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Purpose The shear bond strength of orthodontic brackets is an important factor in imparting desired treatment as repeated breakages during treatment not only delay its completion but also affect the quality of treatment. Thus, the aim of this review is to analyze the in vitro studies related to bond strength testing and to identify experimental conditions that are not standardized while performing in vitro studies. Materials and Method The total of 580 studies were searched, and 84 studies were accepted for review as per inclusion criteria. The 12 experimental conditions were analyzed, and it was found that none of the studies described all the conditions listed. Results There is no uniformity in parameters guidelines such as storing media, temperature, crosshead speed, type of testing method, and testing machine used in studies. None of the studies considered all reviewed conditions in their study design. Conclusion There is a need to frame proper recommendations for the testing protocols to be followed for in vitro bond strength studies so that baseline data as a reference will allow the intercomparison of results among studies and to reach any conclusion.

Online education is existing since 2014 but it becomes the only mode of instruction in 2020 due to the Covid pandemic. The whole world faces a lot of challenges, especially in developing countries. It is because in developing countries technology is confined to metropolitan cities only. A major portion of these countries are still rural and cannot provide the necessary infrastructure for digital education. Even aft er these chal lenges, it brings manifold opportunities too. This paper will study the opportunities and challenges faced while providing education in Online Mode from the perspective of s t u d e n t s , t e a c h e r s , a n d e d u c a t i o n Institutes/Universities. Keywords : Digital Education, Online education, Co v i d - 1 9 , Ch a l l e n g e s , Op p o r t u n i t i e s , Recommendations

Several studies have reported on the shortage of drugs with the changing demographic and disease profile, especially triggered by the growing burden of lifestyle diseases. However, very few have evaluated the demand-side challenges from the objective of universalisation of healthcare. Therefore, this study was designed to evaluate the factors that have impeded access to affordable generic and essential drugs in non-metropolitan urban and rural India. The study was conducted in six states and responses were elicited from a sample of doctors, pharmacists, nurses, accredited social health activist (ASHA) workers, state officials, warehouse managers and patients across the study states. The study reveals that while the acceptance of prescribing generic drugs has improved over the last decade, the use of branded drugs has been restricted only to complex cases or where generic drug efficacy has not been established. The centralised procurement efficiencies seem to have hit a plateau in terms of assuring drug availability to the last mile, thereby impacting local purchase, especially pandemic procurement. Most states have also established dedicated corporations for drug procurement, albeit at different levels of organisational maturity as far as adherence to the processes and systems are concerned. However, supply chain phenomena like the bullwhip effect gets accentuated given the levels of our public health system. Learnings from other consumer-facing sectors with similar challenges of increased variability and uncertainty are yet to be explored for the health sector to leapfrog towards achieving improved ‘drug availability’ or ‘zero stock-out’. Standardising drug categories, regular updating of the essential drug list (EDL) reflecting the demographic and disease profile, various practices like complete digitisation, rolling forecasts, stock-keeping unit rationalisation, flexible public procurement contracts, etc., have been explored as potential solutions in this paper. Creating a dedicated team of forecasters within the procurement organisations, well adept at using analytics, could be key to real-time demand estimation, paving the way for a quarterly rolling forecast to facilitate procurement using well-designed rate contracts with suppliers that captures variability in such rolling forecasts.

Sensor design using ultra-wideband (UWB) technology is considered powerful emerging technique to extract information about the state of biological and physiological conditions of human organs for diagnostic purposes. Recently, UWB radio sensor technology is being proposed for early stage breast cancer detection in view of some superior characteristics or bio-markers over current methods. In this paper, a RDRA is designed, leading to develop the smart data acquisition system. A novel RDRA structure is simulated, which operates in the range of 3.7–7.4 GHz (67% bandwidth) which lies in the lower European UWB frequency band. The positive gain of the proposed antenna is stable across the active bandwidth and the peak value is 2.5 dB, which makes the RDRA structure highly suitable for body centric applications, especially for early detection of breast cancer. Thus, the proposed RDRA antenna structure can be integrated for early stage breast cancer detection application as well.

