Long-term management of GERD in the elderly with pantoprazole

The prevalence of gastroesophageal reflux disease (GERD) increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs) are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD

Evaluation of Some Non-hazardous Insecticides and Repellents for the Control of Stored Grain Insect Pests

Entomolog

Macrostructure and Mechanical Properties of AA6082/SiC Composite Produced By Mechanical Stir Casting Process

Abstract In the present study, AA6082/SiC metal matrix composite with different size of reinforcements (75µm, 50µm and 25 µm) were fabricated by mechanical stir casting route. Macrostructural analysis, tensile test, hardness test, impact test were performed to find out microstructure and mechanical properties of the metal matrix composites. Minimum porosity was observed for the 25 µm of silicon carbide. The mechanical properties showed that the reduction of the size of SiC particles led to the improvement in tensile strength, hardness and toughness. It indicates that size of reinforcement is the effective factor influencing the mechanical properties

Effect of α-aluminium oxide nano additives with Sal biodiesel blend as a potential alternative fuel for existing DI diesel engine

The increasing demand, rapid consumption, price increase, limited reserves, and environmental concern due to pollution produced by conventional fossil fuel (diesel & gasoline) are a few reasons why biofuels need to be explored. The present paper employs a systematic methodology to examine the performance of a 20% volumetric blend of Sal biodiesel (S20) blended with diesel using αaluminium oxide (α-Al2O3) nanoparticles (NP) as additives and is compared with a diesel under like circumstances. The central composite design, Box-Behnken design (BBD) based response surface methodology, and desirability tests are used in the organized experiments on a diesel engine configuration to facilitate calibration. The created multivariate regression model yields all of the best engine inputs. Interaction effects are used to determine the most influential element by observing the interaction of two distinct input factors on a single response. According to the desirability tests, the highest estimated desirability was 0.579; the optimal input parameters found are 21°bTDC injection timing (IT), 238 bar injection pressure (IOP), 17 compression ratio (CR), and 74 ppm concentration of α-Al2O3NP, estimated the optimized response of brake thermal efficiency (BHTE) 31.18%, brake specific fuel consumption (BSFC) 0.2975 kg/kWh, carbon monoxide (CO) 0.0887%, hydrocarbon (HC) 31 ppm, oxide of nitrogen (NOx) 677 ppm, and smoke level 54.92%. These predicted values were validated with experimental results, and errors were within the range. The nanoparticle combination sample offers improved brake thermal efficiency (BTHE) and lower BSFC rate than the S20 while testing for the optimal parametric condition

Visszapillantás közgazdaságunk egy negyed századára

Aims: Diagnosis of heart failure in older people in long-term care is challenging because of co-morbidities, cognitive deficit, polypharmacy, immobility, and poor access to services. This study aimed to ascertain heart failure prevalence and clinical management in this population. Methods and results: A total of 405 residents, aged 65–100 years, in 33 UK care facilities were prospectively enrolled between April 2009 and June 2010. The presence of heart failure was determined using European Society of Cardiology guidelines, modified where necessary for immobility. Evaluation of symptoms and signs, functional capacity, and quality of life, portable on-site echocardiography, and medical record review were completed in 399 cases. The point prevalence of heart failure was 22.8% [n = 91, 95% confidence interval (CI) 18.8–27.2%]; of these, 62.7% (n = 57, 95% CI 59.6–66.5%) had heart failure with preserved ejection fraction and 37.3% had left ventricular systolic dysfunction (n = 34, 95% CI 34.8–40.5%). A total of 76% (n = 61) of previous diagnoses of heart failure were not confirmed, and up to 90% (n = 82) of study cases were new. No symptoms or signs were reliable predictors of heart failure. Conclusion: Heart failure was diagnosed in almost a quarter of residents: the prevalence was substantially higher than in other populations. The majority of heart failure cases were undiagnosed, while three-quarters of previously recorded cases were misdiagnosed. Common symptoms and signs appear to have little clinical utility in this population. Early, accurate differential diagnosis is key to the effective management of heart failure; this may be failing in long-term care facilities