Indian Experience Research Articles

Double-arterial cannulation strategy in patients presenting with Type A aortic dissection

Background: Cannulation strategies in ascending aorta and arch surgeries are a matter of immense discussion. Majority of time deep hypothermic circulatory arrest (DHCA) is the preferred strategy, but it does come with its set of demerits. Double-arterial cannulation (DAC) may decrease DHCA time and avoid its related morbidity and mortality. Aim: The aim was to compare patients undergoing surgery in acute Type A dissection by DAC with antegrade cerebral perfusion under moderate hypothermia and single-arterial cannulation (SAC) technique under DHCA with respect to the primary outcome of stroke, seizure, and psychosis and the secondary outcome as malperfusion, hospital stay, and mortality. Materials and Methods: This study was a retrospective analysis of 64 patients operated for acute ascending aortic dissection (AAD) extending into arch and major vessels in the Department of CTVS, UN Mehta Institute of Cardiology and Research between July 2015 and July 2020. After screening through the hospital data, 30 patients operated by SAC and 34 patients operated by DAC technique were selected and their files were studied and analyzed. All patients were diagnosed using two-dimensional echocardiogram and computerized tomography aortogram to confirm the diagnosis. Forty-four patients who presented to emergency were stabilized before taking up for emergency surgery and 20 were operated semi-electively. Out of 64 patients, 40 patients underwent Bentall's procedure using composite mechanical valve, 10 patients underwent ascending aorta replacement, 7 patients underwent ascending aorta replacement with hemiarch, 2 patients underwent Bentall's with coronary artery bypass grafting, 2 patients underwent David's procedure, 2 patients underwent Yacoub's procedure, and 1 patient underwent Bentall's procedure using biological valve. Out of 30 patients operated by SAC, 25 patients had femoral cannulation and 5 patients had only right axillary cannulation. In the DAC group, all had right axillary artery and femoral cannulation. All patients were analyzed for primary and secondary outcomes. Results: A total of 64 patients diagnosed with Type A AAD with dissection flap extending into major vessels were included in the study. Those patients operated with DAC technique had a significantly lower incidence of stroke, malperfusion, and hospital mortality as compared to the patients with SACs. Conclusion: In AAD involving major arch vessel and femoral arteries, the idea is to provide rapid and safe blood inflow to arterial system in order to maintain cardiopulmonary bypass (CPB) and organ perfusion, which is of utmost iimportance. The idea is to provide rapid and safe blood inflow to arterial system in order to maintain cardiopulmonary bypass (CPB) and organ perfusion, which is of utmost importance. The right axillary artery is least involved in acute aortic dissection and when cannulated can provide uninterrupted flow to brain and also provide sufficient inflow to maintain CPB. Along with this, if femoral artery cannulation provides flow to abdominal organs and lower limb, it will prevent malperfusion syndrome. DAC is safe in complex Type A aortic dissection and aortic arch surgery and has better perioperative outcomes compared to SAC.

Impact of Body Mass Index on Pathological Complete Response Following Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer – A South Indian Single-institute Experience

Context: Obesity is a risk factor for the development of breast cancer. Neoadjuvant chemotherapy (NACT) is now increasingly being used in its management. Pathological complete response to NACT has proven to be a surrogate marker for improved outcomes in various molecular subtypes of breast cancer. Aims: The primary objective of this prospective observational study was to analyze the impact of body mass index (BMI) on pathological complete response (pCR) rates for locally advanced breast cancer (LABC) after NACT. The secondary endpoint was to assess the histopathological features of the surgical specimen in response to NACT and to investigate the relationship with prechemotherapy BMI taking into account the various molecular subtypes of breast cancer. Subjects and Methods: Biopsy-proven LABC patients who received NACT and underwent surgery were included. Patients were categorized based on BMI classification for Asian population prechemotherapy. Molecular subtyping of breast cancer was done using immunohistochemistry and fluorescence in situ hybridization as necessary. An analysis of the association between BMI and pCR in various subtypes of breast cancer, based on hormone receptors and HER2 status, was performed. Results: The study included 205 patients. The pCR detection rate in this study was 15.6% (n = 32) which was highest in under/normal weight patients (30.2%) in comparison to overweight (12.5%) and obese (7.8%) patients (P = 0.002). For the patients who achieved pCR, the breast-conservative surgery rates were seen as higher than modified radical mastectomy rates (P = 0.025). The molecular subtype triple-negative breast cancer patients were more likely to achieve pCR (32.5%) than other molecular subtype patients (P < 0.001). Stage II patients were more likely to achieve pCR than Stage III and IV patients (P = 0.005). Conclusions: This prospective study established that overweight and obese patients suffering from breast carcinoma had a reduced chance of achieving pCR following NACT in comparison with those who had an under-/normal BMI.

