Supply chain partnership assessment of a diabetes clinic

Purpose Diabetes is one of the major healthcare challenges in India. The chronic nature of the disease makes the lifetime cost of the treatment exorbitantly high. The medicine cost contributes a major size of expense in diabetes management. To make healthcare available to poorest of the poor, it is imperative to control the rising cost of diabetes treatment. The earlier research works done in this area focuses more on inventory management techniques to control the cost of healthcare. Less interest is shown in the role of better supply chain partnership (SCP) in reducing the cost of procurement of medicine. The purpose of this paper is to develop and use the SCP assessment framework for a diabetes clinic. The approach is generalized enough to be adopted for other similar organization. Design/methodology/approach This paper adopts self-assessment criteria of the European Foundation for Quality Management (EFQM) business excellence model for analysis of SCP in the supply chain of a private diabetes clinic in Varanasi. The paper uses analytic hierarchy process (AHP) method for calculation of weights of criteria. Findings The EFQM-based framework can be adopted as easy-to-use tool to make an objective assessment of the SCP. The proposed model in the study is a balanced model between enablers and results, which includes multiple assessment dimensions. The supply chain performance score of the diabetes clinic under study was found as the Tool Pusher, which means the effort in direction of SCP is not too good. The organization needs to clearly define the SCP goal and analyze the results to identify the gap areas. Originality/value The study is first of its kind and contributes to the literature by providing non-prescriptive and easy-to-use SCP assessment framework, for chronic disease care. The case study approach provides a procedure for the healthcare organization willing to adopt this approach.

Physico-chemical characteristics and hydrogeological mechanisms in groundwater with special reference to arsenic contamination in Barpeta District, Assam (India)

Deterioration in the groundwater quality is prevalent in many parts of the eastern and north-eastern India; however, little attention has been paid for its assessment. In order to evaluate the groundwater suitability in the north-eastern region of India, this study was carried out in Barpeta District of Assam. The groundwater samples were collected from various locations to represent the overall water quality of the district. Suitability was assessed in terms of its usability for drinking and irrigation. It was found that the groundwater samples are contaminated with high amount of arsenic, which refers that water is unfit for consumption as well as agricultural activities. Hydrogeological studies revealed that regional geological factors might be responsible for excess arsenic concentration in the region. Overall, groundwater quality was found to be alkaline having moderate hardness with high amount of iron, manganese, and lead as well.

Evaluation of multiplex polymerase chain reaction as an alternative to conventional antibiotic sensitivity test

Aim

This study was designed to evaluate the potential of the use of multiplex polymerase chain reaction (PCR) as an alternative to conventional antibiotic sensitivity test.

Materials and Methods

Isolates of Staphylococcus aureus (total = 36) from clinical cases presented to Teaching Veterinary Clinical Complex of College of Veterinary and Animal Sciences (CVAS), Navania, Udaipur, were characterized by morphological, cultural, and biochemical methods. Then, the isolates were further subjected to molecular characterization by PCR targeting S. aureus-specific sequence (107 bp). Phenotypic antibiotic sensitivity pattern was analyzed by Kirby-Bauer disc diffusion method against 11 commonly used antibiotics in veterinary medicine in and around Udaipur region. The genotypic antibiotic sensitivity pattern was studied against methicillin, aminoglycosides, and tetracycline targeting the gene mecA, aacA-aphD, and tetK by multiplex PCR.

Results

There was 100% correlation between the phenotype and genotype of aminoglycoside resistance, more than 90% correlation for methicillin resistance, and 58.3% in the case tetracycline resistance.

Conclusion

As there is a good correlation between phenotype and genotype of antibiotic resistance, multiplex PCR can be used as an alternative to the conventional antibiotic susceptibility testing, as it can give a rapid and true prediction of antibiotic sensitivity pattern.

Carbonaceous Species of PM2.5 in Megacity Delhi, India During 2012-2016

Organic carbon (OC) and elemental carbon (EC) in PM_2.5 were estimated to study the seasonal and inter-annual variability of atmospheric total carbonaceous aerosols (TCA) at an urban site of megacity Delhi, India for 5 years from January, 2012 to December, 2016. The annual average (± standard deviation) concentrations of PM_2.5, OC, EC and TCA were 128 ± 81, 16.6 ± 12.2, 8.4 ± 5.8 and 34.5 ± 25.2 µg m^-3, respectively. During the study, significant seasonal variations in mass concentrations of PM_2.5, OC, EC and TCA were observed with maxima in winter and minima in monsoon seasons. Significant correlations between OC and EC, and OC/EC ratio suggested that vehicular emissions, fossil fuel combustion and biomass burning could be major sources of carbonaceous aerosols of PM_2.5 at the sampling site of Delhi, India.

