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Introduction Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality. Case summary We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control. Discussion Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

The key intends of Ayurveda is to maintain the health of healthy persons and make well the ill health of the diseased person. In Swasthavritta it has been clearly mentioned about Hitakara ahara-vihara and Yoga for healthy life. Amlapitta is a very common disease of Annavaha srotas. In present time a huge population is highly affected from Amlapitta due to unhealthy food habits, mental stress, and inactive life style. This paper investigates the effect of Mudga and Kwathita Sheeta Jala (Boiled and cooled water) as a Pathya- ahara and Yoga modalities in Amlapitta. Furthermore, the combined effect of Mudga, Kwathita Sheeta Jala and Yoga modalities in Amlapitta has also studied. In this present study, 60 patients were assigned into three Group A, B and C (20 patients in each group). All the general observations and results with statistical data of 20 patients of each group were illustrated in the form of tables and graphs. In this study, the therapy of Group C shows better result than Group A and Group B. Hence, Mudga Yusha and Kwathita Sheeta Jala (boiled and cooled water) along with Yoga modalities is more effective to control Amlapitta disease.

Objectives Pleural effusion, defined as an abnormal accumulation of fluid in pleural space, can be of two types: transudative and exudative. The primary aim of the study was to assess the predictive accuracy of procalcitonin (PCT) and pentraxin-3 (PTX-3) in comparison to other biochemical markers such as C-reactive protein (CRP), and adenosine deaminase (ADA) in the differential diagnosis of pleural effusions. Methods A cross-sectional analytical study was conducted on patients with pleural effusion. Multiple comparisons and receiver-operating characteristics (ROC) analyses were made to evaluate the diagnostic significance of biochemical markers. Results Sixty-six patients with exudative pleural effusion classified as malignant, tuberculous, and parapneumonic effusions (malignant pleural effusion [MPE], tuberculous [TPE], and parapneumonic [PPE]) were included. Significant differences in pleural fluid levels in both PCT (p-value: 0.001) and PTX-3(p-value: 0.001), as well as serum levels of PCT (p-value: 0.001), were observed between the three groups. ROC analysis showed both PTX-3 and PCT having favorable discrimination ability with high sensitivity (≥90%) and specificity to predict PPE from TPE and MPE. Conclusions Evaluation of serum and pleural fluid PCT and levels of PTX-3 in the pleural fluid may be used as an early biomarker to differentiate the etiology of pleural effusion.

Early case detection by sputum smear microscopy is a crucial step in the control of pulmonary tuberculosis in high burden countries. Due to low sensitivity of this rapid and cost effective method, culture of Mycobacterium tuberculosis (MTB) is considered as the gold standard. Modified Petroff's method using 2%-4% sodium hydroxide (NaOH) and N-acetyl- l-cysteine (NALC) to digest and at the same time to decontaminate the specimen is widely used in developing countries prior to culture. This method is considered tedious and cumbersome. A novel ReaSLR (ReaMetrix's Sputum Liquefying Reagent) methodology has been proposed as a simple and low-cost method for sputum processing. This study was undertaken to evaluate the performance of the ReaSLR method of sputum processing prior to culture in comparison to the modified Petroff's method.Early morning sputum samples, collected from suspected TB patients, were divided into two equal halves and processed by two different methods i.e modified Petroff's method and ReaSLR method. After processing with different methods, each sample was inoculated in Lowenstein Jensen (LJ) medium and Mycobacteria growth indicator tube (MGIT). Smears were also prepared from the samples processed with modified Petroff's method and graded according to Centers for Disease Control and Prevention (CDC) grading after microscopic examination. Culture results of both the methods were recorded and analysed using SPSS 20.0 version.On comparing different methods of sputum processing for culture in solid and liquid media, the rate of contamination in both the media was significantly high with ReaSLR method as compared with modified Petroff's method. Also, the mean time-to-detection of MTB growth in LJ medium was significantly less with modified Petroff's method i.e 30.21 days as compared to ReaSLR method (34.23 days; p 0.001). However, the mean time-to-detection of MTB growth in MGIT was similar with both the methods.Due to the high contamination rate in solid and liquid culture media, ReaSLR method cannot be considered as an alternative to modified Petroff's method for sputum processing prior to culture. The detection of growth of MTB in LJ media was also earlier with modified Petroff's method than ReaSLR method.

Background Older patients undergoing emergency surgery experience higher mortality and morbidity. 'Care of Older People in Surgery' (COPS) is a comprehensive geriatric care model developed for acute surgical units (ASU) to improve clinical outcomes in older general surgical patients. This study aimed to evaluate the impact of COPS on clinical and health service outcomes in an Australian hospital. Methods The before-and-after study was conducted in the ASU, at Nepean Hospital. Data from patients ≥75 years admitted for >24 h into the ASU during the intervention period between April 2017 and March 2018 were compared to patients admitted in the previous year (April 2016 to March 2017) prior to the COPS intervention (n = 212). Health service outcomes measured include the average stay length, medical emergency team response, unplanned intensive care unit admission and 28-day readmission rates. Results The COPS group (n = 214) suffered significantly fewer medical complications, including less acute kidney injuries, arrhythmias and urinary tract infections compared to the pre-intervention cohort (n = 212). Medical emergency team activation was significantly reduced after COPS model implementation and the average length of stay decreased. However, the incidence of postoperative delirium and acute coronary syndrome were higher in COPS cohort. Conclusion Our study demonstrated that comprehensive geriatric assessment and care delivered through a shared model of care in older general surgical patients improved clinical outcome and patient safety measures.

