Extraction and characterization of novel fibers from Tecoma stans Linn bark for use as reinforcement in polymer composites

Embarking on a pioneering investigation, this study unravels the extraordinary qualities of Tecoma stans Fibers (TSFs), freshly harvested from the rachis, establishing them as prospective reinforcements for biocomposites. Delving into their intricate characteristics, TSFs exhibit a unique fusion of physical resilience, with a density of 1.81 ± 0.39 g/cc and a diameter of 234.12 ± 7.63 μm. Complementing their physical prowess, their chemical composition boasts a harmonious blend of cellulose (70.1 ± 9.06 wt%), hemicellulose (13.56 ± 4.29 wt%), lignin (7.62 ± 2.39 wt%), moisture (4.21 ± 1.56 wt%), wax (2.37 ± 0.63 wt%), and ash (1.25 ± 0.36 wt%). In the realm of mechanical strength, TSFs showcase an impressive tensile strength of 639 ± 18.47 MPa, coupled with a robust strain at failure of 1.75 ± 0.13 % and a Young Modulus of 36.51 ± 1.96 GPa. Unveiling their crystalline intricacies, these fibers reveal a microfibril angle of 14.66 ± 0.15°, a crystalline index (CI) of 63.83 %, and a crystallite size (CS) of 9.27 nm. Beyond their mechanical marvels, TSFs exhibit unwavering thermal stability, enduring temperatures up to 297.36 °C, with a Tmax reaching an impressive 392.09 °C.

Mental health workers' perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study

OBJECTIVE

The introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers' (MHWs) experiences with peer support comes from high-income countries. Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) is an international multicentre study, which aims at scaling up peer support for people with severe mental illness in Europe, Asia and Africa. This study investigates MHWs experiences with UPSIDES peer support.

DESIGN

Six focus groups with MHWs were conducted approximately 18 months after the implementation of the UPSIDES peer support intervention. Transcripts were analysed with a descriptive approach using thematic content analysis.

SETTING

Qualitative data were collected in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel) and Pune (India).

PARTICIPANTS

25 MHWs (19 females and 6 males) from UPSIDES study sites in the UPSIDES Trial (ISRCTN26008944) participated.

FINDINGS

Five overarching themes were identified in MHWs' discussions: MHWs valued peer support workers (PSWs) for sharing their lived experiences with service users (theme 1), gained trust in peer support over time (theme 2) and provided support to them (theme 3). Participants from lower-resource study sites reported additional benefits, including reduced workload. PSWs extending their roles beyond what MHWs perceived as appropriate was described as a challenge (theme 4). Perceptions about PSWs varied based on previous peer support experience, ranging from considering PSWs as equal team members to viewing them as service users (theme 5).

CONCLUSIONS

Considering local context is essential in order to understand MHWs' views on the cooperation with PSWs. Especially in settings with less prior experience of peer support, implementers should make extra effort to promote interaction between MHWs and PSWs. In order to better understand the determinants of successful implementation of peer support in diverse settings, further research should investigate the impact of contextual factors (eg, resource availability and cultural values).

TRIAL REGISTRATION NUMBER

ISRCTN26008944.

Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach

BACKGROUND

Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial.

METHODS

One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers.

RESULTS

The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences.

CONCLUSIONS

UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings.

TRIAL REGISTRATION

ISRCTN26008944 (Registration Date: 30/10/2019).

Synthesis of silver‑bismuth oxide encapsulated hydrazone functionalized chitosan (AgBi2O3/FCS) nanocomposite for electrochemical sensing of glucose, H2O2 and Escherichia coli O157:H7

In this work, silver‑bismuth oxide encapsulated 1,3,5-triazine-bis(4-methylbenzenesulfonyl)-hydrazone functionalized chitosan (SBO/FCS) nanocomposite was synthesized by a simple hydrothermal method. The amine (-NH2) group was functionalized by the addition of cyanuric acid chloride followed by 4-methylbenzenesulfonol hydrazide. The SBO/FCS has been characterized by FT-IR, X-ray diffraction, XPS, HR-SEM, HR-TEM, AFM, and thermogravimetry (TGA). Under the optimum conditions, the SBO/FCS sensor showed brilliant electrochemical accomplishment for the sensing of glucose and H2O2 by a limit of detection (LOD) of 0.057 μM and 0.006 μM. It also showed linearity for glucose 0.008-4.848 mM and for H2O2 of 0.01-6.848 mM. Similarly, the sensor exhibited a low sensitivity to glucose (32 μA mM-1 cm-2) and a good sensitivity to H2O2 (295 μA mM-1 cm-2). In addition, that the prepared electrode could be used to sense the glucose and H2O2 levels in real samples such as blood serum and HeLa cell lines. The screen printed electrode (SPE) immunosensor could sense the E. coli O157:H7 concurrently and quantitatively with a linear range of 1.0 × 101-1.0 × 109 CFU mL-1 and a LOD of 4 CFU mL-1. Likewise, the immunosensor efficiently detect spiked E. coli O157:H7 in milk, chicken, and pork samples, with recoveries ranging from 89.70 to 104.72 %, demonstrating that the immunosensor was accurate and reliable.

