Formulation of sumatriptan succinate orodispersible tablets using chitosan and sodium starch glycolate for immediate migraine relief.

Migraine is one of the common neurological disease affecting around 23% of the Pakistani population. Prompt treatment is required to regain the functional ability of patients. The present study was designed to develop sumatriptan succinate orodispersible tablets that would quickly overcome acute migraine episodes using 22 full-factorial design. The chitosan and sodium starch glycolate were taken as independent variables; friability, disintegration, dispersion time and water absorption ratio as response variables. Eight trial formulations were generated by Design Expert® software. The main effect plots were used to check the interaction of formulations with response variables. All trial formulations showed good micromeritic properties in terms of angle of repose (19.59o-24.57°), Carr's index (17.08-24.90%) and Hausner's ratio (1.20-1.33). The tablets wetted quickly (17.1- 39 sec) in dispersion medium, showed higher water absorption ratio (188-341 sec) and disintegrated quickly (13-20 sec) with an excellent dissolution rate (94-99%). The main effect plots show interactions between the independent variables against most of the study responses. A 22 full-factorial model was found to be effective in studying the influence of formulation variables on response parameters. Both chitosan and sodium starch glycolate can be used in combination to fabricate an effective orodispersible formulation of sumatriptan succinate.

Does Practice Match Training? Consultation Practices in Surgical Critical Care.

INTRODUCTION: Intensive care unit (ICU) patient and provider attributes may prompt specialty consultation. We sought to determine practice patterns of surgical critical care (SCC) physicians for ICU consultation. METHODS: We surveyed American Association for the Surgery of Trauma members. Various diagnoses were listed under each of nine related specialties. Respondents were asked for which conditions they would consult a specialist. Conditions were cross-referenced with the SCC fellowship curriculum. Other perspectives on practice and consultation were queried. RESULTS: 314 physicians (18.6%) responded (68% male; 79% White; 96.2% surgical intensivist); 284 (16.8%) completed all questions. Percentage of clinical time practicing SCC was 26-50% in 57% and >50% in 14.5%. ICUs were closed (39%), open (25%), or hybrid (36%). Highest average confidence ratings (1 = least, 5 = most) for managing select conditions were ventilator, 4.64; palliative care, 4.51; infections, 4.44; organ donation, hemodynamics (tie), 4.31; lowest rating was myocardial ischemia, 3.85. Consults were more frequent for Cardiology, Hematology, and Neurology; less frequent for nephrology, palliative care, gastroenterology, infectious disease, and pulmonary; and low for curriculum topics (<25%) except for infectious diseases and palliative care. Attending staffing 24 h/day was associated with a lower mean number of topics for consultation (mean 24.03 versus 26.31, P = 0.015). CONCLUSIONS: ICU consultation practices vary based on consultant specialty and patient diagnosis. Consultation is most common for specialty-specific diseases and specialist interventions, but uncommon for topics found in the SCC curriculum, suggesting that respondents' scope of practice closely matched their training.

Simultaneous adsorption of methylene blue and amoxicillin by starch-impregnated MgAl layered double hydroxide: Parametric optimization, isothermal studies and thermo-kinetic analysis.

Textile and pharmaceutical effluents contain significant amounts of dyes and antibiotics, which pose a serious threat to the ecosystem when discharged directly. Therefore, they should be treated by facile treatment techniques using low-cost materials. Layered double hydroxide (LDH) and its hybrids have emerged as robust and economic adsorbents for water treatment. Herein, magnesium/aluminum LDH and its starch-based composite were synthesized by a co-precipitation technique. The physicochemical features of the developed adsorbents were thoroughly characterized using various analytical tools. The developed materials were tested for the eradication of methylene blue (MB) and amoxicillin (AMX) in batch mode adsorption by varying operating conditions. Adsorption performance depends on the solution's pH. Under optimum adsorption conditions of pH 11, adsorbent dosage of 50 mg/L, and treatment time of 120 min, starch-impregnated MgAl-LDH exhibited maximum MB and AMX adsorption capacities of 114.94 and 48.08 mg/g, respectively. The adsorption mechanism states that hydrogen bonds and weak van der Waals forces are responsible for the removal of pollutants by the developed materials. Moreover, equilibrium and kinetic studies revealed that the removal of dye and antibiotic followed the Freundlich and Langmuir models with the pseudo-second-order reaction kinetics, respectively. The spent adsorbents were regenerated using 0.1 M HCl (for MB) and methanol (for AMX) eluent, and reusability studies ensured that the developed adsorbents retained their performance for up to four consecutive adsorption/desorption cycles. MgAl-LDH and its starch-based hybrid could thus be used to effectively remove organic contaminants from wastewater streams on a commercial scale.

