity in the Indian subcontinent (>95%). In Brazil, Ethiopia, and Spain the sensitivity and specificity of the dipstick test (83.78-100% and 79.06-100%) were better as compared to the earlier reports of the performance of rK39 rapid test in these regions. Interestingly, less cross-reactivity was found with the cutaneous form of the disease in Spain, Brazil, and Sri Lanka demonstrating 91.58% specificity. This dipstick test can therefore be a useful tool for diagnosing VL from other symptomatically similar diseases and against cutaneous form of leishmaniasis.S

Enhancer Reprogramming Confers Dependence on Glycolysis and IGF Signaling in KMT2D Mutant Melanoma.

Histone methyltransferase KMT2D harbors frequent loss-of-function somatic point mutations in several tumor types, including melanoma. Here, we identify KMT2D as a potent tumor suppressor in melanoma through an in vivo epigenome-focused pooled RNAi screen and confirm the finding by using a genetically engineered mouse model (GEMM) based on conditional and melanocyte-specific deletion of KMT2D. KMT2D-deficient tumors show substantial reprogramming of key metabolic pathways, including glycolysis. KMT2D deficiency aberrantly upregulates glycolysis enzymes, intermediate metabolites, and glucose consumption rates. Mechanistically, KMT2D loss causes genome-wide reduction of H3K4me1-marked active enhancer chromatin states. Enhancer loss and subsequent repression of IGFBP5 activates IGF1R-AKT to increase glycolysis in KMT2D-deficient cells. Pharmacological inhibition of glycolysis and insulin growth factor (IGF) signaling reduce proliferation and tumorigenesis preferentially in KMT2D-deficient cells. We conclude that KMT2D loss promotes tumorigenesis by facilitating an increased use of the glycolysis pathway for enhanced biomass needs via enhancer reprogramming, thus presenting an opportunity for therapeutic intervention through glycolysis or IGF pathway inhibitors

Association between Incidental Pelvic Inflammation and Aggressive Prostate Cancer

The impact of pelvic inflammation on prostate cancer (PCa) biology and aggressive phenotype has never been studied. Our study objective was to evaluate the role of pelvic inflammation on PCa aggressiveness and its association with clinical outcomes in patients following radical prostatectomy (RP). This study has been conducted on a retrospective single-institutional consecutive cohort of 2278 patients who underwent robot-assisted laparoscopic prostatectomy (RALP) between 01/2013 and 10/2019. Data from 2085 patients were analyzed to study the association between pelvic inflammation and adverse pathology (AP), defined as Gleason Grade Group (GGG) > 2 and ≥ pT3 stage, at resection. In a subset of 1997 patients, the association between pelvic inflammation and biochemical recurrence (BCR) was studied. Alteration in tumor transcriptome and inflammatory markers in patients with and without pelvic inflammation were studied using microarray analysis, immunohistochemistry, and culture supernatants derived from inflamed sites used in functional assays. Changes in blood inflammatory markers in the study cohort were analyzed by O-link. In univariate analyses, pelvic inflammation emerged as a significant predictor of AP. Multivariate cox proportional-hazards regression analyses showed that high pelvic inflammation with pT3 stage and positive surgical margins significantly affected the time to BCR (p ≤ 0.05). PCa patients with high inflammation had elevated levels of pro-inflammatory cytokines in their tissues and in blood. Genes involved in epithelial-to-mesenchymal transition (EMT) and DNA damage response were upregulated in patients with pelvic inflammation. Attenuation of STAT and IL-6 signaling decreased tumor driving properties of conditioned medium from inflamed sites. Pelvic inflammation exacerbates the progression of prostate cancer and drives an aggressive phenotype.</p