In vitro anticancer activity of Hirudinaria manillensis methanolic extract and its validation using in silico molecular docking approach

Cancer has emerged as a potentially lethal illness, which recently upsurged in the mortality rate. Animal-derived compounds could be promising targets with higher efficacy and low toxicity in anticancer therapy. The present study aimed to explore the presence of anticancer potential compounds in Hirudinaria manillensis methanolic extract and their anticancer potential against various cancer cell types and target identification by Auto dock method. Initially, the identification of bioactive compounds was achieved by GC-MS analysis followed by the anticancer activity by MTT assay against A549, HeLa, MDA-MB-231, MG-63, and MOLT-4. Further, the effect of a lead compound on the cancer cell target was analyzed by the Auto dock method. GC-MS analysis results revealed the presence of 25 different bioactive compounds including anticancer potential compounds, such as Lupeol, Carvacrol, and Demecolcine. Interestingly, MTT assay results demonstrated the anticancer potential of Hirudinaria manillensis extract (LE) against various cancer cell lines, such as A549 (54.60 µg/ml), HeLa (19.93 µg/ml), MDA-MB-231 (20.23 µg/ml), MG-63 (20.04 µg/ml), and MOLT-4 (171.8 µg/ml), respectively. Among these cell types, the maximum inhibition was observed against HeLa with the IC50 concentration of 19.93 µg/ml. Furthermore, Demecolcine compound was docked with the EGFR tyrosine kinase showed the binding affinity of the docked complex was predicted to be - 6.2 kcal/mol. Thus, we conclude that H. manillensis has a significant anticancer effect on human cancer cell lines and could be used as a natural target which paves the way for further studies on biomedical applications in cancer therapeutics.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries

BACKGROUND

Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries.

METHOD

Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed.

RESULTS

397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions.

DISCUSSION

Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study

BACKGROUND

Peer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR).

METHOD

6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis.

RESULTS

Across study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting).

CONCLUSIONS

This study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.

Strengthening primary health care in China: governance and policy challenges

Primary care is often the weakest link in health systems despite its acknowledged central importance in promoting population's health at economical cost. A key reason for the lacunae is that both scholars and practitioners working on the subject typically underestimate the enormity of the task and the range of complementary measures required to build an effective primary care system. The objective of the paper is to highlight theoretical gaps and practical limitations to strengthening primary care. The challenges and difficulties are illustrated through a case study of China where primary care continues to struggle despite the government's strong political, financial and policy support in recent years. In this paper, we review the development of primary health care in China and how it is governed, provided, and financed, highlighting the gaps and misalignments that undermine its performance. We argue that governance deficiencies coupled with flawed financing and payments arrangements are major impediments to improving performance. China's experience offers valuable lessons for other governments seeking to strengthen primary health care.

Assessment of biodegradation of lignocellulosic fiber-based composites - A systematic review

Lignocellulosic fiber-reinforced polymer composites are the most extensively used modern-day materials with low density and better specific strength specifically developed to render better physical, mechanical, and thermal properties. Synthetic fiber-reinforced composites face some serious issues like low biodegradability, non-environmentally friendly, and low disposability. Lignocellulosic or natural fiber-reinforced composites, which are developed from various plant-based fibers and animal-based fibers are considered potential substitutes for synthetic fiber composites because they are characterized by lightweight, better biodegradability, and are available at low cost. It is very much essential to study end-of-life (EoL) conditions like biodegradability for the biocomposites which occur commonly after their service life. During biodegradation, the physicochemical arrangement of the natural fibers, the environmental conditions, and the microbial populations, to which the natural fiber composites are exposed, play the most influential factors. The current review focuses on a comprehensive discussion of the standards and assessment methods of biodegradation in aerobic and anaerobic conditions on a laboratory scale. This review is expected to serve the materialists and technologists who work on the EoL behaviour of various materials, particularly in natural fiber-reinforced polymer composites to apply these standards and test methods to various classes of biocomposites for developing sustainable materials.

Antimicrobial, anti-inflammatory and anti-arthritic activity of hemolymph lectin (NagLec) isolated from the freshwater crab, Oziotelphusanaga

Lectins are non-immune glycoproteins or proteins having a unique capacity to interact with carbohydrate ligands found on the surface of their host cells. In the present investigation, the lectin was purified from the hemolymph of freshwater crab, Oziotelphusa naga and its antimicrobial, anti-inflammatory and anti-arthritic activity was analysed. The preliminary characterization of the hemagglutinin was carried out to identify the erythrocyte and sugar specificity, optimum pH and temperature and cation dependency. The agglutinin was found to be highly specific to rabbit erythrocyte and inhibited by fetuin and α-lactose. Maximum hemagglutination activity was noted at pH 7.5-8 and temperature 20-40 °C. An O-acetyl sialic acid specific 75 kDa hemolymph lectin, designated as NagLec was isolated from the freshwater crab, Oziotelphusa naga by affinity chromatography on fetuin coupled Sepharose 4 B, with a purification fold of 185. The bacteria Staphylococcus aureus, Proteus mirabilis and fungus Candida albicans had the greatest zone of inhibition when treated with NagLec. The results of the Minimum inhibitory concentration (MIC) and Minimum bactericidal concentration (MBC) assays showed that the purified lectin inhibited the growth of Staphylococcus aureus at 0.031 and 0.065 μg/ml, which proved the bactericidal property of NagLec. NagLec generated alterations on the bacterial cells and led to protein leakage, which was dosage (24 and 48 μg/ml) and time dependent (10-40 min). COX and LOX enzyme was inhibited to 49.43% and 61.81% with 100 μg/ml concentration of NagLec respectively, demonstrating NagLec's ability to reduce inflammation. Furthermore, NagLec (500 μg) suppressed protein denaturation up to 77.12% whereas diclofenac sodium (a standard drug) was inhibited by 89.36%. The results indicate that NagLec, a sialic acid specific lectin isolated from the freshwater crab O. naga could be formulated as a nano drug in future owing to its antimicrobial, anti-inflammatory and anti-arthritic potential that could be targeted to specific pathogenic microbes and treat arthritis.

