Adverse drug effects monitoring of amlodipine in a tertiary care hospital

Background: Amlodipine have been widely used drug for the treatment of Hypertension. It has many beneficial effects and less side effects. But, only very few adverse effects of Amlodipine have been documented and many were not reported. So, this study will bring out the possible adverse effect of Amlodipine.Methods: This study included 100 patients with hypertension who are taking amlodipine only. Patients who were willing to participate in the study were given a questionnaire containing demographic data and adverse drug profile of amlodipine. The symptoms of adverse drug reaction were documented. They were also asked about the other symptoms they are having, other than the questionnaire. The causality assessment was done by WHO assessment scale and severity by using modified Hartwig seigel severity assessment scale.Results: This study showed that most of the patients belong to 51-60 years age group. Mostly they were females, and many were having disease for less than a year. Most of the patients developed adverse drug reaction. Many patients had more than one adverse drug reaction. The commonest adverse effect were fatigue, palpitation, dizziness, insomnia, headache, joint pain, light-headedness, somnolence, nausea, flushing abdominal pain, tremor, leg pain, neck pain, back pain and edema. The adverse drug reaction(ADRs) mostly belongs to possible category and were mild.Conclusions: Most of the patients who were taking amlodipine had atleast one adverse drug reaction during their treatment period. It is mild, needs dose adjustment and healthy life style modification

Comparative study of adverse drug reaction pattern of two anti-asthma groups of drugs in a tertiary care hospital

Background: Bronchial Asthma is one of the worldwide health problems associated with increased morbidity and also mortality. Bronchial Asthma is a disease of airways that is characterized by increased responsiveness of the trachea-bronchial tree. Anti asthmatic drugs are associated with adverse effects which can affect the compliance and course of treatment. Monitoring adverse drug reactions in asthma will play a vital role in alerting physicians about the possibility and circumstances of such events, thereby protecting the user population from avoidable harm.Methods: The study was conducted in 500 bronchial asthma patients (250 patients in Beta 2 agonist group (Salbutamol) and 250 patients in Methylxanthine group (Deriphyllin) who fulfilled the study criteria and were observed for three months at Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. Their prescriptions were collected and analysed. Adverse drug reactions(ADRs) in each group were collected and evaluated. The causality assessment was done by WHO-UMC assessment scale and severity by using Modified Hartwig-Seigel severity assessment scale.Results: Total 38% of patients taking anti-asthma drugs were encountered adverse drug reactions and were more common in elderly females (61 to 70 years). Adverse Drug Reactions were more common in Methylxanthine group (48%) compared to Beta 2 agonist group (28%). Headache (38%) was the commonest ADR in Methylxanthine group and Tremors (31%) in Beta 2 agonist group. Most of ADRs were mild (95 %), manageable and comes under possible (60 %) category of WHO causality assessment scale.Conclusions: Treatment of Bronchial Asthma is mainly based on Beta 2 agonist and Methylxanthine group. So, occurrence of ADR is much common. Our study offers a representative idea of the ADR profile of anti asthmatic drugs. Constant vigil in detecting ADRs and subsequent dose adjustments can make therapy with anti asthmatic drugs safer and more effective. This, in turn, will improve compliance

A BIBLIOMETRIC ANALYSIS OF CONTRIBUTIONS IN THE JOURNAL “NATURE”

The present study Bibliometric analysis of the Journal “Nature” covers 13499 articles of 59 volumes in five years from 2013 to 2017. The aim of study was to analyze the year wise distribution of articles & citations, authorship pattern of articles, group co-efficient values for collaborative author’s publications, ranking of authors based on publications and h-index score, most productive countries and institutions, type of document published, keyword distribution, impact factor and future growth of journal. Form the analysis the following Results has been found that, in the year 2015 highest number of 2944(21.81%) articles was published out of 13499 articles in five years. Average numbers of citations per article are 33.70. Single author contribution has more dominant with 7063(52.3%) articles. A total number of 88670 authors around the globe are contributing articles in this journal. The anonymous author has been ranked top contributing maximum 987 articles. Witze A is in the second position with 179 articles. Wang J has been influenced author contributed in “Nature” journal, who produced 54 articles with having h-index 41 with 17031 citations and ranked in first place. It is identified that distribution number of references is gradually decreased year by year. In geographical distribution articles, United States of America has contributed highest number of 5815 articles with 31.07%. Majority of the participants are from University of California with 980 (7.25%) articles. The maximum number of 4719(34.96%) records is Editorial Materials which is more than one-fourth of total publications. The word “Expression” was most occurred keyword in 359(2.65%) articles. Impact Factor of the previous year (2017) is 25.95 and five-year impact factor is 33.70. The future trend of growth of research articles in “Nature” journal may take increasing for upcoming years

Implementation of Driver Software of Trailer Module Chip

The aim of the project is to develop a driver software for UJA1076A SBC in embedded C using IAR Embedded Workbench and integrate the driver software with application software of Trailer module. Currently MC33903 system basis chip from Freescale is used in Trailer Module. As an initiative to reduce the material cost for the Trailer module product, a lower price SBC NXP UJA1076A has been used. Also due to the fact that the newly proposed SBC has less number of operating modes and registers to configure, it helps in making the driver software much more simpler, thus reducing the risk of hidden issues in the otherwise complex design and code of the current SBC driver software

