ASH choosing wisely

The Choosing Wisely(R) campaign challenges medical societies to identify 5 tests, procedures, or treatments within each specialty's clinical domain that are offered to patients despite an absence of evidence demonstrating benefit or, in some cases, despite evidence demonstrating disutility or harm

Study of effect of myoinositol on menstrual irregularities and skin problems in polycystic ovarian syndrome cases

Background: Polycystic ovary syndrome (PCOS), first identified in 1935 as Stein-Leventhal syndrome, is a complex neuro-endocrine disorder affecting approximately 5% to 10% of women reproductive age. Typically PCOS is characterized by hyperandrogenism (extremely variable in its occurrence), chronic anovulation, polycystic ovaries at ultrasound evaluation and dermatological problems such as acne, hirsute and seborrhoea. PCOS is indeed the most common cause of female infertility.Methods: This prospective interventional study was conducted during December 2012 to June 2013 in Department of Obstetrics and Gynaecology at Pt. Jawaharlal Nehru Memorial Medical College and Associated Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur (C.G.) India, after obtaining permission of ethical committee of institute. All young girls and married women who attended GOPD of Department of Obstetrics and Gynaecology having polycystic ovarian syndrome as defined by Rotterdam Criteria were registered and screened for inclusion in the study. At the end of three months’ data were compiled in MS-Excel and checked for its completeness and correctness then it was analysed suitable statistical test was applied and p-value <0.05 was considered statistically significant.Results: Maximum no of cases were between 21 to 25 yrs age, youngest one was of 15 yrs and oldest one was of 33 yrs. 72% cases belonged to urban area and only 28% cases belonged to rural area. 94.67% of cases were presented with abnormal menstrual cycle. The most common menstrual abnormality was Oligomenorrhoea (43.66%) followed by Oligomenorrhoea+Menorrhagia (21.13%) than Amenorrhoea (19.71%) and Hypomenorrhoea+Oligomenorrhoea (15.49%). 42.7% cases had oily skin, 26.7% cases had hirsutism, 20% cases had acne and 9.3% cases had acanthosis nigricans. 74.65% cases (53/75) were improved in their menstrual complaints; most common menstrual abnormality improved was Oligomenorrhoea+ Menorrhagia i.e. 88.67% (13/15). Out of all cases of oligomenorrhoea 77.4% cases (24/31) achieved regular menses. Out of all cases of oligomenorrhoea+ hypomenorrhoea 81.8%% cases (2/11) achieved regular menses.Conclusions: Present study confirms that Myoinositol, an insulin sensitizer, by improving insulin signalling reduces insulin resistance and improves menstrual irregularities and skin problems of PCOS cases

Valuasi Ekonomi Lingkungan Dampak Abrasi Menggunakan Metode Replacement Cost, Hedonic Pricing Dan Loss of Income (Studi Kasus: Kelurahan Mangunharjo, Kecamatan Tugu, Kota Semarang)

Abrasi menyebabkan kualitas air yang menurun dengan terjadinya peningkatan salinitas air bersih menyebabkan penduduk harus membayar lebih untuk pemenuhan kebutuhan air serta menyebabkan adanya kehilangan pendapatan sawah dan tambak di Kelurahan Mangunharjo. Kerusakan dan penurunan kualitas lingkungan ini bisa berpotensi memiliki pengaruh juga terhadap harga lahan yang ada. Oleh karena itu, penelitian ini bertujuan untuk mengetahui persepsi masyarakat terhadap dampak abrasi serta menghitung estimasi valuasi ekonomi lingkungan dari kerugian akibat dampak abrasi. Metode yang digunakan dalam penelitian ini adalah analisis deskriptif untuk mengetahui persepsi masyarakat serta metode replacement cost, hedonic pricing dan loss of income untuk analisis valuasi ekonomi lingkungan dari kerugian akibat dampak abrasi. Berdasarkan hasil penelitian ini, persepsi 50% responden terhadap dampak abrasi menyatakan kondisi lingkungan semakin memburuk. Dilakukan perhitungan biaya pengganti (replacement cost) air bersih baik dari penyediaan sumur dan air isi ulang dengan total biaya pengganti sebesar Rp 2.916.466.336 selama satu tahun pada tahun 2015. Selain itu, hedonic pricing dilakukan dengan uji regresi linier berganda untuk melihat pengaruh kondisi lingkungan terhadap harga lahan dimana faktor yang berpengaruh terhadap harga lahan yaitu status kepemilikan lahan dan aksesibilitas, sedangkan biaya air bersih dan frekuensi genangan air laut tidak berpengaruh. Valuasi ekonomi lingkungan yang terakhir dilakukan yaitu dengan metode loss of income untuk mengetahui kehilangan pendapatan dari petani dan petambak di Kelurahan Mangunharjo. Berdasarkan hasil perhitungan, didapatkan rata-rata pendapatan yang hilang dari petambak selama 1 tahun sebesar Rp 49.595.803, rata-rata pendapatan yang hilang dari petani yang menjadi petambak sebesar Rp 18.161.400 dalam setahun dan rata – rata pendapatan yang hilang selama 1 tahun dari petani sebesar Rp 10.639.733 akibat abrasi