Coolitude

In this short essay, the author examines the influence of the concept of Coolitude on his understanding of the Indian indenture experience. Parallels between patterns of immigration are alluded to – whether the indentured immigration of the nineteenth and early twentieth century or post-colonial immigration from those sugar colonies of empire to their former metropoles. Coolitude’s recognition of the role of space and place is at the fore and the author asks us to take this into account in our exploration of the global indentured story, making the case for a more concentrated address of the geography of indenture.

Indian VenaSeal™ Experience Study Extension: Outcomes of Nonthermal, Nontumescent Endovenous Ablation (VenaSeal™) for the Treatment of Truncal Reflux in Varicose Vein Disease – An Indian Perspective with 2-Year Follow-up

Background: Varicose vein disease is a common disease in nearly 37.25% of Indian population affecting quality of life. Endovenous thermal ablation has been the first-line treatment for superficial venous reflux. A new technique, available now, is nonthermal, nontumescent vein sealing system (VenaSeal™), which comprises endovenous delivery of cyanoacrylate tissue adhesive into the vein causing obliteration of lumen and has shown better results in terms of safety and efficacy. Being a new modality, only a handful of institutes across India perform this procedure and there is a scarcity of Indian data on its outcomes. Aims and Objectives: To evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in VCSS score. Materials and Methods: The Indian VenaSeal Experience Study was carried out a year back, which was a single-center prospective study of 50 patients over 1 year and 4 months with 3 and 6 months of follow-up, and we aimed to evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in venous clinical severity score (VCSS). This is an extension of that study with 200 patients (378 limbs) with similar parameters for outcome evaluation. Results: The study showed the mean age of study group to be 48.6 years and majority (87%) had an early varicose vein (C2/C3) disease. The average length of vein treated per limb was 62.6 cm and the average glue used per limb was 3.05 ml. All patients showed improvement in VCSS score averaging 2.3 ± 1.6 (P < 0.0001, n = 378) with target vein occlusion rate of 98% at 6 months (n = 182), 97% at 12 months (n = 126), and 95% at 2 years (n = 98). Conclusion: VenaSeal™ glue ablation procedure is a promising and effective modality for the treatment of varicose veins with excellent treatment success rates and maximum patient acceptability. However, complications such as severe phlebitis and anaphylaxis have been reported. It is a feasible option under local anesthesia, does not require tumescence, and hence an efficient outpatient department-based procedure.

Real-World Indian Experience of Switchover to Bilastine 40 mg/day in CSU Patient Refractory to Other Antihistamines at Double Dose.

Although second-generation antihistamines (SGAHs) are recommended as first-line drugs in chronic spontaneous urticaria (CSU), symptom relief has been reported in <50% of patients at licensed doses and up to fourfold dosing is recommended for these patients. Bilastine (SGAH), at licensed doses and higher doses, is efficacious in CSU. However, large-scale real-world data is scarce. To report the real-world evidence of the safety and effectiveness of bilastine at a double dose (40-mg per day) in CSU management. In this retrospective questionnaire-based study carried out from February 2022 to July 2022, a pre-validated questionnaire was used to gather data on patients with CSU in dermatology practice from 62 centres across India. Adult patients of either gender diagnosed with CSU and switched over to bilastine 40 mg/day due to a non-satisfactory response (UCT score <12) to other antihistamines at double dose were considered for analysis. Based on UCT scores, patients were classified as responders (UCT ≥12) and non-responders at follow-up assessment at 2 weeks as compared to baseline. 177 patients with a mean disease duration of 2.11 ± 1.48 years were included in the final analysis, with 53% females and 47% males. At the end of two weeks, 74/177 (42%) patients were classified as responders, and 103/177 (58%) were non-responders to Bilastine 40 mg/day. The mean change of UCT score from 5.0 ± 2.2 at baseline to 8.08 ± 5.41 (62% improvement) was significant (P < 0.001). Sedation was reported by ten patients without any discontinuation of treatment. Bilastine 40 mg/day was effective and well-tolerated in controlling CSU symptoms refractory to antihistamines at double doses.

