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Biomedical subjects

Ravi Shankar

Publications and source records attributed to Ravi Shankar.

At least 19 recordsLinked to original sources
PubMed2026

Experiences of stigma, bias, and communication challenges among pregnant healthcare workers: A systematic review of qualitative evidence.

BACKGROUND: Healthcare work environments are fraught with occupational hazards that can impact pregnant healthcare workers' health as well as patient care. Despite the feminization of healthcare globally, systematic discrimination against pregnant workers persists across diverse healthcare settings and cultural contexts. The intersection of stigma, bias, and communication challenges creates substantial barriers to career advancement and wellbeing. However, no systematic review has synthesized qualitative evidence on how these three constructs interact across healthcare professions and cultural contexts using an integrated theoretical framework. OBJECTIVE: To systematically review and synthesize qualitative evidence on experiences of stigma, bias, and communication challenges among pregnant healthcare workers across different healthcare settings and cultural contexts using an integrated theoretical framework. DESIGN: Systematic review of qualitative studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with thematic synthesis. DATA SOURCES: Seven databases were searched from inception to January 2026. REVIEW METHODS: Included qualitative studies were appraised using the Critical Appraisal Skills Programme (CASP) checklist and synthesized through theory-guided thematic synthesis. Confidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. RESULTS: Fourteen studies encompassing 1223 participants across 17 countries revealed four major themes: (1) professional identity stigma and workplace discrimination through systematic labeling and stereotyping; (2) gender-based institutional bias rooted in masculine organizational logic; (3) multilevel communication failures creating fear-based climates; and (4) individual and collective resistance strategies developed despite constraints. Occupational hazards specific to pregnancy included exposure to infectious diseases, imaging, physical tasks, cleaning products, patient violence, and medication administration. Support from coworkers and supervisors was identified as the most critical facilitator for avoiding hazards and making necessary modifications, while the desire to be 'supernurses' and fear of consequences emerged as significant barriers. These patterns were consistent across healthcare professions, settings, and cultural contexts, with specialty culture and healthcare system type moderating discrimination intensity. Confidence in core findings was rated high using GRADE-CERQual. CONCLUSIONS: Pregnant healthcare workers globally experience interconnected stigma, bias, and communication challenges that are systematically embedded within healthcare organizational structures. These challenges operate synergistically, requiring comprehensive multilevel interventions beyond policy compliance. Healthcare organizations must implement evidence-based strategies addressing stigma reduction, bias interruption, and communication transformation simultaneously to retain skilled workers and ensure quality patient care.

Female↗
PubMed2025

Genome-wide identification, characterization, and expression pattern analysis of the glyoxalase gene family in Phyllostachys pubescens during abiotic stresses.

BACKGROUND: The glyoxalase pathway comprising of three enzymes i.e., glyoxalase I (GLYI), glyoxalase II (GLYII), and glyoxalase III (GLYIII), which play vital role in mitigating abiotic stresses by detoxifying the stress induced cytotoxic metabolite methylglyoxal (MG). Phyllostachys pubescens an ecologically and economically important forest species, plays vital roles in carbon sequestration and climate change mitigation. A genome-wide study was conducted to identify and characterize GLYI, GLYII, and unique DJ-1/GLYIII gene candidates in P. pubescens. The identified members were evaluated based on phylogenetic analysis, gene structure, chromosomal distribution, gene duplication, presence of conserved domain(s) and cis regulatory region. RESULTS: A total of 19 GLYI, 18 GLYII, and 15 GLYIII members were identified, each featuring characteristic domains: glyoxalase, metallo-β-lactamase, and DJ-1/PfpI, respectively. The presence of different cis-elements in the promoter region of the glyoxalase genes gives insights into their role and regulation under hormonal response, developmental processes and stress adaptation. Besides this, stress responsive transcription factors binding sites also dominated the promoter regions of glyoxalase genes. Expression analysis of various glyoxalase genes demonstrated significant variability under different stress conditions, underscoring their potential roles in stress modulation. Significant upregulation of all of the PhGLYI, PhGLYII, and PhGLYIII were observed under cold, drought, heavy metal and salinity stress suggesting their involvement in oxidative stress management, osmotic regulation and remodelling cellular redox homeostasis. Among the glyoxalase genes, PhGLYI-15, PhGLYII-9, and PhGLYIII-3 showed consistent upregulation under various abiotic stresses. CONCLUSIONS: Our findings reveal that glyoxalase genes crucially contribute towards the improvement of cellular osmotic potential in moso bamboo under different abiotic stresses. This study enhances our understanding of glyoxalase genes' evolution and functional roles in plants and opens new avenues for developing stress resilient crop varieties for sustainable agriculture.