Comparative Evaluation of a 6MV Flattened Beam and a Flattening Filter Free Beam for Carcinoma of Cervix – IMRT Planning Study

Purpose:

Intensity modulated radiotherapy (IMRT) plan quality, beam on time and integral dose were compared using 6MV FB (Flattened Beam) and FFFB (Flattening filter free beam) for carcinoma of cervix.

Materials and Methods:

Ten patients with stage II–IIIB cervix cancer (Ca.Cx) were retrospectively identified from the department database. Target volume (TV) and organ at risk (OAR) were delineated as per Radiation Therapy Oncology Group (RTOG) cancer guidelines. Dose prescribed to planning target volume (PTV) was 50.4Gy in 28 fractions. Two plans (6MV FB IMRT and 6MV FFFB IMRT) were generated to achieve 95% of prescription dose to PTV and sparing OAR as per normal tissue guidelines. Numbers of beams and their orientations were the same for all plans. The homogeneity index (HI), conformity index (CI), treatment monitor unit (MU), beam on time (BOT) and non-tumor integral dose (NTID) were chosen for comparison.

Results:

FFFB generated plans were clinically acceptable. There was a statistically significant difference among the FB IMRT and FFFB IMRT plans with respect to CI, HI, D50%, D2% in PTV coverage, bladder V50Gy, MU, mean NTID and non-tumor low dose volume.

Conclusions:

6MV flattened and flattening filter free photon beams produce comparable plans by IMRT. FFF beams allow time efficient treatment delivery and may help reduce the risk of secondary malignances in carcinoma cervix cases.

Unraveling the sub-nanoscopic structure at interphase in a poly(vinyl alcohol)-MOF nanocomposite, and its role in thermo-mechanical properties

A microscopic model of the interfacial region is required to improve understanding of the role of local structure in bulk physical properties in metal organic framework-based polymer nanocomposites. A zeolitic imidazolate framework (ZIF-8)-based (loading 2-30 wt%) composite of poly vinyl alcohol (PVA) is studied as a model system to investigate the role of interfacial interaction in molecular packing, glass transition process and tensile properties. Attractive interfacial interaction between the surface of ZIF particles and PVA chains is established by Fourier transform infra red (FTIR) measurements. The morphology of the nanocomposites is characterized using X-ray diffraction and scanning electron microscopy (SEM), showing that aggregation of particles started from 5 wt% of ZIF-8. At low loadings, occurrence of two glass transitions measured using differential scanning calorimetry indicates two spatial zones, viz. interphase and bulk layers, of different packing density in the PVA matrix. With increase in loading, molecular packing throughout the polymer matrix is changed as the interparticle distance and interphase width become comparable. At the highest loading, PVA shows bulk glass transition temperature because of the non-significant volume fraction of interphase resulting from aggregation of ZIF. Molecular packing (free volume structure) of PVA in the nanocomposites is investigated using ortho-positronium lifetime distributions, which show that large vacant spaces are created at the interfacial region leading to a low-density interphase. The existence of a low-density interphase is also supported by bulk-density measurements of the nanocomposites. Tensile testing measurements show a decrease in ductility of the nanocomposites, indicating enhancement in rigidity of polymer chains at the interfacial region because of attractive interfacial interaction. This study indicates that the polymer chain framework at the interfacial region in PVA-MOF nanocomposites can be represented by a rigid but rather open network.

Inter-annual Variation of Ambient Ammonia and Related Trace Gases in Delhi, India

In this study, ambient NH₃, NO, NO₂, CO and SO₂ were measured continuously from February, 2008, to December, 2016. The annual average mixing ratios (mole/mole) of NH₃, NO, NO₂, CO and SO₂ were 17.8 ± 3.4 ppb; 21.2 ± 2.3 ppb, 18.1 ± 3.2 ppb; 1.7 ± 0.3 ppm and 2.0 ± 0.3 ppb, respectively. All the trace gases (NH₃, NO, NO₂, CO and SO₂) showed significant annual variation during the study. A significant increasing trend in mixing ratios of ambient NH₃ and NO₂ were observed at the observational site of Delhi, whereas, increasing trend were recorded in case of NO, CO and NO₂ mixing ratios. The results emphasized that traffic could be one of the significant sources of ambient NH₃ at the urban site of Delhi, as illustrated by positive correlations of NH₃ with traffic related co-pollutants (NO and CO).