Frequency of Private Prayer Predicts Survival Over 6 Years in a Nationwide U.S. Sample of Individuals with a Chronic Illness.

Prayer is central to religious/spiritual life, and there are many claims for its effectiveness. However, few studies have examined whether frequency of prayer predicts survival in people with a chronic illness. This study follows a nationwide United States sample of people with a chronic illness (N = 1931) from 2014 to 2020. Those who prayed on a daily basis or more were significantly more likely to survive over 6 years (Hazard Ratio = 1.48; 95% Confidence Intervals: 1.08-2.03) compared with those who prayed less often, after controlling for biomedical variables (age, medical symptoms), sociodemographics (sex, race, and education), psychosocial variables (depression, social support), and health behaviors (alcohol use, smoking, exercise, and body mass index/weight).

"Reverse roussouly": cervicothoracic curvature ratios define characteristic shapes in adult cervical deformity.

PURPOSE: To investigate normal curvature ratios of the cervicothoracic spine and to establish radiographic thresholds for severe myelopathy and disability, within the context of shape. METHODS: Adult cervical deformity (CD) patients undergoing cervical fusion were included. C2-C7 Cobb angle (CL) and thoracic kyphosis (TK), using T2-T12 Cobb angle, were used as a ratio, ranging from -1 to + 1. Pearson bivariate r and univariate analyses analyzed radiographic correlations and differences in myelopathy(mJOA > 14) or disability(NDI > 40) across ratio groups. RESULTS: Sixty-three CD patients included. Regarding CL:TK ratio, 37 patients had a negative ratio and 26 patients had a positive ratio. A more positive CL:TK correlated with increased TS-CL(r = 0.655, p = < 0.001)and mJOA(r = 0.530, p = 0.001), but did not correlate with cSVA/SVA or NDI scores. A positive CL:TK ratio was associated with moderate disability(NDI > 40)(OR: 7.97[1.22-52.1], p = 0.030). Regression controlling for CL:TK ratio revealed cSVA > 25 mm increased the odds of moderate to severe myelopathy and cSVA > 30 mm increased the odds of significant neck disability. Lastly, TS-CL > 29 degrees increased the odds of neck disability by 4.1 × with no cutoffs for severe mJOA(p > 0.05). CONCLUSIONS: Cervical deformity patients with an increased CL:TK ratio had higher rates of moderate neck disability at baseline, while patients with a negative ratio had higher rates of moderate myelopathy clinically. Specific thresholds for cSVA and TS-CL predicted severe myelopathy or neck disability scores, regardless of baseline neck shape. A thorough evaluation of the cervical spine should include exploration of relationships with the thoracic spine and may better allow spine surgeons to characterize shapes and curves in cervical deformity patients.

Cepharanthine action in preventing obesity and hyperlipidemia in rats on a high-fat high sucrose diet.

Background: It was demonstrated that cepharanthine (CEP), derived from Stephania cepharantha hayata, is a potent inhibitor of the ABCC10 transmembrane protein. It is approved to be a natural product or remedy. The present study focuses on investigating whether cepharanthine effectively reduces hyperlipidemia and obesity in an experimental hyperlipidemic rat model. Method: Four groups of Wistar rats were assigned randomly to the following groups: a high-fat high sucrose diet (HFHS), normal-fat diet (NFD), HFHS plus cepraranthine (10 mg/kg) (HFHS-C), and a HFHS diet with atorvastatin (HFHS-A). The responses of rats were observed on the basis of serum and hepatic biochemical parameters, food intake, and body weight after CEP treatment, and assessing the histopathological modifications by the optical microscope in the liver and its cells. Results: Significant improvement in the serum total cholesterol (TC), serum triglycerides (TG), and serum low-density lipoprotein (LDL) levels were observed following CEP treatment. We have also observed significant improvement in the structure of liver tissue and reduced-fat droplets in the cytoplasm. Moreover, CEP had a significant effect in preventing the gain in body weight of animals, and food intake was not significantly affected. Conclusion: Our research results revealed that CEP significantly improved dyslipidemia and prevented the accumulation of fatty deposits in the rats' liver tissue fed an HFHS diet. In addition, CEP exerted an anti-obesity effect.

