Explore the vast range of titles available.

Executive Summary The Indian microfinance sector has experienced fundamental changes in the structure of ownership and management of microfinance institutions (MFIs). The current study seeks to evaluate the competition level of the Indian microfinance sector during the period 2005–2017 and attempts to find the cause-and-effect relationship between concentration and competition. Furthermore, it analyzes the performance of leading MFIs to explore if there is evidence of exploitation of clients by these institutions. The study is the first of its kind with explicit focus on the market structure of the Indian microfinance market. The study uses unbalanced panel data sets generated from the microfinance information exchange (MIX) data source. The representative sample includes firm specific data of 127 MFIs of different legal statuses and sizes. The dynamic equation model is estimated applying the difference generalized methods of moments (GMM). The results of the empirical investigation find a rise in the concentration with a decrease in competition in the Indian microfinance market during recent years. Intense competition in the past and introduction of new regulations in the wake of sectoral crisis are responsible for this transition. High concentration gives large MFI market powers to exploit the customers. However, the study fails to find any evidence of any such exploitation from the conduct of the leading MFIs. The survey highlights the potential connection between the drop in the competitiveness of the sector and the first appearance of new regulations in light of the sectoral crisis. It is imperative that regulators keep a tight vigil on the operations of leading MFIs and take necessary actions to ensure a healthy competitive environment in the sector. Furthermore, existing rules should be modified to help small MFIs as they play a very crucial role in the fulfilment of the primary objective of the microfinance.

Nitin Navin (Nitin.n_phd16@ fms.edu) is a research scholar at the Faculty of Management Studies, University of Delhi, and teaches at Satyawati College (Day), University of Delhi. Since its inception, the performance of the self-help group programme in the area of rural development and women’s empowerment has been admirable. Banks found it challenging to provide credit in tiny denominations to individual borrowers. [...]the then institutional structure built to provide rural credit-focused more on the quantity of loans while ignoring vital qualitative aspects (Misra 2006). In the 2020 Union Budget, the central government announced the setting up of storage facilities4 at the village level, which would be run by women SHGs. [...]the government proposed uplifting the nano-enterprises of women SHGs to the level of microenterprises and providing more bank credit to them (Government of India 2020).5 Expansion of the SHG Programme The SHG programme is one of the foremost modes of microfinance in India; it has been quite successful in improving the lives of the rural poor (NIRDPR 2019; BIRD 2019). Figure 1 shows the total loan amount that banks have provided under the SHG scheme. Since 2011, the credit disbursement by banks to SHGs has been rising.

The Indian microfinance sector was one of the largest in the world with full of growth potential. However, series of incidents happened in 2010 and thereafter changed the face of the industry. Though the crisis proved a death warrant for many MFIs, it also brought some good news for the sector. The present study attempts to overview the performance of Indian microfinance sector after the crisis. The main objective is to observe the current state of affairs of the sector and to check if the sector has recovered from that shock. Data have been taken from Mixmarket database.

We present data on analytical validation of the multigene variant profiling assay (CellDx) to provide actionable indications for selection of targeted and immune checkpoint inhibitor (ICI) therapy in solid tumors. CellDx includes Next Generation Sequencing (NGS) profiling of gene variants in a targeted 452-gene panel as well as status of total Tumor Mutation Burden (TMB), Microsatellite instability (MSI), Mismatch Repair (MMR) and Programmed Cell Death—Ligand 1 (PD-L1) respectively. Validation parameters included accuracy, sensitivity, specificity and reproducibility for detection of Single Nucleotide Alterations (SNAs), Copy Number Alterations (CNAs), Insertions and Deletions (Indels), Gene fusions, MSI and PDL1. Cumulative analytical sensitivity and specificity of the assay were 99.03 (95% CI: 96.54–99.88) and 99.23% (95% CI: 98.54% - 99.65%) respectively with 99.20% overall Accuracy (95% CI: 98.57% - 99.60%) and 99.7% Precision based on evaluation of 116 reference samples. The clinical performance of CellDx was evaluated in a subsequent analysis of 299 clinical samples where 861 unique mutations were detected of which 791 were oncogenic and 47 were actionable. Indications in MMR, MSI and TMB for selection of ICI therapies were also detected in the clinical samples. The high specificity, sensitivity, accuracy and reproducibility of the CellDx assay is suitable for clinical application for guiding selection of targeted and immunotherapy agents in patients with solid organ tumors.