Production and characterization of lipase and glucolipids by Halomonas zhanjiangensis and study of their antimicrobial potential

Production and characterization of lipase and glucolipids by Halomonas zhanjiangensis and study of their antimicrobial potential

新世纪中国京剧国际传播现状與问题的考察

Chinese Peking Opera has been promoted and disseminated globally since the beginning of the last century. In this century, with the development of China's economy and the increase of official investment, Peking Opera has reached an unprecedented level in overseas dissemination.&#x0D; There has been great development in the subject of dissemination, the number of frequency of dissemination, the scope and form of dissemination. However, compared with the huge investment, Peking Opera still cannot become an international drama category. It mostly appears overseas as a symbol of Chinese culture, and there are also many misunderstandings in communication. For example, the functions of communication goals are ambiguous, the form of communication for tour performances is single, the lack of cross-cultural communication talents, and the incomplete communication system.&#x0D; Therefore, the overseas dissemination of Chinese Peking Opera needs to clarify the dissemination goals and objectives, clarify the main functions of dissemination, improve the content to meet the needs of cross-cultural dissemination, enrich the means of dissemination in form, cultivate and excavate cross-cultural dissemination talents, establish a three-dimensional communication system for exhibition performances, opera education, and folk communication. At the same time, new communication channels such as the Internet should be effectively used, and the communication experience of India, Japan, South Korea and other countries should be used for reference, in order to achieve greater and better effects of Peking Opera overseas communication.

Commentary on implantation of the Micra transcatheter pacing system: A single center North India experience

Transvenous pacemakers (TVPs) using pectoral pulse generators and transvenous leads are a well-established treatment for bradyarrhythmias and have served us well for 6 decades [1]. However, implantation of these pacemaker devices are not devoid of substantial complications. The complications are primarily related to the need for pacemaker pockets and the requirement for leads for right ventricular pacing. Around half of them are attributable to lead-and generator

Is menstrual cup a sustainable and safe alternative in menstrual hygiene management? A qualitative exploratory study based on user's experience in India

IntroductionMenstrual cup (MC) is the least popular alternative for Menstrual Hygiene Management (MHM) among the reproductive age group women in India. While studies across the globe have shown its usefulness over the conventional sanitary pads, there is a dearth of studies on use and satisfaction status among the MC users from Low- and Middle-Income Countries. Our study intends to explore the experiences and challenges encountered by the MC users. MethodA qualitative explorative study among 26 MC users was carried out telephonically using an In-Depth Interview Guide (IDI). The interviews were audio-recorded followed by transcription and translation. Data were analysed using thematic analysis method. MAXQDA (VERBI Software, Berlin, Germany) software was used for analysis. ResultThe age of participants ranged 25–37 years with a mean age of 29.6 (±0.91) years and their average duration of MC use was 2.4 (±0.34) years. MCs were found to be more economical, safe, convenient, and environment friendly compared to sanitary pads. The motivation to use MC was ingrained with the detrimental experiences of using sanitary pad. However, MC users had concerns about the lack of easy accessibility to cups, availability of appropriate size cup and support system for guidance and awareness. ConclusionMC is an effective and convenient period product that has potential to be an alternate method for MHM. However, it needs more awareness, promotion for wider use leveraging existing platforms. Future research is recommended to study the socio-cultural aspect about the acceptability of MC in rural India.

Reviving lending or safeguarding stability: what purpose did recapitalization serve?

ABSTRACT Two cardinal objectives of recapitalization are promoting bank lending and ensuring systemic stability. Whether the Indian experience ensured that one or both these objectives are addressed remains an open question. To examine this, we utilize data on Indian state-owned banks for 2009–2020. The findings reveal that although recapitalization led to a decline in bank lending, there was an improvement in systemic stability. Robustness tests reveal that these findings differ across bank size and quality of loan book. The price impact of such recapitalization is an increase in borrowing costs, which banks compensate for by modestly increasing lending rates.