Ultra Wide Band technology has specifically endowed radio sensor technology in information retrieval of physiological conditions measured among various human organs. Radio sensors possess several characteristics in comparison of the contemporary counterparts. Due to which they are ardent candidate for detection of early stage of breast cancer. In this paper, the antenna structure highlights the hybridisation of Ring Rectangular Dielectric Resonator [RRDR] placed on multiple ring patch, which operates at a frequency band of 5.4–15 GHz. Impedance bandwidth of 94.1% is achieved with the hybridisation of patch and dielectric resonator antenna along with slotted ground structure. A peak gain of 5.7 dBi and high efficiency of 95% is achieved over the entire operating band which presented hybrid antenna is highly suitable for wearable and On-body communication. Breast Phantom is designed and Specific Absorption Rate (SAR) is calculated to check the feasibility of contemplated structure. Acceptable SAR and ringing free impulse response makes this antenna suitable for primitive breast cancer detection as well as Wireless Body Area Networks (WBAN).

In the recent era, the demand of the internet is increasing. The Internet is global computer network that provide the sharing of data and information. Internet is useful in every field. It modifies the way of working, living style and contributed positive impact on our life. With the raising of the demand new tools and technologies are developed. The internet is classified in various generations depends on the functionality and key features. In this paper the generations of the internet and functionality are discussed. The internet has 1.0, 2.0, and 3.0 that provides internet protocols. Internet 4.0 and 5.0 are grownup and it works on wireless and sensor network devices. With the development of new generation the data rate, flexibility, Quality of service, performance and many other features are improved. In this survey focus on the features, techniques and tools provided by each generation.

This paper presents a novel, compact Ultra Wide Band , Asymmetric Ring Rectangular Dielectric Resonator Antenna (ARRDRA), which is a unique combination of Thin Dielectric Resonator (DR), Fork shape patch and defective ground structure. The base of the proposed antenna is its Hybrid structure, which generates fundamental TM, TE and higher order modes that yields an impedance bandwidth of 119%. Proposed antenna provides a frequency range from 4.2 to 16.6 GHz with a stable radiation pattern and low cross polarization levels. Peak gain of 5.5 dB and average efficiency of 90% is obtained by the design. Antenna is elongated on a FR4 substrate of dimension 20 x 24x 2.168 mm3 and is particularly suitable for C band INSAT, Radio Altimeter, WLAN, Wi-Fi for high frequencies. Ease in fabrication due to simplicity, compactness, stable radiation pattern throughout the entire bandwidth are the key features of the presented design. Inclusion of Defective ground structure and asymmetric ring not only increases the bandwidth but also stabilize the gain and efficiency due to less surface current. Presented design launch an Ultra Wide Band antenna with sufficient band rejection at 4.48-5.34 and 5.64-8.33 GHz with stable radiation pattern and high gain.

Online education is existing since 2014 but it becomes the only mode of instruction in 2020 due to the Covid pandemic. The whole world faces a lot of challenges, especially in developing countries. It is because in developing countries technology is confined to metropolitan cities only. A major portion of these countries are still rural and cannot provide the necessary infrastructure for digital education. Even after these challenges, it brings manifold opportunities too. This paper will study the opportunities and challenges faced while providing education in Online Mode from the perspective of students, teachers, and education Institutes/Universities.

In the last decade, with the development of new technologies crime rate is increasing rapidly. Nowadays, the crime rate analysis and identification is one of the systematic approaches to reduce the illegal activities in all around the world. Thus, this is the biggest challenge to the IT field to solve these critical issues by applying some tools and technologies. Data mining along with the machine learning approach is one of the efficient as well as best approaches to solve this critical issue. It provides the method to identify region and criminal in an appropriate time. In paper is basically emphasis on various machine learning algorithms such as K-means, SVM, A priori Algorithm, CART algorithms, Fuzzy-C and FP tree and machine learning is used to learn the pattern and matches it with actual data. This process is used to reduce the normalized the data and to delete all anomalies and provide better result.

