Facility In India Research Articles

Comparative Analytical Study of Intravitreal Triamcinolone Acetonide Versus Bevacizumab in Managing Diabetic Macular Edema: Insights From a Tertiary Eye Care Facility in India

Comparative Analytical Study of Intravitreal Triamcinolone Acetonide Versus Bevacizumab in Managing Diabetic Macular Edema: Insights From a Tertiary Eye Care Facility in India

Efficacy and Safety of an Indian Bevacizumab BIOSimilar (BEVATAS) for Retinal Vein Occlusion (BIOS-RVO Study).

To evaluate the efficacy and safety of Bevatas®, an Indian bevacizumab biosimilar, in the management of both Central Retinal Vein Occlusion (CRVO) and Branch Retinal Vein Occlusion (BRVO) (BIOS-RVO). The BIOS-RVO study was a retrospective interventional study conducted at a single tertiary eye care facility in India. 154 treatment-naïve eyes with RVO (CRVO: 62 eyes; BRVO: 92 eyes) received intravitreal bevacizumab biosimilar (IVBb) therapy. Data on best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were collected at baseline and at 3, 6, and 12 months post-therapy. The average age of participants was approximately 55.99 (+12.56) years, with a nearly equal gender distribution (M:F = 49.4:50.6). Age differences between BRVO and CRVO groups were not significant (P=0.501), but gender distribution varied significantly (P=0.035), with more males in the CRVO group. Significant improvements in BCVA were observed in both CRVO and BRVO groups at 3 months, 6 months, and 1 year compared to baseline (P<0.001). Both groups showed significant reductions in CMT throughout the follow-up period (P<0.001). The mean number of injections was higher in the CRVO group (5.27[±1.45]) compared to the BRVO group (4.27 [±1.28]) (P<0.001). Significant IOP increases were observed at 1 month (P<0.001) and 6 months (P<0.001) in both BRVO and CRVO groups, although not clinically significant. Safety analysis revealed no additional ocular or systemic adverse events during the study period. The BIOS-RVO study demonstrates that Bevatas is an effective and safe treatment option for both CRVO and BRVO. These findings support the use of Bevatas as a cost-effective alternative to branded anti-VEGF agents, particularly in resource-limited settings.

An Outbreak Investigation of Salmonella Weltevreden Illnesses in the United States Linked to Frozen Precooked Shrimp Imported from India – 2021

In 2021, the U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and state partners investigated a multistate sample-initiated retrospective outbreak investigation (SIROI) consisting of a cluster of nine Salmonella Weltevreden illnesses associated with frozen, precooked shrimp imported from India. Import surveillance testing identified Salmonella Weltevreden recovered from a cooked shrimp sample from Supplier B. In total, nine patients with clinical isolates highly related via whole genome sequencing were reported in four states with illness onset dates between February 26 and July 17, 2021. Epidemiologic data were gathered by state partners for seven patients, who all reported exposure to shrimp. Five patients reported consuming shrimp cocktail from the same retailer. A traceback investigation for five of the six patients converged on Supplier B. This evidence demonstrated that the outbreak of Salmonella Weltevreden illnesses was caused by the consumption of cooked, ready-to-eat shrimp manufactured by Supplier B. At the time of the investigation, outbreak and recall information was shared with Indian competent authorities. In March 2022, a follow-up inspection of Supplier B’s facility in India was conducted, and insanitary conditions and practices were observed. This outbreak investigation highlighted the importance of multidisciplinary national and international public health partnerships. The lessons learned from this investigation should continue to inform investigational activities and food safety guidance for the industry.

A CROSS-SECTIONAL CLINICOMYCOLOGICAL STUDY OF TINEA CORPORIS IN AN INDIAN TERTIARY CARE HOSPITAL

Tinea corporis, a fungal infection of the skin, hair, and nails, has become a significant public health concern in recent years. This study aimed to assess the frequency of various fungal species associated with Tinea corporis and explore potential correlations with clinical features. A total of 311 cases from a tertiary care facility in India participated in this cross-sectional study. Samples from skin, hair, and nails were analyzed using fungal cultures and potassium hydroxide (KOH) mounts. Most patients were male and in their third decade of life, with 13% having Tinea corporis et cruris and 48.8% reporting a positive family history. Trichophyton mentagrophytes was the most commonly isolated species (80.92%), followed by Trichophyton rubrum (14.54%). No significant correlation was found between clinical characteristics, such as body surface area or illness duration, and the type of fungus identified.

