Complementary and alternative medicines usage in elderly patients in tertiary care teaching hospital of North India

Background: Complementary and alternative medicine (CAM) is defined as a group of diverse medical health care systems, practices and products that are not presently considered to be part of conventional medicine. Its use is highly prevalent in elderly population because of presence of chronic diseases. So, present study was planned to assess CAM usage in elderly patients.Methods: This observational, questionnaire-based study was conducted at department of pharmacology, in association with department of medicine and included all adult patients of more than 60 years of age who have taken any CAM therapy. Demographic data, name of CAM preparation, its characteristics and behavioral pattern for its usage were recorded.Results: Out of 200 patients of more than 60 years attending medicine outpatient department, 115 were found to be CAM users. CAM usage was more in females (59.1%); age group of 60-69 years (49.57%); rural residents (66.08%); low socioeconomic status (81.73%). Most common CAM preparations used were dietary supplements (61.7%) and vitamins and minerals (56.52%) for indications such as chronic pain and endocrine disorders because it was thought to be safe. 76.52 % of CAM users did not discuss CAM with their health care provider.Conclusions: CAM use is highly prevalent in elderly patients and more so in females of low socioeconomic status. Most common CAM therapy used was dietary supplements. Continuous educational efforts are needed to enhance the awareness of patients and healthcare providers regarding the CAM therapy

A CLINICAL STUDY TO EVALUATE THE ANTIHYPERTENSIVE EFFECT OF TRINPANCHMOOL KWATH IN MANAGEMENT OF ESSENTIAL HYPERTENSION

The present study was conducted to evaluate the antihypertensive effect of an Ayurvedic formulation Trinpanchmool Kwath in the management of essential hypertension. The study was conducted in 30 patients selected from OPD and IPD of R.G.G. P.G.A.C. and Hospital, Paprola. Patients were randomly divided into three groups. Group- I patients were managed with Trinpanchmool Kwath , Group- II patients were managed with Tab Chlorthalidone and Group– III patients were managed with both Trinpanchmool Kwath and Tab. Chlorthalidone. The results obtained were analysed on the basis of various objective and subjective parameters. However change in blood pressure was the main criteria for assessing the effect of the therapy. Statistically highly significant reduction was observed in systolic and diastolic blood pressure after 45 days of therapy. In Group-I systolic blood pressure reduced by 9.374%, in Group-II systolic blood pressure decreased by 15.46% and in Group-III systolic blood pressure decreased by 16.86%. Similarly in Group-I diastolic blood pressure decreased by 8.195% , in Group-II showed 11.250% reduction and in Group-III diastolic blood pressure decreased by 12.17% after completion of therapy. Results revealed that therapy given in Group-III i.e. the combination of Trinpanchmool Kwath and Tab. Chlorthalidone showed best results as compared to other groups. Group-II, in which patients were managed with Tab Chlorthalidone showed better results over Group-I where only Trinpanchmool Kwath was given to the patients. However statistically highly significant reduction in both systolic and diastolic pressure was observed in all three groups

Development of a seamlessly integrated factory planning software tool (prototype) to evaluate and optimize surface mount manufacturing lines

Thesis (M.S.)--Massachusetts Institute of Technology, Sloan School of Management, 1995.Includes bibliographical references (p. 182).by Vijay Mehra.M.S

Modeling Coordination in Offshore Software Development

Controlling and minimizing coordination costs has been shown to be an important factor to reduce overall project performance in distributed software development. In this research-in-progress paper we investigate the effects of software complexity, software integration, distributed labor division policies, learning effects on software coordination costs. Drawing from data collected on 130 software construction cycles in 34 large projects of a leading offshore development firm, we first present our analysis on how coordination costs relate to team organization factors and complexity of evolving software. We base our analytic model of coordination costs in offshore software development on these empirical relationships, and give an overview of our modeling approach. We apply our model of software coordination costs to develop resource allocation policies in the projects we studied. We consider both waterfall and iterative software development methodologies and also tandem and parallel integration schemes. Our modeling approach helps managers to develop a dynamic coordination policy to aid iterative software development in distributed development environments

Assessment of the knowledge, attitude and practice of self medication among second year undergraduate medical students in a tertiary care teaching hospital