Societal and organisational influences on implementation of mental health peer support work in low-income and high-income settings: a qualitative focus group study

OBJECTIVES

Despite the established evidence base for mental health peer support work, widespread implementation remains a challenge. This study aimed to explore societal and organisational influences on the implementation of peer support work in low-income and high-income settings.

DESIGN

Study sites conducted two focus groups in local languages at each site, using a topic guide based on a conceptual framework describing eight peer support worker (PSW) principles and five implementation issues. Transcripts were translated into English and an inductive thematic analysis was conducted to characterise implementation influences.

SETTING

The study took place in two tertiary and three secondary mental healthcare sites as part of the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) study, comprising three high-income sites (Hamburg and Ulm, Germany; Be'er Sheva, Israel) and two low-income sites (Dar es Salaam, Tanzania; Kampala, Uganda) chosen for diversity both in region and in experience of peer support work.

PARTICIPANTS

12 focus groups were conducted (including a total of 86 participants), across sites in Ulm (n=2), Hamburg (n=2), Dar es Salaam (n=2), Be'er Sheva (n=2) and Kampala (n=4). Three individual interviews were also done in Kampala. All participants met the inclusion criteria: aged over 18 years; actual or potential PSW or mental health clinician or hospital/community manager or regional/national policy-maker; and able to give informed consent.

RESULTS

Six themes relating to implementation influences were identified: community and staff attitudes, resource availability, organisational culture, role definition, training and support and peer support network.

CONCLUSIONS

This is the first multicountry study to explore societal attitudes and organisational culture influences on the implementation of peer support. Addressing community-level discrimination and developing a recovery orientation in mental health systems can contribute to effective implementation of peer support work. The relationship between societal stigma about mental health and resource allocation decisions warrants future investigation.

TRIAL REGISTRATION NUMBER

ISRCTN26008944.

Synthesis, antimycobacterial screening, molecular docking, ADMET prediction and pharmacological evaluation on novel pyran-4-one bearing hydrazone, triazole and isoxazole moieties: Potential inhibitors of SARS CoV-2

The respiratory infection tuberculosis is caused by the bacteria Mycobacterium tuberculosis and its unrelenting spread caused millions of deaths around the world. Hence, it is needed to explore potential and less toxic anti-tubercular drugs. In the present work, we report the synthesis and antitubercular activity of four different (hydrazones 7-12, O-ethynyl oximes 19-24, triazoles 25-30, and isoxazoles 31-36) hybrids. Among these hybrids 9, 10, 33, and 34, displayed high antitubercular activity at 3.12 g/mL with >90% of inhibitions. The hybrids also showed good docking energies between -6.8 and -7.8 kcal/mol. Further, most active molecules were assayed for their DNA gyrase reduction ability towards M. tuberculosis and E.coli DNA gyrase by the DNA supercoiling and ATPase gyrase assay methods. All four hybrids showed good IC50 values comparable to that of the reference drug. In addition, the targets were also predicted as a potential binder for papain-like protease (SARS CoV-2 PLpro) by molecular docking and a good interaction result was observed. Besides, all targets were predicted for their absorption, distribution, metabolism, and excretion - toxicity (ADMET) profile and found a significant amount of ADMET and bioavailability.

Silver-functionalized bismuth oxide (AgBi2O3) nanoparticles for the superior electrochemical detection of glucose, NO2- and H2O2

In this study, silver-functionalized bismuth oxide (AgBi₂O₃) nanoparticles (SBO NPs) were successfully synthesized by a highly efficient hydrothermal method. The as-synthesized SBO nanoparticles were characterized using FT-IR, P-XRD, XPS, HR-SEM, and HR-TEM analytical methods. It was found that the NPs were in spherical shape and hexagonal crystal phase. The newly prepared SBO electrode was further utilized for the detection of glucose, NO₂^- and H₂O₂ by cyclic voltammetry (CV) and amperometric methods. The electrodes exhibited high sensitivity (2.153 μA mM^-1 cm^-2 for glucose, 22 μA mM^-1 cm^-2 for NO₂^- and 1.72 μA mM^-1 cm^-2 for H₂O₂), low LOD (0.87 μM for glucose, 2.8 μM for NO₂^- and 1.15 μM for H₂O₂) and quick response time (3 s for glucose, 2 s for both NO₂^- and H₂O₂ respectively). The sensor exhibited outstanding selectivity despite the presence of various interferences. The developed sensor exhibited good repeatability, reproducibility, and stability. In addition, the sensor was used to measure glucose, H₂O₂ in human serum, and NO₂^- in milk and river water samples, demonstrating its potential for use in the real sample.

The Possible Role of Selected Vitamins and Minerals in the Therapeutic Outcomes of Leishmaniasis

Leishmaniasis is a protozoal disease declared as an endemic in areas suffering from severe malnutrition and poverty. The factors associated with poverty like low income, ecological factors, and malnutrition cause disruption in immunity and host defense increasing risk of infection. Altered resistance to infection and host susceptibility are associated with low micronutrient levels in undernourished patients. Malnutrition has been recognized as a poor predictive marker for leishmaniasis, in particular the deficiency of trace elements like zinc, iron, and vitamin A, B, C, D which has a prominent function in the regulation of innate and adaptive immunity, cell proliferation, human physiology, etc. Malnourishment can exacerbate host sensitivity and pathophysiologic intensity to infection in variety of ways, whereas infection can enhance underlying poor nutrition or enhance host vulnerability and sandfly's urge to attack specific hosts. The intensity of leishmaniasis can be influenced by body mass and micronutrient availability in the blood. Vitamin D, C, zinc, and iron are proved effective in inhibiting the growth of leishmaniasis in both amastigote or promastigote forms, either directly or by acting as precursor for a pathway which inhibits the parasite growth. This article elucidates a new perception to the crucial role of micronutrients and their probable role in the therapeutic outcomes of leishmaniasis. Since there is requirement of novel drugs to fight drug resistance and relapse of leishmaniasis, this article may pave way to understand the importance of micronutrients and their role in therapeutic outcomes of leishmaniasis.

