Pattern of anti-diabetic drugs prescribed in a tertiary care hospital of Bangladesh

Background: Globally, diabetes mellitus is a common endocrine disorder. This study was conducted for collecting the demographic details of diabetic patients and determining the pattern of drugs prescribed among them in outpatient department of a tertiary healthcare center.Methods: A descriptive type of cross-sectional study was carried out at the outpatient department of Endocrinology, Dhaka Medical College Hospital, Bangladesh from 1 May to 31 July, 2015. Diabetic patients receiving the management for at least 6 months were enrolled and interviewed by the researchers after getting informed written consent. Structured case record form was used for demographic data & prescription details. Data were analysed using computer in SPSS 22 and Microsoft Excel 2010.Results: Altogether 105 patients, 40 males (38.1%) and 65 females (61.9%) were enrolled with urban predominance (69.5%) where 51 (48.6%) were in the age group 47-61 years with a mean of 53.4 (SD±10.6) years. 70 (66.7%) had diabetic history of less than 5 years and 66 (62.9%) had at least one concurrent illness. Hypertension accounted for majority (34.3%) of complications. On an average, 5.62 (SD±3.16) drugs were advised per prescription for diabetes as well as associated co-morbidities and majority (23.8%) had 4 drugs. The majority of drugs (74.3%) were from local manufacturers. Most patients (62.9%) were prescribed with oral drugs singly. Metformin alone predominated in 41% prescriptions followed by the combination of Metformin and Sitagliptin (31.4%).Conclusions: The findings can serve as a guide to choose the formulation and combination of anti-diabetic drugs in this part of the world before developing & marketing any new drug

Comparison of serum cystatin C and creatinine based methods in detection of early renal dysfunction in critically ill patients

Early detection of renal dysfunction is of importance inthe care of critically ill patients. Cystatin C was proposedto be superior to serum creatinine in estimation of renal function. This work aimed to compare serum cystatin Cto serum creatinine and creatinine based formulae indetection of early decline in renal function at a singlepoint in critically ill patients. Fifty critically ill patientsadmitted to Cairo University Hospitals ICUs - Egypt wereincluded. Patients with chronic renal disease,thyroid disease, malignancy, patients receivingcorticosteroid therapy, with serum creatinine > 1.4 mg/dland patients receiving diuretics or large volumes of IVfluids were excluded. Serum creatinine, serum cystatinC, adjusted creatinine clearance (Adj Ccr), estimatedGFR (eGFR) by modification of diet in renal disease(MDRD), abbreviated MDRD (abb MDRD) andCockcroft-Gault (CG) formulae were measured. Patientswith renal dysfunction (adj Ccr < 80 ml/min/1.73m2)were 26 (52%) in number. Patients with renaldysfunction and high serum creatinine were 12/26(46.2%) while those with high cystatin C were 23/26(88.5%). Cystatin C was found to be significantlycorrelated with serum creatinine, adj Ccr and eGFR by all studied formulae. Using receiver operatingcharacteristic (ROC) analysis; AUC for Cystatin C(0.976) was more than that for eGFR by abb MDRD(AUC=0.839), MDRD (AUC=0.822), CG formulae(AUC=0.808) and serum creatinine (AUC=0.710)respectively. In conclusion; cystatin C was found to bebetter than serum creatinine, eGFR by abb MDRD,MDRD and CG formulae in detection of early renaldysfunction at a single point in critically ill patients

Performance Optimization of Self-Excited Induction Generator Using Particle Swarm Technique

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The impact of memory effect on space fractional strong quantum couplers with tunable decay behavior and its numerical simulation

The nontrivial behavior of wave packets in the space fractional coupled nonlinear Schrödinger equation has received considerable theoretical attention. The difficulty comes from the fact that the Riesz fractional derivative is inherently a prehistorical operator. In contrast, nonlinear Schrödinger equation with both time and space nonlocal operators, which is the cornerstone in the modeling of a new type of fractional quantum couplers, is still in high demand of attention. This paper is devoted to numerically study the propagation of solitons through a new type of quantum couplers which can be called time-space fractional quantum couplers. The numerical methodology is based on the finite-difference/Galerkin Legendre spectral method with an easy to implement numerical algorithm. The time-fractional derivative is considered to describe the decay behavior and the nonlocal memory of the model. We conduct numerical simulations to observe the performance of the tunable decay and the sharpness behavior of the time-space fractional strongly coupled nonlinear Schrödinger model as well as the performance of the numerical algorithm. Numerical simulations show that the time and space fractional-order operators control the decay behavior or the memory and the sharpness of the interface and undergo a seamless transition of the fractional-order parameters

Impact Factors on Subcontractor's Cash Flow Management

Objective: This study aims to define how to maintain and protect the subcontractor firms' cash flow from economic fluctuation through legally sustainable solutions. Methods/Analysis: We conducted a case study in the Eastern Delta Region of Egypt. A questionnaire containing a list of 22 impact factors on subcontractors' cash flow was distributed across multiple subcontractor firms with an 82% response rate. It was designed to explore the factors causing cash flow instability and analyze them using SPSS statistics. Findings: The study finds that inflation, late payments, non-compensation for late payments, poor subcontractor cash flow management, subcontractor firms' inclination to avoid disputes, material price fluctuation, and non-compensation terms, as well as suppliers rejection of payment delays, are the most critical factors of subcontractor cash flow problems. Novelty/Improvement:The study suggests adding three sub-articles to Article 57 in "Tender Law" as legally sustainable solutions to protect and maintain the firm's growth rate from inflation, late payment, and the inclination to avoid disputes. Also, the study recommends that the owner ensure that cash is available before procuring the general contractors, as stated in Egyptian Law 182 of 2018. This study will contribute to establishing a sustainable win-win relationship between subcontractors and general contractors. Doi: 10.28991/CEJ-SP2023-09-08 Full Text: PD