Impact of sperm DNA fragmentation in couples with unexplained recurrent pregnancy loss: A cross-sectional study.

Recurrent pregnancy loss (RPL) has a multifactorial etiology, with a majority of cases remaining unexplained. To account for these unexplained cases, possible male factors are being explored. Conventional semen analysis lacks a qualitative assessment of sperms and information regarding sperm DNA integrity. Sperm DNA fragmentation (SDF) has diagnostic value in unexplained RPL, and it may account for a number of unexplained cases. Hence, we planned a study to explore and evaluate the impact of sperm DNA fragmentation in couples with unexplained recurrent pregnancy losses. Analytical cross-sectional study was conducted at a tertiary-level referral facility in India between August 2021 and July 2023. Participants (n = 70) were divided into two groups-male partners of couples with unexplained RPL (following spontaneous conceptions) (n = 35) and men with at least one previous live birth (spontaneous or following fertility treatments for female factor infertility such as ovulation induction or intrauterine insemination) as controls (n = 35). Neither of the two groups of couples recruited for this study had undergone ART as fertility treatment. Primary outcome assessed was mean DNA fragmentation index (DFI). Secondary outcomes included differences in semen parameters such as sperm concentration, progressive sperm motility and morphology, proportion of men with high (≥30%) and low DFI in the two groups, and the association between various semen parameters and DFI. Univariate logistic regression revealed that sperm DNA fragmentation was higher in men with unexplained RPL (30.0; IQR (interquartile range) 19.0, 46.0) as compared to controls (22.0; IQR 14.0, 30.0) although it was not statistically significant (OR, odds ratio, 1.02; 95% CI 1.0-1.1, p = 0.08). A higher proportion of men with unexplained RPL had DFI ≥30% compared to controls (54.2% vs. 25.7%; OR 3.43 (95% CI 1.2-9.4); p = 0.02). No statistically significant differences were observed in semen volume, sperm concentration, progressive motility, and morphology between the two groups. Sperm DNA fragmentation index also showed a weak but significant inverse relationship with sperm morphology (r = -0.336, p = 0.004). The current study did not show any significant difference in the mean sperm DNA fragmentation levels in male partners of couples with unexplained RPL compared to controls. However, a higher proportion of men with DFI ≥30% were observed in unexplained RPL population when compared to controls.

Overview of physics results from the ADITYA-U tokamak and future experiments

The ADITYA upgrade (ADITYA-U), a medium-sized (R0=75 cm,a=25 cm) conventional tokamak facility in India, has been consistently producing experiments findings by using circular and shaped-plasmas. Recognizing the plasma parameters aligning closely with the design parameters of circular limited plasmas, ADITYA-U shifted its focus toward exploring the operational regime for experimentation on saw-tooth and MHD phenomena. Moreover, ADITYA-U has made consistent advancements toward conducting preliminary plasma shaping experiments through the activation of top and bottom divertor coils utilizing hydrogen as well as deuterium fuels. Confinement is improved by a factor of ∼1.5 in D2 plasmas when compared to H 2 plasmas of ADITYA-U. Further, ADITYA-U operations emphasize preventing disruptions and runaway electrons (REs) to ensure safe operations for future fusion devices. Significant suppression of REs has been achieved in ADITYA-U with the application of pulsed localized vertical magnetic field (LVF) perturbation, thereby establishing the technique’s independence from the tokamak device. The successful RE mitigation requires a critical threshold of LVF pulse magnitude, which is approximately 1% of the toroidal magnetic field, and a minimum duration of ∼5 ms. Apart from this, several novel findings have been achieved in the ADITYA-U experiments, including the modification of sawtooth duration through gas-puff, the emergence of MHD-induced geodesic acoustic mode-like oscillations, the propagation of fast heat pulses induced by MHD activity, the control of RE dynamics through Gas-puffs, the propagation of pinch-driven cold-pulses, the transport and core accumulations of argon impurities, the mass dependency of plasma toroidal rotation and the detection of ‘RICE’ scaling, as well as the characterization of edge plasma using wall conditioning methods, such as glow discharge cleaning using a combination of Ar-H 2 mixture, localized wall cleaning by electron cyclotron resonant plasma, and the development of machine learning-based disruption predictions, will be discussed in this paper.

Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India.