Combined application of bioinoculants and agriusable nanocompounds has the potential to make beneficial impact on agricultural sector. Plant growth-promoting activities of bioinoculants and unique physical properties of nanocompounds can synergistically help to overcome challenges such as low crop productivity, overuse of agrochemicals and nutrient loss in agricultural practices. The present study was conducted to assess the biocompatibility of two bacterial cultures and their effect on maize by way of phosphate solubilization, production of siderophore and 1-aminocyclopropane-1-carboxylate deaminase. Results indicated that both the bacterial isolates were compatible with each other and showed better phosphate solubilization and siderophore production when used jointly. Presence of acdS gene in bacterial strains also supported the role of bioinoculants under biotic and abiotic stresses. Impact of nanochitosan on bioinoculants evaluated on the basis of growth pattern, number of colony-forming units and by SEM analysis was encouraging significantly. Bacterial cultures and nanochitosan showed significantly enhanced seed germination and plant vigor including plant height, chlorophyll and carotenoid content over control in maize. The present study indicated the positive effect of nanochitosan on bacterial growth and hence can be used as a bioformulation to enhance plant health parameters and shelf life of the test bioinoculants.

In present era, thousands of harmful toxins are accumulated in environment are taken by human beings in different forms. These harmful toxins cause cumulative toxicity in human being which results in symptoms that can be seen slowly after their long- term use. These harmful toxins may be of Sthavara Visha/plant origin (e.g. Fruits and vegetables contaminated with pesticides, ripening agents, infections, heavy metal toxicity in plants, Maida, Pollen grains, dust, Latex from plants) Jangama Visha/ animal origin (e.g. Animal dander, adulteration in milk and milk products, Sea food containing heavy metals such as Hg, PCBs) Kritrim Visha (e.g. Toxic ingredients in cosmetics, Food preservatives, Food Flavouring agents, Synthetic Colour Additives, Environmental Pollution, Agricultural poisons, Medications like aspirin etc.). This Cumulative toxicity is similar to Dushi Visha as described in Ayurveda. A poison, which is having fewer properties, which means less than ten classical properties that a poison should contain, or either the poison which is having lesser potency of all the ten properties, attains a latent stage in the body is called as Dushi Visha (latent poison). The aim and objectives of this study is to study the concept of Dushi Visha in modern era and its toxic effects on human body.

In the present era skin diseases like atopic dermatitis/eczema get a suitable atmosphere especially in developing countries like India, due to unhygienic living condition, Disturbed life style, Polluted environment and repeated use of chemical additives. This type of diseases make a person feels much more humiliation in society because no one wants to touch them, forbidden by everyone, in that conditions person leads to lack of confidence and feels underestimated mentally as well as physically. Due to this life disturbing condition this disease was chosen for the study. The study was conducted in 30 clinically diagnosed patients of Vicharchika (Atopic Dermatitis) and randomly divided in to two groups, namely group A and group B. Each group has 15 number of patients. Group A is treated with Arka Taila (external application) used twice in a day for 45 days along with Baakuchikadyam Churna for internal consumption (3-6 grams). Group B is treated with Cutis Capsule (2 Capsules) twice a day orally along with external application of Cutis Cream as required for 45 days.

The main intention of the organization is to focused on enhancing its efficiency, life cycle, and productivity by maintaining better delivery time so that customer satisfying can be guaranteed. One way to achieve this intention is by implementing the concept of Total Productive Maintenance (TPM). In this study, barriers faced by Indian manufacturing organizations in the new emerging market had been determined through the questionnaire survey with the help of renowned academician and industrial experts. These barriers had been divided into key areas namely behavioral, organizational, cultural, technological, departmental, operational, and financial barriers. The barriers had positive as well as negative effects on the actual implementation of TPM aligned with life cycle engineering of productive equipment. The study identifies the crucial barriers to TPM employment in Indian manufacturing industries from the literature review and industrial experience. Hence, a unique model was developed for the determination of the driving and dependence power of the barriers to TPM execution to enhance the life cycle of productive equipment using Interpretive Structure Modelling (ISM).

The corona virus diseases 2019 (COVID-19) pandemic may be stressful for people. The COVID-19 pandemic is a major health crisis affecting several nations. Such widespread outbreaks are associated with adverse mental health consequences. Preliminary evidence suggests that symptoms of anxiety and depression (16-28%) and self- reported stress (8%) are common psychological reactions to the COVID-19 pandemic and may be associated with disturbed sleep. A number of individual and structural variables moderate this risk. In planning services for such population, both the needs of the concerned people and the necessary preventive guideline must be taken into account. The available literature has emerged from only a few of the affected countries and may not reflect the experience of persons living in other parts of the world. Fear and anxiety about a new disease and cause strong emotions in adults and children. Public health actions, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety. However, these actions are necessary to reduce the spread of COVID-19. Mental health is an important part of overall health and wellbeing. It affects how we think, feel and act. It may also affect how we handle stress, relate to others and make choices during an emergency. Mental health problems are a common response to the COVID-19 pandemic. There is a need for more representative research from other affected countries, particularly in vulnerable populations.

Obesity is a health disorder and increasing all over the world. Human beings are under threat from many chronic diseases and lifestyle disorders. A major cause of all these diseases was found to be improper life-style and stress leading to obesity and excessive lipid per oxidation indicating increased production of reac-tive oxygen species. It is also a cause for many non-communicable diseases. Yoga practice reduces the stress level which may improve the eating habits and help in weight reduction. Obesity is a growing public health concern in modern societies. Physical inactivity and unhealthy diet have been identified as major risk factors for obesity. [1] The role of obesity as a risk factor for a large number of chronic health compli-cation, such as cardiovascular disease, hypertension, type 2 diabetes, stroke, sleep apnoea and certain type of cancer, as well as in mood change and depression in obese individual. The effect of Pranayama and certain Yogicasanas on parameters of obesity viz. weight reduction (BMI and waist hip ratio).

