The Cost-Effectiveness of and Adherence to Disease-Modifying Antirheumatic Drug (DMARD) Therapy in Rheumatoid Arthritis Patients in a Tertiary Care Teaching Hospital in Uttarakhand, India.

Objective This study was conducted with the aim of evaluating the cost-effectiveness of and adherence to treatment in patients on disease-modifying antirheumatic drug (DMARD) therapy for rheumatoid arthritis (RA) in a tertiary care teaching hospital in Uttarakhand, India. Methodology This prospective observational study was conducted on 150 rheumatoid arthritis patients presenting to the Rheumatology Outpatient Department (OPD) receiving DMARD therapy (approval number AIIMS/IEC/18/160). The patients were followed up for an average of 10.7 weeks and received drugs in four regimens with methotrexate (MTX) (Regimen 1) having the least contribution with a mean of 46.05 Rs, methotrexate + hydroxychloroquine (MTX + HCQ) (Regimen 2) with 174.15 Rs, methotrexate + hydroxychloroquine + leflunomide (MTX + HCQ + Lef) (Regimen 3) with Rs 371.70, and methotrexate + hydroxychloroquine + leflunomide + biological DMARD adalimumab (MTX + HCQ + Lef + bDMARD adalimumab) (Regimen 4) with 17,349.4 Rs. The cost of drug therapy was assessed by calculating the cost of therapy per month for each patient, and adherence was assessed using the Morisky-Green-Levine Scale (MGLS) at the follow-up visit. Results The overall mean cost of DMARD treatment was 205.81 Rs. The overall DMARD therapy cost-effectiveness was Rs 878.14 for a unit change of Disease Activity Score (DAS28). The most cost-effective treatment came out to be Regimen 1 with the least cost of 290.9 Rs for a unit change of DAS28, and the least cost-effective was Regimen 4 with 65,661.8 Rs for a unit change of DAS28. At follow-up, among all subjects of the study, 49 (32.7%) subjects showed high adherence, 71 (47.3%) subjects showed medium adherence, and 30 (20%) subjects showed low adherence. Accordingly, the maximum number of participants fell in the category of medium adherence, i.e., 71 (47.4%). Conclusion Our study concluded that the cost burden varied according to the number of DMARDs being given to the patient. The double-drug therapy of methotrexate + hydroxychloroquine had a maximum "high adherence." On a whole, the majority of patients had "medium adherence" to therapy.

MUSTARD-a comprehensive resource of mutation-specific therapies in cancer.

The steady increase in global cancer burden has fuelled the development of several modes of treatment for the disease. In the presence of an actionable mutation, targeted therapies offer a method to selectively attack cancer cells, increasing overall efficacy and reducing harmful side effects. However, different drug molecules are in different stages of development, with new molecules obtaining approvals from regulatory agencies each year. To augment clinical impact, it is important that this information reaches clinicians, patients and researchers swiftly and in a structured, well-annotated manner. To this end, we have developed Mutation-Specific Therapies Resource and Database in Cancer (MUSTARD), a database that is designed to be a centralized resource with diverse information such as cancer subtype, associated mutations, therapy offered and its effect observed, along with links to external resources for a more comprehensive annotation. In its current version, MUSTARD comprises over 2105 unique entries, including associations between 418 unique drug therapies, 189 cancer subtypes and 167 genes curated and annotated from over 862 different publications. To the best of our knowledge, it is the only resource that offers comprehensive information on mutation-specific, gene fusions and overexpressed gene-targeted therapies for cancer. Database URL: http://clingen.igib.res.in/mustard/.

Evaluation of prescription practices in rheumatoid arthritis at the rheumatology clinic in a tertiary care teaching hospital in Uttarakhand: A cross-sectional study.

