Explore the vast range of titles available.

Measurement of health-related quality of life (HRQOL) of people with chronic illnesses has become extremely important as the mortality rates associated with such illnesses have decreased and survival rates have increased. Thereby, such measurements not only provide insights into physical, mental and social dimensions of patient's health, but also allow monitoring of the results of interventions, complementing the traditional methods based on morbidity and mortality. The present study was conducted to describe the HRQOL of patients suffering from Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD), and to identify socio-demographic and clinical factors as predictors of HRQOL. A cross-sectional study was conducted to assess the HRQOL among 702 RF and RHD patients using EuroQol 5-dimensions 5-levels instrument (EQ-5D-5L), EuroQol Visual Analogue Scale and Time Trade off method. Mean EQ-5D-5L quality of life scores were calculated using EQ5D index value calculator across different stages of RF and RHD. Proportions of patients reporting problems in different attributes of EQ-5D-5L were calculated. The impact of socio-economic determinants on HRQOL was assessed. The mean EQ-5D-5L utility scores among RF, RHD and RHD with Congestive heart failure patients (CHF) were estimated as 0.952 [95% Confidence Interval (CI): 0.929-0.975], 0.820 [95% CI: 0.799-0.842] and 0.800 [95% CI: 0.772-0.829] respectively. The most frequently reported problem among RF/RHD patients was pain/discomfort (33.8%) followed by difficulty in performing usual activities (23.9%) patients, mobility (22.7%) and anxiety/depression (22%). Patients with an annual income of less than 50,000 Indian National Rupees (INR) reported the highest EQ-5D-5L score of 0.872, followed by those in the income group of more than INR 200,000 (0.835), INR 50,000-100,000 (0.832) and INR 100,000-200,000 (0.828). Better HRQOL was reported by RHD patients (including RHD with CHF) who underwent balloon valvotomy (0.806) as compared to valve replacement surgery (0.645). RF and RHD significantly impact the HRQOL of patients. Interventions aiming to improve HRQOL of RF/RHD patients should focus upon ameliorating pain and implementation of secondary prevention strategies for reducing the progression from ARF to RHD and prevention of RHD-related complications.

Background Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants. Methods Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics. Results Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45–60 years and females (49.3–58.3%). Most patients were found to be in stage III (40–40.6%) or stage IV (29.4–37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value < 0.001]. The outpatients on hormone therapy (B = 0.076) showed significantly better HRQoL in comparison to patients on chemotherapy. However, palliative care (B=-0.137) and surgery (B=-0.110) were found to be associated with significantly with poorer HRQoL paralleled to chemotherapy. The utility scores among outpatients ranged from 0.305 (bone cancer) to 0.782 (Leukemia). Among hospitalized cases, the utility score was lowest for multiple myeloma (0.255) and highest for testicular cancer (0.771). Conclusion Older age, lower educational status, chemotherapy, palliative care and surgery, advanced cancer stage and progressive disease were associated with poor HRQoL. Our study findings will be useful in optimising patient care, formulating individualized treatment plan, improving compliance and follow-up.

In the present study, the catalytic degradation of selected toxic dyes (methylene blue, 4-nitrophenol, 4-nitroaniline, and congo red) using biosynthesized green silver nanoparticles (AgNPs) of Cestrum nocturnum L. was successfully performed. These AgNPs are efficiently synthesized when a reaction mixture containing 5 mL of aqueous extract (3%) and 100 mL of silver nitrate (1 mM) is exposed under sunlight for 5 min. The synthesis of AgNPs was confirmed based on the change in the color of the reaction mixture from pale yellow to dark brown, with maximum absorbance at 455 nm. Obtained NPs were characterized by different techniques, i.e., FTIR, XRD, HR-TEM, HR-SEM, SAED, XRD, EDX, AFM, and DLS. Green synthesized AgNPs were nearly mono-dispersed, smooth, spherical, and crystalline in nature. The average size of the maximum number of AgNPs was 77.28 ± 2.801 nm. The reduction of dyes using a good reducing agent (NaBH4) was tested. A fast catalytic degradation of dyes took place within a short period of time when AgNPs were added in the reaction mixture in the presence of NaBH4. As a final recommendation, Cestrum nocturnum aqueous leaf extract-mediated AgNPs could be effectively implemented for environmental rehabilitation because of their exceptional performance. This can be utilized in the treatment of industrial wastewater through the breakdown of hazardous dyes.

