Impact of Computer-Aided Warfarin Dosing in a Saudi Arabian Cardiac Centre

Purpose: To compare the efficacy of computer-aided dosing using Coagclinic (a web-based software) with physician dosing in patients receiving warfarin for various cardiac indications.Methods: In order to calculate the effectiveness of physician managed anticoagulation dosing, we calculated the “percentage of time international normalized ratio, INR, was in the therapeutic range" (TTR) for a random sample of 70 patients in the center. For each patient, 4 INR values were taken at 4 consecutive visits, before and after the installation of Coagclinic. Data on the doses given by physicians were collected at each visit and c omp ar ed them with the pharmacy-based computer aided dosing system data.Results: After performing paired samples t-test of doses based on the physician group with those based on the computer system (mean -1.5654 ± 2.09 ), a statistically significant difference was found (p < 0.015). Furthermore, the patients kept at TTR by physicians amounted to 26 % compared to 70 % by the software.Conclusion: The difference between TTR managed by physicians and those managed using CoagClinic™ software is statistically significant. It appears that the software improves the effectiveness of warfarin dosing in patients.Keywords: Anticoagulation, Computer dosing, Physician dosing, Cardiac, Warfarin

Cost Analysis of Medications Used in Upper Respiratory Tract Infections and Prescribing Patterns in University Sans Malaysia, Penang, Malaysia

Purpose: To conduct a cost analysis, a narrow cost-utility study, for upper respiratory tract infection medications in University Sans Malaysia’s clinics.Methods: Retrospective analysis was done for all medical claims of upper respiratory tract infections in the period 2008 - 2009. The study was done in the clinics under University Sains Malaysia. A total of 302 patients  suffering from upper respiratory tract infection were enrolled. Cost analysis of the pattern of antibiotic prescriptions for upper respiratory tract infections was done. For cost analysis, costs were calculated based on the acquisition cost from the perspective of the medical center (USM) as the provider.Results: The research results states that there were 90% among the patients were prescribed an antibiotic, 81 percent were prescribed an  antihistamine, 81 percent were prescribed an analgesic, and 21 percent were prescribed a mucolytic or an expectorant.Conclusion: In comparison to the previously revised researchers, the percentage of the prescribed antibiotics is very high which is unacceptable. A tremendous amount of expenditure and other adverse events can be avoided by halting this behavior. A local guideline for prescribing antibiotics and implementing the same is the need of the hour.Keywords: Prescribing patterns, Cost analysis, Upper respiratory tract,  Infections, Antibiotic

Temperature Impact in Electromagnetic Non-Invasive Water/Oil/Gas Multiphase Real Time Monitoring

The measurement of the reflected S-parameter (S11) for multiphase (liquid-liquid-gas) 10-60% water, 70-20% oil and 20% gas (air) in volume are monitored using an electromagnetic microwave resonation method at a frequency range of 1-6 GHz. The measurements were examined at variable temperature ranges from 5-60 oC that were stepped by 5 oC. Clear shifts are observed in three resonant peaks of the S-parameter measurements as a volume fraction of mixture constituents. These are changed by 10% per step. The two frequency type (horizontal) S11 shifts take place at main (4 GHz frequency) and around 5 GHz frequency resonant peaks and one power type (vertical) shift at 5.45 GHz frequency resonant peak. When the temperature is held constant, the S11 values for all resonant peaks increase as WVF (water volume fraction) in the mixture increases. When WVF is held constant, the values of S11 increase as the temperature increases for around 5 GHz, 5.45 GHz frequency peaks and decreases for main peak. The results are validated by HFSS simulation executed for all tested volume fractions at 5 and 60 oC. For verification, a complete simulation is carried out at 40-40-20 percent of water-oil-gas and compared with experimental results at 5 oC intervals from 5-60 oC. The experimental results agreed well with theoretical predictions that simulated the HFSS software package with a maximum error of 1.91% for 5 oC mixtures and 1.13% for 60 oC mixtures at the main peak and 5.4% for 5 oC mixtures and 6.01% for 60 oC mixtures at 5.45 GHz peak. The study shows that the S11 measurements can be used as a dependent method to specify both the phase fraction of the multiphase mixture as well as its salinity and temperature