Background To illuminate learning, a case study approach was used to examine early, authentic experiences within Pharmacists' Patient Care Process (PPCP)-focused practices. Educational activity Six students were matched with five practitioners and spent five half-days in a primary care clinic in a PPCP-committed health system. Students practiced interviewing, determining the patient's medication experience, and formulating the beginnings of the assessment, as well as observing and debriefing on the completion of the process by a practitioner mentor. The Five R Model was used to prompt student learning reflection. In addition, instructors examined students' work for evidence of transformative learning and observations were captured using forms of reflective practice and collaborative debriefing. Critical analysis of the educational activity Reflection performance ratings varied; however, there was strong evidence of transformative learning for all students. Specifically, most student reflections demonstrated a focus on elaborating on existing frames of reference. The most prevalent indicator of transformative learning was exploration of options for new roles, relationships, and actions. The codes from instructors' observations revealed five categories of learning evidence, with the strongest in the patient centeredness category. The process of reviewing student work products, documenting instructor observations, and collaborative debriefing resulted in insights for curricular improvement and explanations for learning difficulties. Further work is needed in understanding student experiential learning intentions and their influence on learning and reflection. Additionally, further research should explore the value of longitudinal assessment of reflection and the value of assessing student work products using criteria beyond traditional reflection criteria.

Insomnia is a very common sleep disorder in present’s era as it make hard to fall asleep, hard to stay asleep or cause to wake up too early and not be able to get back to sleep. Insomnia causes many problems in day to day life such as tiredness, a lack of energy, difficulty in concentrating and irritability. As there is no permanent cure of insomnia in modern science because they use only Hypnotics and sedatives as its treatment but there are chances that the patient may get addicted to these particular drugs. In Ayurveda difficulty to fall asleep, stay asleep, or both are considered under heading of Nidranasha. According to Charaka, sukha, dukh, pusti, karshya, bala, abala, vrishtha, kleebta, gyanm, agynam jivan and maran all these factors depends on proper and improper nidra. In Nidranasha the main doshas which are involved are vata and pitta prakopa. So treatment of Nidranasha is mainly Vata-Pitta Shamak chikitsa. In Ayurveda there are a variety of treatments for insomnia. An attempt has been made in order to compile different types of treatment protocols for insomnia according to different acharayas.

Background Since the World’s population is increasing, it’s critical to boost agricultural productivity to meet the rising demand for food and reduce poverty. Fertilizers are widely used in traditional agricultural methods to improve crop yield, but they have a number of negative environmental consequences such as nutrient losses, decrease fertility and polluted water and air. Researchers have been focusing on alternative crop fertilizers mechanisms to address these issues in recent years and nanobiofertilizers have frequently been suggested. “Nanophos” is a biofertilizer and contains phosphate-solubilising bacteria that solubilises insoluble phosphate and makes it available to the plants for improved growth and productivity as well as maintain soil health. This study evaluated the impact of nanophos on the growth and development of maize plants and its rhizospheric microbial community such as NPK solubilising microbes, soil enzyme activities and soil protein under field condition after 20, 40 and 60 days in randomized block design. Results Maize seeds treated with nanophos showed improvement in germination of seeds, plant height, number of leaves, photosynthetic pigments, total sugar and protein level over control. A higher activity of phenol, flavonoid, antioxidant activities and yield were noticed in nanophos treated plants over control. Positive shift in total bacterial count, nitrogen fixing bacteria, phosphate and potassium solubilizers were observed in the presence of nanophos as compared to control. Soil enzyme activities were significantly (P Conclusion The study concluded a stimulating effect of nanophos on Zea mays health and productivity and indicates good response towards total bacterial, NPK solubilising bacteria, soil enzymes, soil protein which equally showed positive response towards soil nutrient status. It can be a potential way to boost soil nutrient use efficiency and can be a better alternative to fertilizers used in the agriculture.

Pulmonary hypertension (PH) is a global health issue with a prevalence of 10% in ages >65 years. Right heart failure (RHF) is the main cause of death in PH. We have previously shown that monocrotaline (MCT)‐induced PH and RHF are due to an increase in oxidative stress. In this study, probucol (PROB), a strong antioxidant with a lipid‐lowering property, versus lovastatin (LOV), a strong lipid‐lowering drug with some antioxidant effects, were evaluated for their effects on the MCT‐induced RHF. Rats were treated (I.P.) with PROB (10 mg/kg ×12) or LOV (4 mg/kg ×12), daily 6 days before and 6 days after a single MCT injection (60 mg/kg). Serial echocardiography was performed and at 4‐week post‐MCT, lung wet‐to‐dry weight, hemodynamics, RV glutathione peroxidase (GSHPx), superoxide dismutase (SOD), catalase, lipid peroxidation, and myocardial as well as plasma lipids were examined. MCT increased RV systolic and diastolic pressures, wall thickness, RV end diastolic diameter, mortality, and decreased ejection fraction as well as pulmonary artery acceleration time. These changes were mitigated by PROB while LOV had no effect. Furthermore, PROB prevented lipid peroxidation, lowered lipids, and increased GSHPx and SOD in RV myocardium. LOV did decrease the lipids but had no effect on antioxidants and lipid peroxidation. A reduction in oxidative stress and not the lipid‐lowering effect of PROB may explain the prevention of MCT‐induced PH, RHF, and mortality. Thus targeting of oxidative stress as an adjuvant therapy is suggested., Pulmonary Hypertension (PH) is a progressive cardiovascular disease particularly in 65 years of age or older patients. Present study on monocrotaline‐induced PH model suggests that controlling oxidative stress reduces PH and improves RV dysfunction, RH failure, as well as mortality. Our laboratory data raise a strong possibility for a drug design which has antioxidant capability for addressing of the PH and RV dysfunction.

Aim To assess the knowledge, attitude, and practice toward cleaning and disinfection among housekeeping (HK) staff amid the coronavirus disease 2019 (COVID-19) pandemic. Methods A quasi-experimental was undertaken among HK staff at a tertiary care hospital. A 30-item structured questionnaire was used in the study, which consisted of questions pertaining to knowledge (11), attitude (8), and practice (11) toward cleaning and disinfection. Result One-hundred-two participants were included by convenient sampling, with mean age = 30-37 years. There was an improvement in pre-test and post-test knowledge (6.21 to 9.7) and practice score (9.97 to post-test 10.52). However, the attitude score did not show a significant change in the post-test score (p=0.964), showing that they were having a positive attitude toward the practices before training too. Conclusion Improvement in the post-test score shows that periodic targeted training sessions on cleaning and disinfection among housekeeping staff help improve their knowledge, attitude, and practices toward infection prevention and control (IPC) during the COVID-19 pandemic, thus minimizing the spread of the virus in a hospital environment, reducing their apprehension, and preparing them to work in such pandemic situations.

