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To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition. We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-of-pocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993-1994 expenditure survey (12.4%) and the 2011-2012 expenditure survey (18.2%) and 2.24-fold between the 1995-1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76-3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31-2.89), with a female head (aOR: 1.32; 95% CI: 1.19-1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20-1.35). The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure.

The in vitro diagnostics of cancer are not represented well yet, but the need for early-stage detection is undeniable. In recent decades, surface-enhanced Raman spectroscopy (SERS) has emerged as an efficient, adaptable, and unique technique for the detection of cancer molecules in their early stages. Herein, we demonstrate an opto-plasmonic hybrid structure for sensitive detection of the prostate cancer biomarker sarcosine using silica nanospheres coated silver nano-islands as a facile and efficient SERS active substrate. The SERS active platform has been developed via thin (5–15 nm) deposition of silver islands using a simple and cost-effective Radio Frequency (RF) sputtering technique followed by the synthesis and decoration of silica nanospheres (~500 nm) synthesized via Stober’s method. It is anticipated that the coupling of Whispering Gallery Modes and photonic nano-jets in SiO2 nanospheres induce Localized Surface Plasmon Resonance (LSPR) in Ag nano-islands, which is responsible for the SERS enhancement. The as-fabricated SERS active platform shows a linear response in the physiological range (10 nM to 100 μM) and an extremely low limit of detection (LOD) of 1.76 nM with a correlation coefficient of 0.98 and enhancement factor ~2 × 107. The findings suggest that our fabricated SERS platform could be potentially used for the rapid detection of bio-chemical traces with high sensitivity.

Tissue Engineering and skin grafting, an essential part of regenerative medicine is one of the fastest growing biomedical fields which could offer an important therapeutic strategy for management of hard to heal wounds. 2D and 3D polymeric scaffolds are prerequisites in this field to promote cell adhesion, proliferation and tissue regeneration. Convergence of technology and research has successfully unveiled unknown properties of Chitosan as a bioactive polymer. Natural abundance, cost effectiveness, biodegradability, biocompatibility and wound healing capabilities of chitosan and its derivatives has drawn the attention of many researchers for its use as an alternative for fabrication of a scaffold in tissue engineering and skin graft. However lower mechanical strength and solubility has limited its application in the biomedical field. It has been found that the derivatization and combination with other polymers can successfully overcome these limitations. This review focuses on the applicability of chitosan and its derivatives in combination with other polymers in tissue engineering and skin grafting along with the novel scaffold fabrication techniques. Studies so far have demonstrated the potential of chitosan and its derivative as a scaffold in the field of regenerative medicine. However, even if the promising results obtained from in-vitro and preclinical studies prove the efficacy of chitosan scaffolds it still has a long way to go to be used in clinical set ups.

Background India’s large youth population presents a significant opportunity to harness the demographic dividend. The disease burden in adolescents could be a hindrance for the future economy if not appropriately addressed. Methods We utilised the data on the number of adolescent deaths and attributable years lived with disability (morbidity) in every state of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We estimated the economic impact as the cost of lost output due to premature adolescent deaths and morbidity for every state of India in 2021, using an output-based method. The cost of lost output is reported in US Dollars (USD) and as a percentage of Gross Domestic Product (GDP) for all diseases/conditions together, and separately for communicable diseases (CDs), non-communicable diseases (NCDs), and injuries. Results The lost output from premature deaths and morbidity attributable to adolescents was USD 9.87 (95% CI 9.04–10.71) and USD 28.13 (95% CI 20.53–37.71) billion respectively, in India in 2021. The total economic loss of USD 38.01 billion (95% CI 29.57–48.41) was 1.30% (1.01–1.65) of India’s GDP. The total economic loss as a percentage of the state’s GDP varied 3.42 times between the states in 2021, ranging from 2.43% in Bihar to 0.71% in Sikkim. The total economic loss due to CDs, NCDs, and injuries was estimated at 0.45%, 0.69% and 0.16% of India’s GDP in 2021, with significant variations across the states. Conclusions Strengthening the Indian Adolescent Health Strategy to address the diseases/ conditions contributing most to the total economic loss is needed to facilitate substantial avoidance of the high economic losses attributable to adolescent premature deaths and morbidity in India.

Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in every state of India and the changes over a decade. We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India. In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time. Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state.