Introduction  Fractures of the distal tibia are complex injuries with high complication rates, which include delayed union, non-union, and wound complications like dehiscence and infection. The two commonly employed definite internal fixation modalities include locked intramedullary (IM) nailing and plating. There is controversy regarding the superiority of the fixation construct, although nailing is proven to be more biological and devoid of soft tissue complications. There is also no consensus regarding the minimum distance of the fracture from the tibial plafond that is amenable to nailing of the fracture. Hence, the present study is designed to evaluate the effect of distal fragment length relative to the total length of the tibia, which makes it stable enough for IM nailing to be effective.  Methods A prospective biomechanical study was performed using 28 fourth-generation composite tibial sawbones. Osteotomies were created at 12%, 15%, 20%, and 25% of the total tibial length (38 cm) from the distal articular surface, forming four experimental groups (A-D, n=7 each). All models were stabilized with 10 mm stainless-steel interlocking nails. Mechanical testing was conducted using a servo-hydraulic fatigue testing machine and included mediolateral (ML) and anteroposterior (AP) three-point bending, as well as cyclic axial loading. Outcome measures included bending stiffness, construct laxity (neutral zone), fracture gap angle, axial micromotion, and construct failure. Results  The bending stiffness of all constructs tended to be lower in the AP plane than in the ML plane. The neutral zone of all groups tended to be higher in the AP plane than in the ML plane. The peak fracture gap angle tended to be higher in the AP plane than in the ML plane. Group A (shortest distal fragment length) demonstrated significantly lower AP stiffness, higher AP neutral zone, and higher AP peak fracture gap angle as compared to group D (longest distal fragment length). Group A demonstrated significantly greater instability in the AP plane than Group D. No statistically significant difference was found in the stability parameters on medio-lateral three-point bending and axial compressive testing.  Conclusion The results of this biomechanical study show that comminuted extra-articular distal tibial fractures show significant instability in the sagittal plane when the length of the distal fragment is 12% of the total tibial length.

Diabetes is the most prevailing disease worldwide and emerged as the fourth leading cause of mortality. Inhibition of intestinal α-Glucosidase enzyme is an effective approach for controlling post prandial hyperglycemia. α-Glucosidase inhibitors are known to be very effective in decreasing post-prandial hyperglycemia but the existing drugs are weak inhibitors of α-Glucosidase and also have side effects. Hence it needs for new therapeutic candidate which can effectively inhibit the activity of α-Glucosidase. Flavones recognized as the potential lead structure for many pharmacological activities. In the present research work 3D QSAR (comparative molecular field analysis and comparative molecular similarity indices analysis) was carried out on a series of flavones to identify structural requirement for effective inhibition of α-Glucosidase enzyme. The QSAR results shows that the LOO cross-validated q2 values of CoMFA and CoMSIA models are 0.742 and 0.759, respectively. The outcome of this research work could be effectively utilized for design of better α-Glucosidase inhibitors.

Background There is paucity of data regarding clinical characteristics, laboratory parameters and outcomes of coronavirus disease (COVID‐19) in cancer versus non‐cancer patients, particularly from India. Materials and Methods This was an observational, single‐centre, retrospective analysis of patients with laboratory‐confirmed COVID‐19 hospitalised in our institution between 22 May 2020 and 1 December 2020. We compared baseline clinical characteristics, laboratory parameters and outcomes of COVID‐19 (overall mortality, time to discharge) between cancer and non‐cancer patients. Results A total of 200 COVID‐19 infection episodes were analysed of which 109 (54.5%) were patients with cancer and 91 (45.5%) were patients without cancer. The median age was 43 (interquartile range [IQR]:32–57), 51 (IQR: 33–62) and 38 (IQR: 31.5–49.3) years; of whole cohort, cancer and non‐cancer patients, respectively. Comparison of outcomes showed that oxygen requirement (31.2% [95% CI: 22.6–40.7] vs. 17.6% [95% CI: 10.4–26.9]; p = 0.03), median time to discharge (11 days [IQR: 6.75–16] vs. 6 days [IQR: 3–9.75]; p < 0.001) and mortality (10.0% [95% CI: 5.2–17.3] vs. 1.1% [95% CI: 0.03–5.9]; p = 0.017) were significantly higher in patients with cancer. In univariable analysis, factors associated with higher mortality in the whole cohort included diagnosis of cancer (10.1% vs. 1.1%; p = 0.027; odds ratio [OR]: 7.04), age ≥60 (17.4% vs. 2.6%; p = 0.001; OR: 7.38), oxygen requirement (22% vs. 0.6%; p < 0.001; OR: 29.01), chest infiltrates (19.2% vs. 1.4%; p < 0.001; OR: 22.65), baseline absolute lymphocyte count <1 × 109/L (10.8% vs. 1.9%; p = 0.023; OR:5.1), C‐reactive protein >1 mg% (12.8% vs. 0%; p = 0.027; OR: 24.69), serum procalcitonin >0.05 ng/ml (22.65% vs. 0%; p = 0.004; OR: 4.49) and interleukin‐6 >6 pg/ml (10.8% vs. 1.3%; p = 0.036; OR: 3.08). In multivariable logistic regression, factors significantly associated with mortality were oxygen requirement (p = 0.005; OR: 13.11) and high baseline procalcitonin level (p = 0.014; OR: 37.6). Conclusion Cancer patients with COVID‐19 have higher mortality and require longer hospital stay. High procalcitonin levels and oxygen requirement during admission are other factors that affect outcomes adversely. This is the first data from India, describing comparison of cancer and non‐cancer patients with COVID‐19 treated with a uniform protocol. It shows that cancer patients with COVID‐19 have higher mortality and require longer hospital stay. High procalcitonin levels and oxygen requirement during admission are factors that adversely affect outcomes.