OBJECTIVE: This study was aimed to analyze the prescription pattern of disease modifying anti-rheumatic drug (DMARD) therapy in patients with rheumatoid arthritis (RA) in a tertiary care teaching hospital in Uttarakhand, India. METHODOLOGY: This cross-sectional study was conducted in 150 RA patients who were given DMARD therapy. Patient's demographic details, drugs prescribed with their dosage and administration routes and the usage of complementary and alternative medicine (CAM) therapy were recorded to study the prescription pattern. RESULTS: Overall, 4 DMARDs were prescribed in all the studied patients: Methotrexate (n = 150), hydroxychloroquine (n = 35), leflunomide (n = 5), and adalimumab (n = 1). Single DMARD therapy with methotrexate was prescribed to 110 (73.3%) followed by double therapy with methotrexate + hydroxychloroquine in 35 (23.3%), triple therapy (methotrexate + hydroxychloroquine + leflunomide) in 4 (2.7%) and triple therapy with biological DMARD (methotrexate + hydroxychloroquine + leflunomide + adalimumab) in 1 (0.7%) patient. Adjuvant therapy drugs included: Prednisolone (n = 150), folic acid (n = 150), naproxen (n = 150), calcium (n = 150), vitamin D (n = 150) and indomethacin (n = 40). Of the total, 61.4% patients also took complimentary alternative medicine (CAM) therapy. CONCLUSION: Our study concludes that the most commonly prescribed DMARDs in our setting, to patients of RA, in descending order of frequency were methotrexate, followed by hydroxychloroquine, leflunomide and lastly adalimumab. A total of five adjuvant medications were commonly prescribed to all patients. There was a high prevalence of self-medicated CAM therapy in the majority of these patients.

Effect of far-infrared radiation assisted microwave-vacuum drying on drying characteristics and quality of red chilli.

Fresh red chilli (Capsicum frutescens L.) was dried using microwave-vacuum drying (MVD) and the far-infrared radiation assisted microwave-vacuum drying (FIR-MVD) method. The MVD was operated using the microwave power of 100, 200 and 300 W under absolute pressure of 21.33, 28.00 and 34.66 kPa. In terms of FIR-MVD, far-infrared power was applied at 100, 200 and 300 W. The effect of drying conditions, i.e., microwave power, absolute pressure and FIR power, on drying characteristics and qualities of dried product were investigated. It was observed that an increase in microwave power and FIR power with a decrease in absolute pressure could accelerate the drying rate. It was also found that FIR-MVD method required shorter drying time than MVD. Moreover, qualities, i.e., color changes, texture, rehydration ability and shrinkage, of FIR-MVD chilli were found to be better than those of MVD. Consequently, the optimum drying condition of FIR-MVD within this study was microwave power of 300 W under absolute pressure of 21.33 kPa with FIR power of 300 W.

Drying characteristics and quality of shiitake mushroom undergoing microwave-vacuum drying and microwave-vacuum combined with infrared drying.

Shiitake mushrooms were dehydrated by two different drying methods, i.e., microwave-vacuum drying (MVD) and microwave-vacuum combined with infrared drying (MVD + IR). MVD was operated at microwave powers of 56, 143, 209 and 267 W under absolute pressures of 18.66, 29.32, 39.99 and 50.65 kPa, whereas infrared radiation was added in MVD + IR at 100 and 200 W. The effects of microwave power, absolute pressure and infrared power on drying characteristics, qualities and specific energy consumption were investigated. It was found that drying rate increased with lower absolute pressure, higher microwave power and higher infrared power. In particular, the results also indicated that drying undergoing MVD + IR could provide better qualities in terms of color of dried shiitake mushroom, rehydration ratio and texture of rehydrated ones. Furthermore, the drying characteristics were described by fitting data to six different drying models. Based on their coefficient of determination, root mean square error, residual of sum square and chi-square, Modified Page model could accurately predict moisture ratio for all drying conditions. Within the range of this study, the suitable drying condition with respect to the product qualities and energy consumption was MVD + IR drying at 267 W of microwave power, 18.66 kPa of absolute pressure and 200 W of infrared power.

[FI-KR non-separated method coupled with FAAS for the determination of Fe(II) and Fe(III) in water].

An FI-KR non-separated method coupled with FAAS for the determination of Fe(II) and Fe(III) was developed. With 60 s of sampling at a flow rate of 6.0 mL x min(-1), EF of 41 for Fe(III) and 9 for Fe(II) were obtained. The precision (RSD, n = 11) for Fe(III) and Fe(II) was 2.3% and 3.1% at the 0.04 mg x L(-1) level respectively. When 0.1 per thousand phi TEA was used as masking reagent, the recovery rate for Fe(III) and Fe(II) was from 97% to 101% and from 96% to 100% respectively.

[Two steps elution method FI on-line adsorption and preconcentration coupled with FAAS for the determination of trace zinc].