IntroductionThe rising economic burden of cancer on healthcare system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritising available resources to maximise value of investments in health. Economic evaluations are an integral component of this important evidence. Lack of existing evidence on healthcare costs and health-related quality of life (HRQOL) makes conducting economic evaluations a very challenging task. Therefore, it is imperative to develop a national database for health expenditure and HRQOL for cancer.Methods and analysisThe present study proposes to develop a National Cancer Database for Cost and Quality of Life (CaDCQoL) in India. The healthcare costs will be estimated using a patient perspective. A cross-sectional study will be conducted to assess the direct out-of-pocket expenditure (OOPE), indirect cost and HRQOL among cancer patients who will be recruited at seven leading cancer centres from six states in India. Mean OOPE and HRQOL scores will be estimated by cancer site, stage of disease and type of treatment. Economic impact of cancer care on household financial risk protection will be assessed by estimating prevalence of catastrophic health expenditures and impoverishment. The national database would serve as a unique open access data repository to derive estimates of cancer-related OOPE and HRQOL. These estimates would be useful in conducting future cost-effectiveness analyses of management strategies for value-based cancer care.Ethics and disseminationApproval was granted by Institutional Ethics Committee vide letter no. PGI/IEC-03/2020-1565 of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study results will be published in peer-reviewed journals and presented to the policymakers at national level.

This study reports the synthesis and antibacterial evaluation of two novel complexes, [Cd (Q) (Bpy) (CH 3 COO) 2 , complex 1] and [Cd (Q) (Phen) (CH 3 COO) 2 , complex 2], based on quercetin ligand. The method of synthesis was by reacting natural flavonoid quercetin (Q) with a good chelator (Bpy = 2,2'-bipyridine, Phen= 1,10-phenanthroline and Q = quercetin) and metal ions. The produced metal complexes were studied in the solid state by Fourier-transform infrared (FTIR) spectroscopy and in solution by UV-Vis absorption. Further analysis included high resolution mass spectrometry (HRMS) for confirmation. To understand the nature and coordination of quercetin and its metal complexes, density functional theory (DFT) calculation was performed. The scavenging (DPPH radical), antibacterial, MTT, enzymatic and non-enzymatic antioxidant activity assay, cytotoxicity assay (fluorescence study) were done and quercetin was used for comparison. Both complex 1 and complex 2 induced loss of cell viability via impairment of metabolic activity, leakage of intracellular proteins, and increased oxidative stress. The free-radical scavenging activity of complex 2 (IC 50 340.175 µg/mL) was statistically significantly more potent than that of complex 1. The MIC values of complex 2 (7.80 µg/mL Escherichia coli, 15.62 µg/mL Staphylococcus aureus) were higher as compared to complex 1 and quercetin in both test microorganisms. There was inhibition of cell proliferation in Escherichia coli treated with 2 µg/mL of complex 2, whereas Staphylococcus aureus did not show inhibition at this concentration. The cytotoxicity screening on MG 63 cell line showed that the compounds were safe up to 500 mg/L.

Purpose Takeovers play a critical role as an external corporate governance mechanism to ensure investor protection. There is a long-standing debate on whether the convergence of corporate governance to global standards can enable emerging economies to ensure investor protection. This paper aims to analyse the evolution of the takeover code, namely, Securities Exchange Board of India’s Substantial Acquisition of Shares and Takeovers (2011) in India from the lens of investor protection. It then compares the takeover provisions in India, the USA, the UK, Singapore and Australia to examine the extent of convergence and its implications for investor protection. Design/methodology/approach Using a cross-national comparative analysis of takeover mechanisms in common law countries, the study analyses the extent and relevance of convergence in form. The focus of the comparison is on regulations governing offer size, offer price, creeping acquisition and initial trigger limit for the mandatory open offer. Findings The findings suggest that certain provisions such as the initial trigger threshold for the mandatory offer and the offer prices of the Indian takeover code are converging with the standards in common law countries. However, the offer price determination based on market prices may not reflect true market value in an inefficient market like India. Other provisions such as creeping acquisition and offer size are not only diverging from the international standards but are also inconsistent with the key objective of investor protections of the Indian regulator. Research limitations/implications Indian takeover regulation needs to converge to higher global standards to ensure adherence to improved investor protection. This needs to be done for the initial trigger limit for mandatory bid and offer prices, after accounting for the differences in institutional structure. The Indian regulators need to revisit provisions on the initial trigger, creeping acquisition to converge to the broader principle of investor protection. Originality/value This technical paper provides a comprehensive depiction of takeover mechanisms in an emerging economy context as a means of investor protection. Further using a comparative lens, it analyses the relevance of convergence of takeover laws. Thus, advances the theoretical knowledge of limited extant work on external corporate governance mechanism in an emerging economy context.

