Improvement in Inhaler Techniques After Training and Counseling in Patients With Chronic Obstructive Pulmonary Disease or Asthma.

Background Chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma significantly impair quality of life and impose a substantial burden on healthcare systems. Proper inhalation technique is important for effective management of these diseases, yet remains poorly performed by many patients. This study evaluated the impact of structured counseling and training sessions on inhaler use among patients with COPD and asthma, aiming to enhance technique correctness and disease control. Methodology This cross-sectional study analyzed 150 patients with asthma and COPD who fulfilled the inclusion criteria for inhalation techniques. Patients were counseled regarding the proper seven-step inhalation technique for each inhaler type [metered-dose inhaler (MDI), MDI with spacer, and dry powder inhaler (DPI)] through practical demonstration at baseline visits. Correct use of inhalers was assessed by a predefined checklist for each inhaler device at the baseline visit and after three months. The correctness of the inhalation technique was evaluated by scoring each of the seven steps. The disease control assessment was done using the COPD assessment test (CAT) and asthma control test (ACT) at the baseline visit and after three months. Results In this study of 150 patients, there were 97 (64.7%) males and 53 (35.3%) females. In total, 67 (44.7%) were diagnosed with asthma and 83 (55.3%) with COPD. The mean age was 45.33 ± 12.62 years. Post-counseling improvements in inhaler technique were marked, with MDI users enhancing their technique score from an average of 4.4 to 6.1, MDI with spacer from 4.56 to 6.26, and DPI from 4.92 to 6.24 (p < 0.001 for all). Disease control also showed significant gains; CAT scores decreased for MDI users from 23.4 to 20.5, MDI with spacer from 23.92 to 20.96, and DPI from 24.89 to 21.96. Concurrently, ACT scores increased for MDI users from 16.4 to 18.0 (p = 0.002), MDI with spacer from 17.29 to 19.04, and DPI from 16.42 to 18.37 (p < 0.001 for both), reflecting substantive advances in managing COPD and asthma symptoms. Furthermore, patients with primary education exhibited a significant boost in technique mastery post-counseling (p < 0.001), underscoring the potential of well-crafted counseling to transcend educational barriers in promoting effective inhaler use. Conclusions Post-counseling, inhaler technique improved significantly across all types, with MDI with spacer users demonstrating the most progress. Technique scores increased notably (p < 0.001), and disease control scores for COPD and asthma, measured by CAT and ACT, also showed significant improvements (p < 0.001). Remarkably, primary education level participants exhibited substantial technique gains post-intervention, emphasizing the effectiveness of counseling irrespective of initial educational status in enhancing inhaler use and disease management.

Thrombocytopenia and Grading of Esophageal Varices in Patients With Chronic Liver Disease.

Background Chronic liver disease (CLD) is associated with a variety of consequences, including thrombocytopenia and esophageal varices, which significantly impact patient prognosis and management. Thrombocytopenia, frequently observed in patients with CLD, may correlate with the severity of esophageal varices, a critical complication leading to variceal bleeding. Methodology A cross-sectional study was carried out in the Department of Medicine and Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from October 2021 to March 2022. The study enrolled 94 patients, aged 18-70 years, diagnosed with CLD, regardless of the cause. These patients were categorized into four groups based on platelet count: <50,000/uL, 50,000-99,999/uL, 100,000-150,000/uL, and >150,000/uL. Pearson's correlation was utilized to evaluate the association between the severity of thrombocytopenia and the grading of esophageal varices. Results A total of 94 patients were enrolled in the study, with 53 (56.4%) males and 41 (43.6%) females. The mean age of patients was 51.06 ±11.09 years. Seventeen (18.1%) had no esophageal varices, 16 (17.0%) were diagnosed with Grade I varices, 35 (37.2%) with Grade II varices, and 26 (27.7%) had Grade III varices. Most patients without varices had a platelet count above 150 x 103 (17, 18.1%). Conversely, most patients with Grade III varices (19, 20.2%) had platelet counts below 50 x 103. Patients with no esophageal varices had a mean platelet count of 173.70 ± 37.48 x 103. Among the patients, those with Grade III esophageal varices exhibited the lowest mean platelet count, recorded at 78.54 ± 24.14 x 103. These findings indicate a statistically significant difference in mean platelet counts across the various esophageal varices grades (P = 0.000). There was an inverse correlation of platelet count with the grading of esophageal varices (r = -0.645, P < 0.000). Conclusions A negative correlation was observed between the platelet count and the grading of esophageal varices, implying that as the severity of esophageal varices increased, the platelet counts proportionally decreased.