Background. This manuscript describes the genetic features of SARS-CoV-2 mutations, prevalent phylogenetic lineages, and the disease severity amongst COVID-19-vaccinated individuals in a tertiary cancer hospital during the second wave of the pandemic in Mumbai, India. Methods. This observational study included 159 COVID-19 patients during the second wave of the pandemic from 17th March to 1st June 2021 at a tertiary cancer care centre in Mumbai. The cohort comprised of healthcare workers, staff relatives, cancer patients, and patient relatives. For comparison, 700 SARS-CoV-2 genomes sequenced during the first wave (23rd April to 25th September 2020) at the same centre were also analysed. Patients were assigned to nonvaccinated (no vaccination or <14 days from the 1st dose, n = 92), dose 1(≥14 days from the 1st dose to <14 days from the 2nd dose, n = 29), and dose 2 (≥14 days from the 2nd dose, n = 38) groups. Primary measure was the prevalence of SARS-CoV-2 genomic lineages among different groups. In addition, severity of COVID-19 was assessed according to clinical and genomic variables. Results. Kappa B.1.1671.1 and delta B.1.617.2 variants contributed to an overwhelming majority of sequenced genomes (unvaccinated: 40/92, 43.5% kappa, 46/92, 50% delta; dose 1: 14/29, 48.3% kappa, 15/29, 51.7% delta; and dose 2: 23/38, 60.5% kappa, 14/38 36.8% delta). The proportion of the kappa and delta variants did not differ significantly across the unvaccinated, dose 1, and dose 2 groups (p = 0.27). There was no occurrence of severe COVID-19 in the dose 2 group (0/38, 0% vs. 14/121, 11.6%; p = 0.02). SARS-CoV-2 genomes from all three severe COVID-19 patients in the vaccinated group belonged to the delta lineage (3/28, 10.7% vs. 0/39, 0.0%, p = 0.04). Conclusions. Sequencing analysis of SARS-COV-2 genomes from Mumbai during the second wave of COVID-19 suggests the prevalence of the kappa B.1.617.1 and the delta B.1.627.2 variants among both vaccinated and unvaccinated individuals. Continued evaluation of genomic sequencing data from breakthrough COVID-19 is necessary for monitoring the properties of evolving variants of concern and formulating appropriate immune response boosting and therapeutic strategies.

Introduction: There is paucity of data from India about the outcomes of patients with various hematological malignancies. Since its formation in 2009, the adult hematolymphoid disease management group of the Tata Memorial Centre is dedicated to the treatment of hematological malignancies alone. In this report, we present the outcomes of patients treated at our centre over a 5 year period for various haematological malignancies in both transplant and non-transplant setting. Methods: This is a retrospective analysis of all patients registered in adult hematolymphoid disease management group between 1st January 2010 to 31st December 2014. Patients not treated at our centre were excluded from survival analysis. The cut off date for survival analysis was 31st January 2016. Results: Overall, 1869, 3633 and 544 patients with acute leukemias, various lymphomas and myeloma respectively were registered at our centre from 1st January 2010 to 31st December 2014. Of these, 1178 (63%), 3091 (85%) and 454 (83%) respectively received treatment at our centre. The cumulative probability of 5 year overall survival for patients with acute leukemias, Hodgkin's lymphoma, non-Hodgkin lymphoma and myeloma treated at our centre is 40%, 85%, 78% and 40% respectively. Four hundred and fifteen stem cell transplants were done between 14th November 2007 to 31st December 2014 with 46% being allogeneic and 54% being autologous. The 5 year overall survival of patients with allogenic and autologous transplant was 52% and 63% respectively. Conclusions: This is the largest single centre data on outcomes of various haematological malignancies from India. This real world data identifies areas which need further attention to improve outcomes.

The science of multiple myeloma (MM) and related plasma cell disorders is rapidly evolving with increased understanding of the disease biology and recent approval of the newer drugs widening the therapeutic armamentarium. Despite multiple international guidelines regarding the management of this disease, the practice of managing MM is not uniform amongst Indian physicians. There are challenges in management which are unique to the Indian patients. This review discusses these challenges and the consensus of the nation-wide experts in dealing with the same. We also briefly highlighted the perspective of international experts as discussed in the Myeloma State of the Art conference held in September 2016 at PGI, Chandigarh. An I ndian M yeloma A cademic G roup e (IMAGe) group was formed to strengthen the research, create awareness about myeloma and related disorders and form consensus guidelines/ recommendations that can be adapted to the Indian Scenario.