Introduction: Adverse effects of exposure to second hand smoke during pregnancy are associated with decrease in pulmonary functions, small for gestational age babies & preterm delivery. Aim of our study was to observe the pregnancy outcome & pulmonary function tests in pregnant women exposed to second hand smoke (SHS) & in women not exposed to SHS. Objectives: (1). To observe pulmonary function tests (PFT) in pregnant women exposed to second hand smoke & not exposed to SHS. (2) To observe the pregnancy outcome in both pregnant women exposed & not exposed to second hand smoke (SHS) like preterm delivery, caesarean section and small for gestational age (SGA) neonates. Materials and Methods: It is a hospital-based prospective case control observational study done at department of obstetrics & gynecology, UCMS & GTB hospital, Delhi from October 2015 to March 2017. Total 204 antenatal women between 6 to 28 weeks of pregnancy were recruited. Out of these, 82 women had exposure to SHS (second hand smoke) & 122 women had no exposure to SHS. Spirometry of these women were done & FEV1, FEV6 & FEV1/FEV6 ratios were obtained. These patients were followed up till delivery for pregnancy outcome & small for gestational age babies. Results: PFT parameters, FEV1 & FEV6 were reduced in women exposed to SHS as compared to non- exposed women (84.1% vs 64.8% & 73.2 vs 62.3% respectively). Ratio of FEV1/FEV6 ( Conclusion: The study concluded that pregnant women exposed to second hand smoke have many negative effects on their lung functions and pregnancy outcome. Keywords: Pregnancy, Second hand smoke, Pulmonary function test, Small for gestational age.

In this research article, a square monopole multiband antenna is designed for applications including Wireless Wide Area Network which includes Digital Cellular System (1.71GHz-1.88GHz) and Personal Communication System (1.85GHz-1.99GHz), Bluetooth (2.402GHz-2.480GHz) and World Wide Interoperability for Microwave Access (3.30GHz-3.80GHz). These above said operating wireless technologies are obtained by using 2 L-Shaped stubs embedded with patch and etched L-shaped slot on radiating patch. Lengths of the stubs are optimized by using simulators and algorithm used by artificial intelligence (Radial Basis Model) Antenna results are simulated on two different EM simulators to validate and offers gain of 3.86, 4.42 and 4.18dBi respectively in operating bands.

This paper includes the study of the various voltage instability problems which occurs due to various reasons which can lead to the system collapse. Voltage stability is the phenomenon which shows the ability of the system to regain its original properties of voltage control after a small disturbance. To maximise wind penetration and the wind energy output, it is necessary to minimise these instability problems. There are various methods to test the voltage instability and correct it, but in this paper, P and Q power of isolated wind turbine farm and wind integrated grid system will be calculated. Most of the wind farm consists of the PMSG which does not provide uniform wind speed so that DFIG is used in this paper to attain the uniform speed and efficient use of the wind speed. The maximum wind power penetration is very crucial to increase the power quality as well as to increase the voltage stability and it is always desirable that the voltage profile is maintained within acceptable levels to ensure stability and reliability of the system and instability issue is solved by placing wind farms by installing various SVCs. The wind farm has been modelled by including a 14 BUS system which can be used to test the system.

Protein interactions with surfactants are dependent on their physiochemical properties. The effect of cationic gemini surfactant hexanediyl-α,ω-bis-(N-(2-hydroxyethyl)-N-methylhexadecylammonium dibromide) on the stability and activity of hen egg white lysozyme was compared with its monomeric counterpart N-(2-hyroxyethyl)-N,N-dimethylhexadecylammonium bromide at pre and post micellar concentrations. This study utilizes circular dichroism (CD), steady-state fluorescence spectroscopy, extrinsic fluorescence spectroscopy, time-resolved fluorescence spectroscopy, UV-visible spectroscopy, molecular docking and turbidity assays to resolve the conformational stability and antibacterial activity of lysozyme in the presence of surfactants. Micelles of both cationic surfactants were observed to stabilize the conformation of the protein, however, gemini was found to stabilize it in a much higher micellar concentration range. Detailed analysis of the time-resolved fluorescence spectroscopy results suggests contribution of the lifetime values of Trp62 and Trp108 to the overall conformation change of lysozyme with the increase in concentration of the respective surfactants, which is further correlated with the steady-state fluorescence and CD spectroscopy results. Furthermore, from the CD analysis it was found that the cationic single chain surfactant strongly perturbs the secondary and tertiary structure of the protein as compared to the gemini surfactant. Through docking results, it was found that the gemini surfactant binds weakly with lysozyme as compared to the single chain surfactant. Specifically, the antibacterial activity of lysozyme was found to be increased in the presence of cationic gemini surfactant, which extrapolates the use of these surfactants in pharmaceutics and industries.

