Foundation for Medical Research

Background: Gender-diverse populations in India, including transgender and non-binary individuals, experience systemic barriers to healthcare, with dentistry remaining particularly underexplored. Despite legislative protections, oral health professionals (OHPs) often lack the knowledge, sensitivity, and preparedness needed to provide inclusive care. This study aimed to benchmark gender sensitivity, inclusivity, and clinical preparedness of Indian OHPs using the novel Oral Healthcare Professional’s Gender Sensitivity, Inclusivity, and Preparedness (OHP–GSIP ©) tool. Methods: A descriptive cross-sectional survey was conducted among 3660 registered dental practitioners across six zones of India using probability proportional to size sampling. The prevalidated OHP–GSIP © scale assessed five domains: gender sensitivity, inclusive environments, diversity in practice, professional attitudes, and preparedness for transgender oral healthcare. Data were collected through a structured online questionnaire and analyzed with SPSS 17.0 using descriptive statistics, chi-square tests, correlation matrices, and multiple regression. Results: Participants demonstrated moderate LGBTQIA+ knowledge (mean = 6.52/10, SD = 1.78) and comfort in treating transgender patients (mean = 3.81/5, SD = 1.09). Structural inclusivity was limited: only 23.5% reported gender-neutral restrooms, and 17.5% used non-binary intake forms. Over 90% expressed willingness to employ or collaborate with transgender colleagues, though this did not significantly predict clinical comfort. Regression analysis showed inclusivity in practice (β = 0.38, p < 0.001), awareness of gender-affirming clinics (β = 0.29, p < 0.001), and LGBTQIA+ knowledge (β = 0.22, p < 0.001) as the strongest predictors of comfort in treating transgender patients, collectively explaining 41% of the variance. Conclusion: While Indian OHPs displayed generally supportive attitudes toward transgender individuals, substantial gaps persist in structural inclusivity, clinical preparedness, and knowledge. Bridging these gaps requires systemic reforms in dental education, policy, and practice environments. The OHP–GSIP © tool provides a benchmark for guiding curricular integration, institutional inclusivity, and policy advocacy toward equitable, gender-affirming oral healthcare.

Background: Managing critically ill obstetric patients is complex due to dual maternal and fetal considerations. In resource-limited settings, delayed referrals from peripheral centres often worsen outcomes.Objective: To analyse the clinical spectrum, management, and outcomes of obstetric patients requiring critical care at a tertiary facility in coastal India.Methods: A prospective observational study was conducted over two years, involving obstetric patients admitted to the critical care unit (CCU). Data on demographics, diagnoses, interventions, and outcomes were analysed descriptively.Results: Most patients were unregistered and referred from peripheral centres. Obstetric haemorrhage and hypertensive disorders were the predominant causes of admission. Respiratory distress was a leading clinical indication. All maternal deaths occurred among referred cases. A considerable number of neonates required NICU care, indicating associated fetal compromise.Conclusion: Strengthening antenatal care, timely referral, and implementing tools like the Modified Early Obstetric Warning Score (MEOWS) can improve maternal and fetal outcomes in critical obstetric cases.

Cough is a prominent symptom in both the acute and postinfective phases of coronavirus disease 2019 (COVID-19). This retrospective study examined the prevalence and clinical characteristics of acute cough before, during, and after COVID-19. The anonymized electronic medical records (EMR) data of the pediatric, adult, and elderly patients with cough complaints from 2017 to 2023 was analyzed. Before, during, and after the pandemic, adults accounted for a higher proportion of the patient population with acute cough than the other two age-groups. Among the specialties, consultant physicians (CPs) and general physicians (GPs) were frequently consulted. When the cough type was analyzed, unspecified cough was the most common before and during COVID-19 in all three age categories, which continued even after the pandemic. The age-wise distribution of the cough prevalence till 2023, with 2020 as the base year, also showed unspecified cough as the most common in all three age-groups. Nonproductive cough was prevalent among adult and pediatric age-groups, while productive cough occurrence was more frequent in the elderly. Upon comparing the prevalence of cough during and after the pandemic, there was an increase in the overall occurrence of cough, with the unspecified cough being the most. In the age-wise comparison of the cough prevalence pre- and post-COVID-19, adult patients had the highest prevalence of all three cough types, followed by elderly patients. Pediatric patients had the lowest cough prevalence. A significant increase in the incidence of acute cough post-COVID-19 highlights the complex and long-term respiratory consequences of COVID-19. The higher prevalence of unspecified cough suggests the need for cough categorization and adapting efficient documentation to ensure holistic management of cough.