Lactoylglutathione Lyase↗
PubMed2006

Expanding the scope of sulfur-centered Arbuzov rearrangement in diethyl/di-n-propyl sulfite for the synthesis of mixed-ligand di-n-butyltin alkanesulfonates.

A one-pot reaction between di-n-butyltin oxide and diethyl/di-n-propyl sulfite in the presence of an equimolar amount of alkyl iodide proceeds via sulfur-centered Arbuzov rearrangement to afford the corresponding di-n-butyltin (alkoxy)alkanesulfonates n-Bu2Sn(OR')OS(O)2R [R = R' = Et (1), n-Pr (2); R = Me, R' = Et (3), n-Pr (4)]. The compounds 1 and 3 react with methylphosphonic acid under mild conditions to give [n-Bu2Sn(OS(O)2R)OP(O)(OH)Me]n [R = Et (5), Me (6), respectively].

Journal Article↗
PubMed2006

Selectivity- and size-induced segregation of molecular and nanoscale species in microphase-ordered triblock copolymers.

Microphase-ordered block copolymers serve as model systems to elucidate the potential of molecular self-assembly and organic templates to fabricate functionalized polymeric materials. Both aspects are related to the incorporation of secondary species such as low-molar-mass compounds or nanoparticles within the copolymer matrices. Since the resulting properties of such functionalized copolymers critically depend on the morphology of the blend or composite, the nonrandom distribution of such inclusions within the copolymer matrix must be understood. Using a self-consistent field theoretical approach, we quantitatively evaluate the segregation and interfacial excess of low-molar-mass and nanoscale species in ordered triblock copolymers as functions of block selectivity and inclusion size. The predictions are found to agree with the morphology observed in a model triblock copolymer/nanoparticle composite, thereby demonstrating the generality of this approach. Our results suggest a wide correspondence in the structure-forming effect of molecular and nanoscale inclusions that will have implications in the design and processing of functional nanostructured polymers.

Computer Simulation↗
PubMed2006

Norepinephrine modulates the inflammatory and proliferative phases of wound healing.

BACKGROUND: Injury results in the massive release of norepinephrine (NE) into the peripheral circulation. Recent investigations have demonstrated functional adrenoreceptors on the cellular mediators of cutaneous wound healing and NE-induced phenotypic alterations in immune cells have been demonstrated in vitro. Despite this, there is little description of how NE might alter the phases of wound healing in vivo. The purpose of this study was to compare cutaneous wound healing in norepinephrine-intact and norepinephrine-depleted mice. METHODS: Norepinephrine-depleted (NED) mice were generated by chemical axotomy with 6-hydroxydopamine and compared with norepinephrine-intact (NEI) animals (n = 6-12 per group, per time point). Using an excisional wound model, neutrophil recruitment was measured by myeloperoxidase assay. Macrophage recruitment and angiogenesis were measured by immunohistochemistry and re-epithelialization was determined histologically. The development of incisional wound disruption strength was determined over time. Finally, macrophage scavenger function was assessed by an in vitro latex bead phagocytosis assay. RESULTS: Wounds from NEI mice demonstrated greater neutrophil infiltration than NED wounds (24, 72 hours; p < 0.05). Wound macrophage recruitment was initially higher in NEI animals (24 hours, p < 0.05), but was eventually surpassed by that of NED animals (120 hours, p < 0.05). Angiogenesis was decreased while re-epithelialization was accelerated in NEI animals (p < 0.05). Wound disruption strength and macrophage scavenger function were unaltered between NED and NEI mice. CONCLUSIONS: Norepinephrine modulates the inflammatory and proliferative phases of wound healing in a temporally defined, cell-specific manner. By increasing recruitment of innate immune cells and expediting wound closure, norepinephrine appears to play a protective role in defense against infection.

