No study has yet attempted to measure mean out-of-pocket expenditure on health care at household level, separately for government and private health facilities in India. Therefore, this study analyses the change in the out-of-pocket expenditure between 1995-96 and 2004 for fifteen major states of India, separately for rural/urban sector and inpatient/outpatient care. Using data from the 52nd and 60th rounds of the National Sample Survey, we present a disaggregated analysis of the trends and patterns of inflation adjusted household expenditure on health care. The analysis of average household expenditure on health care demonstrated that the mean outpatient care expenditure in government health sector decreased marginally at the aggregate level in both rural and urban sector, whereas it showed a significant increase in private facilities. A substantial rural-urban differential was also observed regarding households’ mean hospitalization expenditure in private hospitals while the same was not true for government hospitals. Almost all states observed a very high growth in households’ mean hospitalization expenditure in the private sector, while it was quite low in the government sector and even negative in rural areas of some states. The same pattern was observed in the growth pattern of households’ outpatient care expenditure. The analyses indicated a little improvement in the performance of government health sector in terms of out-of pocket expenditure. The improvement was more visible in developed and less developed states than in least developed states. Similarly, the improvement was more visible in rural areas than in urban areas.
Health Expenditures ; Delivery of Health Care ; India

Non-Leisure Time Physical is the main component of physical activity in Malaysia. The aim of this study is to study the associated factors related to Non-Leisure Time Physical (occupational & travel) in Malaysia. This data is from the Third National Health and Morbidity Survey, consisting of 32,575 respondents. It was a cross-sectional study among Malaysian adult, aged 18 years and was conducted using proportional to the size stratified sampling method. Chi square test and logistic regression model were used to analyse the data. The result showed that non-leisure time physical activity (NLTPA) gives more contribution to total physical activity, as compared to leisure time physical activity with percentage of 64.3% and 35.7% respectively. There was a significant association between NLTPA with age (P < 0.001), gender (P < 0.001), ethnicity (P < 0.001), education (P < 0.001), occupation (P < 0.001), income (P < 0.001), marital status (P < 0.001), region (P <0.001) and residence (P < 0.001). The main component of physical activity in Malaysia is NLTPA. Promoting NLTPA may have potential to increase physical activity levels in Malaysia.

Objective: The study is aimed at assessment of time trend for substance use disorder and psychiatric disorders among patients seeking treatment from a dual diagnosis clinic of a tertiary care substance use disorder treatment centre in India. Methods: The study is based on chart review of the patients seeking treatment from the Dual Diagnosis Clinic of a tertiary care substance use disorder treatment centre. The records of the patients seeking treatment over a six-year period (2009-2014) were reviewed. Information was collected on sociodemographic variables, substance use disorder and co-occurring psychiatric disorder. Results: A total of 289 patients sought treatment from the dual diagnosis clinic of the centre. Majority were male (97.2%). Primary drugs of abuse were nicotine (74.4%), alcohol (49.5%), cannabis (38.4%), and opioids (28.7%). Most common co-occurring psychiatric disorders were psychiatric disorders, including schizophrenia (45.0%), Major depressive disorder (24.9%), Bipolar disorder (18.3%), anxiety disorder (4.5%) and OCD (2.4%). Most patients with psychotic disorders and depressive disorders had co-occurring alcohol dependence. Most patients with bipolar disorder had co-occurring cannabis dependence. There was a marginally significant increase in proportion of subjects with cannabis dependence (PTrend= .07). There was no significant time trend for various co-occurring psychiatric disorders. Conclusions: The findings of the current study suggest that there has been a marginally significant increase in proportion of subjects with cannabis dependence over the six study years. However, the proportion of co-occurring psychiatric disorders was stable across these years. The findings of the current study suggest that the centre should be prepared to cater to an increasing proportion of patients with cannabis dependence and possibly co-occurring psychotic disorders in the coming years. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Spinal dural arteriovenous fistulae (AVF) are rare and can result in spinal cord dysfunction. We present one such case wherein the patient presented with a venous congestive myelopathy. Magnetic resonance imaging showed a syrinx formation, spinal cord edema, and flow voids. Digital subtraction angiography confirmed the dural AVF, which was treated with embolization. The syrinx disappeared, other spinal cord changes improved, and the patient had remarkable clinical improvement. The case is presented to draw attention to the rare formation of a syrinx in a spinal dural arteriovenous fistula and its disappearance after successful embolization.

This study was carried out to analyse retrospectively the data of 1,349 patients receiving antiepileptic drugs (AEDs) distributed drug wise into subtherapeutic, therapeutic, toxic and not detectable ranges. Patients were divided into three groups based on the monotherapy they received. In Phenytoin group (n=1255), 26.4% were found to be in therapeutic range, 51.6% in the subtherapeutic range and 20.6% in the toxic range. For Carbamazepine (n=63), 52.4% were in the therapeutic range, 14.3% were in subtherapeutic range, 31.7% in the toxic range and 1.6% were undetectable. Phenobarbitone levels (n=31) were found to be 64.5% in therapeutic range, 22.6% in subtherapeutic range, 9.7% in toxic range and 3.2% in the undetectable range. In 100 patients of phenytoin analyses which were under good seizure control and free of adverse effects, 46% were found to be in therapeutic range, 31% were in subtherapeutic range and 23% were found to be in toxic range. On the basis of this data, it is recommended that therapeutic drug monitoring should be carried out in all patients receiving AEDs for better overall management and long term clinical outcome.