Hydrothermal synthesis of ZnZrO2/chitosan (ZnZrO2/CS) nanocomposite for highly sensitive detection of glucose and hydrogen peroxide

In this work, pure ZnZrO₂ and chitosan supported (ZnZrO₂/CS) nanocomposite have been synthesized at low coast by hydrothermal method. FT-IR, Micro Raman, PXRD, HR-SEM-EDAX, HR-TEM, AFM, BET and XPS were used to analyze the structural and morphological properties of the fabricated nanocomposites. The fabricated ZnZrO₂ and ZnZrO₂/CS nanocomposites were measured for their electrocatalytic activity towards glucose and hydrogen peroxide determinations. The ZnZrO₂/CS sensor exhibited wide detection range (5 μM to 5.85 mM), high sensitivity (6.78 μA mM^-1 cm^-2), LOD (2.31 μM), and long-term stability for glucose detection in alkaline solution. Also, as a multifunctional electrochemical sensor, ZnZrO₂/CS sensor exhibits excellent sensing ability towards hydrogen peroxide, with a wide dynamic range (20 μM to 6.85 mM), a high sensitivity (2.22 μA mM^-1 cm^-2), and a LOD (2.08 μM) (S/N = 3). The electrochemical measurement shows that the ZnZrO₂/CS sensor has excellent catalytic activity and a much LOD than ZnZrO₂. The modified electrode showed excellent anti interference nature. Furthermore, this ZnZrO₂/CS electrode was used to detection of glucose and H₂O₂ in human blood serum and HeLa cells respectively.

Mixed methods study to determine the impact of the COVID-19 pandemic on availability, utilization, and readiness of family planning and contraceptive services at selected primary health care facilities in Africa and Asia: A study protocol

BACKGROUND

The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning and contraceptive services. This protocol is adapted from a generic study protocol titled 'Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas', conducted by the WHO Department of Reproductive Health and Research.

OBJECTIVE

This study aims to assess the availability and utilization of family planning and contraceptive services in primary health facilities during and after the COVID-19 pandemic, assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients' and providers' perspectives in the COVID-19 affected areas and to assess the post-pandemic recovery of the facilities in the provision of family planning and contraceptive services.

METHODS

The study will be conducted in India, Nigeria and Tanzania by the Indian Council of Medical Research -National Institute of Research in Reproductive and Child Health, the University of Ilorin Teaching hospital and the Ifakara Health Institute, respectively. In each country, study sites will be selected based on geographical location, organization of family planning and contraceptive services and epidemic status where the COVID-19 pandemic is likely to have significantly affected service delivery. This study uses a mix of quantitative and qualitative methods. In-depth interviews will be conducted with clients (women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services) and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions with be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients' and health service providers' perspectives of FP and contraceptive service availability and readiness in COVID-19 affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure's ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the three countries.

RESULTS

Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries.

CONCLUSIONS

The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on family planning and contraceptive services at the facility level, which will help policymakers and health managers develop and strengthen FP policies and services to be more responsive to community needs by strengthening FP service delivery in the health facilities.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/43329.

Synthesis and thermo-mechanical properties of bioplastics and biocomposites: A systematic review

Materials research relating to bio-based polymers and composites has become the order of the day and several researches are being undertaken on these materials. This is mainly due to the...

Impact of COVID-19 on Antimicrobial Resistance in Paediatric Population: a Narrative Review

Purpose of Review

Irrational use of antimicrobials has been reported in paediatric population during the COVID-19 time period. This may lead to potential development of antimicrobial resistance and increased morbidity and mortality among this vulnerable population. The purpose of this review is to ascertain the impact of COVID-19 pandemic on antimicrobial resistance among paediatrics and the possible strategies to minimize the menace of antimicrobial resistance.

Recent Findings

Recent findings indicate that the COVID-19 pandemic has direct as well as indirect impact on the development of antimicrobial resistance among paediatric population.

Summary

This review article shows the impact of COVID-19 on the development of antimicrobial resistance and strategies to prevent it with special reference to antimicrobial stewardship programmes among paediatric population.

Sustainable and renewable nanobiocomposites for sensors and actuators: a review on preparation and performance

BACKGROUND:

Nano-materials derived from sustainable and biodegradable polymers, are the most attractive materials among the researchers. Polymeric nano-biocomposites (PNBCs) are a specific class of materials derived by combining nanosized fillers with polymer materials and the most commonly used nano-fillers were hydroxyapatite, organic or inorganic metal nanoparticles, clays and so on.

METHODS:

Many of the recent researches rendered its focus towards the utilization of biopolymer based hydrogel materials for the fabrication of analyte sensors and electrode modifiers owing to their high permeability nature and faster, mobilization of electrons. Such biopolymer hydrogelutilize newer printing methods in electrode prototyping, which renders portable, flexible, and advanced bioelectronics sensor with high performance characteristics. Few researchers have also stated the use of polyaniline reinforced biocomposites for the fabrication of electro-chemical sensors and actuators because of their advantageous properties, which makes them a potential material choice for electronics applications.

