Study of variation in prices of oral antiplatelet drugs available in Indian market

Background: Coronary artery disease is one of the most prevalent causes of death and disability in developed and developing countries. There is a wide variation in the prices of oral antiplatelet drugs marketed in India. Thus, a study was planned to find out the variation in cost in the oral antiplatelet drugs available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of the same antiplatelet drug by calculating percentage variation in cost.Methods: Cost of oral antiplatelet drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “current index of medical specialties” October 2015-January 2016. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost per 10 tablets was calculated.Results: Percentage variation in cost for oral antiplatelet drugs marketed in India was found to be-clopidogrel 75 mg (1067.3%), clopidogrel 150 mg tablet (148.7%), prasugrel 5 mg (94.4%), aspirin 150 mg (69.8%), prasugrel 10 mg (54.8%), aspirin 75 mg (51.5%), clopidogrel 300 mg tablet (42.9%) and ticlopidine 250 mg (32%). The lowest percent cost variation found is ticagrelor 90 mg (0%). In combination therapy the highest price variation (235.6%) was found for aspirin (75 mg)+clopidogrel (75 mg) followed by aspirin (150 mg)+clopidogrel (75 mg) (24.2%).Conclusions: There is a wide difference in the cost of different brands of oral antiplatelet drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy

Studies on the interaction between the estrogen and vitamin D endocrine system

Estrogen deficiency and vitamin D deficiency play key roles in the pathogenesis of postmenopausal osteoporosis. Aim of the studies in this thesis is to extend our knowledge on the interaction between E2 and 1,25-(0H)2D3 and thereby to provide more insight into the significance of E, for 1,25-(0H)2D3 mediated processes in calcium and bone metabolism. Furthermore the significance of VDR genotypes for the biological response to 1,25-(0H)2D3 and the interaction between ERa and VDR genotypes in relation to BMD and fracture risk are studied. The first part of the thesis focuses on the effect of E2 on 1,25-(0H)2D3 mediated processes. In chapters 2 and 3 the effect of E, deficiency and E2 repletion on 1,25-(0H),D, synthesis and 1,25-(0H)2D3 mediated intestinal calcium absorption in a rat model for postmenopausal osteoporosis is described. An important bone anabolic factor is IGF-1. Both 1,25-(0H)2D3 as well as Ez have been shown to regulate IGF-I expression in vitro. Chapter 4 describes the effect of E, deficiency and E2 repletion on IGF-I levels in bone in vivo in relation to bone metabolism. The effect of E2 on bone mineralization is discussed in Chapter 5. The second part of the thesis considers the significance of VDR genotypes for the biological response to 1,25-(0H)2D3 and the interaction between ERa and VDR gene polymorphisms in relation to BMD and fracture risk. Chapter 6 describes a pilot study addressed to whether differences in rates of bone turnover between women with either extremely low or extremely high BMD can be ascribed to genetic variations of the VDR. Furthermore, the biochemical response to short-term substitution of 1,25-(0H)2D3 in both BMD groups was related to VDR gene polymorphisms. In chapter 7 functional consequences of VDR gene polymorphisms in vitro are studied. Chapter 8 discusses the association between ERa gene polymorphism and fracture risk in postmenopausal women. Moreover, the interaction between ERa gene and VDR gene polymorphisms on fracture risk is described. In chapter 9 the results are discussed and suggestions for future research are made. Finally, the main findings are summarized in Chapter 10

Manejo de las complicaciones de postoperatorio de reemplazo de cadera a través de la telemedicina

Objetivo: revisar fuentes de información científica para diseñar un modelo virtual de telemedicina para pacientes con postoperatorio de reemplazo de cadera en el domicilio y disminuir complicaciones en su rehabilitación. Materiales y métodos: revision docuemntal teniendo en cuenta los postulados expuestos por (Paramo 2007); mediante la recopilación de datos bibliográficos, artículos académicos, monografías y libros. Para ello se elaboró una matriz para agrupar información y clasificar datos obtenidos durante la investigación. Resultados: según los artículos revisados, la telemedicina es un programa que con el paso de los años, ha evolucionado; logrando oportunidad para la población y los profesionales de la salud que lo utilizan. En cuanto a enfermería, el conocimiento sobre telemedicina es amplio y está al alcance de los profesionales; pero la implementación no ha tenido resultados ya que los usuarios no conocen el cuidado de enfermería fuera del ámbito hospitalario. Conclusión y discusión La telemedicina es una herramienta que apoya el desarrollo de mejores formas de atención, y se ajusta a la evolución de ámbito de la salud. Es posible que el paciente desde su casa tenga acceso a información y no hay lugar a errores de ejecución respecto al objetivo inicial de la cirugía. Las herramientas virtuales son efectivas y se adhieren a diversas necesidades, esto se evidencia mediante la matriz de análisis, que sugiere la creación de un programa para la rehabilitación y cuidado a distancia para pacientes en postoperatorio de reemplazo total de cadera

