Generic prescribing in India: a stumbling block

In India, there is 62% out-of-pocket health expenditure per capita and only 15% are covered by health insurance. The use of generics can save a lot of money which can be used for other health issues. But lack of knowledge about cost effectiveness of generic medicines among various health-care professionals had led to a low rate of generic medicine prescription in India. This review aims to identify the barriers in adoption of generic prescribing in clinical practice in India. A systematic literature review was conducted using various healthcare databases such as PubMed and google scholar. The literature search using various combination of keywords retrieved 2360 articles. After excluding duplicates, articles in languages other than English and based on relevance to subject only 15 articles were selected. The barriers to generic prescribing identified from reported literature can be broadly classified based on stakeholders of healthcare setting such as physicians, patients, pharmacist and government policies. The major barriers to generic prescribing identified were negative perception of various stakeholders, lack of awareness of regulatory standards, maturity of health care system, vulnerability of patients, lack of standard guidelines in brand substitution, incentives and influence of drug advertisements. In Indian set up, studies on impact evaluation of generic prescription, emphasizing the quality and cost saving by their use in clinical practice should be conducted. This evidence will help to build the confidence of various stakeholders towards implementing generic prescribing in clinical practice

Assessment of knowledge, attitude and practice of generic medicines among the interns and post graduate dental students: comparison with medical practitioners

Background: India is one of the highest per capita out-of-pocket health expenditures (62%) country and use of generics can save a lot of money which can be used for other health issues. Lack of knowledge about cost effectiveness of generic medicines among the health-care professionals had led to a low rate of generic medicine prescription. The objective of this study was to explore the knowledge, attitude and practice of dental students towards the generic medicines.Methods: A cross-sectional study was carried out using questions from pretested and validated questionnaire which are applicable to Indian scenario. A 22 items questionnaire were distributed to the participants to assess their knowledge, attitude and practice of generic medicine. All the Interns and MDS students were included in this study. The collected data was analyzed using microsoft excel.Results: 63.4% participants agreed generics can be interchanged with a branded drug. 89.74% participants were aware that bioequivalence studies are conducted by generic manufacturers for all the marketed generic medicines. Mostly participants (78.04%) were of opinion that generic medicines do not produce greater side effects than branded drugs. 54.05% participants reported that they were prescribing generic medicines. 52.38% participants were aware that generic medicine contains the same active substances as that innovator and used at same dose to treat same disease.Conclusions: In our study, we found that the prescribers had a considerable knowledge regarding the concept of generic medicines. However, to further increase the rate of generic medicine prescription training programs on generic medicines should be organized

Bacterial Diversity and Ecology of Two Cryptoendolithic Habitats in the Grand Staircase Escalante National Monument, Utah, USA

Sandstone outcrops in the Grand Staircase Escalante National Monument, Utah are host to cryptoendolithic communities dominated by cyanobacteria. These communities produce extracellular polymeric substances that not only aid their survival, but also support other heterotrophic bacteria. Developing a better understanding of the role of these cryptoendolithic communities requires a deeper knowledge of the microbial diversity present. We analyzed the cryptoendolithic bacterial communities in the Jurassic Navajo Sandstone samples collected from several microgeological features associated with a large sandstone dome. These communities clustered into distinctive groups that correlated with topography, suggesting that moisture availability plays an important role in shaping the community structure in this microhabitat. Comparisons of diversity between these distinctive groups showed that a core bacterial community exists in this habitat. The overall bacterial community structure was dominated by Cyanobacteria, Proteobacteria, Bacteroidetes and Actinobacteria. Cyanobacteria were chiefly represented by Leptolyngbya in this habitat while the genus Acidiphilium was particularly abundant in the class Alphaproteobacteria. In contrast, the major inhabitants of the cryptoendolithic communities in the Entrada Sandstones are Cyanobacteria followed by Proteobacteria, Actinobacteria, Bacteroidetes and Deinococcus-Thermus. Cyanobacteria were chiefly represented by Chroococcidiopsis in this habitat while the genus Truepera belonging to the phyla Deinococcus-Thermus had a notable presence. The differences in the bacterial composition of the Navajo and Entrada cryptoendolithic habitats are attributed to the varying sand grain size and distribution patterns which affects porosity and moisture availability in the underlying substrate. The number of unclassified OTUs found in both the cryptoendolithic habitats suggests that abundant, unexplored microbial diversity exists in this microecosystem, identifying a conservation value for these communities. EPS produced by both the natural and laboratory grown cryptoendolithic communities are capable of binding divalent metal cations (Fe, Mn, Mg, Cu, Zn), all essential cofactors for oxygenic photosynthesis. Based upon these data, we conclude that the EPSs produced by these cryptoendolithic communities act as a biofilter to bind and concentrate essential metal ions, to provide a source of key nutrients for cellular metabolism. This study sets the premise for elaborating on the ecological functions of cryptoendolithic communities in sandstones