RESULTS:

Nano-particles of polyaniline were proved to improve the detection limit and sensitivity of the sensor even when used for recognizing a single molecules. Bionanocomposites possess excellent thermo-mechanical properties in the designed nanocomposite, even at low nanoparticle concentrations. In fact, these materials have high hardness and stability, giving rise to excellent mechanical characteristics. Furthermore, the incorporation of nanoparticles into a biopolymeric matrix enhanced its electrical conductivity, barrier properties, and consistency. Also, the powerful interaction between biopolymers and functional groups of nanoparticles increased the strength of bio-nanocomposites.

CONCLUSION:

Nanobiocomposites based biosensors were found to possess high specificity, sensitivity, and wider target spectrum. Current review deals with the use of sustainable and renewable biocomposites for the preparation of biosensors and actuators, their properties like sensitivity, limit of detection, advantages over the synthetic material and environmental hazards.

Proportionate translation of study materials and measures in a multinational global health trial: methodology development and implementation

OBJECTIVES

Current translation guidelines do not include sufficiently flexible translation approaches for different study materials. We aimed to develop a proportionate methodology to inform translation of all types of study materials in global health trials.

DESIGN

The design included three stages: (1) categorisation of study materials, (2) integration of existing translation frameworks and (3) methodology implementation (Germany, India, Israel, Tanzania and Uganda) and refinement.

PARTICIPANTS

The study population comprised 27 mental health service users and 27 mental health workers who were fluent in the local language in stage 7 (pretesting), and 54 bilingual mental health service users, aged 18 years or over, and able to give consent as judged by a clinician for step 9 (psychometric evaluation).

SETTING

The study took place in preparation for the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) randomised controlled trial (ISRCTN26008944).

PRIMARY OUTCOME MEASURE

The primary outcome measure was the Social Inclusion Scale (SIS).

RESULTS

The typology identifies four categories of study materials: local text, study-generated text, secondary measures and primary measure. The UPSIDES Proportionate Translation Methodology comprises ten steps: preparation, forward translation, reconciliation, back translation, review, harmonisation, pretesting, finalisation, psychometric evaluation and dissemination. The translated primary outcome measure for the UPSIDES Trial (SIS) demonstrated adequate content validity (49.3 vs 48.5, p=0.08), convergent validity and internal consistency (0.73), with minimal floor/ceiling effects.

CONCLUSION

This methodology can be recommended for translating, cross-culturally adapting and validating all study materials, including standardised measures, in future multisite global trials. The methodology is particularly applicable to multi-national studies involving sites with differing resource levels. The robustness of the psychometric findings is limited by the sample sizes for each site. However, making this limitation explicit is preferable to the typical practice of not reporting adequate details about measure translation and validation.

TRAIL REGISTRATION NUMBER

ISRCTN26008944.

A novel study on clinical pharmacist and psychiatrist collaborative pharmacotherapy management services among elderly population with psychiatric illness

BACKGROUND

Geriatric psychiatry has yet to receive its due recognition in India. There is increasing evidence of a rise in morbidity, mortality, hospitalization, and loss of functional status related to common mental disorders in the elderly patients. Collaborative care approach, including a clinical pharmacist, is one of the possible approaches to cope with geriatric patients with psychiatric patients.

OBJECTIVE

The study aimed to assess the impact of pharmacotherapy management of geriatric patients in collaboration with pharmacist and psychiatrist.

MATERIALS AND METHODS

A prospective interventional study was conducted in the psychiatry outpatient department of a tertiary care hospital in Mysore over 6 months. Geriatric patients who were newly diagnosed with depression, bipolar affective disorder (BPAD) and alcohol dependency syndrome (ADS) were included in this study. The clinical pharmacist scrutinized the patients for their participation in the study. Included patients were followed up on monthly basis for up to 4 months. Pharmacotherapy management was provided to the enrolled patients. Interventions provided were discussed with the psychiatrist. Descriptive analysis was performed for categorical variables.

RESULTS

A total of 84 geriatric patients were enrolled in the study. Majority of the enrolled patients were female (n = 46, 54.7%). Nearly half of the patients were illiterate (n = 40, 47.6%) and unemployed (n = 38, 45.2%). Among the enrolled patients, half of the study participants were diagnosed with depression (63.09%) followed by BPAD (27.38%), Schizophrenia (7.14%), and ADS (2.38%). A total of 155 medication information services were provided to 84 patients including patient counseling (n = 84, 100%), pharmacist interventions (n = 48, 30.96%) and medication information (n = 23, 14.83%). Most of the interventions were adverse drug reactions followed by drug-drug interactions, failure to receive drugs, untreated indication, subtherapeutic dose, drug use without indication, and overdose. Majority of the interventions (n = 46, 95.8%) provided were accepted by the psychiatrist.

CONCLUSION

The study findings indicate that pharmacotherapy management services provided by the clinical pharmacist in collaboration with the psychiatrist benefited the geriatric psychiatric patients.

Supply-side factors influencing informal payment for healthcare services in Tanzania

Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive, potentially limiting access to quality healthcare, particularly for the most vulnerable, and can have catastrophic consequences for households. Yet there is little empirical research that uses theory-driven hypotheses to explore what influences informal payments and, especially, from health workers' perspectives. Consequently, we have explored the characteristics of health workers and facilities influencing informal payments in Tanzania, examining two hypotheses: health workers with power and position in the system are more likely to receive informal payments, and transparency and accountability measures can be bypassed by those who can game the system. We conducted a cross-sectional survey of 432 health workers from 42 public health facilities (hospitals and health centres) in 12 district councils from Pwani and Dar es Salam regions in Tanzania. Our dependent variable was whether the health worker has ever asked for or been given informal payments or bribes, while explanatory variables were measured at the individual and facility level. Given the hierarchical structure of the data, we used a multilevel mixed-effect logistic regression to explore the determinants. Twenty-seven percent of 432 health workers ever engaged in informal payment. This was more common amongst younger (<35 years) health workers and those higher in the hierarchy (specialists and heads of departments). Those receiving entitlements and benefits in a timely manner and who were subject to continued supervision were significantly less likely to receive informal payments. The likelihood of engaging in informal payments varied among health workers, consistent with our first hypothesis, but evidence on the second hypothesis remains mixed. Thus, policy responses should address both individual and system-level factors, including ensuring adequate and progressive health sector financing, better and timely remuneration of frontline public health providers, and enhanced governance and supervision.