Влияние физических нагрузок разной направленности на вариабельность ритма сердца у спортсменов

During examining the heart rate variability a method of the spectral analysis was used. It was discovered that the spectral analysis indexes (ТР, HF, LF, VLF) of the highly qualified sportsmen depend on the training process direction. It was also revealed that VLF-spectral component is considered to be a condition of metabolic processes running in the sportsmen’s organisms and is linked with the formation and using the energy during physical tensions activity in an anaerobic conditions.При изучении вариабельности ритма сердца использовали метод спектрального анализа. Установлено, что показатели спектрального анализа (ТР, HF, LF, VLF) у спортсменов высокой квалификации зависят от направленности тренировочного процесса. Выявлено, что VLF-компонента спектра обусловлена метаболическими процессами, происходящими в организме спортсменов, и связана с образованием и использованием энергии при выполнении физических нагрузок в анаэробных условиях

Low Doses of Acetylsalicylic Acid: An Overview of Indications

Kardiovaskularne bolesti (KVB) vodeći su uzrok smrti u razvijenim zemljama i Republici Hrvatskoj (RH). Niz dokaza iz bazičnih istraživanja, opservacijskih studija i randomiziranih kliničkih ispitivanja potvrđuje korist od primjene acetilsalicilne kiseline (ASK) u smanjenju incidencije neželjenih kardiovaskularnih događaja. Kao takva je ASK 2014. godine u RH bila najpropisivaniji od svih lijekova. Prema mehanizmu djelovanja ASK se razlikuje od ostalih nesteroidnih antireumatika, jer reakcijom acetilacije dovodi do ireverzibilne inhibicije enzima ciklooksigenaze i time do antiagregacijskog učinka za vrijeme cijeloga životnog vijeka trombocita. Navedeni učinak prisutan je već kod primjene 75 – 150 mg ASK, tzv. niskih doza ASK. Prednost uporabe niskih doza ASK u odnosu prema višim dozama očituje se u nižoj incidenciji nuspojava (poglavito krvarenja i nuspojava vezanih za gastrointestinalni sustav), uz zadržavanje jednakog antiagregacijskog učinka. Indikacije za primjenu niskih doza ASK uključuju akutni koronarni sindrom s elevacijom ST-spojnice i bez nje, primarnu i sekundarnu prevenciju KVB-a te primjenu ASK u sklopu dvojne antiagregacijske terapije nakon perkutane koronarne intervencije. Primjena ASK u primarnoj prevenciji strogo je individualna te je prije propisivanja potrebno dobro prosuditi korist naspram moguće štete od primjene lijeka.Cardiovascular diseases (CVD) are the leading cause of death in developed countries and Croatia. Several lines of evidence from basic, observational and randomized controlled studies confirm the benefit of acetylsalicylic acid (ASA) in decreasing the incidence of adverse cardiovascular events. As such, ASA was the most prescribed drug in Croatia in 2014. The mechanism of its action differs from that of other non-steroidal anti-inflammatory drugs, since it irreversibly inhibits enzyme cyclooxygenase and therefore achieves antiaggregation effect during the whole life span of platelets. This effect is already present with the administration of the so-called low ASA doses of 75 – 150 mg. The advantage of low ASA doses in comparison with higher doses is the lower incidence of side effects (principally bleeding events and side effects related to gastrointestinal system), along with the preservation of the same antiaggregation effect. Indications for the administration of low ASA doses include acute coronary syndrome with and without ST segment elevation, primary and secondary prevention of CVD and the use of ASA as part of dual antiplatelet therapy after percutaneous coronary intervention. As the use of ASA in primary prevention is strictly individual, a careful prior evaluation of the risk-benefit ratio is needed

