Role and safety of prokinetic drugs in the treatment of upper gastrointestinal motility disorders: an Indian perspective

Upper gastrointestinal (GI) motility disorders such as functional dyspepsia (FD), gastroesophageal reflux disease, and gastroparesis are associated with symptoms such as acid reflux, regurgitation, bloating, and heartburn. This review summarizes the prevalence, diagnosis and management of upper GI motility disorders in clinical practice in India, with focus on the use of prokinetics. Lifestyle and dietary modifications, psychotherapy, and pharmacotherapy form the armamentarium for management of motility disorders. Among pharmacotherapies, prokinetics increase gastric emptying and provide symptomatic relief. However, neurological and cardiovascular safety issues are associated with commonly prescribed prokinetics making it important to judiciously select an appropriate drug after weighing out its risk-benefit profile. While metoclopramide, domperidone, and levosulpiride are widely prescribed prokinetics in Indian clinical practice, they are associated with adverse effects such as extrapyramidal symptoms (EPS) and cardiovascular side effects. Itopride, which is a prokinetic with dual mechanism of action, has been found to have equivalent efficacy to other prokinetics and has shown significant improvement in quality of life and symptoms in randomized controlled trials in patients with FD. It acts as a D2 receptor antagonist and acetylcholinesterase inhibitor. Both these actions cause increase in acetylcholine levels, which increases gastric motility. Itopride also has negligible cardiac and neurological safety concerns. Thus, it is a relatively safer molecule compared with other prokinetics, with no EPS or cardiotoxicity concerns and can be used for the long-term management of upper GI motility disorders in a wide pool of patient groups either alone or in combination with other drug classes

Sport Sector and its Sources of Sustainable Competitive Advantage

It is understood by the author of this paper that national competitiveness consists of competitiveness of all kind of sectors and industries included into them. An industry in return has its members striving to obtain and mantain a competitve advantage for as long as possible. Identification and efficient and effective utilization of unique resources and core competencies has to be ensured along with alignment of performance of sectors in the national economy. The paper is tending to provide a comparative assessment of the sport sector in four out of five main areas: – Sponsorship activities and processes – Gate revenue development – Media rigts and opportunities – Merchandising intellectual property Although food concessions are important fifth area we omitt them for later research to comply with the challenge of in-depth analysis of four above listed area development trends and major key challenges for making sport sector an even more substantial contributor to national competitiveness and international sport and leisure process improvement efforts. Data will be provided to demonstrate the key challenges and trends to be taken into consideration by any sport organization willing successfully identify how to reach appropriate competitiveness expectations formulated by its stakeholders.It is understood by the author of this paper that national competition consists of competitiveness of all kinds of sectors and industries within them. Sport in return has its members striving to obtain and maintain a competitive advantage for as long as possible. Identification of efficient and effective utilization of unique resources and core competencies has to be assured along with alignment of the performance of sectors in the national economy. The paper intends to provide a comparative assessment of the sport sector in four out of five main areas: – Sponsorship activities and processes – Gate revenue development – Media rights and opportunities – Merchandising intellectual property Although food concessions are the important fifth area, we omitted them for later research. The challenge of in-depth analysis of the four above listed area development trends and the major key challenges of these sporting sector is a more substantial contributor to national competitiveness and the international sport and leisure process improvement efforts. Data will be provided to demonstrate the key challenges and trends to be taken into consideration by any sport organization willing to successfully identify how to reach appropriate competitiveness expectations formulated by its stakeholders

Importance of Value Analysis in Domestic and International Outlook

The value analysis is a well-known and widely used multi-criteria group decision-making procedure that not only looks for the cheapest, or not only the better, but also satisfies the desired and necessary needs at the lowest cost. Covering all important details of the project (product, service, procedure, process), the so-called multidisciplinary team of internal and/or external experts works together with the consultant. Value analysis identifies project functions and focuses on the most impactful intervention points. It then explores alternative solutions and creates optimal solutions for functions to cost-effectively satisfy and/or increase performance. Value analysis is now used by almost every large company in the world and is widespread in all industries. According to expert estimates, around 50,000 value analysis projects are carried out in Europe every year. Based on the provisions of the EN 12.973:2000 Value Management Standard in Hungary, the Public Procurement Act recommends the contracting authority require the tenderer to apply the method. This review paper reviews the process of the formation and development of value analysis, its fields of application in international comparison, the main methodological frameworks, its current challenges, and new opportunities

Retrospective analysis of random and systematic errors in radiation therapy of head and neck cancer patients and its clinical predictive implications with VMAT treatment