The world has shown growing interest in generating the energy using renewable sources of energy. Due to many advantages like reduced cost higher system efficiency, controllability, DFIG has become a popular concept and has become an interesting research topic. This paper deals with comparison of three different models of MATLAB using Sim Power Systems of Simulink. Firstly Phasor, Average & Detailed models has been presented which uses a (DFIG) having a capacity of 12 MW that is supplied to the distribution system. Different models are studied, reviewed, simulated & compared properly.

Tunnelling nanotubes (TNTs), also known as membrane nanochannels, are actin-based structures that facilitate cytoplasmic connections for rapid intercellular transfer of signals, organelles and membrane components. These dynamic TNTs can form de novo in animal cells and establish complex intercellular networks between distant cells up to 150 μm apart. Within the last decade, TNTs have been discovered in different cell types including tumor cells, macrophages, monocytes, endothelial cells and T cells. It has also been further elucidated that these nanotubes play a vital role in diseased conditions such as cancer, where TNT formation occurs at a higher pace and is used for rapid intercellular modulation of chemo-resistance. Viruses such as HIV, HSV and prions also hijack the existing TNT connections between host cells for rapid transmission and evasion of the host immune responses. The following review aims to describe the heterogeneity of TNTs, their role in different tissues and disease conditions in order to enhance our understanding on how these nanotubes can be used as a target for therapies.

Introduction: Currently irrational prescribing is a major concern to community physicians. The promotional drug literature of pharmaceutical companies in medical journal is an important mode to get the information about new drug being introduced and marketed in the country. Most of the community physician depends completely on these published dug literatures. That’s why it is important to maintain high standards of quality of drug advertisement published in medical journals and thus help physician prescribe drugs in a rational manner. Aims and Objective: To evaluate and compare the quality of drug promotional advertisement published in an Indian and international medical journal and highlight the measures to improve the quality of drug advertisement. Materials and Methods: It was an observational cross sectional study of promotional drug advertisements published in two medical journals i.e. one Indian and one international journal over a period of one year [June-2014 to June-2015]. Advertisements pertaining to parenteral fluids, milk foods, medical devices, laboratory equipment and the educational advertisements were excluded. The identified published drug advertisements were evaluated for adherence to the ethical guidelines of World Health Organization (WHO) or the Organisation of Pharmaceutical Producers of India (OPPI). Results: A total of 76 and 35 medicinal drug advertisements were published in an Indian and an international medical journal respectively. There was a significant difference in compliance to WHO criteria among Indian (43.5±35.2) and international (70.6±23.8) journal [p< 0.05]. Only brand name and manufacturer details were provided in all the promotional drug literature i.e. 100% compliance. There was significant difference in the compliance to WHO criteria for active ingredient causing adverse reaction, pregnancy category, precaution and contraindication, drug interaction, dosage regimen and date of production in the two journals. Conclusion: The compliance criteria are frequently overlooked by the medical journal publishers. It is expected that the promotional drug literature may be thoroughly checked for compliance more so by the reputed Indian than an international medical journal.

An ultrawideband (UWB) antenna covering the lower terahertz band is designed and numerically analyzed. A number of higher-order modes are excited and merged to provide the UWB response. The band-notch is obtained by applying graphene nanoribbons at the top of the radiating metallic patch. The antenna response can be set with the tunable single/dual/triple band-notch characteristics depending on the size and location of the applied graphene nanoribbons. The notched frequency band can be tuned by changing the chemical potential of the graphene nanoribbons by keeping the cutoff frequencies of the antenna response unchanged. Moreover, the antenna radiates like a monopole throughout the passband with consistent radiation pattern, high gain, and radiation efficiency.