In resource-limited facilities, the greatest number of unfavorable maternal-fetal outcomes at referral hospitals is chronicled from emergency obstetric referrals of critically ill patients from lower health facilities. An efficient obstetric referral system is thus necessitated for improving maternal health. Referral practices have not been optimized effectively till date, owing to paucity of a detailed profile of referred women and indigenous barriers encountered during implementation process. This five-year retrospective audit was conducted in the Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi from September 2018 to 2023, in which records of all critically ill obstetric women referred were reviewed. The primary outcomes included were proportion and pattern of patients being referred, while secondary outcomes included demographic variables, referring hospital, reason and number of steps in referral, duration of hospital stay and fetomaternal outcome. The data were recorded on a predesigned case proforma and analyzed using the SPSSv23 version of software, after application of appropriate statistical tests. The referral rate to obstetric intensive care unit (ICU) ranged from 39 to 47% in last 5 years; hypertensive disorder of pregnancy (31%) being the foremost cause of the referrals. Around 2/3rd women were transferred without escort (70%) or prior communication (90.6%) and referral slips were incomplete in half the admissions. Ensuring emergency obstetric care (EmOC) at various levels by up-gradation of health infrastructure would go a long way in improving fetomaternal health outcomes. There is need of standardized referral slips tailor-made to each state and contextualized protocols for early recognition of complications and effective communication between referral centers. Marwah S, Suri J, Shikha T, Sharma P, Bharti R, Mann M, et al. Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India. Indian J Crit Care Med 2024;28(8):734-740.

A Cross-sectional Study to Evaluate the Efficacy and Safety of Pregabalin Use in Young Adults of a Tertiary Care Indian Setting

Background and Aims: Neuropathic pain refers to the illness that affects the somatosensory nerve system which is characterised by spontaneous pain and pathologically increased sensitivity to both noxious and benign stimuli. The purpose of this study was to compare the short-term therapy of young adults with chronic neuropathic pain with gabapentin in order to assess the safety and effectiveness of pregabalin. Materials and Methods: In cooperation with the Department of Pharmacology at a tertiary care facility in India, the outpatient departments of neurology, orthopaedics, general medicine, and psychiatry undertook this prospective, comparative, randomised, open-label, single-centre cross-sectional study. One hundred and thirty-five patients in Group A received 75 mg of pregabalin and were then given 150 mg of pregabalin twice a day. One hundred thirty-five participants in Group B received 300 mg of gabapentin. The Numeric Pain Rating Scale (NPRS) was used to quantify pain intensity at baseline, 1 month, and 2 months later in order to compare the negative effects of pregabalin to those of gabapentin. Results: When comparing the two groups’ NPRS scores at baseline, 1 month, and 2 months, Group A (pregabalin) had a comparatively lower NPRS score. At baseline, Group A had a mean ± SD score of 8.5 ± 1.25, when compared to Group B with 8.7 ± 1.20. After 2 months, Group A had a mean ± SD score of 2.5 ± 1.50, when compared to Group B with 4.5 ± 1.80, respectively, which was statistically significant with P &lt; .001. Conclusion: This study suggests that gabapentin and pregabalin are equally effective at reducing pain in persons with neuropathic pain. In terms of NPRS score, pregabalin performs better than gabapentin.

“I just cannot take medication for the rest of my life”: Non adherence Towards Diabetes Treatment

Diabetes is a rapidly growing health challenge and potential epidemic across the low-and-middle-income countries. In primary health care settings, the management of diabetes is mainly by providing hypoglycemic drugs and lifestyle change. The level of adherence and compliance to the therapy is a critical element in glycaemic control. In developed countries, adherence to long-term therapies in the general population is around 50% and is much lower in developing countries. A specific trend of non compliance and non adherence towards medication was seen in patients coming to a rural primary health care facility in India. Several beliefs regarding non adherence were identified in such patients which are - Beliefs about chronic diseases in general, beliefs about long term drug intake, behavior towards diabetes medication, peers observations and switching between different treatments. There is a need to identify specific reasons for non compliance and/or non adherence so that more focused behavioral change strategies can be made for patients of chronic diseases.