Indian Experience of Managing Impossible Trinity, Growth and Possible Tradeoff Between FDI and FIIs: Nature of Capital Inflows Matter

The current focus emphasizes the difficult choices faced by Indian management of the impossible trinity to manage import-led growth. The management highlights two mechanisms by which FDI (foreign direct investment) flows are easily substituted for short-run FII (foreign institutional investment) flows. First, GDP and its growth in an open economy framework and the associated international trade participation can clarify this substitution prospect. Specifically, this study develops reasoning whereby imports under the trilemma management can give some decisive advantage to FII at the cost of FDI to manage Indian import-led growth. Second, it underlines how the related policies, especially the sterilization interventions, constrain the interactions of higher domestic investments (domestic savings), spillover impacts of imports of intermediate and capital goods, and specialized FDI. If so, the Indian economy’s import-led growth can indicate FII and FDI tradeoffs. The study uses the ARDL regression method. The results show that the Indian policy-led macro environment can limit the scope of specialized FDI that aims to induce advanced domestic investment, exports, and FDI interactions. India’s focus on import-led growth thereby underpins how FII substitutes FDI. JEL Classification F21, F3, F4, O11, O14

Brolucizumab in Neovascular Age-Related Macular Degeneration - Indian Real-World Experience: The BRAILLE Study - Fifty-Two-Week Outcomes.

To report the 52-week real-world efficacy and safety outcomes of brolucizumab therapy for neovascular age-related macular degeneration (nAMD) in Indian eyes. A retrospective, multicentre chart analysis of 82 eyes of 82 patients with nAMD (switch therapy: 65 eyes; treatment-naïve: 17 eyes) with 52-week follow-up data was performed. Pro-re-nata re-treatment was offered based on visual and tomographic criteria. Changes inbest-corrected visual acuity (BCVA), intraretinal fluid (IRF), subretinal fluid (SRF), central-subfield thickness (CST), and pigment epithelial detachment (PED) were the key outcome measures, coupled with the safety profile. The mean age of the study population was 67.65 (±10.67) years, with 57 male patients (69.5%). The study's mean number of injections was 4.8 (± 0.77). After brolucizumab therapy, the BCVA improved significantly at weeks 4 (P<0.001), and maintained up to week 52 (P<0.001). The CST also reduced significantly at all the visits (Baseline: 413.6 ± 64.6 µm; 52-week: 292.37 ± 13.5 µm; P<0.001). Significantly fewer eyes demonstrated residual SRF (P<0.001) and IRF (P<0.001) at all visits, starting with week 12 and continuing until week 52. The PED resolution was significant from week 24 through week 52 (P=0.004). Each of the 82 eyes received four injections of brolucizumab, with 63.4% (52 eyes) receiving a fifth dose and only 17.1% requiring a sixth. Mild intraocular inflammation (IOI) was seen in three eyes (3.66%) that resolved conservatively. One patient (1.2%) developed mild fever that subsided with oral medications. The 52-week BRAILLE study demonstrates that brolucizumab is effective and safe in nAMD eyes in a real-world setting. Brolucizumab treatment can reduce the therapeutic burden in patients with nAMD due to its rapid, sustained efficacy and favourable safety profile.

A Cross-Regional Analysis of Colorism Experiences in High Schoolers in India and the United States

Around the world, various beauty standards are often portrayed in the media and expressed by people living in that region, which devolve into unconscious biases. Previous research points to a worldwide skin tone perception standard: dark skin is undesirable. Slavery in the United States and the caste system in India, among other historical phenomena, have played a role in creating this common perception. This study investigates colorism, defined as prejudice against dark skin tones, and aims to examine experiences of colorism and self-esteem through an online survey sent to high school students in India and in the United States. This research paper is unique because a comparison study of regions is not commonly found in the existing literature and, high school students, living in a globally connected world, will provide new perspectives on the cross-cultural issue of colorism. 122 responses (90 from India and 32 from the United States) were collected. A T-test comparing India to the United States found that students in India reported higher colorism than those in the United States (t = -70.219, p &lt; 0.01), and students in the United States reported lower self-esteem (t = -53.33, p &lt; 0.01) compared to those in India. However, skin tone was not significantly correlated with self-esteem or colorist experiences in India or the USA. These results show that the stigma of dark skin tones has not been mitigated and also suggests that there may be other variables apart from skin tone that have greater effect on self-esteem.

Effects of sanitation and hygiene perceptions on international travelers' health, travel plans and trip experiences in India.