Rachel Pullen, 1, 2 Marc Miravitlles, 3 Anita Sharma, 4 Dave Singh, 5 Fernando Martinez, 6 John R Hurst, 7 Luis Alves, 8, 9 Mark Dransfield, 10 Rongchang Chen, 11 Shigeo Muro, 12 Tonya Winders, 13 Christopher Blango, 14 Hana Muellerova, 15 Frank Trudo, 16 Paul Dorinsky, 17 Marianna Alacqua, 15, 18 Tamsin Morris, 19 Victoria Carter, 1, 2 Amy Couper, 1, 2 Rupert Jones, 20 Konstantinos Kostikas, 1, 21 Ruth Murray, 1 David B Price 1, 2, 22 1Observational and Pragmatic Research Institute, Singapore, Singapore; 2Optimum Patient Care, Cambridge, UK; 3Pneumology Dept, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 4Platinum Medical Centre, Chermside, QLD, Australia; 5Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK; 6New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA; 7UCL Respiratory, University College London, London, UK; 8EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal; 9Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal; 10Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; 11Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, People’s Republic of China; 12Department of Respiratory Medicine, Nara Medical University, Nara, Japan; 13USA & Global Allergy & Airways Patient Platform, Vienna, Austria; 14Janssen Pharmaceutical Companies of Johnson & Johnson, Philadelphia, PA, USA; 15AstraZeneca, Cambridge, UK; 16AstraZeneca, Wilmington, DE, USA; 17AstraZeneca, Durham, NC, USA; 18CSL Behring SpA, Milan, Italy; 19AstraZeneca, Luton, UK; 20Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK; 21Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece; 22Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UKCorrespondence: David B PriceCentre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UKTel +65 3105 1489Email dprice@opri.sgBackground: Chronic obstructive pulmonary disease (COPD) are managed predominantly in primary care. However, key opportunities to optimize treatment are often not realized due to unrecognized disease and delayed implementation of appropriate interventions for both diagnosed and undiagnosed individuals. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) is the first-of-its-kind, collaborative, interventional COPD registry. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. The first step in CONQUEST was the development of quality standards (QS). The QS will be imbedded in routine primary and secondary care, and are designed to drive patient-centered, targeted, risk-based assessment and management optimization. Our aim is to provide an overview of the CONQUEST QS, including how they were developed, as well as the rationale for, and evidence to support, their inclusion in healthcare systems.Methods: The QS were developed (between November 2019 and December 2020) by the CONQUEST Global Steering Committee, including 11 internationally recognized experts with a specialty and research focus in COPD. The process included an extensive literature review, generation of QS draft wording, three iterative rounds of review, and consensus.Results: Four QS were developed: 1) identification of COPD target population, 2) assessment of disease and quantification of future risk, 3) non-pharmacological and pharmacological intervention, and 4) appropriate follow-up. Each QS is followed by a rationale statement and a summary of current guidelines and research evidence relating to the standard and its components.Conclusion: The CONQUEST QS represent an important step in our aim to improve care for patients with COPD in primary and secondary care. They will help to transform the patient journey, by encouraging early intervention to identify, assess, optimally manage and followup COPD patients with modifiable high risk of future exacerbations.Keywords: identification, assessment, intervention, follow-up

Agriculture contributes majorly in the Indian economy being the most important aspect of it. Often the plants suffer from many diseases which may be dependent on climatic conditions and pests which further degrades the quality of the crop. Early and accurate detection of disease in plants is very crucial step in depicting the overall yield of the crop, as this can increase the yield and productivity of the crop by a great margin. In the current climatic conditions, to obtain the superior quality crop is getting difficult day by day as the plants suffer from different diseases. To solve the problem of early and accurate detection image processing has come up with various techniques to find best and suitable ways. This paper presents a review to examine the power of these techniques in detection for plant diseases and add in the agriculture advancement. This survey enfolds larger scope of deep learning in the future research while detecting plant diseases along with improvised performance and accuracy. This paper also states certain challenges which still exist in the detection of diseases in plants and opens some areas of research for the researchers. Various problems in the field of dataset collection have been addressed. Some possible solutions also have been suggested which can help the accuracy to increase for a model.

The objective of this work is to analyse the performance of an underlay cognitive radio network which incorporates a variable-gain amplify-and-forward relay to enhance its performance. The system i...

Understanding the implications of cardiovascular (CV) outcomes data of glucose-lowering agents on the management of type 2 diabetes mellitus can be challenging for many primary practitioners. Amongst different classes of diabetes medications assessed for CV safety, several agents within the sodium-glucose transport protein-2 inhibitor and glucagon-like peptide-1 receptor agonists classes have demonstrated CV risk reduction. Applying the trial findings to patients typically seen in clinical practice, such as those with established CV disease and those with multiple CV risk factors without established CV disease, requires further clarity. To bridge this gap in our current knowledge, the aim of this review was to utilise expert-driven opinions on common case scenarios and practical recommendations on the most appropriate choice of agents, according to an individual patient’s clinical risk profile (CV and kidney disease), treatment preference and reimbursement environment from an Australian perspective. Funding: Boehringer Ingelheim Australia.