With India preparing for the next decennial Census in 2021, we compared the disability estimates and data collection methodology between the Census 2011 and the most recent population-level survey for India and its states, to highlight the issues to be addressed to improve robustness of the disability estimates in the upcoming Census. Data from the Census 2011 and from two complementary nationally representative household surveys that covered all Indian states with the same methodology and survey instruments-the District-Level Household Survey-4 (DLHS-4, 2012-2013) and the Annual Health Surveys (AHS three rounds, 2010-11, 2011-12 and 2012-13) were used. Data from DLHS-4 and AHS 2012-13 round were pooled to generate estimates for the year 2012-13. Data collection methodology between the sources was compared, including the review of definitions of each type of disability. The overall, mental, visual, hearing, speech, and movement disability rate (DR) per 100,000 population were compared between the sources for India and for each state, and the percent difference in the respective rates was calculated. We explored the reliability of these estimates comparing yearly data from the AHS for three successive rounds. Survey data were collected through proxy reporting, however, it is not entirely clear whether the data were proxy- or self-reported or a mix of both in the Census. The overall DR was 25.1% higher in the Census (2,242; 95% CI 2,241-2,243) than the survey (1,791; 95% CI 1,786-1,797) per 100,000 population, with the state-level difference ranging from -64% in Tamil Nadu to 107% in Sikkim state. Despite both sources using nearly similar definitions for overall disability and disability by type, the difference in DR was 125.5%, 54.2%, -25.7%, -19.7%, and 21.9% for hearing, speech, mental, movement, and visual DR, respectively. At the state-level, the difference in disability-specific estimates ranged from -84% to 450%. The extent of variations in the disability-specific estimates in AHS successive rounds ranged from -25% to 929% at the state-level. There is momentum globally towards building disability measurement that is consistent with the data required for monitoring of the Sustainable Development Goals to ensure robust estimation of disability. The current estimates from the Census and surveys seem much lower than would be expected at the population level. We make recommendations that India needs to take serious note of in order to improve the validity and reliability of India's disability estimates.

The sudden emergence of COVID-19 caused by a novel coronavirus (nCoV) led the entire world to search for relevant solutions to fight the pandemic. Although continuous trials are being conducted to develop precise vaccines and therapeutic antibodies, a potential remedy is yet to be developed. Plants have largely contributed to the treatment of several human diseases and different phytoconstituents have been previously described to impede the replication of numerous viruses. Despite the previous positive reports of plant-based medications, no successful clinical trials of phyto-anti-COVID drugs could be conducted to date. In this article, we discuss varying perspectives on why phyto-anti-viral drug clinical trials were not successful in the case of COVID-19. The issue has been discussed in light of the usage of plant-based therapeutics in previous coronavirus outbreaks. Through this article, we aim to identify the disadvantages in this research area and suggest some measures to ensure that phytoconstituents can efficiently contribute to future random viral outbreaks. It is emphasized that if used strategically phyto-inhibitors with pre-established clinical data for other diseases can save the time required for long clinical trials. The scientific community should competently tap into phytoconstituents and take their research up to the final stage of clinical trials so that potential phyto-anti-COVID drugs can be developed.

Covishield is in wide use in India with about 80% efficacy. Serious side effects are still under study. A 30-year-old female presented to us 7 days post-vaccination with a 5-day history of sudden diminution of vision in both eyes. The clinical findings were suggestive of the Vogt-Koyanagi-Harada (VKH) syndrome. She was treated with high-dose oral steroids. At this juncture, the association was unclear. However, it was justified by an acute flare-up of uveitis on day 2 post the second dose of vaccination despite ongoing steroids. A direct correlation of Harada-like syndrome with the Covishield vaccine is observed here.