Background: The accuracy of radiotherapy is based on the matching of 2D portal/CBCT image with a reference image. The aim of this study is to determine the random and systematic setup errors (in cm) in radiotherapy of head and neck cancer patients and to derive the setup margin and its clinical implications.Methods: Author retrospectively reviewed the records of 25 head and neck cancer (HNC) patients treated with radiotherapy between Dec 2017 and July 2018. After immobilization, setup accuracy was assessed by registration of XVI image with planning reference image using Elekta XVI image guidance system and the isocenter correction was applied. For each patient 10 CBCT image sets were taken. The translational errors in X, Y and Z directions were used to estimate systematic (Σ) and random (σ) errors and to derive the final setup margin by using van Herk’s formula (2.5Σ + 0.7σ).Results: The mean translational errors ranges from -0.23 cm to 0.32 cm in Lateral (X), -0.15 to 0.16 cm in Longitudinal (Y) and -0.11 to 0.17 cm in vertical (Z) directions. The Mean and SD for systematic errors 0.21±0.13, 0.11±0.18, 0.14±0.11 and random error (in cm) are -0.03±0.33, 0.00±0.21 and 0.05±0.30 in X, Y and Z axis respectively. The final total margin for CTV to PTV including setup margin in the X, Y and Z directions (in cm) were 0.56, 0.61, and 0.47 respectively.Conclusion: Thus, the precise immobilization techniques are very important to reduce the setup margins, and the number of CBCTs during head and neck radiotherapy treatment

Emerging inflammatory bowel disease demographics, phenotype, and treatment in South Asia, South-East Asia, and Middle East: preliminary findings from the Inflammatory Bowel Disease-Emerging Nations' Consortium.

Background and Aim: Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South-East Asia, and the Middle East, yet epidemiological data are scarce. Methods: We performed a cross-sectional study of IBD demographics, disease phenotype, and treatment across 38 centers in 15 countries of South Asia, South-East Asia, and Middle East. Intergroup comparisons included gross national income (GNI) per capita. Results: Among 10 400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD unclassified 227, and 58% male). Peak age of onset was in the third decade, with a low proportion of elderly-onset IBD (5% age > 60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was the commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12 months; interquartile range 5–30). Treatment of CD included mesalamine, steroids, and immunomodulators (61%, 51%, and 56%, respectively), but a fifth received empirical antitubercular therapy. Treatment with biologics was uncommon (4% UC and 13% CD), which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD) per 100 patients per year. Conclusions: The IBD-ENC cohort provides insight into IBD in South-East Asia and the Middle East, but is not yet population based. UC is twice as common as CD, familial disease is uncommon, and rates of surgery are low. Biologic use correlates with per capita GNI