Probing Structure and Dynamics of Amorphous Ice with Small-Molecule Nanoprobes

Water (H2O) is omnipresent on the surface of the Earth, the atmosphere, in nature, and on various celestial bodies.1 The phase diagram of ice exhibits enormous complexity with a plethora of structures and at least two amorphous ices. 2, 3 One of these, low-density amorphous ice, is the most abundant solid in the Universe. Despite H2O’s significance, a full understanding of its role in physical processes remains elusive.4 H2O is capable of building complex hydrogen-bonded networks, and solvates hydrophobic/hydrophilic species.2 Carbon and H2O often coexist, forming interfaces in highly diverse environments.5, 6 This thesis focuses on the structure of H2O in the hydration shells of hydrophobes, tracking the structure and dynamics of vapour deposited amorphous ice with finely dispersed small-molecule nanoprobes. Detailed insights into the morphology of amorphous solid water (ASW)7 and evidence for the presence of three discernible desorption processes present in macroscopic films of amorphous ice have been demonstrated. They are attributed to gas desorption from open cracks, from the collapse of internal voids, and from matrix-isolated gas induced by the irreversible crystallisation of H2O to stacking disordered ice. 7 Due to adamantane (C10H16) being expelled from the amorphous ice matrix upon heating, a number of important insights were gained – the uncharted regime of small hydrophobes surrounded by a H2O network were detected. Neutron diffraction studies of C10H16/ASW employing structure refinement modelling identified a new type of cage structure, with 28 H2O molecules constructed from distorted five- and six-membered rings, named the 566 4 polyhedron. Beyond this phenomenon, unusual, yet strong orientation correlations of the H2O molecules were detected. Intriguingly, the closest O– H bonds were found to point towards the centre of mass of C10H16 – it is quite striking that such a non-polar solute induces intense orientation correlations in its hydration shells. H2O has been at the forefront of many breakthroughs and will continue to push boundaries, probing the chemistry and physics of ice research. 3 References 1. L. del Rosso, M. Celli, F. Grazzi, M. Catti, T. C. Hansen, A. D. Fortes and L. Ulivi, Nat. Mater., 2020, 19, 663-668. 2. C. G. Salzmann, P. G. Radaelli, B. Slater and J. L. Finney, Phys. Chem. Chem. Phys., 2011, 13, 18468-18480. 3. C. G. Salzmann, J. Chem. Phys., 2019, 150, 060901. Abstract 4 4. T. Loerting, K. Winkel, M. Seidl, M. Bauer, C. Mitterdorfer, P. H. Handle, C. G. Salzmann, E. Mayer, J. L. Finney and D. T. Bowron, Phys. Chem. Chem. Phys., 2011, 13, 8783-8794. 5. M. C. De Sanctis, F. Capaccioni, M. Ciarniello, G. Filacchione, M. Formisano, S. Mottola, A. Raponi, F. Tosi, D. Bockelée-Morvan, S. Erard, C. Leyrat, B. Schmitt, E. Ammannito, G. Arnold, M. A. Barucci, M. Combi, M. T. Capria, P. Cerroni, W. H. Ip, E. Kuehrt, T. B. McCord, E. Palomba, P. Beck, E. Quirico, V. T. The, G. Piccioni, G. Bellucci, M. Fulchignoni, R. Jaumann, K. Stephan, A. Longobardo, V. Mennella, A. Migliorini, J. Benkhoff, J. P. Bibring, A. Blanco, M. Blecka, R. Carlson, U. Carsenty, L. Colangeli, M. Combes, J. Crovisier, P. Drossart, T. Encrenaz, C. Federico, U. Fink, S. Fonti, P. Irwin, Y. Langevin, G. Magni, L. Moroz, V. Orofino, U. Schade, F. Taylor, D. Tiphene, G. P. Tozzi, N. Biver, L. Bonal, J. P. Combe, D. Despan, E. Flamini, S. Fornasier, A. Frigeri, D. Grassi, M. S. Gudipati, F. Mancarella, K. Markus, F. Merlin, R. Orosei, G. Rinaldi, M. Cartacci, A. Cicchetti, S. Giuppi, Y. Hello, F. Henry, S. Jacquinod, J. M. Reess, R. Noschese, R. Politi and G. Peter, Nature, 2015, 525, 500. 6. B. A. Buffett, Annu. Rev. Earth Planet Sci., 2000, 28, 477-507. 7. S. K. Talewar, S. O. Halukeerthi, R. Riedlaicher, J. J. Shephard, A. E. Clout, A. Rosu-Finsen, G. R. Williams, A. Langhoff, D. Johannsmann and C. G. Salzmann, J. Chem. Phys., 2019, 151, 134505