The present concept is given to help for to establish as bridge between Ayurveda and contemporary science. The Concept of Ayurvedic vishaghna properties is near about detoxifying action (Antidote action) in modern era. It is may be beneficial integrated concept for metabolic toxicity, substance acquired acute and chronic toxicity, biological toxicity, cumulative toxicity etc. and it also help to understand the detoxifying phenomenon. The single and multiple preparations of manjistha are available which indicates its utility in many poisoning. All aspects of manjishtha are studied in detail especially in field of detoxification. Selection of all logical references are done and collection, correlation and explanation as per requirement. According to indication and detoxifying therapeutic use of manjishtha are highlights, which described especially in Ayurvedic and modern text. All ayurvedic and contemporary references regarding vishaghna are collected from Ayurvedic fundamental books and various textbooks, research article, international journals. Theoretically, it will breakdown the pathogenesis of toxicity and progress forward to denaturized any poison. It can be useful for disease which comes under area of any field of toxicity. We can prevent and treat much toxicological disorder. On the basis of concept of vishaghana properties of manjishtha, it can be broadly used in today’s era for preventive as well as curative disease free life from toxicological agent. Keywords; manjishtha, vishaghana properties, detoxifying uses

Introduction: Growing pressures upon Emergency Departments [ED] call for new ways of working with frequent presenters who, although small in number, place extensive demands on services, to say nothing of the costs and consequences for the patients themselves. EDs are often poorly equipped to address the multi-dimensional nature of patient need and the complex circumstances surrounding repeated presentation. Employing a model of intensive short-term community-based case management, the Checkpoint program sought to improve care coordination for this patient group, thereby reducing their reliance on ED. Method: This study employed a single group interrupted time series design, evaluating patient engagement with the program and year-on-year individual differences in the number of ED visits pre and post enrolment. Associated savings were also estimated. Results: Prior to intervention, there were two dominant modes in the ED presentation trends of patients. One group had a steady pattern with ≥7 presentations in each of the last four years. The other group had an increasing trend in presentations, peaking in the 12 months immediately preceding enrolment. Following the intervention, both groups demonstrated two consecutive year-on-year reductions. By the second year, and from an overall peak of 22.5 presentations per patient per annum, there was a 53% reduction in presentations. This yielded approximate savings of $7100 per patient. Discussion: Efforts to improve care coordination, when combined with proactive case management in the community, can impact positively on ED re-presentation rates, provided they are concerted, sufficiently intensive and embed the principles of integration. Conclusion: The Checkpoint program demonstrated sufficient promise to warrant further exploration of its sustainability. However, health services have yet to determine the ideal organisational structures and funding arrangements to support such initiatives.

Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at higher risk to develop depression. Depression in turn adversely affects glycaemic control and increases the risk of diabetes-related complications and mortality. There is a large variation among Indian studies on prevalence of depression in T2DM and associated risk factors. Aim: To assess the prevalence, severity, and determinants of depression among patients with T2DM. Materials and Methods: The study was conducted at a Tertiary Care Hospital during February 2018-February 2019, in North-Indian state of Uttarakhand. Study subjects were patients with T2DM, age >18 years. Based on exclusion and inclusion criterias, a total sample of 290 patients were studied. Presence of depression was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Hamilton Depression Rating Scale (HAM-D) was used to estimate the severity of depression. Unpaired t-test and Mann-Whitney U test were used to compare continuous variables between subjects with and without depression. Chi-Square test was used to analyse categorical data. Binary logistic regression analysis was used to study the association between likelihood of depression and predictor variables. Results: Among 290 (155 males and 135 females, mean age of all subjects 58.2±11.08 years) study subjects with T2DM, 64 (22.1%) were found to have depression using DSM-5 criteria. Out of these 64 patients with depression, 46 were detected to have mild depression, 14 moderate depression and 4 severe depression using HAM-D scale. Subjects with T2DM and depression had: higher proportion of females (62.5% vs. 42.0%; p-value 0.004); lower literacy level (53.1% vs. 67.3%; p-value 0.037); higher frequency of diabetic retinopathy (85.9% vs. 62.8%; p-value

Background C-reactive protein (CRP) testing can be used as a point-of-care test (POCT) to guide antibiotic use for acute cough. Aim We wanted to determine feasibility and effect of introducing CRP POCT in general practices in an area with high antibiotic prescribing for patients with acute cough and to evaluate patients’ views of the test. Methods We used a McNulty–Zelen cluster pragmatic randomised controlled trial design in general practices in Northern England. Eight intervention practices accepted CRP testing and eight control practices maintained usual practice. Data collection included process evaluation, patient questionnaires, practice audit and antibiotic prescribing data. Results Eight practices with over 47,000 patient population undertook 268 CRP tests over 6 months: 78% of patients had a CRP 100 mg/L, where 90%, 22% and 100%, respectively, followed National Institute for Health and Care Excellence (NICE) antibiotic prescribing guidance. Patients reported that CRP testing was comfortable (88%), convenient (84%), useful (92%) and explained well (85%). Patients believed CRP POCT aided clinical diagnosis, provided quick results and reduced unnecessary antibiotic use. Intervention practices had an estimated 21% reduction (95% confidence interval: 0.46–1.35) in the odds of prescribing for cough compared with the controls, a non-significant but clinically relevant reduction. Conclusions In routine general practice, CRP POCT use was variable. Non-significant reductions in antibiotic prescribing may reflect small sample size due to non-use of tests. While CRP POCT may be useful, primary care staff need clearer CRP guidance and action planning according to NICE guidance.

Background As per regulations, drugs have to be used within their shelf life and must be discarded after their expiry date. The present study was conducted in commonly used analgesic agents to investigate the change in the physical, chemical, and efficacy parameters of the drugs over a period of two years after their expiry date. Methods The drugs studied were Tab Ibuprofen, Tab Diclofenac, Tab Piroxicam, Inj Diclofenac, and Inj Piroxicam. The parameters investigated were chemical potency, physical stability, and analgesic efficacy. Testing for these parameters was carried out once before expiry to establish the baseline followed by at expiry, and then every six months for two years post expiry date. Results The active ingredient in all the drugs were within the accepted range as per IP during the study period indicating that they retained their potency up to a period of two years post expiry. The analgesic efficacy as determined by the “Radiant Heat Tail flick” and “Acetic acid-induced writhing” model also showed no significant difference in the Maximum Possible Efficacy and Percent protection, indicating that the drugs retained their efficacy. There was a slight difference in the dissolution times at expiry as compared to different time periods in the case of Ibuprofen and Diclofenac, while there are was no statistical difference in the disintegration times during the study period. Conclusion The analgesic drugs in our study retained their chemical potency, physical stability and analgesic efficacy up to a period of two years after expiry. The expiry date of a drug, as estimated currently, is not an accurate reflection of its actual shelf life.