Praying for People You Know Predicts Survival over 17 Years Among People Living with HIV in the U.S.

Most studies predicting the effects of prayer on health have examined intercessory prayer (prayers by others who often don't know you), yet most people pray for their own health and the health of others who they know. Our study, conducted in Miami, USA, differentiated praying for self, known others, and unknown others in people living with HIV, a virus with clearly defined biological markers of progression, enabling control for initial CD4-count and viral load. Only praying for known others predicted greater survival. People with HIV who prayed for known others were twice as likely to survive over 17 years compared to those who did not.

Assessment of COVID-19 vaccine booster dose acceptance, reluctance and concerns among elderly diabetes patients in Pakistan.

People around the globe rumored so many things about the safety and efficacy of initial two doses and booster dose of Covid-19 vaccine, which eventually affected the acceptance of the only tool available against the fight between humans and virus. The aim of current study is to evaluate the acceptance and reluctance level among the population specifically elderly diabetes patients. The cross-sectional study was conducted during a time period of 3 months i.e. from July 2021 until September 2021. A 16-item questionnaire was used to assess the acceptance, reluctance and concerns of the Covid-19 vaccine booster dose among elderly diabetes patients. A 16-item questionnaire was used to assess the acceptance, reluctance and concerns of the Covid-19 vaccine booster dose among elderly diabetes patients. A total of 497 responses were collected and analyzed. Approximately 32% of respondents believed that they need additional information about the Covid-19 vaccine booster dose will be ineffective due to not enough information about the potential side effects of the vaccine dose, while around 80% of respondents showed concerns about safety, efficacy, newness and not enough information about vaccine contents. Around 47.1% of respondents expressed robust concerns about possible side effects of the Covid-19 vaccine booster dose.

Assessment of empagliflozin add-on therapy to metformin and glimepiride in patients with inadequately controlled type-2 diabetes mellitus.

Diabetes mellitus is a multifaceted metabolic disorder, which often required frequent blood glucose monitoring, poly-pharmacy and timely adjustments for its management. The present study focuses to check the effectiveness of empagliflozin add-on therapy in diabetic patients already taking metformin and glimepiride. This was observational, comparative and follow-up cohort study, conducted in a tertiary care hospital of Pakistan. Ninety subjects were enrolled and evenly distributed in Group A (patients on oral therapy of Metformin & Glimepiride) and Group B (patients on oral therapy of metformin, glimepiride and empagliflozin) randomly. The results showed that the addition of empagliflozin to metformin and glimepiride standard therapy provided better control over blood sugar with a significant decrease in HbA1c (16.1% decrease in HbA1c for Group B patients against 8.2% in Group A patients), FBS (23.8% decrease as compared to 14.6% decrease) and BMI (1.5% decrease in Group B patients against 0.06% increase in Group A). The addition of empagliflozin did not exacerbate the toxicity of the existing regimen and is safe to be included in multiple drug regimens. Empagliflozin addition to standard antidiabetic therapy might possess beneficial impacts in managing poorly controlled Type-2 Diabetes Mellitus in the Pakistani population.

Observer and descriptor satisfying incremental quadratic constraint for class of chaotic systems and its applications in a quadrotor chaotic system.

A drone based on four rotors is considered in this research paper. Its chaotic solution is shown bounded in an inscribed sphere whose vertices are tangent to faces of octahedron. Based on concept of constrained optimization; Linear Matrix Inequalities (LMIs) satisfying quadratic constraint increment multiplier matrix σm , state observers and descriptors with estimated parameter is calculated. Moreover, an image file is decrypted by designing description for mentioned chaotic system and then encrypted on its receiver end. Furthermore, an electric circuit is designed for chaotic quadrotor using LTspice and is fitted into wireless flying robot to observe its dynamics in bounded rectangular region.