We describe the development, delivery, and evaluation of a program to support junior professionals to publish their work in a scientific journal. Conference delegates with an accepted abstract at the International Conference on Family Planning (ICFP), self-identifying as junior professionals and from a low- or middle-income country (LMIC) or working predominantly in LMIC settings, were eligible for the program. The program involved: (1) Four face-to-face workshops at ICFP from the 14th to 17th of November 2022; (2) mentoring meetings at ICFP; (3) a six-month post-conference online coaching program; and (4) post-conference learning webinars from December 2022 to May 2023. We used online surveys to assess the participants' reactions, learning, and behaviour changes to the workshops and the online coaching program. We present participants' self-reported progress towards achieving a scientific publication. Sixty-seven participants from 29 countries participated in the workshops, and 40 attended the post-conference program. Workshops were rated positively, though the in-conference mentoring program faced challenges, including low attendance. The post-conference program was highly rated, with most participants engaging well with coaching and the webinars. At the end of the six-month program, 31 (46%) participants reported some progress in manuscript writing, with five completed manuscripts submitted. Scientific writing is a complex skill, and whilst our program had several positive elements, our participants faced many challenges completing their manuscripts within six months. The post-conference coaching and webinar program was rated highly, emphasising the need for ongoing support. Future programs should address this and other difficulties we highlight.

Anti-pathogenic potential of a polyherbal formulation Enteropan® was investigated against a multidrug-resistant strain of the bacterium Pseudomonas aeruginosa. Growth, pigment production, antibiotic susceptibility, etc., were assessed through appropriate in vitro assays. Virulence of the test pathogen was assessed employing the nematode worm Caenorhabditis elegans as a model host. Molecular mechanisms underlining the anti-pathogenic activity of the test formulation were elucidated through whole transcriptome analysis of the extract-exposed bacterial culture. Enteropan-pre-exposed P. aeruginosa displayed reduced (~70%↓) virulence towards the model host C. elegans. Enteropan affected various traits like biofilm formation, protein synthesis and secretion, quorum-modulated pigment production, antibiotic susceptibility, nitrogen metabolism, etc., in this pathogen. P. aeruginosa could not develop complete resistance to the virulence-attenuating activity of Enteropan even after repeated exposure to this polyherbal formulation. Whole transcriptome analysis showed 17% of P. aeruginosa genome to get differentially expressed under influence of Enteropan. Major mechanisms through which Enteropan exerted its anti-virulence activity were found to be generation of nitrosative stress, oxidative stress, envelop stress, quorum modulation, disturbance of protein homeostasis and metal homeostasis. Network analysis of the differently expressed genes resulted in identification of 10 proteins with high network centrality as potential targets from among the downregulated genes. Differential expression of genes coding for five (rpoA, tig, rpsB, rpsL, and rpsJ) of these targets was validated through real-time polymerase chain reaction too, and they can further be pursued as potential targets by various drug discovery programmes.