In this study, a simple, one-pot, and eco-friendly biosynthesis of silver nanoparticles (AgNPs) was accomplished with the use of aqueous leaves extract of  Cestrum nocturnum L.(AECN). Different techniques like ultraviolet–visible (UV–Vis) spectrophotometry, Fourier transform infrared (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM), and scanning area electron diffraction were used to investigate the optical, operational, and physical properties of the green synthesized AECN-AgNPs.The AECN-AgNPs were further used for the detection of Hg 2+ by UV–Vis and electrochemical methods. The disintegration of the AECN-AgNPs solution caused the formation of an Ag-Hg amalgam, which caused discoloration of the solution. Sensing performance for a variety of metals such as Na + , K + , Mg 2+ , Ca 2+ , Ni 2+ , Cu 2+ , Fe 3+ , Zn 2+ , Co 2+ , Cd 2+ , Pb 2+ , As 3+ , and Mn 2+ at 10-mM concentrations was measured in order to determine the selectivity of the sensor towards the Hg 2+ . For the electrochemical determination of 2 + Hg 2+  , AECN-AgNPs were immobilized on a glassy carbon (GC) electrode, and the resulting modified electrode (GC/AECN-AgNPs) was characterized by cyclic voltammetry. This phenomenon is advantageously used for the sensitive determination of trace level Hg 2+ . GC/AECN-AgNPs demonstrated a linear calibration range of 100 nM to 10 μM and a limit of detection of 21 nM for Hg 2+ determination.

Background Survival outcomes for multiple myeloma have improved dramatically since the introduction of novel therapeutic agents. While these drugs are highly effective in improving survival outcomes and quality of life in patients with multiple myeloma, they come at a significant cost. We assessed the cost-effectiveness of bortezomib-based triplet or quadruplet drug regimens in isolation and followed by autologous hematopoietic stem cell transplantation (AHSCT) for the treatment of newly diagnosed multiple myeloma (NDMM) in the Indian context. Methods A Markov model was developed to assess the health and economic outcomes of novel drug regimens with and without AHSCT for the treatment of NDMM in India. We estimated the lifetime quality-adjusted life-years (QALYs) and costs in each scenario. The incremental cost-effectiveness ratios (ICERs) were computed and compared against the current willingness-to-pay threshold of a one-time per capita gross domestic product of ₹146,890 (US$1,927.70) for India. Parameter uncertainty was assessed through Monte Carlo probabilistic sensitivity analysis. Results Among seven treatment sequences, the VCd (bortezomib, cyclophosphamide, dexamethasone) alone arm has the lowest cost and health benefits as compared to four treatment sequences, namely VTd (bortezomib, thalidomide, dexamethasone) alone, VRd (bortezomib, lenalidomide, dexamethasone) alone, VRd plus AHSCT and DVRd (Daratumumab, bortezomib, lenalidomide, dexamethasone) plus AHSCT. It was found that VTd plus AHSCT and VCd plus AHSCT arms were extendedly dominated (ED) by combination of two alternative treatments. Among the five non-dominated strategies, VRd has a lowest incremental cost of ₹ 2,20,093 (US$2,888) per QALY gained compared to VTd alone followed by VRd plus AHSCT [₹3,14,530 (US$4,128) per QALY gained] in comparison to VRd alone. None of the novel treatment sequences were found to be cost-effective at the current WTP threshold of ₹1,46,890 (US$1,927.7). Conclusion At the current WTP threshold of one-time per capita GDP (₹ 146,890) of India, VRd alone and VRd plus AHSCT has 38.1% and 6.9% probability to be cost-effective, respectively. Reduction in current reimbursement rates of novel drugs, namely VRd, lenalidomide, and pomalidomide plus dexamethasone under national insurance program and societal cost of transplant by 50%, would make VRd plus AHSCT and VTd plus AHSCT cost-effective at an incremental cost of ₹40,671 (US$34) and ₹97,639 (US$1,281) per QALY gained, respectively .

