Evaluation of oral midazolam as pre-medication in day care surgery in adult Pakistani patients

A placebo controlled randomized double blind study was designed to assess the suitability of oral Midazolam as a premedication in day care surgery in adult Pakistani patients. Fifty ASA I and II patients aged between 20-60 years received either Midazolam 7.5 mg or a placebo approximately one hour prior to surgery. Midazolam 7.5 mg produced significant anxiolysis and sedation (p \u3c 0.001) in comparison to placebo after one hour of premedication. There was a significant difference (p \u3c 0.001) in the mean heart rate and blood pressure in both groups after 1 hour of premedication with a lesser rise in blood pressure and heart rate in the Midazolam group. Psychomotor performance assessed by \u27n\u27 deletion test was impaired by Midazolam (p \u3c 0.001) and recall of pictures revealed differences (p \u3c 0.05) in the groups at one hour after premedication. However, at four hours after surgery there were no differences in both groups. These findings indicate that rapidly acting oral Midazolam in doses of 7.5 mg provided safe and effective premedication in terms of anxiolysis, sedation, amnesia and psychomotor performance and is suitable for day surgery

Analyzing Energy-efficiency and Route-selection of Multi-level Hierarchal Routing Protocols in WSNs

The advent and development in the field of Wireless Sensor Networks (WSNs) in recent years has seen the growth of extremely small and low-cost sensors that possess sensing, signal processing and wireless communication capabilities. These sensors can be expended at a much lower cost and are capable of detecting conditions such as temperature, sound, security or any other system. A good protocol design should be able to scale well both in energy heterogeneous and homogeneous environment, meet the demands of different application scenarios and guarantee reliability. On this basis, we have compared six different protocols of different scenarios which are presenting their own schemes of energy minimizing, clustering and route selection in order to have more effective communication. This research is motivated to have an insight that which of the under consideration protocols suit well in which application and can be a guide-line for the design of a more robust and efficient protocol. MATLAB simulations are performed to analyze and compare the performance of LEACH, multi-level hierarchal LEACH and multihop LEACH.Comment: NGWMN with 7th IEEE Inter- national Conference on Broadband and Wireless Computing, Communication and Applications (BWCCA 2012), Victoria, Canada, 201

Timing and correction of stepping movements with a virtual reality avatar

Research into the ability to coordinate one’s movements with external cues has focussed on the use of simple rhythmic, auditory and visual stimuli, or interpersonal coordination with another person. Coordinating movements with a virtual avatar has not been explored, in the context of responses to temporal cues. To determine whether cueing of movements using a virtual avatar is effective, people’s ability to accurately coordinate with the stimuli needs to be investigated. Here we focus on temporal cues, as we know from timing studies that visual cues can be difficult to follow in the timing context. Real stepping movements were mapped onto an avatar using motion capture data. Healthy participants were then motion captured whilst stepping in time with the avatar’s movements, as viewed through a virtual reality headset. The timing of one of the avatar step cycles was accelerated or decelerated by 15% to create a temporal perturbation, for which participants would need to correct to, in order to remain in time. Step onset times of participants relative to the corresponding step-onsets of the avatar were used to measure the timing errors (asynchronies) between them. Participants completed either a visual-only condition, or auditory-visual with footstep sounds included, at two stepping tempo conditions (Fast: 400ms interval, Slow: 800ms interval). Participants’ asynchronies exhibited slow drift in the Visual-Only condition, but became stable in the Auditory-Visual condition. Moreover, we observed a clear corrective response to the phase perturbation in both the fast and slow tempo auditory-visual conditions. We conclude that an avatar’s movements can be used to influence a person’s own motion, but should include relevant auditory cues congruent with the movement to ensure a suitable level of entrainment is achieved. This approach has applications in physiotherapy, where virtual avatars present an opportunity to provide the guidance to assist patients in adhering to prescribed exercises

Effectiveness of an integrated diabetes care package at primary healthcare facilities: a cluster randomised trial in Pakistan

