Crisis preparedness and debt management in low income countries : strengthening institutions and policy frameworks

The magnitude of the public liabilities incurred as a result of the unprecedented government action in the wake of the financial crisis of 2008-2009, and the consequences of exiting from the projected high debt scenario, have become a major source of concern about a future sovereign debt crisis. As Low-Income Countries (LICs) face unique challenges in debt management (DeM) due to their more limited financing sources and higher capacity constraints, their ability to successfully manage their public debt burdens effectively through a crisis of this magnitude is far from assured. Therefore, the challenges of the last two years will require a re-evaluation of existing DeM strategies in LICs, focusing on the identification of institutional weaknesses and the assessment and mitigation of potential risk. It is in this context that this paper examines the application of two global public goods in LICs: the Debt Management Performance Assessment (DeMPA) and the Medium-Term Debt Management Strategy (MTDS) tools. The results of the application of these tools from 2007-2009 provide valuable information to policymakers and other stakeholders on the development of sound public DeM practices and analytical capacity, with the goal of strengthening the public balance sheet and reducing vulnerability to financial crises.Debt Markets,External Debt,Access to Finance,Emerging Markets,Banks&Banking Reform

Comparative study of intraoperative application of daunorubicin and conjunctival autograft in primary pterygium surgery: an interesting followup study

Background: The exact aetiology and pathogenesis of pterygium remains unclear but it is more common in people with excessive outdoor exposure to sunlight and wind, such as those who work outdoors. Pterygium is of great concerns to both surgeons and patients, as it has been shown to recur in up to 97% of patients within one year after surgical removal. Different adjuvant procedures like lamellar corneal graft, irradiation etc. to prevent recurrence is not encouraging. Of late a new anticancer drug named Daunorubicine (0.02%) has been used intraoperatively in pterygium surgery by one of the study with promising results. Pterygium excision with Conjunctival Autografting is very popular technique to prevent recurrence with very few side effects. This is being tried out with success in different country.Methods: The study was carried out on 60 patients who presented to the eye department at Darbhanga medical college and hospital, Laheriasarai (Bihar), India during the period from May 2005 to may 2006, & was analysed retrospectively. Efforts were made to select patients with primary fleshy pterygium.Patients selected were divided into two groups group 1 & group 2. All patients under this study were suggested to a thorough general & ocular examination. Pterygium excision in all selected cases was done under topical 4% lignocaine drop & subconjunctival injection of 2% lignocaine with adrenaline; pterygium was slowly dissected out. After the pterygium was removed from over the cornea subconjunctival dissection of the fleshy mass was done. The graft, over the scleral bed, was smoothed & spread out; the suture is done with 10-0 nylon. Post – operative management was done. The subsequent checkups were on 15th post-operative day, at 1st month, 3rd month & 6th month & same procedures were followed up to 1 year. Data was compiled in MS-Excel and checked for its completeness and correctness. Then it was analyzed.Results: Majority of patients was of age group ranged from 31 years to 50 years. 11 patients were less than 30 years of age. In group I, out of 30 eyes of 30 patients three eyes (10 %) had bilateral pterygium (both nasal and temporal). Two eyes (6.7%) had temporal pterygium. Rest 25 eyes (83.3%) had pterygium located nasally. In group II, out of 30 eyes of 30 patients two eyes (6.7%) had bilateral pterygium. Three eyes (10%) had temporal pterygium. Rest twenty five eyes (83.3%) had pterygium located nasally. Improvement of visual acuity in most of the patient after pterygium surgery. In group I, out of 30 eyes, two patients had developed recurrence, so the recurrence rate in group I is 6.6 %. In group II, out of 30 eyes, one patient had developed recurrence. So the recurrence rate in group II is 3.3%.Conclusions: The present study concluded that both the procedures are equally effective adjuncts to prevent recurrence in pterygium surgery.

Impact of COVID-19 Nationwide Lockdowns and Unlock Phases in India on River Water Quality of Upper Part of the Ganga River