Animals↗
PubMed2006

Reliability of radiological classifications used in Legg-Calve-Perthes disease.

Radiological assessment is a valuable tool in the assessment, management and prognostication of Perthes disease. Radiological assessment, however, is not an easy task and all classification systems used in Perthes disease have some degree of interrater and intrarater variabilities. In the past, there were some isolated studies to find the reliability of the classifications used in Perthes disease. In this study, we comprehensively studied three most commonly used radiological classifications (Salter-Thompson, lateral pillar and Catterall). We had 44 patients' radiographs (anteroposterior and lateral) taken in the fragmentation stage, and two experienced observers assessed and classified the radiographs on two separate occasions. In this study, we found that the average interrater reliability of the Salter-Thompson, lateral pillar and Catterall classifications was 0.163 (0.08-0.236), 0.722 (0.581-0.824) and 0.433 (0.280-0.546), respectively. The intrarater reliability was 0.313 and 0.699 for the Salter-Thompson, 0.707 and 0.658 for the lateral pillar and 0.38 and 0.577 for the Catterall classifications. Further, we tried to determine the possible reason for the low reliability associated with the Catterall classification. We think that the quantitative method of lateral pillar has better intrarater and interrater reliabilities than other classification systems, and the reliability of the Catterall classification can be significantly improved if some radiological parameters such as metaphyseal reaction and identification of the junction of involved to uninvolved region can be optimized.

Humans↗
PubMed2005

Adrenergic modulation of cytokine release in bone marrow progenitor-derived macrophage following polymicrobial sepsis.

Catecholamines may impact on the pathophysiology of sepsis by attenuating proinflammatory cytokine and augmenting antiinflammatory cytokine production by macrophages. We tested this premise in bone marrow monocyte progenitor-derived macrophages. Polymicrobial sepsis was induced in mice through cecal ligation and puncture. ER-MP 12 monocyte progenitors were isolated and differentiated into macrophages in vitro 72 hr later. Lipopolysaccharide (LPS)-stimulated cytokine production was measured with and without epinephrine, IL-10 and anti-IL-10 antibody. Epinephrine significantly increased IL-10 production, but attenuated TNF-alpha release exclusively through beta2 adrenergic receptors, and is independent of IL-10 production. Together, these results suggest that epinephrine can promote a potent antiinflammatory response in sepsis.

Adrenergic beta-Antagonists↗
PubMed2005

Thermal injury and sepsis modulates beta-adrenergic receptors and cAMP responses in monocyte-committed bone marrow cells.

We have previously reported that adrenergic stimulation enhances monocytopoiesis following experimental burn injury and sepsis (BI/S). In the present work we measured beta-adrenergic receptor number and affinity in bone marrow committed monocyte progenitor cells (CD59(+)) following BI/S. We find that BI/S treatment significantly decreased monocyte progenitor cell beta-adrenergic receptors but significantly increased receptor binding affinity and isoproterenol-stimulated cAMP production. CD14 expression in macrophages derived in vitro from CD59(+) cells following BI/S was significantly increased by epinephrine and this change was blocked by beta(2)-adrenergic receptor antagonist. PCR analysis suggests the presence of beta(2)- but not beta(1)-adrenergic receptors. Enhanced adrenergic receptor signaling in CD59(+) bone marrow cells following BI/S may be important in macrophage development.

Animals↗
PubMed2005

Novel function for vascular endothelial growth factor receptor-1 on epidermal keratinocytes.