Private Equity (PE): Implications for India And Regulatory Issues

Private Equity (PE) is the money invested in companies that are not publicly traded on a stock exchange or invested as a part of buyouts of publicly traded companies in order to make them private. PE investors do not expect return in the form of dividends rather they gain out of share price appreciation. This return is realized at the time of exit from the investee company.Since at the inception stage of a company, there is a limitation on the availability of other sources of finances i.e. debt instruments or bank finance, requisite finance can be provided by private equity. Further, since investments are made in illiquid assets i.e. companies, money gets locked up for a long period and redistributions are made when the investments are converted into cash.With Indian economy recording about 8-9% GDP growth, a buoyant capital market, sensex hovering at around 17000 – mark, improvements in industrial growth and rising exports, India is becoming a leading destination for PE investors.The present paper makes an attempt to look into these aspects. It also deals with the existing multiple regulatory framework and the tax aspects of capital gains arising out of PE investments. It enumerates the impediments in the development of PE investments and also throws light on how the scope of PE investments can be improved by making standalone regulations

Effectiveness of Toothpaste containing Pyrophosphate and Papain to Inhibit Calculus Formation in patient using Fixed Orthodontic Appliance

Patients using fixed orthodontic appliance are more susceptible to calculus formation than patient without orthodontic treatment. Pyrophosphate and papain toothpaste can be used to reduce dental plaque and calculus accumulation. The aim of this study was to analyze the differences in the calcium level and phosphate level in saliva, also saliva pH in patient’s after treated with toothpaste containing pyrophosphate and papain. This study was true experimental study with pre-test and post-test controls group design with random sampling. Sample size was (n=20). Sample was 17-22 years old male or female patient using fixed orthodontic appliance. Sample divided into two groups: control group treated with placebo toothpaste and treatment group treated with toothpaste containing pyrophosphate and papain with blind method. Patients were instructed to brush their tooth twice a day daily. 3 ml unstimulated saliva was collected on the Day 1, 3, and 5. Spectrophotometer Atom Absorbance (SAA) was used to measure calcium level and phosphate level in saliva, while saliva pH measurement using pH meters. Treatment group showed lowest mean (SD) calcium level [1.12(0.29]. Calcium level in treatment group between groups (p0.05). Treatment group showed lowest phosphate level in Day 5. Phosphate level in treatment group between groups (p<0.05) was significantly different. Toothpastes containing pyrophosphate and papain decreased calcium levels, phosphate levels effectively and maintaining normal salivary pH to inhibit calculus formation in patients using fixed orthodontic appliance

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Recent progress in development of dressings used for diabetic wounds with special emphasis on scaffolds

Diabetic wound (DW) is a secondary application of uncontrolled diabetes and affects about 42.2% of diabetics. If the disease is left untreated/uncontrolled, then it may further lead to amputation of organs. In recent years, huge research has been done in the area of wound dressing to have a better maintenance of DW. These include gauze, films, foams or, hydrocolloid-based dressings as well as polysaccharide-and polymer-based dressings. In recent years, scaffolds have played major role as biomaterial for wound dressing due to its tissue regeneration properties as well as fluid absorption capacity. These are three-dimensional polymeric structures formed from polymers that help in tissue rejuvenation. These offer a large surface area to volume ratio to allow cell adhesion and exudate absorbing capacity and antibacterial properties. They also offer a better retention as well as sustained release of drugs that are directly impregnated to the scaffolds or the ones that are loaded in nanocarriers that are impregnated onto scaffolds. The present review comprehensively describes the pathogenesis of DW, various dressings that are used so far for DW, the limitation of currently used wound dressings, role of scaffolds in topical delivery of drugs, materials used for scaffold fabrication, and application of various polymer-based scaffolds for treating DW

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years : an analysis of the Global Burden of Disease Study 2017

Background Many countries have shown marked declines in diarrhoea! disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78.4 deaths (70.1-87.1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69.6% (63.1-74.6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13.3% decrease, 11.2-15.5), childhood wasting (9.9% decrease, 9.6-10.2), and low use of oral rehydration solution (6.9% decrease, 4-8-8-4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.Peer reviewe