Brain metastasis is one of the leading causes of death among cancer patients. Cancer cells migrate to various sites and harbor different niche in the body which help cancer cells in their survival. The brain is one of the safest place where cancer cells are protected from immune cells. Breast, lung, and melanoma cancer cells have high propensity to migrate towards the brain. To enter the brain, cancer cells have to cross the blood brain barrier. Survival and finding new niche in the brain are directed by several mechanisms in which different cellular players take part such as astrocytes, microglia, Schwann cells, satellite cells, oligodendrocytes, and ependymal cells. Usually, cancer cells highjack the machinery of brain cellular players to survive in the brain environment. It has been shown that co-culture of M2 macrophage with cancer cells leads to increased proliferation and survival of cancer cells. One of the challenges of understanding brain metastasis is appropriate model system to understand dynamic interaction of cancer cells and brain cellular players. To meet this challenge, microfluidic-based devices are employed which can mimic the dynamic conditions as well as can be used for culturing human cells for personalized therapy. In this review, we have systematically reviewed the current status of the role of cellular players in brain metastasis along with explaining how translational approach of microfluidics can be employed for finding new drug target as well as biomarker for brain metastasis. Finally, we have also commented on the mechanism of action of drugs against brain metastasis.

Background: Diabetic kidney disease is a life threatening and disabling complication of uncontrolled diabetes mellitus. Clinical proteinuria is a well-established marker of renal dysfunction. A dual L/N-type calcium channel blocker cilnidipine dilates the afferent and efferent arterioles of the glomerulus decreasing the intraglomerular pressure and showing antiproteinuric effects. The present study was conducted to assess the antiproteinuric efficacy of cilnidipine in patients of diabetic kidney disease.Methods: This interventional study was conducted on 50 patients of both genders aged 18 years and above with diabetic nephropathy (stage-2 to stage 4) visiting the medicine OPD at HIMS, Dehradun over a period of six months, the patients were given tablet cilnidipine (5-20 mg) once or twice a day. Baseline urine protein creatinine ratio (UPCR), serum creatinine and the estimated glomerular filtration rate (eGFR) was recorded at baseline and repeated after a period of 12 weeks. The end point was the decrease in UPCR after a period of 12 weeks. Students-paired T test was used for analysing the intragroup data.Results: After 12 weeks of treatment with cilnidipine, a significant reduction was observed in the urinary protein creatine ratio (mean±SD) from 3.2±1.23 at baseline to 3.09±1.09 respectively (p

This paper represents a detail investigation on a Multi Segment Rectangular Dielectric Resonator Antenna (MSRDRA) which is proposed for the purpose of high gain and wideband applications of X and Ku Band. In this design, total four segments are inserted for bandwidth enhancement purposes. Dielectric Resonator Antenna (DRA) of dimension 10 × 15 × 27.2 mm3 is designed and simulated on substrate FR4 using coaxial feeding mechanism with an impedance matching of 50 ohms. Bandwidth is enhanced by inserting multiple segments of different dielectric constants. High bandwidth of 11.9 GHz is achieved when all four segments are inserted at a time. Presented antenna shows ultra wide band characteristics i. e. maximum bandwidth of ranging from 7.03 GHz to 18.95 GHz with a resonance frequency of 9.2845 GHz. The low value of VSWR ensures lossless performance of antenna at a wide range of frequencies with an impedance bandwidth of 128 % and a gain of above 5 dB over entire bandwidth, which makes this design particularly suitable for Satellite and Radar communication. Antenna is designed in simulation software CST which works on Finite Difference Time Domain (FDTD) technique.