Current Perspectives in the Discovery of Newer Medications Against the Outbreak of COVID-19

A rapid and increasing spread of COVID-19 pandemic disease has been perceived worldwide in 2020. The current COVID-19 disease outbreak is due to the spread of SARS-CoV-2. SARS-CoV-2 is a new strain of coronavirus that has spike protein on the envelope. The spike protein of the virus binds with the ACE-2 receptor of the human lungs surface for entering into the host. Therefore, the blocking of viral entry into the host by targeting the spike protein has been suggested to be a valid strategy to treat COVID-19. The patients of COVID-19 were found to be asymptomatic, cold, mild to severe respiratory illness, and leading to death. The severe illness has been noted mainly in old age people, cardiovascular disease patients, and respiratory disease patients. However, the long-term health effects due to COVID-19 are not yet known. Recently, the vaccines were authorized to protect from COVID-19. However, the researchers have put an effort to discover suitable targets and newer medications in the form of small molecules or peptides, based on in-silico methods and synthetic approaches. This manuscript describes the current perspectives of the causative agent, diagnostic procedure, therapeutic targets, treatment, clinical trials, and development of potential clinical candidates of COVID-19. The study will be useful to identify the potential newer medications for the treatment of COVID-19.

Syntheses of five new layered quaternary chalcogenides SrScCuSe3, SrScCuTe3, BaScCuSe3, BaScCuTe3, and BaScAgTe3: crystal structures, thermoelectric properties, and electronic structures

Five new layered transition metal-based chalcogenides (SrScCuSe3, SrScCuTe3, BaScCuSe3, BaScCuTe3, and BaScAgTe3) were discovered by the exploratory solid-state method.

Pattern of Drug Utilisation in the Management of Hyperpigmentary Disorders in a Tertiary Care Hospital- An Observational Study

Introduction: Hyperpigmentary disorders, a common skin disorder affecting individuals with darker skin especially Asians, Blacks, Hispanics and American Indians, has a great impact on patient’s Quality of Life (QOL) with physical distress and psychological impact, and studies have shown that there is an improvement in QOL after treatment. The topical medications include sunscreens, demelanising agents, immunomodulators like tacrolimus, retinoids and Glucocorticoids (GCs). Systemic therapy includes GCs and antioxidants. Physical therapy includes chemical peels, microderma abrasion, Laser and light therapies and mesotherapy. Aim: To determine the pattern of drug use in hyperpigmentary disorders, to assess the tolerability of therapy and to analyse the effect of hyperpigmentary disorders of skin to the prescribed medications on the QOL before and after treatment. Materials and Methods: This was a prospective, observational study conducted on 102 newly diagnosed and untreated participants with hyperpigmentary disorders, who attended Dermatology Outpatient Department of a tertiary care hospital, Bangalore, India. The pattern of drug therapy, route of administration and Adverse Events (AEs) to the therapy was documented and analysed using descriptive statistics. The QOL using Dermatology Life Quality Index (DLQI) was assessed before and after treatment using Analysis of Variance (ANOVA). The patients were monitored every 30 days for three months to study the appropriateness, changing trends in prescription pattern, tolerability and QOL. Results: A total of 102 participants were enrolled for the study. The mean age was 33.71±10.68 years in males and 34.07±10.27 years in females. The different classes of drugs used were demelanising agents, sunscreens, antifibrinolytics, calcineurin inhibitors, keratolytics, glucocorticoids. The number ranged from 2-4 drugs per participant with a mean of 3.01±1.01. A significant improvement in the QOL was observed after treatment (p-value <0.01). Most of the AEs were self limiting except a few (acneiform eruption, rosacea) which were topical GCs induced. Conclusion: The individualised prescription pattern by treating physician was in concurrence with the standard line of therapy as they fulfilled the desired objectives. Hydroquinone (HQ), tranexamic acid and triple formula were the mainstay of treatment. The QOL improved after treatment.

Factors affecting self-medication practices among people living with type 2 diabetes in India- A systematic review

Self-medication practices of type 2 diabetes in India include the use of both traditional and western medications. It is important to understand the factors influencing self-medication. A total of 3257 studies were screened and nine studies (six quantitative and three qualitative) were included. The Hawker tool and Joanna Briggs Institute Critical Appraisal tool were used to assess the quality of studies. The findings of the quantitative studies were descriptively analysed while thematic analysis was performed to identify key themes from the qualitative studies. The analysis indicated that participants had greater trust in traditional medications regardless of their socioeconomic and/or educational backgrounds as these were often recommended by friends and family members. Low cost, ease of availability and perceived lower side effects of traditional medications were some of the factors contributing to greater trust. It is suggested that ongoing management of type 2 diabetes requires stringent policies and regulations in the dispensing of traditional and western medications. Continual education to inform people on the use of self-medications and its possible adverse effects is also required.