AVALIAÇÃO DE SÍNDROME CORONARIANA AGUDA EM SERVIÇO DE EMERGÊNCIA

Dor torácica é um motivo freqüente de procura aos serviços de emergências, sendo responsável por 5-7% do atendimento nestes setores. Muito interesse tem sido focado na identificação de síndrome coronariana aguda nestes pacientes, entre eles infarto agudo do miocárdio e angina instável. Além da história clínica, do exame físico e do eletrocardiograma, os marcadores séricos de lesão miocárdica têm um papel importante em estabelecer o diagnósticoetiológico da dor e também auxiliar no encaminhamento para unidades com monitorização intensiva. As troponinas e as mioglobinas têm sido estudadas como novos marcadores séricos de lesão miocárdica. As troponinas são marcadores novos, que trouxeram um novo paradigma à avaliação de risco em síndrome coronariana aguda. Os dados levantados apontam que as mesmas apresentam uma acurácia muito boa para detecção de infarto e, de forma maisimportante, identificam pacientes com pior prognóstico a curto e médio prazo. Apesar das informações sólidas na área, não existe consenso da melhor estratégia a ser seguida para utilização destes marcadores. Troponinas têm sido preconizadas para todos os casos com suspeita de síndrome coronariana aguda, sendo que esta alternativa permite identificar um maior número de casos de infarto agudo do miocárdio, de acordo com classificação contemporânea. Se, por um lado, o custo do exame é um ônus para o sistema, do ponto de vistado hospital, a remuneração pelo novo diagnóstico compensa, além de sugerir maior eficiência no manejo dos casos de alto risco. Por outro lado, pacientes de baixo risco, sem alterações isquêmicas no eletrocardiograma e com marcadores séricos normais, podem se beneficiar de teste ergométrico precocemente. Se negativo, o mesmo tem um elevado valor preditivo negativo para eventos cardíacos até 6 meses da visita à emergência. A longo prazo, todos estes casosbuscam atendimento médico com freqüência e precisam ser revistos em nível ambulatorial para assegurar um atendimento adequado. Unitermos: Dor torácica, infarto agudo do miocárdio, angina instável, troponinas, mioglobina, teste de esforço, custo-efetividade

Evaluation of acute coronary syndrome in emergency departments

Dor torácica é um motivo freqüente de procura aos serviços de emergências, sendo responsável por 5-7% do atendimento nestes setores. Muito interesse tem sido focado na identificação de síndrome coronariana aguda nestes pacientes, entre eles infarto agudo do miocárdio e angina instável. Além da história clínica, do exame físico e do eletrocardiograma, os marcadores séricos de lesão miocárdica têm um papel importante em estabelecer o diagnóstico etiológico da dor e também auxiliar no encaminhamento para unidades com monitorização intensiva. As troponinas e as mioglobinas têm sido estudadas como novos marcadores séricos de lesão miocárdica. As troponinas são marcadores novos, que trouxeram um novo paradigma à avaliação de risco em síndrome coronariana aguda. Os dados levantados apontam que as mesmas apresentam uma acurácia muito boa para detecção de infarto e, de forma mais importante, identificam pacientes com pior prognóstico a curto e médio prazo. Apesar das informações sólidas na área, não existe consenso da melhor estratégia a ser seguida para utilização destes marcadores Troponinas têm sido preconizadas para todos os casos com suspeita de síndrome coronariana aguda, sendo que esta alternativa permite identificar um maior número de casos de infarto agudo do miocárdio, de acordo com classificação contemporânea. Se, por um lado, o custo do exame é um ônus para o sistema, do ponto de vista do hospital, a remuneração pelo novo diagnóstico compensa, além de sugerir maior eficiência no manejo dos casos de alto risco. Por outro lado, pacientes de baixo risco, sem alterações isquêmicas no eletrocardiograma e com marcadores séricos normais, podem se beneficiar de teste ergométrico precocemente. Se negativo, o mesmo tem um elevado valor preditivo negativo para eventos cardíacos até 6 meses da visita à emergência. A longo prazo, todos estes casos buscam atendimento médico com freqüência e precisam ser revistos em nível ambulatorial para assegurar um atendimento adequado.Chest pain is a common symptom in emergency department patients. It is responsible for 5-7% of emergency visits. Intense efforts have been given to identify patients with acute coronary syndromes, such as acute myocardial infarction or unstable angina. Besides clinical history, physical examination and ECG data, serum markers of myocardial injury play an important role in establishing diagnosis and helping triage patients to intensive care units. Troponins and myoglobins have been studied as new serum markers of myocardial injury. Troponins are new markers that brought a new paradigm in the identification of patients with acute myocardial infarction. Data presented show that troponins have a very good accuracy to identify myocardial infarction, and patients with short- and medium-term worse prognosis. In spite of the available information, there is no consensus on which strategy should be implemented to guide serum markers utilization. Troponins have been suggested for all patients with suspicion of acute coronary syndrome. This alternative allows the identification of a higher number of cases of acute myocardial infarction, according to the contemporary classification. On the one hand, troponin has a more favorable cost-effectiveness ratio when used in high risk patients. On the other hand, low risk patients, without ECG changes and with normal serum markers, could benefit from early exercise test. If negative, exercise test has a high negative predictive value for cardiac events within 6 months from emergency presentation. Long-term studies have shown increased return to emergency department, such that these patients need close follow-up in outpatient clinics