Vascular endothelial growth factor (VEGF-A), a potent stimulus for angiogenesis, is up-regulated in the skin after wounding. Although studies have shown that VEGF is important for wound repair, it is unclear whether this is based solely on its ability to promote angiogenesis or if VEGF can also promote healing by acting directly on non-endothelial cell types. By immunohistochemistry and reverse transcriptase-polymerase chain reaction, expression of VEGF receptor-1 (VEGFR-1), but not VEGFR-2, was detected in murine keratinocytes during wound repair and in normal human epidermal keratinocytes (NHEKs). The presence of VEGF receptors on NHEKs was verified by binding studies with 125I-VEGF. In vitro, VEGF stimulated the proliferation of NHEKs, an effect that could be blocked by treatment with neutralizing VEGFR-1 antibodies. A role for VEGFR-1 in keratinocytes was also shown in vivo because treatment of excisional wounds with neutralizing VEGFR-1 antibodies delayed re-epithelialization. Treatment with anti-VEGFR-1 antibodies also reduced the number of proliferating keratinocytes at the leading edge of the wound, suggesting that VEGF sends a proliferative signal to these cells. Together, these data describe a novel role for VEGFR-1 in keratinocytes and suggest that VEGF may play several roles in cutaneous wound repair.

Animals↗
PubMed2005

Energy dependence of response of new high sensitivity radiochromic films for megavoltage and kilovoltage radiation energies.

The purpose of this paper is to evaluate the energy dependence of the response of two new high sensitivity models of radiochromic films EBT and XR-QA. We determined the dose response curves of these films for four different radiation sources, namely, 6 MV photon beams (6 MVX), Ir-192, I-125, and Pd-103. The first type (EBT) is designed for intensity modulated radiation therapy (IMRT) dosimetry, and the second type (XR-QA) is designed for kilovoltage dosimetry. All films were scanned using red (665 nm) and green (520 nm) light sources in a charge-coupled device-based densitometer. The dose response curves [net optical density (NOD) versus dose] were plotted and compared for different radiation energies and light sources. Contrary to the early GAFCHROMIC film types (such as models XR, HS, MD55-2, and HD810), the net optical densities of both EBT and XR-QA were higher with a green (520 nm) than those with a red (665 nm) light source due to the different absorption spectrum of the new radiochromic emulsion. Both film types yield measurable optical densities for doses below 2 Gy. EBT film response is nearly independent of radiation energy, within the uncertainty of measurement. The NOD values of EBT film at 1 and 2 Gy are 0.13 and 0.25 for green, and 0.1 and 0.17 for red, respectively. In contrast, the XR-QA film sensitivity varies with radiation energy. The doses required to produce NOD of 0.5 are 6.9, 5.4, 0.7, and 0.9 Gy with green light and 19, 13, 1.7, and 1.5 Gy with red light, for 6 MVX, Ir-192, I -125, and Pd-103, respectively. EBT film was found to have minimal photon energy dependence of response for the energies tested and is suitable for dosimetry of radiation with a wide energy spectrum, including primary and scattered radiation. XR-QA film is promising for kilovoltage sources with a narrow energy spectra. The new high sensitivity radiochromic films are promising tools in radiation dosimetry.

Densitometry↗
PubMed2004

Evolution and distribution of RNA polymerase II regulatory sites from RNA polymerase III dependant mobile Alu elements.

BACKGROUND: The primate-specific Alu elements, which originated 65 million years ago, exist in over a million copies in the human genome. These elements have been involved in genome shuffling and various diseases not only through retrotransposition but also through large scale Alu-Alu mediated recombination. Only a few subfamilies of Alus are currently retropositionally active and show insertion/deletion polymorphisms with associated phenotypes. Retroposition occurs by means of RNA intermediates synthesised by a RNA polymerase III promoter residing in the A-Box and B-Box in these elements. Alus have also been shown to harbour a number of transcription factor binding sites, as well as hormone responsive elements. The distribution of Alus has been shown to be non-random in the human genome and these elements are increasingly being implicated in diverse functions such as transcription, translation, response to stress, nucleosome positioning and imprinting. RESULTS: We conducted a retrospective analysis of putative functional sites, such as the RNA pol III promoter elements, pol II regulatory elements like hormone responsive elements and ligand-activated receptor binding sites, in Alus of various evolutionary ages. We observe a progressive loss of the RNA pol III transcriptional potential with concomitant accumulation of RNA pol II regulatory sites. We also observe a significant over-representation of Alus harboring these sites in promoter regions of signaling and metabolism genes of chromosome 22, when compared to genes of information pathway components, structural and transport proteins. This difference is not so significant between functional categories in the intronic regions of the same genes. CONCLUSIONS: Our study clearly suggests that Alu elements, through retrotransposition, could distribute functional and regulatable promoter elements, which in the course of subsequent selection might be stabilized in the genome. Exaptation of regulatory elements in the preexisting genes through Alus could thus have contributed to evolution of novel regulatory networks in the primate genomes. With such a wide spectrum of regulatory sites present in Alus, it also becomes imperative to screen for variations in these sites in candidate genes, which are otherwise repeat-masked in studies pertaining to identification of predisposition markers.