Contrast Enhancement Using Bacteria Foraging Optimization

Image enhancement is one of the leading field in which researches are continuously exploring new algorithms and concepts to enhance dull and low intensity images by various methods. Contrast enhancement techniques are used for improving visual quality of low contrast images. Bacteria foraging optimization(BFO) method is one such technique used for contrast enhancement. As histogram equalization(HE) preserves the original brightness, but it fails to bring out details specially in dark regions and produces artifacts and noise due to overstretching of histogram. Thus this paper processes a variant of histogram equalization i.e bacteria foraging optimization technique, which gives more efficient results

A comparative study of levels of methylglyoxal and reduced glutathione in different organs of rats treated with high carbohydrate diets

Methylglyoxal (MG) is a reactive dicarbonyl compound mainly formed during glucose and fructose metabolism. Diabetic patients have increased plasma levels of MG. Our laboratory has shown that treatment with MG induces insulin resistance and type II diabetes in male Sprague-Dawley rats. However, the increases in endogenous MG level attained in different organs and its contribution to the pathogenesis of diabetes following the administration of either high glucose or high fructose diet have not been addressed. The present study aims to investigate whether the harmful effects induced by increased consumption of glucose and/or fructose is linked to increased MG generation. In vitro studies have suggested that L-arginine is an effective MG scavenger. Accordingly, another goal is to determine whether L-arginine pretreatment would scavenge MG under in vivo setting and reduce the harmful effects of hyperglycemia. MG and reduced glutathione (GSH) levels were determined in plasma and urine and in different organs of male Sprague-Dawley rats after 12 weeks of treatment with either high fructose or high glucose diet. GSH plays an important role in the degradation of MG and bears an inverse relationship with the levels of MG. The key results obtained suggest that both diets significantly increased blood pressure and plasma MG levels. A high fructose but not a high glucose diet, increased the plasma total cholesterol, triglycerides levels and total cholesterol/HDL ratio in parallel with the increases in MG and GSH levels in the liver. Increased MG levels seen in both aorta and mesenteric artery induced by high glucose or fructose diet was attenuated by pretreatment with L-arginine. These findings suggest that elevated MG level induced by treatment with high carbohydrate diets in both conduit (aorta) and resistance type (mesneteric artery) vessels may be linked to endothelial dysfunction seen in hyerglycemic/diabetic states. High glucose but not high fructose diet significantly increased MG levels in the pancreas. This observation is consistent with the well-known glucotoxicity caused by hyperglycemia in the pancreas. Taken together, these data provide the first evidence that elevated MG levels in certain organs/tissues following consumption of high fructose and/or glucose diet(s) may play a critical role in contributing to the metabolic abnormalities and the endothelial dysfunction that precedes the onset of macro and microvascular complications in either hyperglycemic and/or type II diabetic states. Interestingly, quenching of elevated MG levels in tissues by pretreamtent with L-arginine overcomes MG-induced vascular damage and endothelial dysfunction caused by high fructose and high glucose diet regimens

A New Approach to Solve Intuitionistic Fuzzy Linear Programming Problems with Symmetric Trapezoidal Intuitionistic Fuzzy Numbers