Background: Inappropriate self-medication is a cause of concern as it can result in wasteful expenditure, prolonged suffering, drug dependence, resistance and increase in morbidity. Self medication assumes significance among medical students as they have knowledge about ailments and medicines. The aim of the study was to assess the knowledge, attitude and practice of self-medication among undergraduate medical students.Methods: The present study was conducted in December 2017 among second professional undergraduate medical students in the Department of Pharmacology and Therapeutics, GMC Jammu after obtaining approval from the Institutional Ethics Committee of GMC, Jammu. A total of 123 students who took self-medication during last six months were included and given a questionnaire that included open and close ended questions about self-medication. Data was analysed using Microsoft Excel and presented as number and percentages.Results: Total of 123 second professional undergraduate MBBS students were analysed. 72 (58.53%) were males and 51 (41.46%) were females. 96 (78%) students practised self-medication. Allopathic drugs were most commonly used for self medication (93.5%), followed by Ayurvedic drugs. Fever and headache were common ailments treated with self medication. Common class of drugs used for self medication were antipyretics (66.6%), antibiotics (42.2%). Adverse drug reactions were perceived as the most common disadvantage of self medication. Analysis of source of information revealed that old prescriptions (33%), internet (18%) were the main sources of information. Regarding prevention of self medication, many students perceived that enhancing awareness was the most effective solution (72.3%) followed by stoppage of supply of medicines without prescription(39.8%).Conclusions: Self medication is practised by a majority of students. As responsible self medication is now increasingly being considered as a component of self-care, there is need for review of educational programs especially teaching of rational and judicious use of medicines to the undergraduate medical students

Formulation and Evaluation of Cephalexin Extended-release Matrix Tablets Using Hydroxy Propyl Methyl Cellulose as Rate-controlling Polymer

The present investigation reports the design and evaluation of six-hour extended release film-coated matrix tablets of cephalexin using different grades of hydrophilic polymer hydroxypropylmethylcellulose (HPMC) employing direct compression method. The preformulation studies performed included the physical compatibility studies, Differential Scanning Calorimetry analysis, drug characterization using Fourier Transform Infra Red spectroscopic analysis and particle size analysis using sieve method. The tablets were evaluated for weight variation, hardness, thickness and friability. Results of the studies indicate that the polymers used have significant release-retarding effect on the formulation. The dissolution profile comparison of the prepared batches P1 to P8 and market preparation (Sporidex AF 375) was done by using Food and Drug Administration-recommended similarity factor (f2) determination. The formulation P8 (10% HPMC K4M, 15% HPMC 15cps) with a similarity factor (f2) of 77.75 was selected as the optimized formulae for scale-up batches. The dissolution data of the best formulation P8 was fitted into zero order, first order, Higuchi and Korsemeyer-Peppas models to identify the pharmacokinetics and mechanism of drug release. The results of the accelerated stability study of best formulation P8 for three months revealed that storage conditions were not found to have made any significant changes in final formulation F3. The release of cephalexin was prolonged for 6 h by using polymer combinations of HPMC and a twice daily matrix tablet was formulated

Vortex Initialization in the NCEP Operational Hurricane Models

This paper describes the vortex initialization (VI) currently used in NCEP operational hurricane models (HWRF and HMON, and possibly HAFS in the future). The VI corrects the background fields for hurricane models: it consists of vortex relocation, and size and intensity corrections. The VI creates an improved background field for the data assimilation and thereby produces an improved analysis for the operational hurricane forecast. The background field after VI can be used as an initial field (as in the HMON model, without data assimilation) or a background field for data assimilation (as in HWRF model). Keywords: vortex initialization; bogus storm; hurricane initialization</p

Genetic determinants of the ankle-brachial index: A meta-analysis of a cardiovascular candidate gene 50K SNP panel in the candidate gene association resource (CARe) consortium

Candidate gene association studies for peripheral artery disease (PAD), including subclinical disease assessed with the ankle-brachial index (ABI), have been limited by the modest number of genes examined. We conducted a two stage meta-analysis of ~50,000 SNPs across ~2100 candidate genes to identify genetic variants for ABI

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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