Alu Elements↗
PubMed2004

Adrenergic modulation of splenic macrophage cytokine release in polymicrobial sepsis.

Enhanced adrenergic stimulation and catecholamine release are important components of the pathophysiology of sepsis. Under physiological conditions, adrenergic stimulation has been shown to be a negative regulator of proinflammatory cytokine production through increasing IL-10 production. Here we have investigated if adrenergic stimulation similarly inhibits TNF-alpha and IL-6 production by splenic macrophages isolated from a polymicrobial sepsis model. Male B(6)D(2)F(1) mice were subjected to sham (S), laparotomy (Lap), and cecal ligation and puncture (CLP) under anesthesia. Splenic macrophages were isolated 72 h after the initial injury and were stimulated with endotoxin (LPS) in the presence and absence of epinephrine. Compared with S and Lap, splenic macrophages from the CLP group produced significantly less TNF-alpha and IL-6 and more IL-10 when stimulated with LPS. Macrophage cultures from CLP animals incubated with either epinephrine or IL-10 for 2 h had significantly reduced TNF-alpha and IL-6 release in response to LPS. However, similar cultures pretreated with IL-10 antibody before the addition of exogenous epinephrine failed to reverse the attenuation of LPS-stimulated cytokines. Pretreatment of macrophage cultures with beta(2)- (ICI-118551) but not beta(1)-adrenergic (atenolol) receptor antagonists reversed the epinephrine-mediated cytokine attenuation following LPS treatment. Data are also presented that demonstrate the involvement of protein kinase A activation with adrenergic agonist but not with IL-10 stimulation. Taken together, these findings suggest that adrenergic mechanisms may influence peripheral tissue macrophage inflammatory cytokine response following trauma and sepsis, independent of the effects of IL-10.

Adrenergic Agonists↗
PubMed2004

Bone marrow norepinephrine mediates development of functionally different macrophages after thermal injury and sepsis.

OBJECTIVE: We sought to determine the influence of thermal (burn) injury with sepsis and norepinephrine on the clonogenic potential and functional cytokine response to lipopolysaccharide (LPS) stimulation in nonmyeloid committed (CD117) and myeloid committed (ER-MP12) bone marrow progenitor cells. SUMMARY AND BACKGROUND DATA: We have previously demonstrated that norepinephrine stimulated myelopoiesis after burn injury and sepsis, but the site of this stimulation in monocyte development is unknown. In the present study the influence of norepinephrine on the developmental hierarchy of bone marrow cells after thermal injury and sepsis was determined by assessing the clonogenic potential and LPS-stimulated cytokine responses of mature macrophages derived from CD117 and ER-MP12 bone marrow progenitor cells. METHODS: Tissue and bone marrow norepinephrine content was ablated by chemical sympathectomy with 6-hydroxydopamine treatment. CD117 and ER-MP12 bone marrow cells were isolated using antibody-linked magnetic microbeads. Clonogenic potential in response to colony-stimulating factors was determined. Both progenitor cell types were differentiated to mature macrophages in vitro and tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 cytokine responses to LPS provocation were determined. RESULTS: The macrophage- and granulocyte-macrophage colony-stimulating factor responsive clonogenic potential was increased with burn sepsis, suggesting an expansion of both progenitor populations. Such increases were greatly reduced with prior depletion of norepinephrine. TNF-alpha and IL-6 cytokine responses to LPS were markedly influenced by the specific progenitor cells involved as well as the injury conditions and the status of norepinephrine prior to injury. In burn sepsis the depletion of norepinephrine resulted in a dramatic decrease in both IL-6 and TNF-alpha production by both progenitor-derived macrophages. CONCLUSIONS: Depletion of norepinephrine attenuated burn and burn sepsis-induced bone marrow progenitor clonal growth in response to macrophage- and granulocyte-macrophage colony-stimulating factor. Functional phenotypes of bone marrow progenitor-derived macrophages are greatly influenced by norepinephrine and the milieu created by thermal injury and sepsis.