The river water quality index (RWQI) of the upper Ganga canal has been computed to assess the effect of lockdown and unlock phases lead down by COVID-19 in India. Geospatial distribution of RWQI from January 2019 to December 2021 in the study area revealed significant impacts of lockdown on water quality. However, unlock phases (post lockdown) have deteriorated water quality since August 2020 and reached to actual conditions of the river by August 2021. To evaluate the lockdown as a management strategy to clean the river, other factors were reviewed including rainfall data, migration, and other activities. The results revealed that all the monitoring stations have improved water quality index ranging from 3 to 45 between March to June 2020. The River Ganga at Haridwar showed a two-fold improvement in the water quality index making it the highest positive impact of the lockdown, and at Rishikesh, the water quality index showed the least changes. The average decrease in RWQI has been observed to be 13 units in the year 2020 as compared to 2019 between March to June. In October 2020, RWQI has been observed to be higher as compared to the years 2019 and 2021. This is possibly due to a shift in rainfall patterns and other factors such as evapotranspiration, precipitation, and atmospheric temperature involved in river water quality control. Up to 60% reduction in average total coliforms and fecal coliforms has been observed due to the nationwide lockdown and a shift in human behavior towards cleaner and sustainable approaches

MICROBIOLOGIC SPECTRUM OF ACUTE AND CHRONIC DACRYOCYSTITIS

Introduction: The aim of this study is to report the microbiological spectrum of dacryocystitis and the antibiotic sensitivity patterns of the organisms. It was a prospective study done at Department of Ophthalmology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune in 2015 on 42 cases of dacryocystitis. Methodology: Patients were diagnosed with dacryocystitis and on the presence of a pus-filled lacrimal sac and peri lacrimal tissues for acute dacryocystitis. Chronic dacryocystitis patients were diagnosed by ROPLAS Test and sac syringing and were reviewed for demographic and microbiological profile.The culture results, organisms isolated, and their antibiotic sensitivity were studied. Results: In this study 42 clinical samples were evaluated, among them 33(78.5%) were culture positive and rest were reported as no growth 9(21.5%). Among all positive growth, Staphylococcus aureus encountered as the commonest isolate (56%) followed by Streptococcus pneumoniae (2%) among the Gram-positive organisms .In the Gram-negative organisms, Escherichia coli (23%) followed by Pseudomonas aeruginosa (17%) was seen. Gram-positive organisms were commonly sensitive to flouroquinolones, penicillins and vancomycin whereas gram-negative organisms were sensitive to aminoglycosides. Conclusion: Gram-positive and Gram-negative organisms were predominant in this study. The result has significant bearing on the treatment of patients and also when mass cataract surgeries are being performed

A COMPARATIVE STUDY OF INTRAVENOUS METHYL PREDNISOLONE VERSUS DEXAMETHASONE IN MANAGEMENT OF PATIENTS WITH POSTERIOR SCLERITIS

Introduction: Posterior scleritis is a relatively uncommon condition and often misdiagnosed due to varied manifestations. The main stay of treatment is systemic steroids and immunosuppressive therapy. The present study was done to compare the effect of intravenous methyl prednisolone and the conventional intravenous dexamethasone in management of patients diagnosed with posterior scleritis at a tertiary eye care center. Methodology: It was a retrospective comparative study of 6 patients of posterior scleritis at a tertiary eye care center which were treated primarily with intravenous methylprednisolone or dexamethasone. Group A and B comprised of 3 patients each. Group A patients were started on intravenous Methylprednisolone therapy wherein a dose of 1gm in 500ml of 5% Dextrose was infused over 2 hours under cardiac monitoring for 3 days. Group B patients were administered 08 mg intravenous Dexamethasone twice daily for first 3 days. Subsequently on 4th day patients of both groups were switched over to 1.5 mg/ kg body weight of oral Prednisolone therapy in tapering dose. Results: control of pain and inflammation was achieved faster in group A patients treated with intravenous methylprednisolone as compared with group B patients receiving intravenous dexamethasone. Though the final visual and clinical outcomes were nearly the same. Conclusion: Patients of posterior scleritis treated with intravenous Methylprednisolone had a quicker and a more effective response when instituted early in the disease in comparison to Intravenous dexamethasone

Targeting Apoptotic Pathway of Cancer Cells with Phytochemicals and Plant-Based Nanomaterials

Apoptosis is the elimination of functionally non-essential, neoplastic, and infected cells via the mitochondrial pathway or death receptor pathway. The process of apoptosis is highly regulated through membrane channels and apoptogenic proteins. Apoptosis maintains cellular balance within the human body through cell cycle progression. Loss of apoptosis control prolongs cancer cell survival and allows the accumulation of mutations that can promote angiogenesis, promote cell proliferation, disrupt differentiation, and increase invasiveness during tumor progression. The apoptotic pathway has been extensively studied as a potential drug target in cancer treatment. However, the off-target activities of drugs and negative implications have been a matter of concern over the years. Phytochemicals (PCs) have been studied for their efficacy in various cancer cell lines individually and synergistically. The development of nanoparticles (NPs) through green synthesis has added a new dimension to the advancement of plant-based nanomaterials for effective cancer treatment. This review provides a detailed insight into the fundamental molecular pathways of programmed cell death and highlights the role of PCs along with the existing drugs and plant-based NPs in treating cancer by targeting its programmed cell death (PCD) network