A flow injection two steps elution method on-line sorption and preconcentration system coupled to flame atomic absorption spectrometry (FAAS) was developed for the determination of trace Zn in water samples. The conventional elution procedure was divided into two steps: elution procedure and detection procedure. During the elution procedure, the eluent was pumped into KR by the suction of the peristaltic pump and through PTFE tube instead of peristaltic pump tube. By the new method, the dispersion of the analyte was decreased notably, and high absorbance peak value was achieved. Because the eluent was not through the peristaltic pump tube, the peristaltic pump tube was protected from being eroded. Emptying procedure was added in order to insure the veracity and repeatability of the experiment of every time. With 60 s (sample throughput of 37 x h(-1)) of sampling at a flow rate of 6.0 mL x min(-1), an enhancement factor (EF) of 28 (higher than 9 achieved by conventional elution method) and a detection limit (3sigma) of 0.35 x L(-1) were obtained. The precision (RSD, n=11) was 2.1% at the 20 microg x L(-1) level. When 0.1% phi triethannolamine was used as masking reagent, the recovery rate was from 98.7% to 99.6%.

Dynamic biomechanical model for assessing and monitoring robot-assisted upper-limb therapy.

This article describes the design, validation, and application of a dynamic biomechanical model that assesses and monitors trajectory, position, orientation, force, and torque generated by upper-limb (UL) movement during robot-assisted therapy. The model consists of two links that represent the upper arm and forearm, with 5 degrees of freedom (DOF) for the shoulder and elbow joints. The model is a useful tool for enhancing the functionality of poststroke robot-assisted UL therapy. The individualized inertial segment parameters were based on anthropometric measurements. The model performed inverse dynamic analysis of UL movements to calculate reaction forces and moments acting about the 3-DOF shoulder and 2-DOF elbow joints. Real-time fused biofeedback of a 6-DOF force sensor and three-dimensional (3-D) pose sensors supported the model validation and application. The force sensor was mounted between the robot manipulator and the subject's wrist, while the 3-D pose sensors were fixed at specific positions on the subject's UL segments. The model input and output parameters were stored in the subject's database, which is part of the rehabilitation information system. We assigned 20 nondisabled subjects three different therapy exercises to test and validate the biomechanical model. We found that when the biomechanical model is taught an exercise, it can accurately predict a subject's actual UL joint angles and torques and confirm that the exercise is isolating the desired movement.

Mathematical modeling of laser based potato cutting and peeling.

A mathematical model is developed and validated to predict the depth of cut in potato tuber slabs as a function of laser power and travel speed. The model considers laser processing parameters such as input power, spot size and exposure time as well as the properties of the material being cut such as specific heat, thermal conductivity, surface reflectance, etc. The model also considers the phase change of water in potato and the ignition temperature of the solid portion. The composition of the potato tuber is assumed to be of water and solid. The model also assumes that the ablation process is accomplished through ejection of liquid water, debris and water vapour, and combustion of solid. A CO(2) laser operating in c.w. mode was chosen for the experimental work because water absorbs laser energy highly at 10.6 microm, and CO(2) laser units with relatively high output power are available. Slabs of potato tuber were chosen to be laser processed since potato contains high moisture and large amounts of relatively homogeneous tissue. The results of the preliminary calculations and experiments concluded that the model is able to predict the depth of cut in potato tuber parenchyma when subjected to a CO(2) laser beam.

Treatment of wastewater from abattoirs before land application--a review.

Pre-treatments are screening, catch basins, flotation, equalization, and settlers for recovering proteins and fats from abattoir wastewater. With chemical addition, dissolved air flotation (DAF) units can achieve chemical oxygen demand (COD) reductions ranging from 32% to 90% and are capable of removing large amounts of nutrients. Aerobic trickling towers reduced soluble COD by additional 27% but did not reduced total COD. Chemical-DAF reduced 67% of total COD and soluble COD. About 40-60% of the solids or approximately 25-35% of the biological oxygen demand (BOD) load can be separated by pre-treatment screening and sedimentation. Anaerobic systems are lagoon, anaerobic contact (AC), up-flow anaerobic sludge blanket (UASB), anaerobic sequence batch reactor (ASBR), and anaerobic filter (AF) processes. Abattoir wastewater is well suited to anaerobic treatment because it is high in organic compounds. Typical reductions of up to 97% BOD, 95% SS and 96% COD are reported. UASB's average COD removal efficiencies are of 80-85%. UASB seems to be a suitable process for the treatment of abattoir wastewater, due to its ability to maintain a sufficient amount of viable sludge. Wastewater in abattoirs can be reduced by treatment of immersion chiller effluent by membrane filtration which can produce recyclable water. Total organic C can be reduced below 100mg/L, and bacteria can not pass through the membrane pores. The abattoir waste minimization options are also discussed.