An evaluation of the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level: a dynamic simulation analysis.

BACKGROUND: Evidence from randomized control trials suggest that coupled with smoking cessation interventions, CVD events can be reduced significantly if hypertension and diabetes patients are properly managed, raising practical what-if questions at the population level. This research aims to develop a dynamic simulation model using the systems modelling methodology of system dynamics, to evaluate the medium to long-term impact of hypertension and diabetes management, as well as smoking cessation intervention on CVD events, CVD deaths and post-CVD population. METHODS: The systems modelling methodology of system dynamics was used to develop a simulation model to evaluate the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level. RESULT: The insights from this research suggest that despite that at the individual level, hypertension management is associated with the highest risk reduction for CVD (50%) compared to diabetes and smoking (20%) and is also the most prevalent risk factor, at the population level, diabetes management interventions are projected to have higher impact on reducing CVD events compared to hypertension management or smoking cessation interventions. However, a combined intervention of diabetes and hypertension management, as well as smoking cessation has the most impact on CVD outcomes. CONCLUSION: Due to aging population and the increasing prevalence of chronic conditions in Singapore, the number of CVD events in Singapore is projected to rise significantly in the near future-hence the need for proactive planning to implement needed interventions. Findings from this research suggest that CVD events and its associated deaths and disabilities could be reduced significantly if diabetes and hypertension patients are aggressively managed.

Mass Casualty Incident Management.

A mass casualty incident (MCI) by definition can overwhelm local and regional resources. Preparation and training is required by any health system to minimize the loss of life and maximize patient recovery. This update will review lessons learned from recent events and discuss current research that healthcare providers should be familiar with when managing MCI's.

Pediatric Trauma Update.

Trauma is the leading cause of mortality in children, accounting for over 11,000 deaths and more than 8 million nonfatal injuries in 2015 for ages 1-19 years.1 Current issues garnering particular attention and research efforts include traumatic brain injury (TBI), blunt solid organ injuries, imaging guidelines and trauma-induced coagulopathy. This article reviews the evaluation and management of the pediatric trauma patient while focusing on recent updates.

Outcome Of 0.2% Glyceryltrinitrate Cream Versus 2% Diltiazem Cream In The Treatment Of Chronic Anal Fissure.

BACKGROUND: Anal fissure is a linear tear in the distal anal canal resulting from persistent hypertonia and spasm of the internal sphincter which results in mucosal ischemia. We have conducted a study in order to compare the outcome of 0.2% glyceryl trinitrate cream versus 2% diltiazem cream in the treatment of chronic anal fissure. METHODS: This randomized controlled trial (RCT) was carried out in the Department of Surgical "B" unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 15th June 2012 to 15th May 2015. One hundred and eighty-four patients who visited the outpatient department for the treatment of chronic anal fissure were included in the study. They were divided into two groups with 92 patients in each group. Patients in group "A" included those patients receiving topical glyceryl trinitrate and group "B" patients were those receiving topical diltiazem cream. RESULTS: Out of 184 patients 66.3% were males, 33.7% were females. Mean age of the patients was 43.84±7.976 and mean duration of symptoms was 10.55±2.524. Overall outcome in terms of healing was 71.2%, among which 80.4% were from diltiazem group while 62% in glyceryl trinitrate group. Complete relief of pain was observed in 67.9%, 26.1% complained of mild pain and 5.4% complained of moderate pain. Only one patient in glyceryl trinitrate group complained with severe pain with no healing after one month of follow up. No statistical association was found between healing outcome and gender as well as age of the patients (p>0.05) although an association was found between healing outcome and duration of symptoms (p<0.05). CONCLUSIONS: This study shows that diltiazem has better outcome in terms of healing of chronic anal fissure and reductions in symptoms, i.e., pain compared with glyceryl trinitrate.

In-flight ultrasound identification of pneumothorax.