Genetic Algorithm Optimization Model for Determining the Probability of Failure on Demand of the Safety Instrumented System

A more accurate determination for the Probability of Failure on Demand (PFD) of the Safety Instrumented System (SIS) contributes to more SIS realiability, thereby ensuring more safety and lower cost. IEC 61508 and ISA TR.84.02 provide the PFD detemination formulas. However, these formulas suffer from an uncertaity issue due to the inclusion of uncertainty sources, which, including high redundant systems architectures, cannot be assessed, have perfect proof test assumption, and are neglegted in partial stroke testing (PST) of impact on the system PFD. On the other hand, determining the values of PFD variables to achieve the target risk reduction involves daunting efforts and consumes time. This paper proposes a new approach for system PFD determination and PFD variables optimization that contributes to reduce the uncertainty problem. A higher redundant system can be assessed by generalizing the PFD formula into KooN architecture without neglecting the diagnostic coverage factor (DC) and common cause failures (CCF). In order to simulate the proof test effectiveness, the Proof Test Coverage (PTC) factor has been incorporated into the formula. Additionally, the system PFD value has been improved by incorporating PST for the final control element into the formula. The new developed formula is modelled using the Genetic Algorithm (GA) artificial technique. The GA model saves time and effort to examine system PFD and estimate near optimal values for PFD variables. The proposed model has been applicated on SIS design for crude oil test separator using MATLAB. The comparison between the proposed model and PFD formulas provided by IEC 61508 and ISA TR.84.02 showed that the proposed GA model can assess any system structure and simulate industrial reality. Furthermore, the cost and associated implementation testing activities are reduced

Simultaneous detection and differentiation by multiplex real time RT-PCR of highly pathogenic avian influenza subtype H5N1 classic (clade 2.2.1 proper) and escape mutant (clade 2.2.1 variant) lineages in Egypt

<p>Abstract</p> <p>Background</p> <p>The endemic status of highly pathogenic avian influenza virus (HPAIV) of subtype H5N1 in Egypt continues to devastate the local poultry industry and poses a permanent threat for human health. Several genetically and antigenically distinct H5N1 lineages co-circulate in Egypt: Strains of clade 2.2.1 proper replicate mainly in backyard birds causing the bulk of human infections, while a variant lineage within 2.2.1 (2.2.1v) appears to be perpetuated mainly in commercial poultry farms in Egypt. Viruses of the 2.2.1v lineage represent drift variants escaping from conventional vaccine-induced immunity and some of these strains also escaped detection by commercial real time reverse transcriptase PCR (RT-qPCR) protocols due to mismatches in the primers/probe binding sites.</p> <p>Results</p> <p>We developed therefore a versatile, sensitive and lineage-specific multiplex RT-qPCR for detection and typing of H5N1 viruses in Egypt. Analytical characterization was carried out using 50 Egyptian HPAIV H5N1 strains isolated since 2006 and 45 other avian influenza viruses (AIV). A detection limit of 400 cRNA copies per ml sample matrix was found. Higher diagnostic sensitivity of the multiplex assay in comparison to other generic H5 or M-gene based RT-qPCR assays were found by examination of 63 swab samples from experimentally infected chickens and 50 AIV-positive swab samples from different host species in the field in Egypt.</p> <p>Conclusions</p> <p>The new multiplex RT-qPCR assay could be useful for rapid high-throughput monitoring for the presence of HPAIV H5N1 in commercial poultry in Egypt. It may also aid in prospective epidemiological studies to further delineate and better control spread of HPAIV H5N1 in Egypt.</p

Rutin Attenuates Hepatotoxicity in High-Cholesterol-Diet-Fed Rats

Background and Objective. High-cholesterol diet (HCD) intends to increase the oxidative stress in liver tissues inducing hepatotoxicity. Rutin is a natural flavonoid (vitamin p) which is known to have antioxidative properties. The aim of the present study was to investigate the potential effects of Rutin on hypercholesterolemia-induced hepatotoxicity in rats. Materials and Methods. Male Wistar rats were divided into four groups: G-I control, G-II Rutin, G-III HCD, and G-IV Rutin + HCD. The liver functions and lipid profile were used to evaluate the HCD-induced hepatotoxicity. Quantitative real time-PCR was carried out to evaluate the expression levels of genes in TGF-β/Smad signaling pathway. Results. Rutin in combination with HCD showed a significant protective effect against hepatotoxicity. HCD caused significant increase in the mRNA expression of transforming growth factor beta (TGF-β), Mothers Against Decapentaplegic Homolog 2 (Smad-2), Mothers Against Decapentaplegic Homolog 4 (Smad-4), Bcl-2-binding component 3 (Bbc3), caspase-3, P53 and Interleukin-6 (IL-6) and decrease in the expression levels of Cyclin depended kinase inhibitor (P21) and Interleukin-3 (IL-3) in hepatic cells. Conclusion. TGF-β/Smad signaling pathway is involved in HCD-induced hepatotoxicity and Rutin inhibits the hepatotoxicity via suppressing this pathway. Therefore, Rutin might be considered as a protective agent for hepatotoxicity