International travelers often experience travelers' diarrhea. However, there is paucity of data on whether self-reported gastrointestinal symptoms influence travelers' perceptions of adequacy of sanitation and hygiene services encountered during travel, and to what degree their travel plans, and overall trip experience are impacted. A cross-sectional face-to-face survey was conducted amongst international travelers in India. Data collected included socio-demographics, travel characteristics, self-reported occurrence and frequency/severity of gastrointestinal symptoms, perceptions of sanitation and hygiene encountered, and adverse effects of symptoms on travel plans and trip experiences. Chi-square tests and logistic regression were performed to describe differences and associations between categorical variables. Of the 300 international travelers surveyed, 46.3% experienced diarrhea. At least two thirds of travelers perceived the quality of sanitation (67.0%) and hygiene (70.0%) encountered to be inadequate. Perceptions of inadequate sanitation (adjusted OR = 3.0; 95% CI 1.7-5.5) and poor hygiene (adjusted OR = 7.7; 95% CI 4.1-15.5) were higher among travelers who experienced diarrhea. Additionally, both higher likelihood of travel plans being affected (adjusted OR = 10.7; 95% CI 5.1-23.6) and adverse impacts on overall trip experience (adjusted OR = 2.8; 95% CI 1.4-5.8) were reported among those who experienced diarrhea. More than two thirds of travelers surveyed in India experienced inadequate sanitation and hygiene services, with perceptions influenced by occurrence and frequency of diarrhea. Self-reported diarrhea was also associated with adverse effects on travel plans and overall trip experience. While these results may seem intuitive, they have important implications and suggest that improving sanitation and hygiene standards in India could potentially enhance tourism.

Examining the living metaphor in the Indian Constitution

One popular understanding of the Indian Constitution is that it is a living document that evolves with time. Even though this metaphor has been used consistently by all three branches of the Indian state, its use in Indian legal texts is underexplored—as of most metaphors generally. In this article, we critically evaluate the application of the living metaphor in Indian constitutional discourse. We first provide an overview of the use of metaphors generally, and especially in the legal field. We then identify the origins and trace the use of the living metaphor by studying select Supreme Court judgments which have likened the Constitution to a living text and analyse the Court’s reasons, if any, for doing so. A comparative analysis of how the Canadian, US, and Australian courts have employed the living metaphor demonstrates how the Indian experience differs in its application of the metaphor. We find that the Supreme Court has used different variants of the living metaphor, primarily to expand the ambit of Part III of the Constitution. However, due to the inconsistent and unreliable use of this metaphor, we find that this has the potential to lead to illiberal results. We thus make a case for the formulation of a doctrine of living constitutionalism which we think will be more resilient to anti-democratic challenges.

Employment and global value chain participation: the Indian experience

The paper examines the impact of GVC participation and position on overall employment creation and skill composition of the Indian workforce during 1990–2015. Arellano-Bond GMM dynamic panel estimation reveals that the expansion of size of a sector (in terms of higher value added) failed to generate employment opportunities, especially for the educated unemployed. However, stronger backward linkage is found to have labour displacing effect whereas stronger forward linkage has created employment opportunities but for the unskilled workers. Furthermore, the downstream sectors are found to generate more employment opportunities, whereas the upstream sectors are more skill intensive.

Uncontrolled donation after circulatory determination of death: 11-years single center experience in India

Uncontrolled donation after circulatory determination of death: 11-years single center experience in India

Simultaneous pancreas kidney transplant: a tertiary care center experience in India

Simultaneous pancreas kidney transplant: a tertiary care center experience in India

Acute Myeloid Leukemia during the COVID Pandemic: Impact and the Indian Experience

Acute Myeloid Leukemia during the COVID Pandemic: Impact and the Indian Experience

Decentralized manufacturing of anti CD19 CAR-T cells using CliniMACS Prodigy®: real-world experience and cost analysis in India.

Chimeric Antigen Receptor (CAR) T cell therapy is an accepted standard of care for relapsed/refractory B cell malignancies. However, the high cost of existing industry-driven centralized production makes this therapy unaffordable in low and middle-income countries. Decentralized or point of care manufacturing has the potential to overcome some of these challenges. Here we demonstrate a decentralized manufacturing process for anti-CD19-CAR-T cells using a fully automated closed system (Miltenyi CliniMACS Prodigy®) is feasible in a developing country setting. Validation run data, as part of a pre-clinical trial safety evaluation, demonstrates the successful and robust manufacturing of anti-CD19 CAR-T cells with T cell expansion of 25 to 47-fold. The median transduction efficiency was 48.8%, with a median viability of 98% and fulfillment of all standard release criteria assays for clinical application. Evaluation of production costs in an academic, not for profit setting in India provide a benchmark for low and middle-income pricing which could greatly increase access to this therapy. Based on our analysis, the cost per product would be approximately $35,107 US dollars. Our data highlights the safety, efficacy, and reproducibility of the process for use in planned future clinical trials.