Digoxin toxicity: crucial to diagnose

Digoxin is mainly used for heart failure and arrhythmias like atrial flutter and fibrillation. Digoxin is like double edged sword because of its potency to cause life threatening complications like various arrhythmias. Furthermore, it is difficult and important to recognize cardio toxicity caused by digoxin to prevent threat to life. We report a case which was initially diagnosed as arrhythmia and later turned as digoxin toxicity

A comparative study of effect on reducing pain, inflammation and side effect of combination of enzymes (bacterial proteases, papain, bromelain, vitamin C and rutin) versus conventional non-steroidal anti-inflammatory drugs (diclofenac) in patients of closed fracture lower end radius coming at orthopaedic department of a tertiary care hospital

Background: Diclofenac and oral systemic enzymes both are commonly used for control of pain and inflammation in fracture lower end radius as well as other such conditions. Some studies have shown that combination of enzymes like bacterial proteases, papain, bromelain, vitamin C and rutin can reduce pain and Inflammation which is comparable to diclofenac but it still not definite.Methods: Total 50 patients with closed fracture lower end radius were enrolled and randomly divided in to two groups. Group-1 with 25 patients received oral diclofenac and group-2 with 25 patients received oral preparation which contains combination of enzymes bacterial proteases, papain, bromelain, vittamin C and rutin. Effect of drug was assessed by improvement in wrist function which was evaluated by patient rated wrist evolution (PRWE) and reduction in oedema on day 1, day 3 and day 5. Both the groups were compared by unpaired Z test.Results: Mean reduction in PRWE score was 132.08±5.01 in Group 1 and 104.4±11.78 in group 2. Mean of percentage reduction of oedema for group 1 was 8.22 while for group 2 it was 17.8. Both were statistically significant (p<0.05). Total 5 patients out of 25 complained of gastritis in group 1 patients while there was no side effect reported in group 2 patients.Conclusions: Diclofenac was better in reducing pain, while combination of enzymes used in the study was better in reducing oedema. Combination of the enzymes used in this study is safer than diclofenac in cases of the closed fracture lower end radius

Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40

Background: Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. Methods: We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. Findings: In the reference scenario, global health spending was projected to increase from US$10 trillion (95$20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4–5·1) per year, followed by lower-middle-income countries (4·0%, 3·6–4·5) and low-income countries (2·2%, 1·7–2·8). Despite global growth, per capita health spending was projected to range from only $40 (24–65) to$413 (263–668) in 2040 in low-income countries, and from $140 (90–200) to$1699 (711–3423) in lower-middle-income countries. Globally, the share of health spending covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to 97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030. Interpretation: We chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC. Funding: The Bill & Melinda Gates Foundation

Experimental Study Of Effect Of Wall Superheat On Single Bubble Dynamics During Nucleate Pool Boiling Heat Transfer

In nucleate pool boiling heat transfer of saturated water the wall superheat, orientation of nucleation site etc. affects bubble departure diameter. In this paper, effect of wall superheat in nucleate pool boiling heat transfer on single bubble dynamics using saturated water as a base fluid has been studied experimentally. Single bubble generated using vertical hypodermic tip of needle as a nucleation site. The hypodermic needles were used of inner diameters 0.514 mm with a constant depth of 25 mm having different cross section varying from 300to 900with respect to tip. Single bubble dynamics was studied with the help of PCO high speed camera operating at more than 100 frames per second at atmospheric pressure and at different wall superheat of 4 K to 30 K for constant heat flux

EVALUATION OF PHYSICO-CHEMICAL PARAMETERS OF DIFFERENT SHODHIT GUGGUL

Objective: The present study was aimed to identify the physicochemical data of shodhit guggul. Guggul is a gum-resin exudate from the plant Commiphora weightii (Arn.) Bhandari, belonging to Burseraceae family. In Ayurveda, guggul is always purified. This purification is known as Shodhan. Shodhan is a process by which guggul is made non-toxic, effective, suitable and fit for therapeutic purposes.Methods: The seven different shodhan dravya were used to prepare shodhit guggul. They were evaluated by performing physicochemical parameters including five different extractive value; total ash, acid insoluble, water soluble and sulphated ash value; pH, and loss on drying.Results: Analytical results of raw guggul showed total ash, acid insoluble ash, water soluble ash and sulphated ash value to 5.36±0.04%, 0.96±0.03%, 4.51±0.03 % and 8.40±0.04% respectively. These all values of each shodhit guggul were different. The extractive value of raw guggul was comparable with standard value while the extractive value of each shodhit guggul was totally different. The pH value of 1% w/v and 10% w/v aqueous solution of raw guggul was 6.44±0.18 though pH of each shodhit guggul was changed. The loss on drying of raw guggul was found to be 1.88±0.02%w/v, however, this value was different for each shodhit guggul.Conclusion: The present study revealed that the different shodhan process with specific shodhan dravya affects the physicochemical parameters. The analysis and comparison of the data showed the difference in the properties of seven shodhit guggul with respect to raw Guggul

A comparative study of effect on reducing pain, inflammation and side effect of combination of enzymes (bacterial proteases, papain, bromelain, vitamin C and rutin) versus conventional non-steroidal anti-inflammatory drugs (diclofenac) in patients of closed fracture lower end radius coming at orthopaedic department of a tertiary care hospital

Background: Diclofenac and oral systemic enzymes both are commonly used for control of pain and inflammation in fracture lower end radius as well as other such conditions. Some studies have shown that combination of enzymes like bacterial proteases, papain, bromelain, vitamin C and rutin can reduce pain and Inflammation which is comparable to diclofenac but it still not definite.Methods: Total 50 patients with closed fracture lower end radius were enrolled and randomly divided in to two groups. Group-1 with 25 patients received oral diclofenac and group-2 with 25 patients received oral preparation which contains combination of enzymes bacterial proteases, papain, bromelain, vittamin C and rutin. Effect of drug was assessed by improvement in wrist function which was evaluated by patient rated wrist evolution (PRWE) and reduction in oedema on day 1, day 3 and day 5. Both the groups were compared by unpaired Z test.Results: Mean reduction in PRWE score was 132.08±5.01 in Group 1 and 104.4±11.78 in group 2. Mean of percentage reduction of oedema for group 1 was 8.22 while for group 2 it was 17.8. Both were statistically significant (p&lt;0.05). Total 5 patients out of 25 complained of gastritis in group 1 patients while there was no side effect reported in group 2 patients.Conclusions: Diclofenac was better in reducing pain, while combination of enzymes used in the study was better in reducing oedema. Combination of the enzymes used in this study is safer than diclofenac in cases of the closed fracture lower end radius

Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40

Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040