Uraria picta is used as a folk medicine to cure various ailments. Regardless of ethnobotanical application, a therapeutic study of the plant parts has yet to be reported. Aqueous leaf extract was enriched with secondary metabolites like phenols, alkaloids, and terpenoids. Total phenol (60.97 mgG −1 GAE), total flavonoid (52.36 mgG −1 RE), and antioxidant activity (IC 50 2666.95 µgmL −1 ) of the extract were measured. Bio-based silver nanoparticles (LEUP-AgNPs) were fabricated using a secondary metabolite-enriched leaf extract of U. picta (LEUP), and characterization of LEUP-AgNPs was done. The LEUP-AgNPs were crystalline, circular (13.04 ± 5.97 nm), monodisperse (pdi 0.205), and stable (-17.8 mV). The LEUP-AgNPs surface was composed of carbon, nitrogen, oxygen, and silver. A comparative study was performed to evaluate the potential of LEUP and LEUP-AgNPs against promastigotes and intra-RAW264.7 macrophage amastigotes of Leishmania donovani . A high dose of LEUP and LEUP-AgNPs significantly inhibited the growth of promastigotes up to 53% and 68%, with an IC 50 value of 47.90 µgmL −1 and 6.79 µgmL −1 , respectively. LEUP and LEUP-AgNPs higher doses also inhibited intracellular amastigotes up to 53% and 80% with an IC 50 value of 6.72 µgmL −1 and 1.16 µgmL −1 , respectively. The microscopic examination revealed that LEUP-AgNPs lead to size reduction and aggregations of promastigotes. The LEUP-AgNPs efficiently declined the number of amastigotes per RAW 264.7 macrophages compared to LEUP. LEUP-AgNPs had no cytotoxic effects on RAW 264.7 macrophages based on the CC 50 value. Findings showed LEUP-AgNPs were more efficient than LEUP in controlling L. donovani , which induces visceral leishmaniasis.

Background Lack of data on the cost of cardiac care is an impediment to evidence-based planning, especially for determining provider payment rates under publically financed health insurance schemes. Objective This study estimates the unit costs of outpatient consultation, hospitalization, intensive care, selected surgical procedures and diagnostics for providing cardiac care for valvular heart disease at a tertiary hospital in India. Methods We undertook an economic costing of cardiac care using both patient and health system perspectives. For the health system costs, a bottom-up costing methodology was used. Data on all resources (capital and recurrent) utilized for the delivery of cardiac care services for valvular heart disease for 1 year were collected. Data on out-of-pocket expenditures was collected from 100 cardiac patients who underwent valve replacement and balloon valvotomy procedures. All estimated costs represent the year 2016–2017. Results The health system cost of an outpatient cardiac consultation was estimated as 182.4 Indian rupees (INR) (US$2.8) and INR334.8 (US$5.2) in the cardiology, and cardio-thoracic and vascular surgery (CTVS) departments, respectively. The cost of hospitalization per bed-day in cardiology, CTVS and the intensive care unit (ICU) was INR1040 (US$16), INR3853 (US$60) and INR12,635 (US$197), respectively. The median out-of-pocket expenditure for valve replacement surgery using mechanical and bio-prosthetic valves was estimated to be INR107,800 (US$1684) and INR154,000 (US$2406), respectively, and for balloon valvotomy was estimated to be INR14,456 (US$367). Overall package cost per mechanical and bio-prosthetic single valve replacement surgery and balloon valvotomy procedure was estimated as INR127,919 (US$1999), INR148,919 (US$2372) and INR14,456 (US$226), respectively. Conclusion Our findings are useful for planning expansion of public sector cardiac care services, developing package rates for publically financed insurance schemes in India and for undertaking research on cost effectiveness of various models of cardiac care.