Compliance to antihypertensive therapy

Objective: To determine compliance, factors affecting compliance to antihypertensive therapy and to compare compliant and non-compliant groups, in a tertiary care setting.Study Design: Analytical (cross-sectional) study.Place and Duration of Study: The outpatient clinics at the Aga Khan University from May 2004 to February 2005.Patients and Methods: Two hundred patients presenting to the outpatients clinic were included. All patients 18 years and above, who had stage 1 and 2 hypertension, had one clinic visit to a medicine clinic, 6 months prior to presentation and started on antihypertensive medicines, were included.Results: Sixty six percent were males and 33.5 % were females. Mean age was 58.1(+/-12) years and mean duration of hypertension was 7.2 (+/- 6.7) years. Fifty-seven percent were compliant and 43 % were noncompliant. In the noncompliant group, 53.4 % had mild noncompliance, 24.4 % had severe non-compliance, while 22% had moderate noncompliance. Factors of noncompliance were 56.8% missed doses due to forgetfulness, 12.7% deliberately missed their doses, 11.6% could not take the medicine due to side effects, 10.4% did not take the dose due to increased number of tablets, 4.6% were not properly counseled by the physician and 3.48% did not take medicines due to cost issues. The mean systolic blood pressure was 126 +/- 19.2 mmHg in the compliant group while it was 133 +/-16.5 mmHg in the noncompliant group p-value 0.004). The mean diastolic blood pressure in the compliant group was 76 +/- 11.9 mmHg, while in the noncompliant group it was 81.9 +/-10.9 mmHg (p-value 0.001).Conclusion: Compliance to antihypertensive therapy in a tertiary care center is significantly good. Forgetfulness was the major reason for noncompliance. The mean blood pressure control was better in the compliant group

Clinical outcomes of sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes mellitus: An observational study from Pakistan

Objective: To determine the efficacy and safety of Sodium-glucose cotransporter-2 inhibitors (SGLT2i) use in the Pakistani population.Methods: Retrospective review of initial 100 patients who were prescribed with any agent of the SGLT2i group from July 1, 2018, to January 2019 at Aga Khan University Hospital, Karachi. SGLT2i was offered to patients of above 18 years of age with inadequate glycemic control on existing antidiabetic agents. Changes in HbA1c, the Body Mass Index (BMI), serum creatinine, any decrease in the requirement of insulin and sulphonylurea dose along with any side effects reported by the patients on follow-up visits.Results: Most study participants were females (56%) with the mean age of 52±10 years. Substantial changes were observed in the HbA1c (7.5±1.1%, 7.9±1.2% from 8.7±1.5%, p \u3c 0.01), BMI (31.4±5.8, 31.8±5.8 from 32.4±5.9kg/m2, p \u3c 0.01) and in creatinine (0.71±0.1, 0.75±0.1 from 0.79±0.1 mg/dl, p \u3c 0.01) at three and six months of follow up visits. The reduction in insulin and sulphonylurea doses was also significant. Adverse drug events that led to drug discontinuation in 14 individuals were, Urinary tract infection (UTI) (seven patients), Genital infection (three patients), nausea +UTI, abdominal pain +UTI, mild Diabetic Ketoacidosis, and polyuria (one patient each). None reported Fournier\u27s gangrene, limb amputation, or fracture.Conclusion: SGLT2i significantly improved glycemic control, BMI, and serum creatinine in the Pakistani population with a very low number of observed adverse events

Influence of Socio-demographic Variables on Prevalence of Hypertension in Lahore Division, Pakistan

Hypertension is a growing public health issue at global level and it is considered as a potent factor for cardiovascular ailments. But various socio-demographic factors are root causes to provoke this physiological disorder. In current study, through cross sectional survey, performa based data of 100 persons was collected from cities Lahore division, Pakistan. The results showed that males are more suffering than females and fall in age range of 20-40yrs. Most frequently reported initial symptoms are fatigue, irregular heartbeat and difficulty in breathing. Whereas district wise comparison indicated higher prevalence level in Lahore and Kasur than Shiekhupura and Nankana Sahib.   Similarly, ANOVA results highlighted that economic status matters the most, parallel to the extent of awareness among masses, that’s why; mediocre is suffering more than upper or lower class. Thus cost effective treatments based findings should be our future goal to control this growing disease

One factor at a time analysis to modify potting technique for manufacturing of bubble-free high-voltage polyester insulated automotive coils