Abstract IntroductionConstant investment for professional development of health workforce is paramount and can be implemented through locally available competent trainers. However, guidelines for selection and recruitment of trainers, and for approaches and processes of training and nurturing them are lacking. A training intervention research in western Maharashtra, India focusing on maternal and newborn health (MNH) attempted to address these gaps.MethodsDuring the pilot project in Pune District (2016-19), 38 health workers were trained as trainers in MNH with support from the United Kingdom (UK) based technical partners (obstetricians and pediatrician). From these, eight were selected and further trained to become core trainers (CTs) for MNH training during scale-up phase in Palghar District (2019-22). A local cadre of skilled master trainers (MTs) in Palghar (n=32) was developed by these CTs with support from the UK team, through a six-steps approach starting with pre-training of trainers (TOT) screening, TOT with pre– and post-training assessment, staggered induction of MTs, continuous support, regular quality assessment, and virtual refresher training. A mixed-methods approach was adopted to assess the process and outcome of this six-step approach.ResultsThe six-steps approach of developing Palghar MTs helped in optimal resource utilization during TOT. It allowed more time and non-threatening support to MTs to excel through peer learning. Pune CTs became competent and confident mentors through critical feedback and appreciation and provided long term support to the newly trained Palghar MTs. Regular assessment by the UK team was an essential quality control step. The virtual learning served as an effective mode for refresher training without interruptions during COVID-19. Considerable improvement in clinical knowledge and skills of the trainee health providers from Palghar (n=505) was evidence of quality training delivered by the Palghar MTs. The training intervention contributed to increased clinical competency, confidence, recognition, motivation, and contribution to career growth of the Palghar MTs.DiscussionThe TOT model used in Palghar demonstrated the importance of recruiting right candidates with essential attributes as trainers, conscious shift in their teaching style for making them adult-learner-centric facilitators, longer time frames and hybrid platform. A methodical approach for nurturing talent of trainers through opportunities for teaching as well as learning was highlighted. However, a systematic evaluation for assessing long term effects of this model on retention of clinical and teaching competencies of these trainers and their trainees and its application in provision of MNH care is required.

EDITORIAL article Front. Public Health, 27 July 2023Sec. Public Health Policy Volume 11 - 2023 | https://doi.org/10.3389/fpubh.2023.1243676

SummaryBackgroundBedaquiline is a core drug for the treatment of multidrug-resistant tuberculosis; however, the understanding of resistance mechanisms is poor, which is hampering rapid molecular diagnostics. Some bedaquiline-resistant mutants are also cross-resistant to clofazimine. To decipher bedaquiline and clofazimine resistance determinants, we combined experimental evolution, protein modelling, genome sequencing, and phenotypic data.MethodsFor this in-vitro and in-silico data analysis, we used a novel in-vitro evolutionary model using subinhibitory drug concentrations to select bedaquiline-resistant and clofazimine-resistant mutants. We determined bedaquiline and clofazimine minimum inhibitory concentrations and did Illumina and PacBio sequencing to characterise selected mutants and establish a mutation catalogue. This catalogue also includes phenotypic and genotypic data of a global collection of more than 14 000 clinical Mycobacterium tuberculosis complex isolates, and publicly available data. We investigated variants implicated in bedaquiline resistance by protein modelling and dynamic simulations.FindingsWe discerned 265 genomic variants implicated in bedaquiline resistance, with 250 (94%) variants affecting the transcriptional repressor (Rv0678) of the MmpS5–MmpL5 efflux system. We identified 40 new variants in vitro, and a new bedaquiline resistance mechanism caused by a large-scale genomic rearrangement. Additionally, we identified in vitro 15 (7%) of 208 mutations found in clinical bedaquiline-resistant isolates. From our in-vitro work, we detected 14 (16%) of 88 mutations so far identified as being associated with clofazimine resistance and also seen in clinically resistant strains, and catalogued 35 new mutations. Structural modelling of Rv0678 showed four major mechanisms of bedaquiline resistance: impaired DNA binding, reduction in protein stability, disruption of protein dimerisation, and alteration in affinity for its fatty acid ligand.InterpretationOur findings advance the understanding of drug resistance mechanisms in M tuberculosis complex strains. We have established an extended mutation catalogue, comprising variants implicated in resistance and susceptibility to bedaquiline and clofazimine. Our data emphasise that genotypic testing can delineate clinical isolates with borderline phenotypes, which is essential for the design of effective treatments.FundingLeibniz ScienceCampus Evolutionary Medicine of the Lung, Deutsche Forschungsgemeinschaft, Research Training Group 2501 TransEvo, Rhodes Trust, Stanford University Medical Scientist Training Program, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Bill & Melinda Gates Foundation, Wellcome Trust, and Marie Skłodowska-Curie Actions.