Saponins from edible legumes: chemistry, processing, and health benefits.

Demand for bean products is growing because of the presence of several health-promoting components in edible bean products such as saponins. Saponins are naturally occurring compounds that are widely distributed in all cells of legume plants. Saponins, which derive their name from their ability to form stable, soaplike foams in aqueous solutions, constitute a complex and chemically diverse group of compounds. In chemical terms, saponins contain a carbohydrate moiety attached to a triterpenoid or steroids. Saponins are attracting considerable interest as a result of their diverse properties, both deleterious and beneficial. Clinical studies have suggested that these health-promoting components, saponins, affect the immune system in ways that help to protect the human body against cancers, and also lower cholesterol levels. Saponins decrease blood lipids, lower cancer risks, and lower blood glucose response. A high saponin diet can be used in the inhibition of dental caries and platelet aggregation, in the treatment of hypercalciuria in humans, and as an antidote against acute lead poisoning. In epidemiological studies, saponins have been shown to have an inverse relationship with the incidence of renal stones. Thermal processing such as canning is the typical method to process beans. This study reviews the effect of thermal processing on the characteristics and stability of saponins in canned bean products. Saponins are thermal sensitive. During soaking and blanching, portions of saponins are dissolved in water and lost in the soaking, washing, and blanching liquors. An optimum thermal process can increase the stability and maintain the saponins in canned bean products, which is useful for assisting the food industry to improve thermal processing technology and enhance bean product quality.

Combining nonthermal technologies to control foodborne microorganisms.

Novel nonthermal processes, such as high hydrostatic pressure (HHP), pulsed electric fields (PEFs), ionizing radiation and ultrasonication, are able to inactivate microorganisms at ambient or sublethal temperatures. Many of these processes require very high treatment intensities, however, to achieve adequate microbial destruction in low-acid foods. Combining nonthermal processes with conventional preservation methods enhances their antimicrobial effect so that lower process intensities can be used. Combining two or more nonthermal processes can also enhance microbial inactivation and allow the use of lower individual treatment intensities. For conventional preservation treatments, optimal microbial control is achieved through the hurdle concept, with synergistic effects resulting from different components of the microbial cell being targeted simultaneously. The mechanisms of inactivation by nonthermal processes are still unclear; thus, the bases of synergistic combinations remain speculative. This paper reviews literature on the antimicrobial efficiencies of nonthermal processes combined with conventional and novel nonthermal technologies. Where possible, the proposed mechanisms of synergy is mentioned.

Inactivation of Salmonella Typhimurium in orange juice containing antimicrobial agents by pulsed electric field.

Combinations of different hurdles, including moderately high temperatures (<60 degrees C), antimicrobial compounds, and pulsed electric field (PEF) treatment, to reduce Salmonella in pasteurized and freshly squeezed orange juices (with and without pulp) were explored. Populations of Salmonella Typhimurium were found to decrease with an increase in pulse number and treatment temperature. At a field strength of 90 kV/cm, a pulse number of 20, and a temperature of 45 degrees C, PEF treatment did not have a notable effect on cell viability or injury. At and above 46 degrees C, however, cell death and injury were greatly increased. Salmonella numbers were reduced by 5.9 log cycles in freshly squeezed orange juice (without pulp) treated at 90 kV/cm, 50 pulses, and 55 degrees C. When PEF treatment was carried out in the presence of nisin (100 U/ml of orange juice), lysozyme (2,400 U/ml), or a mixture of nisin (27.5 U/ml) and lysozyme (690 U/ml), cell viability loss was increased by an additional 0.04 to 2.75 log cycles. The combination of nisin and lysozyme had a more pronounced bactericidal effect than did either nisin or lysozyme alone. An additional Salmonella count reduction of at least 1.37 log cycles was achieved when the two antimicrobial agents were used in combination. No significant difference (P > 0.05) in cell death was attained by lowering the pH value; only cell injury increased. Inactivation by PEF was significantly more extensive (P < 0.05) in pasteurized orange juice than in freshly squeezed orange juice under the same treatment conditions. This increase might be due to the effect of the chemical composition of the juices.