Background: There were an estimated 7 million people living with diabetes in Pakistan in 2014, and this is predicted to reach 11.4 million by 2030. Aim: To assess if an integrated care package can achieve better control of diabetes. Design & setting: The pragmatic cluster randomised controlled trial (cRCT) was conducted from December 2014–June 2016 at 14 primary healthcare facilities in Sargodha district. Opportunistic screening, diagnostic testing, and patient recording processes were introduced in both the control 'testing, treating, and recording' (TTR) arm, and the intervention 'additional case management' (ACM) arm, which also included a clinical care guide and pictorial flipbook for lifestyle education, associated clinician training, and mobile phone follow-up. Method: Clinics were randomised on a 1:1 basis (sealed envelope lottery method) and 250 patients recruited in the ACM arm and 245 in the TTR-only arm (age ≥25 years and HbA1c >7%). The primary outcome was mean change in HbA1c (%) from baseline to 9-month follow-up. Patients and staff were not blinded. Results: The primary outcome was available for n = 238/250 (95.2%) participants in the ACM arm and n = 219/245 (89.4%) participants in the TTR-only arm (all clusters). Cluster level mean outcome was -2.26 pp (95% confidence intervals [CI] = -2.99 to -1.53) for the ACM arm, and -1.44 pp (95% CI = -2.34 to -0.54) for the TTR-only arm. Cluster level mean ACM–TTR difference (covariate-unadjusted) was -0.82 pp (95% CI = -1.86 to 0.21; P = 0.11). Conclusion: The ACM intervention in public healthcare facilities did not show a statistically significant effect on HbA1c reduction compared to the control (TTR-only) arm. Future evaluation should assess changes after a longer follow-up period, and minimal care enhancement in the comparator (control) arm

Fabrication and Evaluation of Floating Mucoadhesive Tablets of Cefpodoxime Proxetil Using Factorial Design

The present research work aims to fabricate and optimize gastroretentive floating mucoadhesive tablets of Cefpodoxime Proxetil, so as to remain in the gastric region for appropriate hours and hence significantly prolong the gastric residence time of drugs which improve bioavailability. Floating-Mucoadhesive tablets of Cefpodoxime Proxetil were prepared by direct compression method using various polymers such as HPMC K 200 M, Carbopol 940P. Sodium Bicarbonate & Citric acid was incorporated as a gas-generating agents and HPMC K 200 M, Carbopol 940 P was incorporated as Mucoadhesive agent. Optimization study was carried out by using 32 factorial design. The concentration of polymers was considered as independent variables whereas Floating lag time,Swelling Index, Mucoadhesive Strength, of the tablets were utilized as dependent variables. The floating- Mucoadhesive tablets were evaluated for weight variation, hardness, thickness, friability, drug content, in-vitro buoyancy study, and in-vitro and ex-vivo Mucoadhesive studies, swelling index and in-vitro dissolution studies. The study reveals the significant effect of the amount of polymers on Floating lag time, Swelling Index, Mucoadhesive Strength of the tablets. FTIR, DSC study indicates no drug-excipients interaction in the prepared formulations. The prepared tablets exhibited satisfactory physico-chemical characteristics. All prepared batches shown good in-vitro buoyancy studies and Mucoadhesion studies. The In-vitro dissolution profiles of optimized floating- Mucoadhesive formulation of Cefpodoxime Proxetil were found to sustained the drug release up to 12 hrs and release can be extended for longer period over 12 hrs by increasing the concentration of polymers. The best result from optimized batches is of AT5 which gives floating lag time 21±2, Mucoadhesive strength 16.60 gm & drug release 98.65% in 12 hrs. Floating- Mucoadhesive tablet were prepared and could be a promising approach to deliver  Cefpodoxime Proxetil with improved gastric residence time which improve bioavailability &  effective in the management of the bacterial infection. Keywords: Cefpodoxime Proxetil, , HPMC K200M, Carbopol 940P,Floating-Mucoadhesive, factorial desig

Sensory hypoinnervation in club foot

Abstract We have compared the density of nerve fibres in the synovium in club foot with that of specimens obtained from the synovium of the hip at operations for developmental dysplasia. The study focused on the sensory neuropeptides substance P; calcitonin gene-related peptide; protein gene product 9.5, a general marker for mature peripheral nerve fibres; and growth associated protein 43, a neuronal marker for new or regenerating nerve fibres. In order to establish whether there might be any inherent difference we analysed the density of calcitonin gene-related peptide-positive nerve fibres in the hip and ankle joints in young rats. Semi-quantitative analysis showed a significant reduction in the number of sensory and mature nerve fibres in the synovium in club foot compared with the control hips. Calcitonin gene-related peptide (CGRP) positive fibres were reduced by 28%, substance P-positive fibres by 36% and protein gene product 9.5-positive fibres by 52% in club foot. The growth associated protein 43-positive fibres also seemed to be less in six samples of club foot. No difference in the density of CGRP-positive nerve fibres was observed in the synovium between ankle and hip joints in rats. The lack of sensory input may be responsible for the fibrosis and soft-tissue contractures associated with idiopathic club foot