Factor-VIII (f-VIII) and factor-IX (f-IX), which are important coagulation factors in the intrinsic blood coagulation pathway, have been used as therapeutic protein drugs in the therapy of hemophilia A and B, respectively. Application of f-VIII and f-IX concentrates as therapeutic proteins has significantly improved the quality of life as well as the life span of patients suffering from hemophilia. In the case of congenital/acquired coagulation factor-deficient infants, therapies utilizing blood-derived products have shown great potential, especially in some associated risks such as thrombotic disorders and bleeding issues. Also, different factor concentrates have shown their utility in various applications, for instance, in the diagnoses (e.g., inhibitors-related hemophilia, deficiency of specific factor, and von Willebrand illness) and in the treatment of approved as well as off-label indications such as hemorrhage during cardiopulmonary bypass surgery or extracorporeal membrane oxygenation. In modern days, recombinant antibodies have been found crucial not only as therapeutics but also as diagnostics and presented substantial benefits as compared to conventional antibodies. Furthermore, the single-chain variable antibody fragment, which is the most popular recombinant antibody, has been used to establish a recombinant antibody library. Enzymes constitute a small proportion of marketed therapeutic proteins. Certain disorders can be treated only by enzyme therapy. In this chapter, therapeutic applications of enzymes are reviewed, particularly in neuropsychiatric disorders, cell mimicry, cancers, and lysosomal storage disorders.

Background Early case detection is a crucial step in the control of tuberculosis (TB). Sputum smear microscopy is the primary method of TB diagnosis in developing countries. The modified Petroff's method using sodium hydroxide at concentrations ranging between 2% and 4% to digest the specimen is widely used in developing countries. A novel ReaSLR (ReaMetrix's Sputum Liquefying Reagent) methodology has been proposed as a simple, easy, low-cost, and better alternative to conventional methods for sputum processing. This study was undertaken to evaluate the performance of the ReaSLR method of sputum processing in comparison with that of the modified Petroff's method. Methods Early-morning sputum samples were collected. After preparing a direct smear, each sample was divided into two equal halves and processed by both the methods, i.e., modified Petroff's method and ReaSLR method. Direct smears were graded according to Revised National Tuberculosis Control Program grading, and smears prepared after processing by the two different methods were graded according to Center for Disease Control and Prevention grading. Smear microscopy results were compared taking culture results of samples processed by the modified Petroff's method as the gold standard. Results The rate of smear positivity with the modified Petroff's method (22.22%) was found to be higher than that with direct smear microscopy (13.56%; p = 0.0002) and the ReaSLR method (17.32%; p = 0.04). The modified Petroff's method was found to be 26.76% more sensitive than direct microscopy and 15.59% more sensitive than the ReaSLR method. Conclusion The ReaSLR method was not superior to the modified Petroff's method for smear microscopy. Although this method was more sensitive than the direct method in smear microscopy, the modified Petroff's method performed much better than the ReaSLR method.

Endocarditis caused by Mycobacterium abscessus is rare and often missed without appropriate blood cultures. It does not respond to standard antitubercular treatment and is also resistant to many other antibiotics. The course of the disease may be indolent and often results in a fatal outcome. Accurate identification and sensitivity, combination therapy, and prolonged duration of antibiotics are, therefore, important for a successful outcome.

Background: UTI’s are more common during pregnancy because of changes in the urinary tract and has been reported among 20% of the pregnant women with significant reason for hospital admission. It has several adverse outcomes not only on the mother but also on the fetus like chronic renal failure, pyelonephritis, preeclampsia, anemia, fetal mortality and premature delivery. Patients and methods: The aim of this study was to determine the prevalence and etiologyof UTI among 120 pregnant women attending the ANC of GMC Kotaduring the study period from January 2017 to June 2017.UTI was diagnosed by growth of at least 105 CFU/ml of a urinary tract pathogen in a culture of a midstream urine sample. The isolated bacteria were identified by biochemical tests. Results: Of the 120 urine samples examined in this study,34 (28.33%) were found to contain significant bacteriuria. Of the variables examined, Highest prevalence was observed in 21-25 years age group (50%), multipara (44.11%), and in 3rd trimester (55.88%). The bacterial pathogens isolated were most commonly Escherichia coli (55.88%), Klebsiella sps(20.6%), Pseudomonas sps(8.82%), Proteus sps(5.88%), Enterobacter sps(5.88%), Enterococcus sps(2.94%). Conclusion: The prevalence rate of urinary tract infection (UTI) during pregnancy is high. So it is important to do routine screening of all pregnant women for significant bacteriuria to reduce the complications on both maternal and fetal health. The study also recommends health education on personal sanitary hygiene.

Recently, matrix such as polymer, graphene and carbon nanotubes (CNTs) for the semiconductor nanoparticles plays a promising role due to their better structural, functional properties and broad range of applications in every field. This chapter reviews the metal chalcogenide semiconductor nanocomposites, their properties and applications. Furthermore, the importance of aforementioned matrix and their role in superior properties of metal chalcogenide nano composites have been discussed.

Purpose The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery. Design/methodology/approach A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken. Findings There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent. Originality/value Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

In this paper, we analyse the performance of a dual hop cognitive radio underlay network employing a decode and forward relay. The fading channels have been modeled using extended generalized-K fading statistics. The interference temperature is taken as a constraint so that the transmit power of the secondary source and the relay do not exceed this value. This limits the transmit powers of the secondary network to ensure no interference with the primary communication which is imperative in cognitive underlay systems. First the signal to noise ratio at the relay and the destination of the system under consideration are analyzed and then the respective cumulative distribution function and probability density function are evaluated. This is followed by the derivation of statistical expression for end-to-end signal to noise ratio of the relay network, it’s cumulative distribution function and probability density function. These expressions are further utilized to derive the analytical expressions for the outage probability and the ergodic capacity of the underlay dual-hop cognitive relay network. Our results demonstrate the dependence of the performance of the system on various parameters under the constraints of transmit power and interference temperature already defined. The mathematical analysis is followed by various numerical examples to illustrate how the various parameters of the system affect it’s performance.