In view of emerging drug resistance in pathogens, there is a need to explore alternative strategies to combat infections. Use of probiotics is one such option. In this regard, efficacy of Lactobacillus plantarum has been reported against Staphylococcus aureus. Here, we propose that cell free supernatant (CFS) of Lactobacillus paraplantarum when used in combination with conventional antibiotics viz. ampicillin and oxacillin [to which the methicillin resistant Staphylococcus aureus (MRSA) strains were originally resistant] reduce the minimum inhibitory concentrations of these antibiotics, rendering the combination either synergistic or additive against the tested MRSA strain. The anti-staphylococcal activity was observed to be due to organic acids (acetic acid and lactic acid as confirmed by HPLC analysis) present in the CFS, as neutralization of the CFS with an alkali, sodium hydroxide (NaOH), caused the complete abrogation of its activity. The role of H2O2 and bacteriocin present in the CFS was also ruled out. The findings of this study suggest that cell free supernatant and ampicillin/oxacillin combination(s) might help in rejuvenating the use of conventional anti-staphylococcal antibiotics for the treatment of multi-drug resistant strains.

Ganoderma lucidum fungi had been analysed for the estimation of protein and fibre content by various spectrophotometric methods, in which it had been shown that various extracts of the concerned fungi could act as a good source of proteins and fibre. Also the Anti urolithiatic and Anti Arthritis Activity of Various extracts of Ganoderma lucidum had been carried out, in which the observed results show that the concerned fungi extracts posses a good effect against urolithiatic and arthritis. Among the various extracts it had been found that water extracts of the concerned fungi posses high Anti urolithiatic and Anti Arthritis Activity, as compared to other extracts of the concerned fungi. So efforts should be made to make use of these types of herbal and Ayurvedic medicines to overcome various types of ailments or diseases which effect human life from time to time, which are without side effects.

Background: Hypertension is an important worldwide public health challenge. It has changed from a trivial cause of death and disability to one of the global burden diseases. The biggest obstacle for inadequate therapeutic control of blood pressure is meagre knowledge, poor attitude, inadequate treatment practices and lack of adherence towards antihypertensive treatment. The present study was planned to assess the awareness of hypertension on various aspects and to evaluate treatment adherence in hypertensive patients.Methods: This cross-sectional study was conducted on 100 hypertensive patients of both genders visiting medicine OPD at HIMS, Dehradun over a period of six months. A structured and validated questionnaire was used to assess the knowledge, attitude and practice (KAP) among patients. Morisky 8-Item Medication Adherence Questionnaire was used to assess the adherence towards antihypertensive medications. For statistical analysis Chi square test was used.Results: Out of the 100 patients the median KAP scores were 6(5),5(1) and 10(4) respectively. Most of the subjects had high median scores on attitude but majority of the subjects had low knowledge and self-care practice scores. Further Analysis of data revealed that a poor score in self-care practice was significantly associated to the gender(p

Background: Diarrhoea is a major public health problem in children worldwide. It continues to be a major health challenge, especially in developing countries, despite the availability of regularly updated standard treatment guidelines. Non-compliance to such guidelines by the physicians has been a long standing story. The treatment is often marred with incapacitating prescription of drugs besides neglecting even the basic tenets of good prescribing. As a result, the quality of such prescriptions for diarrhoeal disorders in children remains poor. To gauge the magnitude of this problem in this setup towards possible corrective measures, the study was aimed to audit prescription practices in the management of acute and persistent diarrhoea in hospitalised children up to five years of age.Methods: An observational study was conducted in 100 patients of either gender in the age group up to 5 years admitted with acute and persistent diarrhoea. A detailed medical history from the parents/guardians and the details of prescription from the time of admission till the discharge of the patient were obtained. Quality of prescriptions was analysed using prescription quality index (PQI) tool, a validated comprehensive tool described by Hassan et al in 2010. Based on this tool, prescription with the total PQI score of ≤ 31 were interpreted as poor quality, scores with 32 to 33 as medium quality and scores 34 to 43 as high quality with a possible maximum score of ‘43’.Results: Based on the PQI tool for 100 children, 60 prescriptions were found to be of poor quality. Only 2 prescriptions were of medium quality, whereas 38 prescriptions were in high quality range. Average mean±SD score of prescriptions with poor quality was 25.2±1.48, ranging from 21 to 31. The mean±SD of prescriptions with medium quality was observed to be 32±0 and for prescriptions of high quality was 38.07±2.28. The total average mean score of all prescriptions was 30.23±6.50. Poor quality prescriptions were particularly observed for the patients with the diarrhoea with No dehydration.Conclusions: Prescription appropriateness in spite of available guidelines continues to be a big challenge in the adequate management of patients with diarrhoeal disorders under the age group of five years in a tertiary care centre in India.