Alpha-tocotrienol is the most abundant tocotrienol isomer circulated in plasma and lipoproteins after postprandial tocotrienol-rich vitamin E supplementation

<p>Abstract</p> <p>Background</p> <p>Tocotrienols (T3) and tocopherols (T), both members of the natural vitamin E family have unique biological functions in humans. T3 are detected in circulating human plasma and lipoproteins, although at concentrations significantly lower than α-tocopherol (α-T). T3, especially α-T3 is known to be neuropotective at nanomolar concentrations and this study evaluated the postprandial fate of T3 and α-T in plasma and lipoproteins.</p> <p>Methods</p> <p>Ten healthy volunteers (5 males and 5 females) were administered a single dose of vitamin E [526 mg palm tocotrienol-rich fraction (TRF) or 537 mg α-T] after 7-d pre-conditioning on a T3-free diet. Blood was sampled at baseline (fasted) and 2, 4, 5, 6, 8, and 24 h after supplementation. Concentrations of T and T3 isomers in plasma, triacylglycerol-rich particles (TRP), LDL, and HDL were measured at each postprandial interval.</p> <p>Results</p> <p>After TRF supplementation, plasma α-T3 and γ-T3 peaked at 5 h (α-T3: 4.74 ± 1.69 μM; γ-T3: 2.73 ± 1.27 μM). δ-T3 peaked earlier at 4 h (0.53 ± 0.25 μM). In contrast, α-T peaked at 6 h (30.13 ± 2.91 μM) and 8 h (37.80 ± 3.59 μM) following supplementation with TRF and α-T, respectively. α-T was the major vitamin E isomer detected in plasma, TRP, LDL, and HDL even after supplementation with TRF (composed of 70% T3). No T3 were detected during fasted states. T3 are detected postprandially only after TRF supplementation and concentrations were significantly lower than α-T.</p> <p>Conclusions</p> <p>Bio-discrimination between vitamin E isomers in humans reduces the rate of T3 absorption and affects their incorporation into lipoproteins. Although low absorption of T3 into circulation may impact some of their physiological functions in humans, T3 have biological functions well below concentration noted in this study.</p

Current status of endoplasmic reticulum stress in type ii diabetes

The endoplasmic reticulum (ER) plays a multifunctional role in lipid biosynthesis, calcium storage, protein folding, and processing. Thus, maintaining ER homeostasis is essential for cellular functions. Several pathophysiological conditions and pharmacological agents are known to disrupt ER homeostasis, thereby, causing ER stress. The cells react to ER stress by initiating an adaptive signaling process called the unfolded protein response (UPR). However, the ER initiates death signaling pathways when ER stress persists. ER stress is linked to several diseases, such as cancer, obesity, and diabetes. Thus, its regulation can provide possible therapeutic targets for these. Current evidence suggests that chronic hyperglycemia and hyperlipidemia linked to type II diabetes disrupt ER homeostasis, thereby, resulting in irreversible UPR activation and cell death. Despite progress in understanding the pathophysiology of the UPR and ER stress, to date, the mechanisms of ER stress in relation to type II diabetes remain unclear. This review provides up-to-date information regarding the UPR, ER stress mechanisms, insulin dysfunction, oxidative stress, and the therapeutic potential of targeting specific ER stress pathways

Withaferin a-induced apoptosis in human breast cancer cells is mediated by reactive oxygen species