Context: Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system. Aims and Objectives: The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases. Subjects and Methods: We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation. Results: A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%). Conclusions: About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role.

This study aims to explore the factors motivating the prospective investors towards adopting crowdfunding for making investments and assess the impact of motivators on the intention of the investors to invest in the crowdfunding projects in emerging countries. This study used a survey research to collect perceptions regarding motivators for crowdfunding investments. Also, a structural modelling equation has been adopted to model and analyse data. Motivators like monetary utility, personal utility, campaign and campaign owner, social and sense of belongingness and societal utility have been identified from the literature and empirically investigated in the study. This study has been conducted in an emerging country which could limit its generalization for this spectrum. Further studies considering the perceptual factors herein adopted could be run in developed countries in order to understand if the findings remain the same or any other contrasting evidence is observed. The model built in this study could be used by anyone who is planning to raise funds through crowdfunding. The crowdfunding platforms through the research findings can extend advice to the fund seeker and ensure that campaigns posted on his portal has the necessary ingredients. The model built is positively an initial attempt to understand the motivators which pushes the prospective investors towards crowdfunding campaigns in emerging countries. This study contributes especially to the emerging countries, in which crowdfunding concept and initiatives are still few widespread. By the understanding of perceptual factors, policy-makers may act successfully on fostering initiatives regarding crowdfunding developments. This can enhance economic and social aspects of those countries through several innovation developments. The existing literary talks about crowdfunding in developed economies, very few studies have taken place in emerging economies and moreover no study has focused on building a model which could encompass all the factors impacting investors’ decision making towards crowdfunding. This research is novel since the concept of crowdfunding is relatively new and the factors which could possibly motivate the prospective investors to consider projects for investments are not known, mainly in emerging countries and hence has been studied in the current research.

Background: Hospital-acquired infections could occur as a result of lapses in accepted standards of practice on the part of health care personnel (HCP). All individuals, particularly HCPs, are potentially at high risk of infection due to their frequent exposure. This study aimed to assess the knowledge and practices of nurses regarding standard precautions at a tertiary care hospital, North India.Methods: A cross-sectional study was conducted in a tertiary care hospital, Uttarakhand enrolling 134 nurses purposively from different units of the institute. Data was collected using a pre-structured self-administered questionnaire to seek information on participants’ knowledge and practices regarding standard precautions. SPSS version-23 was used to analyse the findings. Descriptive statistics were applied for the analysis of the results.Results: The mean age of the participants was 27.52±2.93 years, with more than half of the respondents were males (58.21%), and (41.79%) were females. Almost 60.45% had three or fewer years of work experience. Most respondents preferred hand hygiene (97.01%) and the use of PPE (88.06%). Almost 94.03% of participants favored disinfection of frequently touched surfaces. Regarding the practices, 95.52% answered that the right hand-washing is before wearing gloves, after removing the gloves, and after leaving the patient’s care area. About 98.51% of them answered that bio-medical waste should be discarded in the right type of color-coded bins.Conclusions: Findings suggested adequate knowledge and compliance among nurses regarding standard precautions. However, specific training programs may be conducted to attain full adherence to standard precautions. These programs can enhance their awareness and can work as a vital tool to achieve the desired improvement in knowledge and practices of standard precautions.

OSA is one of the factors leading to cardio-vascular remodeling. This study was planned to compare pulmonary artery pressure and morphological parameters of left-sided chambers of heart between two groups—severe OSA and a control group. 30 consecutive subjects with severe OSA diagnosed through overnight video-synchronized attended polysomnography and 30 consecutive subjects having “low risk for OSA” were recruited in this study. The latter group served as control group. Informed consent was taken and they were screened for exclusion criteria. Their medical history was obtained and anthropometric parameters were measured. 2-D Echocardiography was done by a cardiologist following standard guidelines. Both groups were comparable with regard to age (52.2 ± 10.1 years cases; 54.5 ± 12.1 years controls; t = − 0.78; P = 0.43). 40% cases and 7% controls had history of systemic hypertension (χ 2 = 9.31; P = 0.002). Half of the OSA patients had mild to moderate tricuspid regurgitation while none among the controls. None of the subjects in either group ever had myocardial infarction. OSA subjects had larger left atrium (3.63 ± 0.43 vs. 3.16 ± 0.41 cm in control; P = 0.003), higher left ventricular end-systolic volume (53.25 ± 16.69 vs. 38.82 ± 9.36 ml in controls; P = 0.01), higher mean pulmonary artery pressure (19.41 ± 7.89 vs 14.91 ± 3.55 mmHg in controls; P = 0.04), thicker left ventricular posterior wall (1.25 ± 0.13 vs 0.65 ± 0.25 cm in controls; P

Objective to determine the oral health status of older patients in acute care wards at admission and after 7 days. Methods a prospective descriptive study was conducted in two acute tertiary referral hospitals in New South Wales, Australia. Oral health was assessed on admission (within 24 h) and Day 7 using the Oral Health Assessment Tool. Results a total of 575 patients were admitted under the Geriatric teams at the two hospitals. Four hundred and thirty-five (76%) patients had oral cleanliness (debris) scores in the 'not healthy' range with food particles, tartar or plaque evident in at least one area in most areas of the mouth, teeth or dentures. At Day 7 206 were reassessed. One hundred and forty-nine patients (73%) were in the 'not healthy' range and of these 127 (62%) had the same score as on admission. Conclusion poor oral health is common in older people admitted to hospital acute care wards and does not improve over a 7-day period. Given the link between oral health and general health the next steps are to determine how oral health can be improved in this setting and see whether this leads to better patient outcomes.