Ultrasound is a standard adjunct to the initial evaluation of injured patients in the emergency department. We sought to evaluate the ability of prehospital, in-flight thoracic ultrasound to identify pneumothorax. Non-physician aeromedical providers were trained to perform and interpret thoracic ultrasound. All adult trauma patients and adult medical patients requiring endotracheal intubation underwent both in-flight and emergency department ultrasound evaluations. Findings were documented independently and reviewed to ensure quality and accuracy. Results were compared to chest X-ray and computed tomography (CT). One hundred forty-nine patients (136 trauma/13 medical) met inclusion criteria. Mean age was 44.4 (18-94) years; 69 % were male. Mean injury severity score was 17.68 (1-75), and mean chest injury score was 2.93 (0-6) in the injured group. Twenty pneumothoraces and one mainstem intubation were identified. Sixteen pneumothoraces were correctly identified in the field. A mainstem intubation was misinterpreted. When compared to chest CT (n = 116), prehospital ultrasound had a sensitivity of 68 % (95 % confidence interval (CI) 46-85 %), a specificity of 96 % (95 % CI 90-98 %), and an overall accuracy of 91 % (95 % CI 85-95 %). In comparison, emergency department (ED) ultrasound had a sensitivity of 84 % (95 % CI 62-94 %), specificity of 98 % (95 % CI 93-99 %), and an accuracy of 96 % (95 % CI 90-98 %). The unique characteristics of the aeromedical environment render the auditory element of a reliable physical exam impractical. Thoracic ultrasonography should be utilized to augment the diagnostic capabilities of prehospital aeromedical providers.

ATRIAL FIBRILLATION AND STROKE PREVENTION PRACTICES IN PATIENTS WITH CANDIDACY FOR ANTICOAGULATION THERAPY.

BACKGROUND: Stroke secondary to Atrial Fibrillation is usually due to thrombi formed in the left atrium and left atrial appendage embolizing to cause ischemic stroke. Therefore, in patients with Atrial Fibrillation, antithrombotic therapy is recommended to prevent stroke. Vitamin K antagonist therapy is most widely used antithrombotic therapy for patients with valvular and non valvular AF. Aspirin is recommended only in low risk patients. This study was conducted to determine the stroke prevention practices in local patients with atrial fibrillation who were candidates for anticoagulation therapy. METHODS: This was descriptive cross sectional study conducted at Cardiovascular Department Lady Reading Hospital Peshawar and Cardiology Department Hayatabad Medical Complex Peshawar. Sampling technique was non probability consecutive. Patients visiting OPD of respective hospitals with EKG evidence of AF and having CHADES VASC score 2 or more or having mitral stenosis and AF were included in the study. Patients with additional indications for anticoagulation were excluded from the study. RESULTS: A total of 205 patients with atrial fibrillation were studied. Mean age was 60.7±14.7 years. Male were 55.6% (n=114) while 44.4% (n=91) were female. Of these 149 (72.7%) were candidates for anticoagulation based on CHA2DS2 VASc score of 2 and more or mitral stenosis with AF. Only 27.5% (n=41) patients were adequately treated with anticoagulant therapy using VKA or novel oral anticoagulant drugs. Majority of them were getting dual antiplatelet therapy (DAPT). CONCLUSION: Most patients with AF and high risk characteristics for thromboembolism are not receiving proper stroke prevention therapies.

FREQUENCY OF ABDOMINAL OBESITY AND ITS ASSOCIATION WITH DIABETES MELLITUS AMONG PEOPLE OF PESHAWAR.