Production and application of polyclonal antibodies against SARS-CoV-2 viral spike protein. Development to rapid, highly sensitive diagnosis kit for early Corona viral detection among the population

Pathogenic novel coronavirus SARS-CoV-2 is a recently rising infection that causes a high death rate in contaminated individuals. Many of the individuals who are infected are unaware of the infection because they may be asymptomatic carriers of the virus.To early analyze the viral disease, we proposed advancement of SARS-CoV-2 spike (S) proteins-explicit polyclonal antibodies-based kit described in this specific circumstance. The tests, if made accessible from variety of makers, can help smooth out early immunodetection of the crown viral infection. The survey Safe and Patient Friendly Healthcare suggests early diagnosis as the key to patients recovering from this deadly ailment.

Challenges to peer support in low- and middle-income countries during COVID-19

BACKGROUND

A recent editorial urged those working in global mental health to "change the conversation" on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts.

CHALLENGES AND LESSONS LEARNED

The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals' reactions, talk about emotional issues and offer appropriate support.

CONCLUSIONS

In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.

Mobilizing Policy (In)Capacity to Fight COVID-19: Understanding Variations in State Responses

The objective of this collection of essays is to gain insights into the different national-level state responses to COVID-19 around the world and the conditions that shaped them. The pandemic offers a natural experiment wherein the policy problem governments faced was the same but the responses they made were different, creating opportunities for comparison of both the kinds of policy tools being used and the factors that accounted for their choice. Accordingly, after surveying on-line databases of policy tools used in the pandemic and subjecting these to topic modelling to reveal the characteristics of a 'standard' national pandemic response, we discuss the similarities and differences found in specific responses. This is done with reference to the nature and level of policy capacity of respective governments, highlighting the critical roles played by (in)adequate preparation and lesson-drawing from past experiences with similar outbreaks or crises. Taken together the articles show how the national responses to the COVID-19 pandemic were shaped by the opportunity and capacity each government had to learn from previous pandemics and their capacity to operationalize and build political support for the standard portfolio of policy measures deployed to deal with the crisis. However, they also show how other factors such as the nature of national leadership, the organization of government and civil society, and blindspots towards the vulnerabilities of certain population segments also helped to shape policy responses to the pandemic.

Systemic Solutions for Addressing Non-Communicable Diseases in Low- and Middle-Income Countries

Non-communicable diseases (NCDs) have been on the rise in low- and middle-income countries (LMICs) over the last few decades and represent a significant healthcare concern. Over 85% of "premature" deaths worldwide due to NCDs occur in the LMICs. NCDs are an economic burden on these countries, increasing their healthcare expenditure. However, targeting NCDs in LMICs is challenging due to evolving health systems and an emphasis on acute illness. The major issues include limitations with universal health coverage, regulations, funding, distribution and availability of the healthcare workforce, and availability of health data. Experts from across the health sector in LMICs formed a Think Tank to understand and examine the issues, and to offer potential opportunities that may address the rising burden of NCDs in these countries. This review presents the evidence and posits pragmatic solutions to combat NCDs.

Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic, multicentre, randomised controlled trial (UPSIDES-RCT)

BACKGROUND

Peer support is an established intervention involving a person recovering from mental illness supporting others with mental illness. Peer support is an under-used resource in global mental health. Building upon comprehensive formative research, this study will rigorously evaluate the impact of peer support at multiple levels, including service user outcomes (psychosocial and clinical), peer support worker outcomes (work role and empowerment), service outcomes (cost-effectiveness and return on investment), and implementation outcomes (adoption, sustainability and organisational change).

METHODS

UPSIDES-RCT is a pragmatic, parallel-group, multicentre, randomised controlled trial assessing the effectiveness of using peer support in developing empowering mental health services (UPSIDES) at four measurement points over 1 year (baseline, 4-, 8- and 12-month follow-up), with embedded process evaluation and cost-effectiveness analysis. Research will take place in a range of high-, middle- and low-income countries (Germany, UK, Israel, India, Uganda and Tanzania). The primary outcome is social inclusion of service users with severe mental illness (N = 558; N = 93 per site) at 8-month follow-up, measured with the Social Inclusion Scale. Secondary outcomes include empowerment (using the Empowerment Scale), hope (using the HOPE scale), recovery (using Stages of Recovery) and health and social functioning (using the Health of the Nations Outcome Scales). Mixed-methods process evaluation will investigate mediators and moderators of effect and the implementation experiences of four UPSIDES stakeholder groups (service users, peer support workers, mental health workers and policy makers). A cost-effectiveness analysis examining cost-utility and health budget impact will estimate the value for money of UPSIDES peer support.

DISCUSSION

The UPSIDES-RCT will explore the essential components necessary to create a peer support model in mental health care, while providing the evidence required to sustain and eventually scale-up the intervention in different cultural, organisational and resource settings. By actively involving and empowering service users, UPSIDES will move mental health systems toward a recovery orientation, emphasising user-centredness, community participation and the realisation of mental health as a human right.

TRIAL REGISTRATION

ISRCTN, ISRCTN26008944. Registered on 30 October 2019.

Exploring the synergistic effect of NixSn2xS4x thiospinel with MWCNTs for enhanced performance in dye-sensitized solar cells, the hydrogen evolution reaction, and supercapacitors

Trifunctional nickel tin sulfide (NixSn2xS4x) with a thiospinel-like structure composited with multiwalled carbon nanotubes (MWCNTs) (M-NixSn2xS4x) was synthesized by a facile method. The unit cell arrangement of the prepared composite was studied by density functional theory, and the theoretical interpretation satisfactorily inferred the presence of a synergistic effect between the thiospinel and MWCNTs. The high metallic conductivity and superior electrocatalytic activity of the M-NixSn2xS4x composite endow it with diverse applications. The composite shows promise as a counter electrode for dye-sensitized solar cells (efficiency of 4.67% for fluorine-doped indium tin oxide compared to 5.23% for platinum); an efficient catalyst for the hydrogen evolution reaction with good cycling stability and a low overpotential of -41 mV at a cathode current density of 10 mA cm2 and a Tafel slope of 43 mV dec-1 on a graphite sheet electrode; and an impressive capacitance material on a graphite sheet electrode alternative to expensive current collectors such as Ni foam, with a specific capacitance value of 1200 F g-1 at a current density of 1 A g-1 and a long life span of 92.6% that is retained for up to 15 000 cycles.