The current study focuses on minimising the bubbles in polyester-insulated ignition coils, which were produced with a defect level of ~21–25% or 210–250 coils per 1000 batch size by using the potting method. This high-level rejection makes a substantial financial impact by increasing waste material, manufacturing, and after-sales costs. Hence, to control the bubbled problem without using expensive and maintenance-heavy techniques, the process parameters in the potting method were alternated and investigated using one factor at a time, which played a vital role in the formation/ reduction of bubbles in the ignition coil insulation. Process parameters, including pre/process heating, the appropriate MEKP/cobalt naphthenate ratio, the pouring amount/increments, and the stirring speeds, reduced the bubble formation per lot from 205 ± 30 to 146 ± 25, 108 ± 21, 61 ± 17, and 10 ± 2 per 1000 lot accordingly. In addition, a comparative study was conducted in terms of performance and life cycle endurance, using Japanese and Indian standards. Furthermore, an after-sale warranty claim also supports the proposed changes in the potting technique. This modification may reduce the after-sales rejection within two years to approximately ~85%. This modification in the potting technique is extremely cost-effective in comparison to expensive processes, i.e., vacuum-pressure impregnation and vacuum impregnation, which require extensive labour and maintenance

Software-Defined Network-Based Vehicular Networks: A Position Paper on Their Modeling and Implementation

There is a strong devotion in the automotive industry to be part of a wider progression towards the Fifth Generation (5G) era. In-vehicle integration costs between cellular and vehicle-to-vehicle networks using Dedicated Short Range Communication could be avoided by adopting Cellular Vehicle-to-Everything (C-V2X) technology with the possibility to re-use the existing mobile network infrastructure. More and more, with the emergence of Software Defined Networks, the flexibility and the programmability of the network have not only impacted the design of new vehicular network architectures but also the implementation of V2X services in future intelligent transportation systems. In this paper, we define the concepts that help evaluate software-defined-based vehicular network systems in the literature based on their modeling and implementation schemes. We first overview the current studies available in the literature on C-V2X technology in support of V2X applications. We then present the different architectures and their underlying system models for LTE-V2X communications. We later describe the key ideas of software-defined networks and their concepts for V2X services. Lastly, we provide a comparative analysis of existing SDN-based vehicular network system grouped according to their modeling and simulation concepts. We provide a discussion and highlight vehicular ad-hoc networks' challenges handled by SDN-based vehicular networks.Comment: 14 pages, 3 figures, Sensors 201

2-(3-Methyl­but-2-en-1-yl)-1,2-benziso­thia­zol-3(2H)-one 1,1-dioxide

In the title compound, C12H13NO3S, a saccharin derivative, the dihedral angle between the aromatic and isothia­zole rings is 2.91 (12)°. The planar 3,3-dimethyl­allyl group [maximum deviation = 0.0086 (16) Å] is oriented at dihedral angles of 71.86 (7) and 74.35 (7)° with respect to the aromatic and isothia­zole rings, respectively. In the crystal structure, weak inter­molecular C—H⋯O inter­actions link the mol­ecules into chains along the c axis. A weak C—H⋯π inter­action is also present

Polyester Usage in Manufacturing of Electrical and Mechanical Products and Assemblies

This chapter focuses on the processes in which polyester is usually used for the manufacturing of mechanical components and assemblies. Various methods of manufacturing these products are mentioned in this chapter. These methods include wet layup method, filament winding, pultrusion, vacuum bagging and autoclave curing, resin transfer molding (RTM) and vacuum-assisted resin transfer molding (VARTM). Various production levels and properties can be achieved by polyester resin using abovementioned processes. Each process has its own benefits and disadvantages, which are discussed in this chapter. Furthermore, the use of polyester in making electrical insulation is also discussed in the chapter. Advantages and disadvantages of each impregnation technique are also explained

Early renal damage assessed by the SLICC/ACR damage index is predictor of severe outcome in lupus patients in Pakistan