Productivity enhancements of compound parabolic concentrator tubular solar stills

The performance of compound parabolic concentrator assisted tubular solar still (CPC-TSS) and compound parabolic concentrator-concentric tubular solar still (CPC-CTSS) (to allow cooling water) with different augmentation systems were studied. A rectangular saline water trough of dimension 2 m × 0.03 m × 0.025 m was designed and fabricated. The effective collector area of the still is 2 m × 1 m with five sets of tubular still – CPC collectors placed horizontally with north-south orientation. Hot water taken from the CPC-CTSS was integrated to a pyramid type and single slope solar still. Diurnal variations of water temperature, air temperature, cover temperature and distillate yield were recorded. The results showed that, the productivity of the un-augmented CPC-TSS and CPC-CTSS were 3710 ml/day and 4960 ml/day, respectively. With the heat extraction technique, the productivity of CPC-CTSS with a single slope solar still and CPC-CTSS with a pyramid solar still were found as 6460 ml/day and 7770 ml/day, respectively. The process integration with different systems cost was found slightly higher but the overall efficiency and the produced distilled water yield was found augmented

Protocol for establishing a model for integrated influenza surveillance in Tamil Nadu, India

The potential for influenza viruses to cause public health emergencies is great. The World Health Organisation (WHO) in 2005 concluded that the world was unprepared to respond to an influenza pandemic. Available surveillance guidelines for pandemic influenza lack the specificity that would enable many countries to establish operational surveillance plans. A well-designed epidemiological and virological surveillance is required to strengthen a country’s capacity for seasonal, novel, and pandemic influenza detection and prevention. Here, we describe the protocol to establish a novel mechanism for influenza and SARS-CoV-2 surveillance in the four identified districts of Tamil Nadu, India. This project will be carried out as an implementation research. Each district will identify one medical college and two primary health centres (PHCs) as sentinel sites for collecting severe acute respiratory infections (SARI) and influenza like illness (ILI) related information, respectively. For virological testing, 15 ILI and 10 SARI cases will be sampled and tested for influenza A, influenza B, and SARS-CoV-2 every week. Situation analysis using the WHO situation analysis tool will be done to identify the gaps and needs in the existing surveillance systems. Training for staff involved in disease surveillance will be given periodically. To enhance the reporting of ILI/SARI for sentinel surveillance, trained project staff will collect information from all ILI/SARI patients attending the sentinel sites using pre-tested tools. Using time, place, and person analysis, alerts for abnormal increases in cases will be generated and communicated to health authorities to initiate response activities. Advanced epidemiological analysis will be used to model influenza trends over time. Integrating virological and epidemiological surveillance data with advanced analysis and timely communication can enhance local preparedness for public health emergencies. Good quality surveillance data will facilitate an understanding outbreak severity and disease seasonality. Real-time data will help provide early warning signals for prevention and control of influenza and COVID-19 outbreaks. The implementation strategies found to be effective in this project can be scaled up to other parts of the country for replication and integration

A recent increase in global wave power as a consequence of oceanic warming

Wind-generated ocean waves drive important coastal processes that determine flooding and erosion. Ocean warming has been one factor affecting waves globally. Most studies have focused on studying parameters such as wave heights, but a systematic, global and long-term signal of climate change in global wave behavior remains undetermined. Here we show that the global wave power, which is the transport of the energy transferred from the wind into sea-surface motion, has increased globally (0.4% per year) and by ocean basins since 1948. We also find long-term correlations and statistical dependency with sea surface temperatures, globally and by ocean sub-basins, particularly between the tropical Atlantic temperatures and the wave power in high south latitudes, the most energetic region globally. Results indicate the upper-ocean warming, a consequence of anthropogenic global warming, is changing the global wave climate, making waves stronger. This identifies wave power as a potentially valuable climate change indicator.Funding for this project was partly provided by RISKOADAPT (BIA2017-89401-R) Spanish Ministry of Science, Innovation and Universities and the ECLISEA project part of the Horizon 2020 ERANET ERA4CS (European Research Area for Climate Services) 2016 Call

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Adverse drug effects monitoring of amlodipine in a tertiary care hospital

Background: Amlodipine have been widely used drug for the treatment of Hypertension. It has many beneficial effects and less side effects. But, only very few adverse effects of Amlodipine have been documented and many were not reported. So, this study will bring out the possible adverse effect of Amlodipine.Methods: This study included 100 patients with hypertension who are taking amlodipine only. Patients who were willing to participate in the study were given a questionnaire containing demographic data and adverse drug profile of amlodipine. The symptoms of adverse drug reaction were documented. They were also asked about the other symptoms they are having, other than the questionnaire. The causality assessment was done by WHO assessment scale and severity by using modified Hartwig seigel severity assessment scale.Results: This study showed that most of the patients belong to 51-60 years age group. Mostly they were females, and many were having disease for less than a year. Most of the patients developed adverse drug reaction. Many patients had more than one adverse drug reaction. The commonest adverse effect were fatigue, palpitation, dizziness, insomnia, headache, joint pain, light-headedness, somnolence, nausea, flushing abdominal pain, tremor, leg pain, neck pain, back pain and edema. The adverse drug reaction(ADRs) mostly belongs to possible category and were mild.Conclusions: Most of the patients who were taking amlodipine had atleast one adverse drug reaction during their treatment period. It is mild, needs dose adjustment and healthy life style modification