Animals↗
PubMed2004

Burn injury and pulmonary sepsis: development of a clinically relevant model.

BACKGROUND: Despite improvements in the early resuscitation of the critically injured, mortality from multiple organ failure has remained stable, with the lung often the first organ to fail. Early intubation and mechanical ventilation predispose patients to the development of pneumonia and respiratory failure. Our objective was to establish a murine model of combined injury, consisting of burn/trauma and pulmonary sepsis with reproducible end-organ responses and mortality. METHODS: Male B6D2F1 mice were divided into four groups: burn/infection (BI), burn (B), infection (I), and sham (S). Burned animals had a full-thickness 15% dorsal scald burn. BI and I groups were inoculated intratracheally with Pseudomonas aeruginosa (3-5 x 103 colony-forming units). S and B animals received saline intratracheally. All animals were resuscitated with 2 mL of intraperitoneal saline. Mortality was recorded at 24, 48, and 72 hours. Bacterial sepsis was confirmed by tissue Gram's stain of the lungs and positive organ and blood cultures for Pseudomonas aeruginosa. Femoral bone marrow cells were collected at 72 hours from surviving animals. Clonogenic potential was assessed by response to macrophage (M) colony-stimulating factor (CSF) and granulocyte-macrophage (GM) CSF in a soft agar assay and the data were represented as colonies per femur. Isolated alveolar macrophages and whole lung tissue were assayed for levels of the inflammatory cytokines tumor necrosis factor-alpha and interleukin-6. RESULTS: Mortality at 72 hours was 30% in BI, 12% in I, and <10% in B and S groups. Pneumonia was documented in all infected animals at 24 hours by Gram's stain and positive tissue cultures for Pseudomonas aeruginosa. Systemic sepsis as confirmed by blood, and remote organ cultures was seen in BI animals only. Significantly increased responsiveness to M-CSF stimulations was noted in all groups (BI, 8,291 +/- 1,402 colonies/femur; B, 6,357 +/- 806 colonies/femur; and I, 8,054 +/- 1,112 colonies/femur; p < 0.05) relative to sham (3,369 +/- 883 colonies/femur, p < 0.05). Maximal responsiveness to GM-CSF stimulation was noted in the BI group (11,932 +/- 982 colonies/femur, p < 0.05), and similar GM responsiveness was noted in all other groups (B, 7,135 +/- 548 colonies/femur; I, 7,023 +/- 810 colonies/femur; and S, 6,829 +/- 1,439 colonies/femur). Alveolar macrophage release of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6 increased in all animals, but the magnitude of increase was not proportional to the strength of the inciting stimulus. CONCLUSION: Although minimal perturbations were seen after burn or pulmonary infection alone, the combined insult of burn and pulmonary sepsis resulted in statistically significant hematopoietic changes with increased monocytopoiesis. Only the combined injury resulted in systemic sepsis and significantly increased mortality. We have developed a clinically relevant model of trauma and pulmonary sepsis that will allow further clarification of the inflammatory response after injury and infection.

Animals↗
PubMed2004

Modeling guidelines for integration into clinical workflow.

The success of clinical decision-support systems requires that they are seamlessly integrated into clinical workflow. In the SAGE project, which aims to create the technological infra-structure for implementing computable clinical practice guide-lines in enterprise settings, we created a deployment-driven methodology for developing guideline knowledge bases. It involves (1) identification of usage scenarios of guideline-based care in clinical workflow, (2) distillation and disambiguation of guideline knowledge relevant to these usage scenarios, (3) formalization of data elements and vocabulary used in the guideline, and (4) encoding of usage scenarios and guideline knowledge using an executable guideline model. This methodology makes explicit the points in the care process where guideline-based decision aids are appropriate and the roles of clinicians for whom the guideline-based assistance is intended. We have evaluated the methodology by simulating the deployment of an immunization guideline in a real clinical information system and by reconstructing the workflow context of a deployed decision-support system for guideline-based care. We discuss the implication of deployment-driven guideline encoding for sharability of executable guidelines.