We investigated Patients with systemic lupus erythematosus with the objective of assessing whether early damage accrued in systemic lupus erythematosus as measured by the SLICC/ACR Damage Index predicts mortality in lupus Patients that have been followed prospectively in a single center. Patients with systemic lupus erythematosus from Aga Khan University hospital presenting between 1992 and 2007 were included. This enabled all Patients to be potentially followed for at least 10 years. Yearly SLICC/ACR Damage Index scores were determined for each Patient. Early damage was defined as a score \u3e= 1, and no damage as a score of 0 at the initial assessment. Kaplan-Meier and Log rank tests were used to compare the survival experience between those with and without damage, with all Patients being assessed at 10 years. In this inception cohort 198 Patients were identified and were followed for 10 years. Of these, 47 (23.7%) Patients had a SLICC/ACR Damage Index score of 0 (no damage) while 151 Patients (76.3%) had at least one SLICC/ACR Damage Index item scored (early damage). Mean renal damage score at 1, 5 and 10 years was 0.16, 0.34 and 0.67, respectively. Of lupus Patients who exhibited renal damage at their first SLICC/ACR Damage Index assessment, 31% died within 10 years of their illness as compared with only 13% who had no early renal damage (p \u3c 0.003). Mean renal damage score at 1 year after diagnosis was a significant predictor of death within 10 years of diagnosis (p \u3c 0.002)

Survival analysis and prognostic indicators of systemic lupus erythematosus in Pakistani patients

To aim of this study is to analyse the survival rate and prognostic indicators of systemic lupus erythematosus (SLE) in Pakistani population. A total of 198 Patients with SLE diagnosed between 1992 and 2005 were reviewed retrospectively. Clinical features at presentation, subsequent evolving features, autoantibody profile, damage scores and mortality data were obtained. Prognostic factors for survival were studied by statistical analysis. Of 198 SLE Patients studied, 174 were women and 24 were men. The women to men ratio was 7.2:1. Mean age at presentation was 31 years (range 14-76). Mean duration of symptoms before diagnosis was 2.8 years. Mean duration of follow-up was 34.21 months (+/- 33.69). Mean disease duration was 15.6 years. At diagnosis, arthritis, malar rash, oral ulcers and alopecia were the commonest features. During the follow-up, the prevalence of nephritis, arthritis, neurological and hematological disease increased significantly. About 76% (n = 151) of the Patients had organ damage at the time of data analysis, and renal disease was the commonest cause. Univariate analysis revealed that renal disease (P = 0.000), seizures (P = 0.048), pleural involvement (P = 0.019), alopecia (P = 0.000) and discoid lesions (P = 0.005) were predictors for damage. Multivariate model, however, revealed that only renal disease was independent risk factor for damage (P = 0.002). During the study period, 47 Patients (24%) died (five due to disease-related complications and rest as a result of infections). The 3-, 5-, 10-, 15- and 20-year survival rates of our cohort were 99, 80, 77, 75 and 75%, respectively. Cox regression analysis revealed that renal involvement (P = 0.002) and infections (P = 0.004) were independent risk factors for mortality. The survival of our Pakistani SLE Patients was significantly lower compared to that of the Caucasian series reported in last decade. Nephritis not only contributes to organ damage but also acts a major determinant for survival. Infection remains the commonest cause of death. Renal involvement and infections are independent risk factors for mortality. Judicious use of immunosuppressive agents is necessary to improve the short-term survival of lupus Patients

Ceftriaxone resistant Salmonella Typhi carries an IncI1-ST31 plasmid encoding CTXM-15

Purpose: Ceftriaxone is the drug of choice for typhoid fever and the emergence of resistant Salmonella Typhi raises major concerns for treatment. There are an increasing number of sporadic reports of ceftriaxone resistant S. Typhi and limiting the risk of treatment failure in the patient and outbreaks in the community must be prioritised. This study describes the use of whole genome sequencing to guide outbreak identification and case management. Methodology: An isolate of ceftriaxone resistant S. Typhi from the blood of a child taken in 2011 at the Popular Diagnostic Center, Dhaka, Bangladesh was subjected to whole genome sequencing, using an Illumina NextSeq 500 and analysis using Geneious software. Results: Comparison with other ceftriaxone resistant S. Typhi revealed an isolate from the Democratic Republic of the Congo in 2015 as the closest relative but no evidence of an outbreak. A plasmid belonging to incompatibility group I1 (IncI1-ST31) which included blaCTX-M-15 (ceftriaxone resistance) associated with ISEcp-1 was identified. High similarity (90%) was seen with pS115, an IncI1 plasmid from S. Enteritidis, and with pESBL- EA11, an incI1 plasmid from E. coli (99%) showing that S. Typhi has access to ceftriaxone resistance through the acquisition of common plasmids. Conclusions: The transmission of ceftriaxone resistance from E. coli to S. Typhi is of concern because of clinical resistance to ceftriaxone, the main stay of typhoid treatment. Whole genome sequencing, albeit several years after the isolation, demonstrated the success of containment but clinical trials with alternative agents are urgently required