Parkinsonism due to an isolated lesion of the substantia nigra following a febrile illness is a rare entity. Anecdotal reports in the literature implicate substantia nigra as peculiarly susceptible to flaviviruses. Here we report a case of isolated substantia nigra involvement in a probable Japanese encephalitis patient who presented with post-encephalitic parkinsonism

Background & Objective:Epilepsy may have an impact on bone health of the patients even before drug therapy is initiated, particularly in the developing countries. This is in view of long delay in diagnosis and lifestyle changes. Therefore, in this study, bone health markers like bone mineral density (BMD) and urinary hydroxyproline were assessed in newly diagnosed epilepsy patients. Methods: The BMD was assessed by DEXA scan, and 24 hour urine hydroxyproline was estimated colorimetrically in 25 newly diagnosed epilepsy patients. Other bone markers like calcium, phosphorus, vitamin D and alkaline phosphatase were also estimated. Results were compared with 25 age and sex matched healthy controls, and were analyzed statistically. Results: The BMD and vitamin D were found to be significantly decreased (p<0.05) while serum alkaline phosphatase and urine calcium and phosphorus were observed to be significantly increased p<0.05) in epilepsy patients as compared to healthy controls. The difference in urinary hydroxyproline and serum calcium/ phosphorus in the two groups was not found to be statistically significant (p>0.05). Conclusions: Bone health is found to be already compromised in epilepsy patients in this study from North India. BMD and urinary hydroxyproline may act as simple, non-invasive, convenient and inexpensive markers to assess bone health in these patients
Bone Density ; Epilepsy

Complex craniovertebral junction (CVJ) defects account for a considerable proportion of CVJ diseases. Given the heavily assimilated C1, an unfavorable C1–C2 joint orientation, an overriding C2 superior facet, a low-hanging occiput, and an abnormal vertebral artery course with a high-riding vertebral artery, placement of C1 lateral mass screws might be difficult. To address this, a novel technique for placing C1 lateral mass screws that avoid vertebral artery injury, low-hanging occiput, and overriding C2 superior facet was developed in this study. This approach enables firm fixation of C1–C2 even in difficult situations where the placement of the C1 lateral mass is challenging.

In the post-genomic era, various computational methods that predict protein-protein interactions at the genome level are available; however, each method has its own advantages and disadvantages, resulting in false predictions. Here we developed a unique integrated approach to identify interacting partner(s) of Semaphorin 5A (SEMA5A), beginning with seven proteins sharing similar ligand interacting residues as putative binding partners. The methods include Dwyer and Root-Bernstein/Dillon theories of protein evolution, hydropathic complementarity of protein structure, pattern of protein functions among molecules, information on domain-domain interactions, co-expression of genes and protein evolution. Among the set of seven proteins selected as putative SEMA5A interacting partners, we found the functions of Plexin B3 and Neuropilin-2 to be associated with SEMA5A. We modeled the semaphorin domain structure of Plexin B3 and found that it shares similarity with SEMA5A. Moreover, a virtual expression database search and RT-PCR analysis showed co-expression of SEMA5A and Plexin B3 and these proteins were found to have co-evolved. In addition, we confirmed the interaction of SEMA5A with Plexin B3 in co-immunoprecipitation studies. Overall, these studies demonstrate that an integrated method of prediction can be used at the genome level for discovering many unknown protein binding partners with known ligand binding domains.
Binding Sites ; genetics ; Cell Line, Tumor ; Cluster Analysis ; Computational Biology ; methods ; Databases, Protein ; Gene Expression Profiling ; Humans ; Hydrophobic and Hydrophilic Interactions ; Immunoprecipitation ; Membrane Proteins ; chemistry ; genetics ; metabolism ; Models, Molecular ; Nerve Tissue Proteins ; chemistry ; genetics ; metabolism ; Neural Cell Adhesion Molecules ; chemistry ; genetics ; metabolism ; Protein Binding ; Protein Interaction Mapping ; methods ; Protein Structure, Tertiary ; Reverse Transcriptase Polymerase Chain Reaction

To investigate two cyanobacteria isolated from different origins i.e. Lyngbya aestuarii(L. aestuarii) from brackish water and Aphanothece bullosa (A. bullosa) from fresh water paddy fields for antifungal and antileishmanila activity taking Candida albicans and Leishmaniadonovain as targets. Methods: Biomass of L. aestuarii and A. bullosa were harvested after 40 and 60 d respectively and lyophilized twice in methanol (100%) and redissolved in methanol (5%) for bioassay. Antifungal bioassay was done by agar well diffusion method while antileishmanial, by counting cell numbers and flageller motility observation of promastigotes and amastigotes fromL. donovani . Fluconazole and 5% methanol were used as control. Results: Both the cyanobacteria were found to be potent source of antifungal activity keeping fluconazole as positive control, however, methanolic crude extract (15 mg/mL) of A. bullosa was found more potent (larger inhibition zone) over that of methanolic crude extract of L. aestuarii. Similarly antileishmanial activity of crude extract (24.0 mg/mL) of A. bullosa was superior over that of methanolic crude extract of L. aestuarii (25.6 mg/mL). Conclusions: Antifungal and antileishmanial drugs are still limited in the market. Screening of microbes possessing antifungal and antileishmanial activity drug is of prime importance. Cyanobacteria are little explored in this context because most of the drugs in human therapy are derived from microorganisms, mainly bacterial, fungal and actinomycetes. Thus in the present study two cyanobacterial strains from different origins showed potent source of antifungal and antileishmanial biomolecules.