Decision Making, Computer-Assisted↗
PubMed2003

Synthesis, characterization, and hydrolytic behavior of mixed-ligand diorganotin esters, [R2Sn(O2CR')OSO2Me]2 (R=n-Pr, n-Bu; R'=C9H6N-2, 4-OMe-C9H5N-2, C9H6N-1).

Reactions of the tin precursors, R2Sn(OMe)OSO2Me (R=n-Pr, n-Bu), with an equimolar quantity of 2-quinoline/4-methoxy-2-quinoline/1-isoquinoline carboxylic acid in acetonitrile proceed under mild conditions (rt,12-15 h) via selective Sn-OMe bond cleavage to afford the corresponding mixed-ligand diorganotin derivatives [R2Sn(O2CR')OSO2Me]2 [R'=C9H6N-2, R=n-Pr (1), n-Bu (2); R'=4-OMe-C9H5N-2, R=n-Pr (3), n-Bu (4); R'=C9H6N-1, R=n-Pr (5), n-Bu (6)]. These have been characterized by FAB mass, IR, and multinuclear (1H, 13C, 119Sn) NMR spectral data and X-ray crystallography (for 4 and 6). The molecular structure of 4 (C20H29NO6SSn, monoclinic, P2(1)/n, a=14.1(13) A, b=16.7(18) A, c=20.3(19) A, beta=107(4) degrees, Z=8) comprises distorted octahedral geometry around each tin atom by virtue of weakly bridging methanesulfonate [Sn(1A)-O(3B)=3.010, Sn(1B)-O(3A)=2.984 A] and (N,O) chelation of the carboxylate ligands. The spectral data of 1-4 suggest a similar structural motif in solution. The molecular structure of 6 (C38H53N2O10S2Sn2, monoclinic, P2(1)/c, a=11.339(2) A, b=14.806(3) A, c=24.929(5) A, beta=100.537(3) degrees, Z=4) reveals varying bonding preferences with monomeric units being held together by a bridging methanesulfonate [Sn(2)-O(5)=2.312(2) A] and a carboxylate group bonded to Sn(1) and Sn(2) atoms, respectively. Slow hydrolysis of compound 2 derived from 2-quinoline carboxylic acid in moist CH3CN affords the asymmetric distannoxane, [Bu2Sn(O2CC9H6N-2)-O-Sn(OSO2Me)Bu2]2 (7) (C27H45NO6SSn2, monoclinic, C2/c, a=21.152(3) A, b=13.307(2) A, c=26.060(4) A, beta=110.02(10) degrees, Z=8) featuring ladder type structural motif by virtue of unique mu2-coordination of covalently bonded oxygen atoms [O(6), O(6)#1] of the methanesulfonate groups.

Journal Article↗
PubMed2003

A comparative study of drug utilisation at different levels of the primary healthcare system in Kaski district, Western Nepal.

AIMS: Studies that compare prescribing patterns at different levels of the primary healthcare system are lacking in Western Nepal. The present study was undertaken to obtain information on age, sex distribution, and morbidity profiles of patients, prescribing patterns and defined daily dose of commonly used drugs. METHODS: The study was carried out over a three-month period (1 June 2000 to 31 August 2000) at four centres in the Kaski district, Western Nepal. Chi-square test was used to compare differences in morbidity profiles and prescribing patterns (p <0.01). RESULTS: There were significant differences in the average number of drugs per prescription across different levels. The morbidity profiles were also different. Vitamins were more commonly prescribed at the primary health centre level. Antibiotics were prescribed in 67% of encounters at the level of primary health centre, but the prescribing decreased at the levels of health post and sub-health post. CONCLUSIONS: The average number of drugs per prescription and the average cost were higher at the primary health centre level and this may be due to the increased prescribing frequency of vitamins and tonics. Comparisons of prescribing patterns at different levels of healthcare, and between government and private healthcare institutions, are urgently required.

Drug Utilization Review↗