Clinical and Electrophysiological Profile of Chronic Kidney Disease Patients Undergoing Peritoneal Dialysis at a Tertiary Care Centre of Bihar

Chronic kidney disease (CKD) is a progressive decline in renal function, which is responsible for significant morbidity and mortality. The present study was carried out to assess prevalence of peripheral neuropathy in CKD patients on PD patients with special emphasis on electrophysiological parameters and severity of peripheral neuropathy and its relation with diabetes mellitus. Methodology: During the period from November 2020 to April 2020, 50 consecutive patients diagnosed to have CKD and are on OPD at J.N.K.T. Medical College, Madhepura, Bihar, India were included in the present study. Patients with pre-existing peripheral neuropathy prior to the diagnosis of CKD were excluded from the present study. The study was approved by the Institutional Ethics Committee and written informed consent was obtained from the patients for their participation in the study. The patients were divided into two equal groups, randomly: Group 1 included 25 diabetic patients Group 2 included 25 nondiabetic patients. All cases were subjected to nerve conduction studies (NCS) using Medelec synergy and Natus machines. NCS procedure was done for both motor conductions and sensory conductions. Median nerve, ulnar nerve, common peroneal nerve, and posterior tibial nerve were assessed for motor conductions. Median nerve, ulnar nerve, and sural nerve were assessed for sensory conductions. Results: The prevalence of peripheral neuropathy among the study participants was 62% (31 out of 50) based on clinical symptoms and 80% (40 out of 50) based on electrophysiological parameters. Based on electrophysiological data, prevalence of peripheral neuropathy in CKD patients on PD with DM and without DM was 100% and 60%, respectively. Conclusion: Rationale management of diabetes in CKD patients on PD probably lowers the prevalence and severity of peripheral neuropathy

A study on correlation of serum uric acid level and glycemic control among patients of type II Diabetes Mellitus at a tertiary care center of Bihar

Introduction: Diabetes mellitus is a metabolic disorder which is characterized by hyperglycaemia and insufficiency of the secretion or the action of endogenous insulin. Although the aetiology of the disease has not been well defined, viral infections, autoimmune diseases, and environmental factors have been implicated. With this background, the present study was undertaken to find the correlation of the serum uric acid and the glycemic control in patients with type 2 Diabetes mellitus. The proxy indicator used for glycemic control here was glycated hemoglobin level (HbA1C). Methodology: The present case control study was undertaken in the Department of Physiology of J.N.K.T. Medical College, Madhepura, Bihar, India. The study period was 6 months that was from May 2020 to October 2020. Prior ethical approval was obtained from the Institutional ethics committee. The subjects who were included in this study were divided into 2 groups: Group A included 20 normal healthy individuals, in the age group 40-65 years, of either sex and without any family history of DM. Group B included 20 diagnosed patients of Type 2 Non-Insulin Dependent Diabetes mellitus (NIDDM), who were in the age group 40-65 years, of either sex, from the same population. Results: The mean age of the patients in group A was 31.8 ± 7.9 years and that of patients in group B was 33.6 ± 6.8 years. In the control group, there was a slight male predominance with 55% being male, while in the study group, female dominant with 75%. There was no statistical difference between both the groups based on gender and age. The mean FBS level of group A was 76.2 ± 8.3 mg/dl and that of group B was 144.9 ± 62.4 mg/dl, which was significantly higher than that of group A (p < 0.05). Conclusion: In conclusion, our study suggests that there is an increase in the serum uric acid levels with an increase in the HbA1C levels. This showed a positive relationship in Type 2 Diabetes mellitus

Repetitive transcranial magnetic stimulation in geriatric psychiatry: A clinical overview

Repetitive transcranial magnetic stimulation (rTMS) has been used widely in adult patients with depression and resistant auditory hallucinations. There is a paucity of data for rTMS use in geriatric patients for these indications. Recent research has revealed newer avenues for the use of rTMS in clinical geriatric psychiatry practice which includes mild cognitive impairment and dementia. rTMS is also being looked at as an effective treatment when combined with cognitive training in the management of Alzheimer's disease. The present review discusses the various uses of rTMS in geriatric psychiatry. This paper analyzes the various studies done with rTMS in older patients in various indications and the safety and efficacy of the procedure are also evaluated. The need for further studies in this area using larger samples is also mentioned