Parvathi & Malathi (Intuitionistic fuzzy simplex method, International Journal of Computer Applications, 48, 39-48, 2012) proposed an intuitionistic fuzzy simplex algorithm to solve Intuitionistic Fuzzy Linear Programming Problems (IFLPPs) with Symmetric Trapezoidal Intuitionistic Fuzzy Numbers (STIFNs) by using a special ranking function and used the linearity property to obtain the desired results. In this paper, it is proved that the linearity property, used by authors, is not satisfied for given ranking function. So, to overcome this drawback, a new method is proposed to solve the same type of intuitionistic fuzzy linear programming problems. Keywords: Intuitionistic fuzzy linear programming problems, Symmetric trapezoidal intuitionistic fuzzy numbers, Ranking function

Hybrid filtering technique to remove noise of high density from digital images

Noise removal is one of the greatest challenges among the researchers, noise removal algorithms vary with the application areas and the type of images and noises. The work proposes a novel hybrid filter which is capable of predicting the best filter for every pixel using neural network and choose the best technique to remove noise with 3x3 mask operation. Proposed algorithm first train the neural network for various filters like mean, median, mode, geometrical mean, arithmetic mean and will use to remove noise later on. Later, the proposed method is compared with the existing techniques using the parameters MAE, PSNR, MSE and IEF. The experimental result shows that proposed method gives better performance in comparison with MF, AMF and other existing noise removal algorithms and improves the values of various parameter

Development and evaluation of nutritionally enhanced potato rice papads (Indian cookie)

The present study was carried out to develop papads (Indian cookie) from potato (Solanum tuberosum L.) and rice (Oryza sativa) blends and to analyze them for organoleptic, physicochemical, phytochemical and shelf life quality. Two processing cultivars (Kufri Chipsona-1, Kufri Chandramukhi) and one commonly grown cultivar (Kufri Pukhraj) were evaluated for processing into papad. Based on preliminary sensory trails, papads with boiled potato mash (60%) and gelatinized rice (30%) level of supplementation were found to be most acceptable and these papads were subjected to nutritional evaluation. Results were compared with rice papads (control). Protein content and yield was significantly (p<0.05) higher in control papads compared to potato supplemented papads. Oil uptake significantly (p<0.05) increased on supplementation with potato. Bioactive compounds including ascorbic acid, totalphenolics and total antioxidant activity measured as DPPH radical scavenging activity increased significantly (p<0.05) on incorporation of potato. Between the cultivars, papads enriched with Kufri Pukhraj, a table variety which is considered unfit for processing, displayed the highest phytochemical content and total antioxidant activity. Sensory evaluation indicated higher overall acceptability scores of potato enriched papads compared to control. During storage of papads at room temperature for up to 3 months, significant (p<0.05) changes in the moisture content, phytochemical content and antioxidant activity were observed. Storage studies showed that the potato supplemented papads can be stored safely for 3 months of storage at ambient temperature

Compilation of registered clinical trials for the treatment of COVID-19 infection

The Wuhan city, the capital of Hubei province in China became the focal point for origin of virulent disease which later named as COVID-19. This paper aims to analyze the on-going clinical trials for drugs/interventions used for treatment of COVID-19 infection in open domain. The data on ongoing clinical trials on COVID-19 was retrieved from database clinicaltrials.gov. The data extracted includes national clinical trial registry number, title of study, recruitment status, results availability, intervention, outcome measure, sponsorship, study types, study design, start and completion dates, and location. All the extracted data was analyzed. As on 10th August 2020, a total of 2935 trials were registered in different countries. Of which 1115 trials are being conducted in Europe and 640 in United States of America (USA). Majority of COVID-19 clinical trials (95%) were enrolling all age groups including children and older adults. Similarly, majority of trials were including both genders (97%). Among all these clinical trials ongoing on COVID-19, 1645 were interventional, 1266 were observational studies. In interventional study 876 trials used drug intervention. Among all these trials 390 different drug interventions are being tried. Among these hydroxychloroquine, antiretrovirals and angiotensin converting enzyme (ACE) inhibitors were top three drug groups. The conduct of clinical trials in time of pandemic have so many tenacious issues that need to be addressed. It is very important to utilize the resources efficiently such as following a standard protocol then one can easily pool the data of various trials conducted at various places. Given the smaller sample sizes, long completion period, high risk of bias and imprecise information, it will take quite a long time to obtain high quality clinical evidence for the treatment of COVID-19 infection