A novel nanohybrid for cancer theranostics: folate sensitized Fe2O3 nanoparticles for colorectal cancer diagnosis and photodynamic therapy

Organic-inorganic nanohybrids are becoming popular for their potential biological applications, including diagnosis and treatment of cancerous cells. The motive of this study is to synthesise a nanohybrid for the diagnosis and therapy of colorectal cancer. Here we have developed a facile and cost-effective synthesis of folic acid (FA) templated Fe₂O₃ nanoparticles with excellent colloidal stability in water using a hydrothermal method for the theranostics applications. The attachment of FA to Fe₂O₃ was confirmed using various spectroscopic techniques including FTIR and picosecond resolved fluorescence studies. The nanohybrid (FA-Fe₂O₃) is a combination of two nontoxic ingredients FA and Fe₂O₃, showing remarkable photodynamic therapeutic (PDT) activity in human colorectal carcinoma cell lines (HCT 116) via generation of intracellular ROS. The light induced enhanced ROS activity of the nanohybrid causes significant nuclear DNA damage, as confirmed from the comet assay. Assessment of p53, Bax, Bcl2, cytochrome c (cyt c) protein expression and caspase 9/3 activity provides vivid evidence for cell death via an apoptotic pathway. In vitro magnetic resonance imaging (MRI) experiments in folate receptor (FR) overexpressed cancer cells (HCT 116) and FR deficient human embryonic kidney cells (HEK 293) reveal the target specificity of the nanohybrid towards cancer cells, and are thus pronounced MRI contrasting agents for the diagnosis of colorectal cancer.

Treatment Planning With Unflattened as Compared to Flattened Beams for Bilateral Carcinoma of the Breast

Aim:

To evaluate the plan quality of 6MV unflattened (UFB) and flattened beam (FB) photon energy using AAA dose calculation algorithms for volumetric arc therapy.

Materials and Methods:

Plans were generated for bilateral carcinoma of breast and the dose prescribed was 50.4Gy in 28 fractions. Two different plans were made for each patient using 6MV FB and 6MV UFB. Dose calculations were performed on an AAA dose calculation algorithm. Plans were generated on Eclipse TPS and were capable of being delivered with a true beam STx linear accelerator. The homogeneity index (HI), conformity index (CI), normal tissue integral dose (NTID), and effect of low dose volume on normal tissue and monitor units (MU) were noted.

Results:

All the plans were clinically acceptable. The HI and CI of 6MV UF rapid arc (RA) plans were higher than with the 6MV FB plan (1.16±0.05 and 0.12±0.00 respectively). There was no appreciable difference observed in Organ at risk (OAR) doses. The mean NTID and low dose volume were significantly low with 6MV RA UFB as compared to FB. 6MV RA UFB required a 35% higher MU than with the 6MV RA plan (p<0.05).

Conclusion:

RA plans generated with UFB on Eclipse TPS achieved target volume coverage and preserved OAR’s essentially similar to 6MV RA FB plans. However RA plans generated in Varian Eclipse of UFB were superior with respect to mean NTID and low dose volumes in normal tissue.

Physiological functioning of Lagerstroemia speciosa L. under heavy roadside traffic: an approach to screen potential species for abatement of urban air pollution

The mitigation potential of avenue tree species needs a sound understanding, especially for landscape planning or planting tree species on roadside, especially in city limits where there is huge traffic due to more number of vehicles. A preliminary study was conducted to investigate the impact of heavy traffic movement and pollution thereof on physiological functioning of Lagerstroemia speciosa trees planted on roadside in terms of carbon absorption, mitigation potential and adaptive behavior. Trees on roadside exhibited reduced carbon assimilation (36.7 ± 2.4%) and transpiration rate (42.14 ± 2.9%), decreased stomatal conductance (66.85 ± 3.87%), increased stomatal resistance (212.2 ± 11.25%), more leaf thickness (40.54 ± 3.25) and water use efficiency (9.4 ± 0.87%), and changes in lead (179.31 ± 10.24%) and proline (15.61 ± 1.92%) concentration in leaf tissues when compared to less traffic area (FRI campus). The impacts were also witnessed in the form of enhanced vapour pressure deficit of air (63.18 ± 4.94%) and leaf (45.72 ± 3.25%), and air temperature (3.2 ± 0.16%) and leaf temperature (9.0 ± 0.82%) along roadside trees. It was inferred that heavy traffic movements interrupt the physiological functioning of trees due to alteration in the surrounding environment as compared to non-traffic areas. The present study provides baseline information to further explore and identify the potential avenue tree species having significant mitigation potential and adaptive efficiency to heavy traffic movements for improving urban environment.