Background: Neuropathic pain is associated with prolonged disability and is usually not responsive to conventional analgesics like NSAIDs and opioids. Even the recommended first-line drugs are effective in less than 50% patients. Thus, drugs with different mechanisms of action are needed. Baclofen, a GABA-B agonist has shown benefit in different types of neuropathic pains and is compared against pregabalin.Methods: The sciatic nerve was ligated in 2 groups of 6 rats each as per the chronic constriction injury model of neuropathic pain on day 0. After 14 days the effect of single doses of pregabalin (30mg/kg) and baclofen (5mg/kg) intraperitoneally were assessed over a 2 hours period. Thermal and mechanical hyperalgesia were assessed as measures of neuropathic pain by the hotplate and pin-prick method respectively.Results: Significant thermal and mechanical hyperalgesia was produced 14 days after sciatic nerve ligation in both the groups (p

Background: Quality of life plays an important role in patients of epilepsy and is the most neglected part during management. The antiepileptic drugs treatment results in seizure control but adversely affect the quality of life in patients.Methods: An observational analytical study was conducted in the Department of pharmacology with Department of Neurology of Himalayan Institute of Medical Sciences, Dehradun over 12 months. 85 patients fulfilling the inclusion criteria with diagnosis of generalized tonic clonic seizures (GTCS) were enrolled and divided into two groups based on physicians discretion and followed up for 12 weeks. Patients were evaluated for quality of life by QOLIE-10 self administered questionnaire at 0 and 12 weeks, assessed for seizure control and drug related adverse effects.Results: 85 patients were enrolled and divided into two treatment arms as per physician discretion, levetiracetam (41) and valproic acid group (44). Study drugs showed significant improvement in quality of life, levetiracetam showed mean change that was significantly greater than valproic acid (p=0.003) at 12 weeks. Patients who failed to achieve seizure control at 6 weeks were 17% patients in levetiracetam and 20% in valproic acid group, reason being non-adherence which was 17% and 20% respectively. Adverse events recorded with Levetiracetam (10), most common being increased sleep and with valproic acid (18), with most common being increased sleep and weight gain.Conclusions: Levetiracetam treatment resulted in better quality of life, with similar seizure control but decreased number of adverse effect then Valproic acid.

Background: Adverse drug reaction (ADR) under-reporting is a hindrance to the implementation of Pharmacovigilance Program of India. This is essentially due to lack of ADR reporting culture among healthcare professionals. Thus, study was conducted to assess and enhance awareness about ADRs and strengthen reporting among medical undergraduates.Methods: This is an interventional crossover study. A total of 140 students of 2nd professional, MBBS were included and divided into two groups of 70 each. In phase 1, group A was given a didactic lecture (DL) on ADR and pharmacovigilance. Group B was also given DL with an addition of a case narrative exercise and they were asked to fill an ADR form. Both groups were assessed based on an MCQ questionnaire for knowledge and skill. After 15 days of washout period, groups were crossed and reassessed. Feedback from students was taken on a 5 point Likert’s scale.Results: The mean scores of batch A without case was 17.5±3 out of a total score of 25 marks, which showed improvement with case narrative and mean increased to 19.6± 2.4 (p 0.05). Similarly, Batch B showed improvement as well and the mean 17.7±3.1 score without case narrative increased to 19.2±2.7 (p