Using Peer Support in Developing Empowering Mental Health Services (UPSIDES): Background, Rationale and Methodology

BACKGROUND

Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health.

OBJECTIVES

To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research.

METHODS

UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.

Understanding the enhanced electrical properties of free-standing graphene paper: the synergistic effect of iodide adsorption into graphene

Free-standing graphene (FSG) paper plays a vital role in a wide variety of applications as an electrode material. Specifically, the electrical properties of FSG are the most important factor affecting its use as an electrode material. Herein, the vacuum filtration technique is utilized to fabricate GO paper, which is then reductively treated with HI. Initially, the electrical conductivity is measured for GO papers with different thicknesses by varying the concentration of GO precursor as well as the reduction time. The FSG paper with a thickness of 3 microns exhibits the lowest sheet resistance and further characterization is carried out to reveal the origin of this enhancement of electrical properties. The low resistance is attributed to its crystalline nature, stacking height (L_c), in-plane crystallite size (L_a) and defect density (n_D). Meanwhile, iodide ions intercalated into the graphene layers act as hole-carriers, and their intercalation is favoured over adsorption at the surface.

Synergistic effect of electrical properties for tri-iodide adsorbed free-standing graphene paper upon different exposure time of GO papers in HI reducing agent for 0.5 hour (FSG1), 1 hour (FSG2) and 24 hour (FSG3).

Assessment of pattern and outcomes of pesticides poisoning in a tertiary care hospital

OBJECTIVES

To assess the socio-demographic profile, pattern and treatment outcomes of pesticides poisoning.

METHODS

A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1.5 years to study the pattern and outcomes of poisoning cases due to pesticides. Level of significance (P) <0.05 was considered as statistically significant.

RESULTS

A total of 375 poisoning victims with intentional/accidental exposure to pesticides were followed up and documented. The male-female ratio was 1:0.32; mean age was 31.65 ± 13.10 years. 72% of cases were rural residents. Organophosphorus compounds were the most implicated pesticides. Mean Glasgow Comatose Score (GCS) of the patients was 12.22 ± 3.86. 80.3% of patients recovered while 6.4% died. About 13.3% patients were lost to follow-up as they were discharged against medical advice (DAMA).

CONCLUSION

There was a statistical significance seen in the implication of pesticides for intentional poisoning with age, route of administration, area of residence and occupation of the victims. However, there was a strong association of the outcomes of poisoning with the toxic agent implicated for the poisoning.

Liquid chromatography/electrospray ionization tandem mass spectrometry study of repaglinide and its forced degradation products

RATIONALE

Stress stability studies of drugs have been recognized as an essential part of the drug development process. These studies are used to investigate the intrinsic stability of the drugs and for the development of a selective stability indicating assay method (SIAM). Stress testing is also useful for the formulation and packaging development, shelf-life determination and designing of manufacturing processes. As per regulatory guidelines, stress degradation studies and structural characterization should be carried out to establish degradation pathways of the drug, which is essential from both the efficacy and safety point of view. As the stress stability studies of repaglinide have not been reported in the literature, the present study has been undertaken.

METHODS

Repaglinide (RP), an oral anti-diabetic drug, was subjected to hydrolysis (acidic, alkaline and neutral), oxidation, photolysis and thermal stress conditions as per International Conference on Harmonization (ICH) guidelines Q1A (R2). The chromatographic separation of the drug and its degradation products (DPs) was achieved on an Agilent XDB C-18 column using the gradient elution method with a mobile phase consisting of 20 mM ammonium acetate and acetonitrile at flow rate of 1.0 mL min^-1 . The DPs were characterized using liquid chromatography/electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) in combination with accurate mass measurements.

RESULTS

The drug degraded under hydrolytic and oxidative stress, while it was stable under thermal and photolytic stress conditions. In total, six DPs were formed and the LC/MS method described here can resolve all DPs from the parent as well as from each other under various stress conditions. To elucidate the structures of DPs, fragmentation of the [M + H]⁺ ions of RP and its DPs was studied by using LC/ESI-MS/MS combined with accurate mass measurements.

CONCLUSIONS

The forced degradation of RP carried out as per ICH guidelines results in the formation of six degradation products which have been characterized using LC/MS/MS in combination with accurate mass measurements.

Program design, implementation and performance: the case of social health insurance in India

Published works on health insurance tend to focus on program design and its impact, neglecting the implementation process that links the two and affects outcomes. This paper examines the National Health Insurance [Rashtriya Swasthya Bima Yojana (RSBY)] in India with the objective of assessing the role of implementation structures and processes in shaping performance. The central question that the paper addresses is: why does the performance of RSBY vary across states despite similar program design? Using a comparative case study approach analyzing the program's functioning in three states, it finds the answer in the differences in governance of implementation. The unavoidable gaps in design of health care program allow abundant scope for opportunistic behavior on the part of different stakeholders. The study finds that the performance of the program, as a result, depends on the extent to which the governance mechanism is able to contain and channel opportunistic behavior during implementation. By opening up the black box of implementation, the paper contributes to improving the performance of national health insurance in India and elsewhere.