Diabetic foot ulcers, their characteristics, and trends in survival: Real world outcomes at a tertiary care facility in India

AimsCharacteristics of diabetes-related foot ulcers (DFU), association with recurrence and amputation are poorly described in the Asian Indian population. MethodsA prospectively maintained database was reviewed to characterize DFU and its association with amputation and recurrence. ResultsOf 200 patients, 63.5 % were male, the median age was 62 years (Min-Max:40–86), and median BMI was 27.90 kg/m2 (Min-Max:18.5–42.7). Median duration of Diabetes mellitus was 15 years (Min-Max:2–43). Complete healing occurred at a median of three months (Min-Max:0.23–37.62). Amputation for the current ulcer was required in 43.4 % of individuals. Ulcer recurrence was documented in 42.4 % instances, 66.1 % evolving on the ipsilateral side. Previous amputation was associated with the risk of subsequent amputation (Adjusted OR-3.08,p-0.047). Median time to ulcer recurrence was 4.23 years among those with amputation, in contrast to 9.61 years in those with healing. Cardiovascular death was the commonest cause of mortality, followed by sepsis. At a median follow up of 6.08 years, mortality at 1,3,5 and 10 years was 2.5 %,2.5 %,8.2 % and 30.9 % respectively among those who underwent amputation versus 0 %,0 %,10.1 % and 24.5 % respectively for those who achieved healing. ConclusionsPatients with DFU in India incur amputations at rates higher than conventionally described. With previous amputation, subsequent amputation risk triples. Ten-year mortality is 25%–30 %. Underestimates of the burden of recurrence and mortality are consequential of limited follow-up.

Cost analysis of different medical oxygen sources for a healthcare facility in India.

Multiple sources of medical oxygen, namely liquid medical oxygen (LMO) tanks, pressure swing adsorption (PSA) plants, concentrators, and gaseous cylinders, are available at different healthcare facilities. These sources of oxygen have varying installation and operational costs. In low-resource settings, it is imperative to utilise these assets optimally. This study investigated the operational costs of multiple oxygen sources available at a healthcare facility. A Microsoft (MS) Excel-based model was developed to analyse and compare the oxygen manufacturing costs (in ₹/m3) using PSA plants and procurement costs (in ₹/m3) of LMO and third-party vendor-refilled cylinders. The oxygen manufacturing costs for PSA plants of different capacities and running times on electricity and diesel generators (DGs) as a power source were calculated. This study highlights the cost-benefit of using PSA plants over LMO and third-party vendor-refilled cylinders as a source of oxygen. PSA plants are most economical when they are of higher capacity and used to their maximum capacity on electricity as the power source. On the contrary, they are most expensive when used on a DG set as a power source. Furthermore, this study provides evidence of PSA plants being more cost-effective for refilling cylinders using a booster compressor unit when compared to third-party vendor-cylinder refilling. Given their cost-effectiveness and low third-party dependence, they should be utilised to their maximum capacity as medical oxygen sources at healthcare facilities.

Course and Outcome of Anorexia Nervosa in Adolescents from a Tertiary-level Mental Health Setting in India: A Retrospective Chart Review.

Anorexia nervosa is one of the least studied mental health conditions in the Indian setting. The objective of this study was to assess the course and outcome of anorexia nervosa in adolescents who had presented to a tertiary care child and adolescent psychiatry center over a period of 10 years. The present study is a retrospective chart review of adolescents (up to the age of 18 years) with a diagnosis of anorexia nervosa, coded as F50.0 or F50.1 according to ICD 10, from 1st April 2009 to 31st March 2019. Data were extracted from the case records using standardized abstraction forms and evaluated using descriptive and nonparametric statistics. The average age at presentation and the average age at onset were 14.1 years and 13.1 years, respectively. The male-to-female ratio of the sample who got admitted was 1:9. The average duration of hospital stay was about 30 days. The duration of in-patient care and weight gain were positively correlated, with severe to extremely ill adolescents improving even in less than one month of in-patient care. Seventy per cent of the admitted adolescents followed up. The functional outcome as measured by a 'return to school' improved in 57.1% of the sample. The present study highlights the collaborative multidisciplinary and individualized treatment approach employed for adolescents diagnosed with anorexia nervosa within an inpatient mental health facility in India. Adolescents who presented with more severe illness at the initial assessment, such as an early onset of symptoms and a low BMI, experienced substantial weight gain that exhibited a positive correlation with the length of their stay in the inpatient facility.