Background: Diabetes mellitus (DM) is a spectrum of metabolic disorders as a consequence of different pathogenic mechanisms resulting in hyperglycemia. A genetic predisposition to develop β-cell dysfunction synergizes with insulin resistance to lead to type 2 DM. Adequate management of type 2 DM requires institution of non pharmacological treatment followed by pharmacological treatment. Monotherapy is started initially followed by combination therapy (dual/triple). Sitagliptin, a DPP-4 inhibitor and voglibose, an α-glucosidase inhibitor has been implicated as an add on therapy to metformin and glimepiride. So, we aimed to assess the efficacy and safety of the sitagliptin and voglibose as add on therapy to metformin and glimepitide in type 2 DM.Methods: This open label randomized control trial was conducted in the department of Pharmacology among patients attending medicine OPD of a tertiary care hospital. 80 patients were randomly divided into two groups of 40 patients each. group A:sitagliptin + metformin + glimepiride and group B:voglibose + metformin + glimepiride. Patients were followed every week for a period of 12 weeks. Data was analysed using paired t test, unpaired t test and chi square test.Results: There was a significant decrease in HbA1c, FPG and PPG in both the groups. Intergroup comparison at 4, 8 and 12 weeks showed a better improvement in glycemic control in group A as compared to group B.Conclusions: Sitagliptin showed a better glycemic control than that with voglibose in patients with uncontrolled type 2 DM on metformin and glimepiride.

Stress in life has been found to play a role in triggering, maintaining and exacerbating chronic pain, yet, direct empirical evidence of the mechanism of such a role is limited. In the present study 120 non-selected chronic pain patients and an equal number of matched healthy normals were investigated with regard to life events stress. The investigation revealed that although, patients and controls did not differ in terms of number of events experienced during the last 1 year, however, patients reported significantly higher frequency of occurrence on a distinctive set of events belonging to personal, interpersonal and familial life and events related to change in eating and sleeping habits. Our results emphasize the importance of studying the life events beyond the simple count of number of event occurrence but to explore the specific events those cluster around pain disorders.

Objective: Preeclampsia is one of the major cause of maternal and perinatal mortality and morbidity. The pathophysiology is complex and involves multiple organs. The purpose of this study was to find out whether the placental laterality as a predictor of preeclampsia and small for gestational age baby.Methods: This was prospective observational study conducted from February 2015 to December 2015, in a tertiary care hospital of Delhi. 347 antenatal patients attending obstetrics OPD without high risk factors were enrolled. After enrolment 50 patients were lost to follow up and 27 not delivered in our hospital. Ultrasonography for placental localization was done at 18-24 weeks of pregnancy. Patients were followed till delivery for pregnancy outcomes such as preeclampsia, small for gestation age (SGA) baby and mode of delivery. Placenta locations were divided into lateral (either right or left) and central (anterior, posterior or fundal).Results: Out of 347, a total of 270 patients were analysed, 39 (14.4%) had lateral placenta and among them 17 (43.5%) developed preeclampsia and 24 (61.5%) had small for gestational age baby (p

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder carrying an enormous burden of morbidity and mortality because of its characteristic complications, many of which are preventable with strict glycaemic control. Initial management of T2DM consists of non-pharmacological interventions; it those fail, an oral anti-diabetic drug, most typically metformin, is started. Combination therapy is initiated only when monotherapy fails to achieve glycaemic control. Glipizide and glimepiride, a second and a third generation sulphonylurea respectively, are the commonest drugs added to metformin when the latter fails to achieve euglycaemia on its own. Aims and Objectives of the study were to compare the efficacy and safety of glimepiride and glipizide as add-on therapy to metformin in patients of uncontrolled T2DM.Methods: This prospective, observational and analytical study was conducted by the Department of Pharmacology among patients attending the Internal Medicine OPD of a tertiary-care hospital. Fifty patients were assigned to two groups of 25 patients each: Group A - Glimepiride + Metformin and Group B - Glipizide + Metformin. Patients were followed up for three months. Data were analysed by Student's t-test.Results: There was a significant decrease in the HbA1c, FBS and 2h-PPBS in both groups. However there was no significant difference between the two groups during the three-month period of follow-up.Conclusions: The combination of glimepiride and metformin is just as effective and safe as the combination of glipizide and metformin in patients not controlled on monotherapy with metformin.