Withaferin A (WA), a promising anticancer constituent of Ayurvedic medicinal plant Withania somnifera, inhibits growth of MDA-MB-231 and MCF-7 human breast cancer cells in culture and MDA-MB-231 xenografts in vivo in association with apoptosis induction, but the mechanism of cell death is not fully understood. We now demonstrate, for the first time, that WA-induced apoptosis is mediated by reactive oxygen species (ROS) production due to inhibition of mitochondrial respiration. WA treatment caused ROS production in MDA-MB-231 and MCF-7 cells, but not in a normal human mammary epithelial cell line (HMEC). The HMEC was also resistant to WA-induced apoptosis. WA-mediated ROS production as well as apoptotic histone-associated DNA fragment release into the cytosol was significantly attenuated by ectopic expression of Cu,Zn-superoxide dismutase in both MDA-MB-231 and MCF-7 cells. ROS production resulting from WA exposure was accompanied by inhibition of oxidative phosphorylation and inhibition of complex III activity. Mitochondrial DNA-deficient Rho-0 variants of MDA-MB-231 and MCF-7 cells were resistant to WA-induced ROS production, collapse of mitochondrial membrane potential, and apoptosis compared with respective wild-type cells. WA treatment resulted in activation of Bax and Bak in MDA-MB-231 and MCF-7 cells, and SV40 immortalized embryonic fibroblasts derived from Bax and Bak double knockout mouse were significantly more resistant to WA-induced apoptosis compared with fibroblasts derived from wild-type mouse. In conclusion, the present study provides novel insight into the molecular circuitry of WA-induced apoptosis involving ROS production and activation of Bax/Bak. © 2011 Hahm et al

The Role of Neighborhood Environment in Promoting Risk Factors of Cardiovascular Disease among Young Adults: Data from Middle to High Income Population in an Asian Megacity

Background: Modifiable risk factors of cardiovascular diseases (CVD) have their triggers in the neighborhood environments of communities. Studying the environmental triggers for CVD risk factors is important to understand the situation in a broader perspective. Young adults are influenced the most by the environment profile around them hence it is important to study this subset of the population.Methods: This was a descriptive study conducted using the EPOCH research tool designed by the authors of the PURE study. The study population consisted of young adults aged 18-25 in two areas of Karachi. The study setting was busy shopping malls frequented by young adults in the particular community being studied.Results: Our total sample size was 120 individuals, who consented to be interviewed by our interviewers. Less than 50% of the population recognized some form of restriction regarding smoking in their communities. The largest contributor to tobacco advertising was actors smoking in movies and TV shows with 89% responses from both communities. Only 11.9% of the individuals disapproved of smoking cigarettes among men with wide acceptance of \u27sheesha\u27 across all age groups. Advertising for smoking and junk food was more frequent as compared to smoking cessation, healthy diet and exercise in both the areas. Unhealthy food items were more easily available in contrast to healthier options. The cost of healthy snack food options including vegetables and fruits was higher than sugary drinks and foods.CONCLUSION: This assessment showed that both communities were exposed to environments that promote risk factors for cardiovascular diseases

Improved prosthetic hand control with concurrent use of myoelectric and inertial measurements

Abstract Background Myoelectric pattern recognition systems can decode movement intention to drive upper-limb prostheses. Despite recent advances in academic research, the commercial adoption of such systems remains low. This limitation is mainly due to the lack of classification robustness and a simultaneous requirement for a large number of electromyogram (EMG) electrodes. We propose to address these two issues by using a multi-modal approach which combines surface electromyography (sEMG) with inertial measurements (IMs) and an appropriate training data collection paradigm. We demonstrate that this can significantly improve classification performance as compared to conventional techniques exclusively based on sEMG signals. Methods We collected and analyzed a large dataset comprising recordings with 20 able-bodied and two amputee participants executing 40 movements. Additionally, we conducted a novel real-time prosthetic hand control experiment with 11 able-bodied subjects and an amputee by using a state-of-the-art commercial prosthetic hand. A systematic performance comparison was carried out to investigate the potential benefit of incorporating IMs in prosthetic hand control. Results The inclusion of IM data improved performance significantly, by increasing classification accuracy (CA) in the offline analysis and improving completion rates (CRs) in the real-time experiment. Our findings were consistent across able-bodied and amputee subjects. Integrating the sEMG electrodes and IM sensors within a single sensor package enabled us to achieve high-level performance by using on average 4-6 sensors. Conclusions The results from our experiments suggest that IMs can form an excellent complimentary source signal for upper-limb myoelectric prostheses. We trust that multi-modal control solutions have the potential of improving the usability of upper-extremity prostheses in real-life applications