Background- The present study is undertaken with limited available facilities to find out the efficacy of two oral antihypertensive drugs namely labetalol and methyldopa in management of pregnancy induced hypertension. Methods- The study consisted of 100 patients with pregnancy induced hypertension attending outpatient department and admitted in ANW, or who directly came to labour room. These patients were randomly selected on lottery basis after they fulfilled the inclusion criteria. Total 100 patients were taken for the study and divided into 2 groups of 50 patients in each group. Results- The mean SBP before treatment in methyldopa group was161.33 ± 8.97 mmHg and 160.03 ± 8.23 mmHg in labetalol group which showed a fall to 138.61 ± 6.67 mmHg (methyldopa group) and 138.08 ± 5.37 mmHg (labetalol groups) after treatment. Fall of SBP was significant in both the groups. But inter group difference was not significant (p > 0.05). The mean DBP before treatment was 106.85 ± 4.33 mmHg in methyldopa group and 105.63 ± 5.23 mmHg in labetalol group which decreased to 89.31 ± 6.51 mmHg and 89.68 ± 5.26 mmHg respectively after treatment. Fall of DBP was significant in both the groups. But inter group difference was not significant (p > 0.05). Fall of MAP was significant in Group A and Group B. But inter group difference was not significant (p > 0.05). Conclusion-Labetalol and methyldopa are equally efficacious in controlling blood pressure in new onset hypertension in pregnancy.

Background- The study was conducted to review Maternal outcome in pregnancy with diabetes and to plan management of pregnancy with diabetes and to study the modalities for treatment of DM in pregnancy. Methods- A prospective case study was conducted at SPMC Bikaner. Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis. Results- 45% patients had polyhydramnios and 38% developed preeclampsia. Preterm labor was common in 23% of GDM patients. Conclusions- There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduces the Maternal outcome.

Breast pain (mastalgia) is experienced by ≤70% of women during their lifetime1 and may be considered a physiological symptom rather like painful menses, but remains a common presentation in primary care. Despite an absence of evidence suggesting that mastalgia alone is associated with breast cancer, it is still commonly referred to secondary care breast units — in one study it accounted for 41% of referrals.2 This article reviews the management of breast pain within primary care and criteria for referral. Cyclical breast pain is the condition experienced by two-thirds of patients with true mastalgia. It is influenced by hormonal changes over the menstrual cycle, usually worsening in the last week of a cycle and relieved at the onset of menses. Pharmacological hormonal agents can exacerbate symptoms. Contributing factors such as caffeine, iodine deficiency, and dietary fat intake have been suggested, but no link definitively proven.3 Non–cyclical breast pain accounts for around one-third of patients with true mastalgia.4 It does not follow a menstrual pattern. Causes could be large pendulous breasts, breast cysts, pregnancy, thrombophlebitis, trauma, and previous breast surgery.3 Inflammatory conditions such as mastitis (both lactational and non-lactational) and breast abscess are painful, and …

Vicharchika is a vata - kapha predominant tridoshaja vikar . Kapha Dosha is most dominant Dosha in Vicharchika . It can be easily treated by both shodhana and shamana chikitsa . Many preparations have been mentioned in the Ayurvedic texts for the treatment of Vicharchika. In Kushtha especially in Vicharchika e xternal application is very much important. Vicharchikari tail drug has been selected with the reference of Bhaisjya ratnavali Kshudra rogadhikara. The main objective of this review article is to discuss the therapeutic uses of Vicharchikari tail and to discuss the different pharmaco logical properties and therapeutic uses of isolated constituent drugs of Vicharchikari tail . The selected drug V icharchikari tail is found to be very effective on Vicharchika. Vicharchikari tail help in eliminating symptoms of V icharchika like Kandu, Srava,and Pidika. V icharchikari tail has Ushna and Tikshana properties. These Gunas are effective on vitiated Kapha and normalize it . The present review attempts to encompass the up to date comprehensive literature analysis on Vicharchikari tail with respect to its therapeutic uses and its various pharmacological activities.

Aim Prescribing drugs during pregnancy needs careful consideration of benefit to the mother and risk to the fetus. Therefore, this study was conducted to evaluate the appropriateness of medications among pregnant women with coexisting illness in a tertiary care hospital, Western India. Materials and methods It was a hospital-based cross-sectional study conducted in the obstetrics and gynecology department of a tertiary care hospital. The study was conducted over a period of 12 months wherein data from 800 pregnant women suffering from any co-existing illness and being prescribed any medication apart from routine supplementation were analyzed. The Medication Appropriateness Index (MAI) was used to assess the appropriateness of medications. Higher MAI scores indicate more inappropriate prescribing. Results Drugs which were most inappropriately prescribed with the highest average MAI scores were albendazole, itraconazole, injection amikacin, oxcarbazepine, warfarin, domperidone, propylthiouracil, and combiflam (ibuprofen + paracetamol). Diseases with the highest average MAI scores were anemia, Grave's disease, umbilical hernia, urinary tract infection, urticaria, allergic rhinitis, and preeclampsia. The MAI criteria which had the highest percentage of inappropriately prescribed medications were "cost of drugs," "duration of therapy," and "indication." Conclusion Potentially inappropriate prescribing was seen in the study with some of the common coexisting illness being treated with drugs which fared poorly on the MAI. The study has also highlighted areas in drug prescribing where scope for improvement exists. Further, it can act as a benchmark for comparison of future studies to evaluate medication appropriateness in pregnant women.

The aim of the study was to assess antimicrobial prescribing patterns, and variation in practice, in India. A point prevalence survey (PPS) was conducted in October to December 2017 in 16 tertiary care hospitals across India. The survey included all inpatients receiving an antimicrobial on the day of PPS and collected data were analysed using a web-based application of the University of Antwerp. In all, 1750 patients were surveyed, of whom 1005 were receiving a total of 1578 antimicrobials. Among the antimicrobials prescribed, 26.87% were for community-acquired infections; 19.20% for hospital-acquired infections; 17.24% for medical prophylaxis; 28.70% for surgical prophylaxis; and 7.99% for other or undetermined reasons. Antibiotic prescribing quality indicators, such as reason in notes and post-prescription review score, were low. This PPS showed widespread antibiotic usage, underlining the need for antibiotic stewardship to promote evidence-based practice. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society.