Evaluation of Xpert MTB/RIF assay performance in the diagnosis of abdominal tuberculosis

Background/Aims

The use of genetic probes for the diagnosis of pulmonary tuberculosis (TB) has been well described. However, the role of these assays in the diagnosis of intestinal tuberculosis is unclear. We therefore assessed the diagnostic utility of the Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay, and estimated the prevalence of multidrug-resistant (MDR) TB in the Indian population.

Methods

Of 99 patients recruited, 37 had intestinal TB; two control groups comprised 43 with Crohn's disease (CD) and 19 with irritable bowel syndrome. Colonoscopy was performed before starting any therapy; mucosal biopsies were subjected to histopathology, acid-fast bacilli staining, Lowenstein-Jensen culture, and nucleic acid amplification testing using the Xpert MTB/RIF assay. Patients were followed up for 6 months to confirm the diagnosis and response to therapy. A composite reference standard was used for diagnosis of TB and assessment of the diagnostic utility of the Xpert MTB/RIF assay.

Results

Of 37 intestinal TB patients, the Xpert MTB/RIF assay was positive in three of 37 (8.1%), but none had MDR-TB. The sensitivity, specificity, positive predictive value, and negative predictive value of the Xpert MTB/RIF assay was 8.1%, 100%, 100%, and, 64.2%, respectively.

Conclusions

The Xpert MTB/RIF assay has low sensitivity but high specificity for intestinal TB, and may be helpful in endemic tuberculosis areas, when clinicians are faced with difficulty differentiating TB and CD. Based on the Xpert MTB/RIF assay, the prevalence of intestinal MDR-TB is low in the Indian population.

Isolated Renal Mucormycosis

Mucormycosis in humans has been described as early as 1885 in literature. Isolated renal mucormycosis is rare as it has been mainly described in developing countries like India and China. It is rarer still to find this entity in immunocompetent young males without any risk factors. Specific guidelines on the treatment is not yet known but combined surgical and medical therapy is considered the best modality for its management. We describe a young male who presented with bilateral hydroureteronephrosis. He was initially treated as a case renal tuberculosis which is relatively more common in TB endemic country like ours. However when he did not respond to the anti-tuberculosis drug (ATT), a biopsy revealed mucormycosis. He was treated with nephrectomy and liposomal amphotericin B and oral posaconazole. On follow up of 2 years he is healthy and leading his normal life.

Systemic Inflammatory Response Syndrome following Gastrointestinal Surgery

INTRODUCTION

Systemic inflammatory response syndrome symptoms immediately after surgery have lately been regarded as potential warnings of impending post-operative complications and multiple organ failure. This study was conducted to find out the clinical significance of systemic inflammatory response syndrome in postoperative patients and to investigate the relationship between the duration of post-operative systemic inflammatory response syndrome and the post-operative morbidity and mortality.

METHODS

Total 30 patients who received different gastrointestinal surgery and fulfilled the diagnostic criteria for systemic inflammatory response syndrome between 2006 and 2008 at Kathmandu Medical College Teaching Hospital were included. Patients were analyzed for preoperative physiologic status, surgical stress parameters, and postoperative status of systemic inflammatory response syndrome, complications, and end-organ dysfunction.

RESULTS

Duration of systemic inflammatory response syndrome or positive criteria's number of systemic inflammatory response syndrome after surgery significantly correlated with surgical stress parameters (blood loss/body weight and operation time). Septic complications and prolongation of systemic inflammatory response syndrome were associated with multiple organ dysfunction syndrome and increased mortality.

CONCLUSIONS

Systemic inflammatory response syndrome is a useful criterion for the recognition of postoperative complications and end-organ dysfunctions. Early recovery from systemic inflammatory response syndrome may arrest the progression of organ dysfunction, thus reducing the mortality.