Chińskie likiery jako światowe marki — studium prypadku Guizhou Moutai Group

China is one of the largest markets in the world for alcoholic beverages. The Chinese liquor industry is over 5,000 years old, reflecting traditional Chinese cultural values. Improving the international competitiveness of Chinese liquor can be the key to promoting the export of Chinese liquor. In recent years, the “Belt and Road Initiative (BRI)” policy and the in-depth implementation of the comprehensive opening-up strategy have brought opportunities for the international development of Chinese liquor to strengthen cultural promotion, establish a strong brand effect, and embark on the path to global market opening. The Chinese liquor industry has now entered the “brand” competition stage after experiencing competition from “quantity” to “quality”. In terms of internationalization, the Chinese liquor industry lacks internationally recognized brands, and Chinese liquor branding is obsessed with cultural appeal and a single consumer group structure, making it difficult to open up international markets. The promotion of the international competitiveness of Chinese liquor requires joint efforts of the national government, industry associations, and enterprises. Two Chinese brands, Moutai and Wuliangye, are among the best-selling luxury liquors worldwide. It will also help to accelerate the break-up of the Chinese liquor industry’s over-reliance on the domestic market. As a leading enterprise in Guizhou Province, Guizhou Maotai Group has played a dominant role in the province’s economic prosperity as well as solving local employment problems and improving people’s living standards at the same time. The Guizhou Maotai Group should implement a multinational strategy that focuses on cost reduction and product diversification to simultaneously achieve low-cost advantages and product differentiation advantages. According to the author’s assumption, after analysing the running business processes of this company and the lessons learned from them, these facts can serve as a good reference example for the other stakeholders in the Chinese liquor industry, contributing to an understanding of some critical factors that influenced decision-making on how Chinese liquors could become globally recognized brands. In this context, this review paper discusses the main trends of the Chinese liquor industry via a Guizhou Maotai Group case study in order to reveal and understand the main challenges that lie ahead and concludes several recommendations on how to overcome the difficulties on the way to transforming Moutai liquors into widely known, respected global brands. Further research work should be implemented to determine how to generalize these conclusions for the entire sector.Chiny to jeden z największych rynków napojów alkoholowych na świecie. Chiński przemysł alkoholowy ma ponad 5000 lat i odzwierciedla tradycyjne chińskie wartości kulturowe. Poprawa międzynarodowej konkurencyjności chińskiego likieru może być kluczem do promowania eksportu chińskiego tegoż trunku. W ostatnich latach polityka „Belt and Road Initiative (BRI)” oraz dogłębna realizacja kompleksowej strategii otwarcia stworzyły możliwości międzynarodowego rozwoju chińskiego trunku w celu wzmocnienia promocji kulturowej, stworzenia silnego efektu marki i wejść na drogę do otwarcia światowego rynku. Chiński przemysł alkoholowy wszedł teraz na poziom konkurencji „markowej” po tym, jak doświadczył konkurencji „ilościowej” do „jakościowej”. Jeśli chodzi o internacjonalizację, chińskiemu przemysłowi alkoholowemu brakuje marek rozpoznawalnych na całym świecie, a chiński branding alkoholi ma obsesję na punkcie atrakcyjności kulturowej i struktury jednej grupy konsumentów, co utrudnia otwarcie rynków międzynarodowych. Promocja międzynarodowej konkurencyjności chińskiego trunku wymaga wspólnych wysiłków rządu krajowego, stowarzyszeń branżowych i przedsiębiorstw. Dwie chińskie marki, Moutai i Wuliangye, należą do najlepiej sprzedających się luksusowych trunków na świecie. Pomoże to również przyspieszyć likwidację nadmiernej zależności chińskiego przemysłu alkoholowego od rynku krajowego. Jako wiodące przedsiębiorstwo w prowincji Guizhou, Guizhou Maotai Group odegrała dominującą rolę w rozwoju gospodarczym prowincji, rozwiązując jednocześnie lokalne problemy związane z zatrudnieniem i poprawiając standard życia ludzi. Grupa Guizhou Maotai powinna wdrożyć wielonarodową strategię, która koncentruje się na redukcji kosztów i dywersyfikacji produktów, aby jednocześnie osiągnąć korzyści w zakresie niskich kosztów i zróżnicowania produktów. Zgodnie z założeniem autora, po przeanalizowaniu procesów biznesowych tej firmy i wyciągniętych z nich wniosków, fakty te mogą służyć jako dobry przykład odniesienia dla innych interesariuszy chińskiego przemysłu alkoholowego, przyczyniając się do zrozumienia niektórych krytycznych czynników, które wpływ na podejmowanie decyzji, w jaki sposób chińskie alkohole mogą stać się rozpoznawalnymi na całym świecie markami. W tym kontekście w niniejszym artykule przeglądowym omówiono główne trendy w chińskim przemyśle alkoholowym za pomocą studium przypadku Guizhou Maotai Group w celu ujawnienia i zrozumienia głównych wyzwań, które stoją przed nimi oraz podsumowano kilka zaleceń dotyczących sposobów przezwyciężenia trudności na drodze do transformacji Likiery Moutai w szeroko znane, cenione światowe marki. Należy podjąć dalsze prace badawcze w celu ustalenia, w jaki sposób uogólnić te wnioski na cały sektor

Biting midges of the genus Palpomyia Meigen (Diptera: Ceratopogonidae) in India

Volume: 56Start Page: 43End Page: 4

Impact of host IL28B rs12979860, rs8099917 in interferon responsiveness and advanced liver disease in chronic genotype 3 hepatitis C patients.

BACKGROUND AND AIMS: Genetic polymorphisms near interleukin 28B gene are associated with spontaneous and treatment induced clearance of hepatitis C virus (HCV). Our objective was to evaluate the impact of interleukin 28B single nucleotide polymorphism (rs12979860, rs8099917) variability in HCV genotype 3 infected populations. METHODS: 400 hepatitis C seroreactive patients from different population groups in Eastern and North Eastern part of India were assessed for host and viral genotypic analysis. 83 HCV genotype 3 infected patients were administered pegylated interferon- ribavirin therapy. Viral genotyping was performed using nested reverse transcriptase-PCR followed by direct sequencing methods. Host interleukin 28B genotyping was performed using real-time PCR based single nucleotide polymorphism analysis. RESULTS: Out of 400 hepatitis C seroreactive individuals, 73.25% were found to be RNA positive. HCV genotype 3 (65.87%) was found to be the major circulating strain in this region followed by genotype 1 (32.08%). rs12979860 CC genotype was significantly associated with sustained virological response in HCV genotype 3 infected population. In patients achieving rapid virological response, favourable CC/TT allele at rs12979860, rs8099917 was found to be predominant at both the alleles at 77%, 73.2% respectively; whereas in case of patients with relapsed HCV infection CT, TG alleles were found to be predominant. Additionally, CC genotypes at rs12979860 were found to be associated with sustained virological response in patients with high viral load (OR = 6.75, 0.05<p). HCV unfavourable rs12979860 TT, rs8099917 GG alleles were present in 34%, 27.6% patients with relapsed HCV infection respectively. Also unfavourable CT, TG genotypes were found to be predominant in patients with advanced stages of liver disease. CONCLUSION: CC, TT the two favourable markers at SNPs rs12979860 and rs8099917 are strongly associated with sustained virological response in genotype 3 infected populations. This information will aid clinicians to effectively design response based treatment regimen