BACKGROUND: Increased body weight is a major risk factor for the metabolic syndrome which is a cluster of coronary heart disease risk factors, like: hypertension, diabetes mellitus and dyslipidaemia. This study was conducted to determine the frequency of abdominal obesity and diabetes mellitus in the population of Peshawar and association between them. METHODS: This was a cross sectional study, performed by the Cardiology Department, Lady Reading Hospital Peshawar, in the population of Peshawar. All participants were interviewed in detail regarding known risk factors for coronary artery disease. Waist circumference (≥102 cm in male and ≥88 cm in females) was used as the surrogate marker for abdominal obesity in already diagnosed patients of type-2 diabetes mellitus. RESULTS: A total of 2548 individuals were included, 71.1% were male. Mean age was 37.94±12.59 years. Mean waist circumference was 90.25±13.45cm in males and 90.52±12.52cm in females. Diabetes was present in 4.4% of the participants and abdominal obesity in 56.6% Among the male, abdominal obesity was present in 39.4% and diabetes in 2.9%. Out of 39.4% males with abdominal obesity, 2% were diabetic. Out of 38.6% males with no abdominal obesity, 0.9% was diabetic. Amongst the total 559 (21.1%) female subjects, 17.2% were having abdominal obesity and 1.4% was diabetics. Among 123 (4.8%) females with no abdominal obesity, 0.1% was diabetic. A positive association was established between abdominal obesity and diabetes mellitus with a significant p-valve (<0.05). CONCLUSION: Abdominal obesity is more common in the local population of Peshawar and associated with type-2 diabetes mellitus.

The impact of familial involvement on dropout in a culturally informed group therapy for people diagnosed with 'schizophrenia'.

Background: Individuals with schizophrenia diagnoses are high-risk for dropout from mental health treatments, yet few studies have examined whether familial involvement in therapy impacts dropout. Methods: We examined whether familial involvement and other demographic variables predicted dropout among 101 patients enrolled in culturally informed group therapy for schizophrenia (CIGT-S), which incorporates collectivistic principles and spiritual coping into treatment. We reviewed records and conducted follow-up calls to identify reasons for dropout, and performed survival analyses to identify when dropout was likely. Results: Familial involvement was linked to greater engagement with treatment and lower dropout, signifying a mechanism for improving treatment attendance in this group. Ethnic minorities and patients with higher symptom severity demonstrated higher rates of dropout. Most patients dropped out of CIGT-S before treatment began. However, significantly lower levels of dropout were observed among those who made it to session 9 (end of the spirituality module). An inability to maintain contact with participants was the most cited reason for dropout within records, and structural reasons (e.g., moving away) were commonly cited among participants who were successfully followed-up with. Discussion: Future work may identify whether family functioning or the quality of familial relationships may predict familial involvement and, consequently, treatment attendance.

A 4-session written emotional disclosure intervention lowers 6-month sympathoadrenal urinary output in persons living with HIV.

OBJECTIVE: We previously reported that a brief guided written emotional disclosure (WED) intervention resulted in significant reductions in post-traumatic stress disorder (PTSD) symptomology in women, but not men, living with HIV. Levels of 24-hour urinary output of epinephrine (E) and norepinephrine (NE) are shown to be elevated in persons diagnosed with PTSD. The current study tested whether there was an effect for the 4-week WED intervention on 6-month change in urinary E and NE output amongst persons living with HIV. METHOD: Fourteen women and 11 men living with HIV randomized to four 30-min expressive writing sessions of either trauma writing or daily events writing in the parent trial were included based upon collection of urine specimens at baseline, 1-, and 6-months after the intervention. Total volume (µg) and concentration (µg/ml) of urinary E and NE were derived from the specimens as study outcomes. RESULTS: Four repeated measures analyses of covariance (ANCOVA) were performed to evaluate study outcomes using trauma- versus daily-writing as the between-subject factors and collection time point as the within-subject factor, controlling for age and sex. A group x time interaction was observed wherein the trauma writing treatment group showed a significantly greater decrease in total urinary output, F(2, 46) = 4.03, p = .03, and concentration, F(2, 46) = 4.74, p = .01 of epinepherine. Post-hoc analyses revealed the interaction effect for the total, F(2, 22) = 4.82, p = .03, and concentration, F(2, 22) = 7.57, p = .005, of urinary E output over 6-months was significant for women. Interactions were not observed in urinary NE output. CONCLUSIONS: Significant reductions in the total output and concentration of urinary E were found up to 6-months following initiation of a 4-session guided written emotional disclosure intervention. Profiles of sympathoadrenal activity and response to expressive writing differ between men and women living with HIV. Futher research is need to characterize the putative pathways linking sympathoadrenal response to upstream neurobiological function and downstream inflammatory-immune status in women living with HIV and PTSD.