Probing the behavior and kinetic studies of amphiphilic acrylate copolymers with bovine serum albumin.

This article presents that acrylate copolymers are the potential candidate against the adsorption of bovine serum albumin (BSA). A series of copolymers poly(methyl methacrylate) (pMMA), poly(3-sulfopropyl methacrylate-co-methyl methacrylate) p(SPMA-co-MMA), and poly(dimethylaminoethyl methacrylate-co-methyl methacrylate) p(DMAEMA-co-MMA) were synthesized via free radical polymerization. These amphiphilic copolymers are thermally stable with a glass transition temperature (Tg) 50-120 °C and observed the impact of surface charge on amphiphilic copolymers to control interactions with the bovine serum albumin (BSA). These copolymers pMD1 and pMS1 have surface charges, - 56.6 and - 72.6 mV at pH 7.4 in PBS buffer solution that controls the adsorption capacity of bovine serum albumin (BSA) on polymers surface. Atomic force microscopy (AFM) analysis showed minimum roughness of 0.324 nm and 0.474 nm for pMS1 and pMD1. Kinetic studies for BSA adsorption on these amphiphilic copolymers showed the best fitting of the pseudo-first-order model that showed physisorption and attained at 25 °C and pH 7.4 within 24 h.

Optimize PLA/EVA Polymers Blend Compositional Coating for Next Generation Biodegradable Drug-Eluting Stents.

In this research work, polymer blends of poly-lactic acid (PLA)/ethylene vinyl acetate (EVA) were prepared as the drug carrier materials for a bi-layer drug-loaded coating film for coronary stents. Different optimum compositions of blends were prepared by using an intense mixer. Then, the blends were hot-pressed and later cold-pressed to prepare for films of different thickness. The changes in weight, surface analysis and biodegradability with increasing time were studied using Scanning electron microscopy (SEM), weight loss and biodegradability tests. The mechanical and thermal properties of drug-loaded films were studied through universal testing machine (UTM) and thermo-gravimetric analysis (TGA). The effects of PLA, EVA and drug contents on in-vitro drug contents were investigated through the Ultraviolet-Visible Spectroscopy (UV-VIS) chemical analysis technique. The results obtained clearly showed that the addition of PLA promoted the unleashing of the drug whereas the addition of EVA nearly did not have the same affect. The mechanical properties of these various films can be tuned by adjusting the contents of blend parts. The factors affecting the unleashing of the drug became a serious matter of concern in evaluating the performance of bio-resorbable drug eluting stents. As a result, today's chemical blends may be useful drug carrier materials for drug-loaded tube coatings capable delivering purgative drug in an incredibly tunable and regulated manner.

Antifouling and Flux Enhancement of Reverse Osmosis Membrane by Grafting Poly (3-Sulfopropyl Methacrylate) Brushes.

A commercial thin film composite (TFC) polyamide (PA) reverse osmosis membrane was grafted with 3-sulfopropyl methacrylate potassium (SPMK) to produce PA-g-SPMK by atom transfer radical polymerization (ATRP). The grafting of PA was done at varied concentrations of SPMK, and its effect on the surface composition and morphology was studied by Fourier-Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM), optical profilometry, and contact angle analysis. The grafting of hydrophilic ionically charged PSPMK polymer brushes having acrylate and sulfonate groups resulted in enhanced hydrophilicity rendering a reduction of contact angle from 58° of pristine membrane sample labeled as MH0 to 10° for a modified membrane sample labeled as MH3. Due to the increased hydrophilicity, the flux rate rises from 57.1 L m-2 h-1 to 71.2 L m-2 h-1, and 99% resistance against microbial adhesion (Escherichia coli and Staphylococcus aureus) was obtained for MH3 after modification.

Reactive Extrusion of Maleic-Anhydride-Grafted Polypropylene by Torque Rheometer and Its Application as Compatibilizer.

This study is based upon the functionalization of polypropylene (PP) by radical polymerization to optimize its properties by influencing its molecular weight. Grafting of PP was done at different concentrations of maleic anhydride (MAH) and benzoyl peroxide (BPO). The effect on viscosity during and after the reaction was studied by torque rheometer and melt flow index. Results showed that a higher concentration of BPO led to excessive side-chain reactions. At a high percentage of grafting, lower molecular weight product was produced, which was analyzed by viscosity change during and after the reaction. Percentage crystallinity increased by grafting due to the shorter chains, which consequently led to an improvement in the chain's packing. Prepared Maleic anhydride grafted polypropylene (MAH-g-PP) enhanced interactions in PP-PET blends caused a partially homogeneous blend with less voids.