Social and cultural determinants of antibiotics prescriptions: analysis from a public community health centre in North India

This paper explores the socio cultural and institutional determinants of irresponsible prescription and use of antibiotics which has implications for the rise and spread of antimicrobial resistance (AMR). This study describes the patterns of prescription of antibiotics in a public facility in India and identifies the underlying institutional, cultural and social determinants driving the irresponsible use of antibiotics. The analysis is based on an empirical investigation of patients’ prescriptions that reach the in-house pharmacy following an outpatient department (OPD) encounter with the clinician. The prescription analysis describes the factors associated with use of broad-spectrum antibiotics, and a high percentage of prescriptions for dental outpatient department prescribed as a precautionary measure. This paper further highlights the need for future research insights in combining socio-cultural approach with medical rationalities, to further explore questions our analysis highlights like higher antibiotic prescription, etc., Along with the recommendations for further research.

Syndromic diagnosis, sexual behavior, and management in rural population among all cases attending sexually transmitted infection clinic in a tertiary care center from the east-central zone of India: A retrospective study.

Rural population constitutes a significant population of our country. According to the regions, the sexual behavior and pattern of sexually transmitted infections (STIs) changes because of variation in health facilities, education, and sociocultural belief. To study the sociodemographic profile, sexual behavior, and pattern of STIs based on the syndromic approach in the rural population attending STIs clinic from the east-central zone of India. Between January 2020 and July 2022, a retrospective study was carried out in a STIs clinic at a tertiary care facility in India's east-central region. Data included demographics, clinical profiles (syndromic approach), and sexual behavior from all the rural population suffering from STIs. The data were corroborated using the proper statistical tools. Seven hundred and twenty-two (63.6%) of the 1135 STI cases were from the rural population. The gender ratio was 17:1, with 333 (46.1%) patients between the ages of 20 and 30 years. Four hundred and ninety-four (68.4%) of the rural population had education qualifications below the 10th class. The predominant occupation was a homemaker (582; 80.6%). Drug abuse was noted in 13 (1.8%) cases. Lower abdominal pain was the most clinical manifestation seen in 441 (61%) cases, followed by vaginal discharge in 89 (12.3%) cases. The majority of the patients presented with the first episode of symptoms and had a single regular partner with no symptoms in a partner. In 22.9% of cases, the partner had a history of frequent travel. In 94.1% of cases, protective measures were not used. Young married adults, female partners, lower education, and low-income classes were among those who had STIs, with frequent unprotected sexual activity. Lower abdominal pain is the most common symptom in this area.

Evaluation of Mean “R” Wave Amplitude in Lead V1 of Electrocardiogram among Term Newborn Infants in Tertiary Care Institution in South India

Background: The changes in the left ventricle to right ventricle muscle mass ratio account for the majority of the age-related changes in pediatric electrocardiograms (ECGs). A newborn's right ventricle muscle mass is more than the newborn's left ventricle. Physiologically, newborn infants have a dominant right ventricle. Race differences in QRS voltage normal values exist. Compared to Euro-Americans, African-Americans have a higher upper normal limit of QRS voltages. Typically, right ventricular hypertrophy is seen in newborns. To distinguish between pathological and physiological newborn hypertrophy, it is critical to measure the mean QRS amplitude in healthy newborns. This is the first study on the Indian population, with previous ones being conducted among African-Americans. Methodology: Between 2015 and 2016, this prospective observational study was carried out in the pediatrics department of a tertiary care facility in India. The study included 76 term newborns who were under 3 days old. In Chennai's Kilpauk Medical College and Hospital, the newborn infants underwent clinical examinations as well as echocardiography before receiving their ECGs. A baseline questionnaire that had been previously created was used for data collection. Results: For the Indian population, the mean R wave amplitude was 11.56 mm, with a standard deviation of 2.96 mm, and the 5th and 95th percentiles were 6.85 mm and 16.15 mm, respectively. The Fridericia formula for the mean QTc interval gives a value of 357.14 ms, a standard deviation of 34.072 ms, and a 95% confidence interval of 349.36–364.93 ms. Since a newborn's heart rate typically exceeds 100 beats/min, the measurement of QTc using the Fridericia formula more accurately predicts QTc in the newborn. The mean heart rate was 125.75 beats/min, with a standard deviation of 15.44 beats/min, and the 5th and 95th percentiles were 93.7 and 149 beats/min, respectively. Conclusions: The “R” wave mean amplitude in lead V1 was 11.56 mm, with a 2.96 mm standard deviation; the fifth and ninety-fifth percentiles, respectively, were 6.85 mm and 16.15 mm. The population's “R” wave in the lead V1 exhibits racial differences in amplitude.

Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data.

Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization's indicator "Availability of EmONC facilities" was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate "Availability of EmONC" by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator's value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator's validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.

Toll Rate Policies of India: A Review, Comparison, and Inferences

Tolling as a method of financing transportation systems is becoming increasingly common worldwide. The collection of fees from road users under public-private partnership agreements is based on prescribed toll fees/rates. According to the prevailing level of human, traffic, environmental and economic development, these toll rate policies vary from country to country. In India, road toll rates are prescribed by the Gazette of India: Extraordinary (Part II Section 3 sub-section [i]) published by the Ministry of Road Transport and Highways under the National Highways Act, 1956. Each year, the toll rates for each toll facility in India are set as per the National Highway Fee (Determination of Rates and Collection) Rules, 2008. There is now a need to revisit the policies on fixing toll rates in India. The present study presents a critical literature review of the toll rate policies in India and other developed and developing countries. The study provides a comparison of the different vehicle classes considered for toll rates and it is found that most of the classifications are based on gross vehicle weight (GVW) and on number of wheels and axles. Additionally, the toll rates for different nations are compared and it is found that Indian toll rates are lower than those of the developed countries. Finally, the research gaps are given for further research.

Costing analysis of an information & communications technology-enabled primary healthcare facility in India.

Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. The estimated overall annual cost of delivering health services through PHC in the public sector was ₹ 7.88 million. The additional economic cost of ICT was ₹ 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ₹ 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ₹ 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.

Bacterial IsolateProfile in Gram-Negative Urinary Isolates: Role ofNitrofurantoin

Background: In current times epidemic drug resistance has renewed interest in drugs belonging to the yesteryears, most importantly Nitrofurantoin for urinary tract infections. Studies have reported that more than 90% of urinary tract infections are due to enteric Gram-negative organisms, of which more than 80% are E.coli.Objectives: To study bacterial profile in Gram-negative urinary isolates and evaluate the role of nitrofurantoin.Methods: We retrospectively evaluated 500 consecutive Gram-negative bacterial isolates for bacteriological profile and nitrofurantoin sensitivity of patients of urinary tract infections at a tertiary care facility in India between January and June of 2022.\Results: We had a total of 500 Gram- negative urinary isolates. 383 (76.6%) of these were found to be susceptible to nitrofurantoin. E. coli alone constituted 343 (68.6%) of total 500 Gramnegative isolates, 264 (76.96%) of which were sensitive to nitrofurantoin. 20 (4%) Proteus and 05 (1%) Citrobacter species were isolated and found to be resistant to nitrofurantoin. 12 (80%) out of the 15 Acinetobacter isolates were resistant to nitrofurantoin. All 12 (100 %) Pseudomonas isolates tested resistant to nitrofurantoin.Conclusion: E. coli is the most common of uropathogens and despite rise in antibiotic resistance, it continues to be sensitive to nitrofurantoin. Resistance to nitrofurantoin is also being reported and this calls for judicious further use of this drug based on culture reports and local prevalence data.International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 Page: 162-165

Dynamic coal blending under sustainability concerns: a case study from the Indian steel industry

PurposeIncreasing scarcity of natural resources and the adverse effects of unsustainable practices call for more and more efficient management strategies in the energy industry. The quality of the coke plays a significant role in the quality and durability of the output steel which is produced using the energy from the coal. This paper aims to investigate the dynamic coal blending problem under overall cost and coke quality constraints in the steel industry within a periodic cycle of operations.Design/methodology/approachConsidering the variability of the natural properties over a periodic cycle, this study proposes a multi-period mixed-integer non-linear programming formulation to optimize the total blending costs while taking various coke quality constraints into account. Besides, this study applies factorial design to investigate about the significant effect of coal proportions as well as improvement into the overall cost of blending.FindingsIn this case study, utilizing real data from a coal blending facility in India, through a factorial design, the authors obtain optimal desirable levels of coal proportions and their criticality levels towards the total cost of blending (TCB) or objective function. This analysis reflects the role of the coke quality constraints in the objective function value while characterizing the price of sustainability for the case study among other critical insights.Originality/valueObjective function (or TCB) includes basic coal cost, movement cost and environmental costs during the coal and coke processing at a coke-oven and blast furnace of steel industry. The price of sustainability provides managerial insights on that sacrifices the industry has to make in order to become more “sustainable”.