Background In the context of the increasing number and proportion of population aged 60 years or more in India, it is imperative to understand their health needs for ensuring healthy ageing. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we identified the top ten causes of disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) disaggregated by sex and age groups (60–64 years, 65–69 years, 70–74 years, 75–79 years, and ≥ 80 years) for India in 2019. We analysed the proportional contribution of individual causes to the total DALYs due to communicable diseases (CMNNDs), non-communicable diseases (NCDs), and injuries disaggregated by age and sex. We report the state-level heterogeneity in the crude DALY rate for CMNNDs, NCDs, and injuries for older persons disaggregated by sex. Additionally, we reviewed if the data capture of service delivery indicators on older persons were age- and sex-disaggregated in the Health and Wellness Centres (HWCs), and in the National Programs aimed at the Health Care for the Elderly (NPHCE), Prevention and Control of Non-communicable Diseases (NP-NCD), Control of Blindness and Visual Impairment (NPCBVI), Prevention & Control of Deafness (NPPCD), the Mental Health Program (NMPH), and the AYUSH Musculoskeletal Disorders Program (MSDP) within the context of disease burden. Results The older persons accounted for a total of 136.1 million DALYs (29.1% of the total DALYs) in 2019 of which 77.9% were from NCDs, 14.8% from CMNNDs, and 7.3% from injuries, and nearly two-thirds of DALYs were accounted by YLLs. In NCDs, cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes and kidney diseases, and musculoskeletal disorders accounted for nearly 80% of DALYs for both sexes. There were variations in the magnitude of disease burden by specific diseases and conditions between females and males, and by age groups within both sexes particularly for injuries and CMNNDs. Injuries accounted for more YLDs than YLLs, ranging between 5.9%-15.2% for females and 15.3%-17.3% for males, with the females having a higher contribution to total injury related DALYs due to falls as compared to the males (54.4% vs 36.6%), whereas the males had a higher contribution to total DALYs due to road injuries (33.8% vs 19.4%). There was substantial variation in the crude DALY rates of major disease groups by the two sexes across the states of India in 2019. The crude DALY rate for CMNNDs varied between 3.6 times -3.7 times between the states for females and males, respectively; NCDs varied between 1.3 times -1.9 times, and injuries varied 2.0 times -1.7 times. The capture of service utilisation indicators was not age- or sex-disaggregated in NPHCE, NPCBVI, NMHP, MSDP, and HWCs; sex-disaggregation was available in NP-NCD but not age-disaggregation; sex-disaggregated data was available for many service indicators in NPPCD but with no age disaggregation beyond 50 years and more. Only NP-NCD and NPPCD allowed for data capture by disease/condition or severity of disease/condition for the older persons whereas the other programs including NPHCE did not allow for much disaggregated understanding by the type of services availed. Conclusions This comprehensive assessment of the differentials in disease burden among older persons across age, sex and states of India, and the gaps identified in the service utilisation data capture by age and sex for the older persons in the national health programs can provide crucial inputs for strengthening the on-going public health policy and programmatic efforts aimed at improving the health and well-being of the growing older population in India.

Crop wild relatives (CWRs), landraces and exotic germplasm are important sources of genetic variability, alien alleles, and useful crop traits that can help mitigate a plethora of abiotic and biotic stresses and crop yield reduction arising due to global climatic changes. In the pulse crop genus Lens , the cultivated varieties have a narrow genetic base due to recurrent selections, genetic bottleneck and linkage drag. The collection and characterization of wild Lens germplasm resources have offered new avenues for the genetic improvement and development of stress-tolerant, climate-resilient lentil varieties with sustainable yield gains to meet future food and nutritional requirements. Most of the lentil breeding traits such as high-yield, adaptation to abiotic stresses and resistance to diseases are quantitative and require the identification of quantitative trait loci (QTLs) for marker assisted selection and breeding. Advances in genetic diversity studies, genome mapping and advanced high-throughput sequencing technologies have helped identify many stress-responsive adaptive genes, quantitative trait loci (QTLs) and other useful crop traits in the CWRs. The recent integration of genomics technologies with plant breeding has resulted in the generation of dense genomic linkage maps, massive global genotyping, large transcriptomic datasets, single nucleotide polymorphisms (SNPs), expressed sequence tags (ESTs) that have advanced lentil genomic research substantially and allowed for the identification of QTLs for marker-assisted selection (MAS) and breeding. Assembly of lentil and its wild species genomes (~4Gbp) opens up newer possibilities for understanding genomic architecture and evolution of this important legume crop. This review highlights the recent strides in the characterization of wild genetic resources for useful alleles, development of high-density genetic maps, high-resolution QTL mapping, genome-wide studies, MAS, genomic selections, new databases and genome assemblies in traditionally bred genus Lens for future crop improvement amidst the impending global climate change.