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1.
Environ Res ; 255: 119141, 2024 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-38754606

RESUMO

The increasing air pollution in the urban atmosphere is adversely impacts the environment, climate and human health. The alarming degradation of air quality, atmospheric conditions, economy and human life due to air pollution needs significant in-depth studies to ascertain causes, contributions and impacts for developing and implementing an effective policy to combat these issues. This work lies in its multifaceted approach towards comprehensive understanding and mitigating severe pollution episodes in Delhi and its surrounding areas. We investigated the aerosol dynamics in the post-monsoon season (PMS) from 2019 to 2022 under the influence of both crop residue burning and meteorological conditions. The study involves a broad spectrum of factors, including PM2.5 concentrations, active fire events, and meteorological parameters, shedding light on previously unexplored studies. The average AOD550 (0.79) and PM2.5 concentration (140.12 µg/m³) were the highest in 2019. PM2.5 was higher from mid-October to mid-November each year, exceeding the WHO guideline of 15 µg/m³ (24 h) by 27-34 times, signifying a public health emergency. A moderate to strong correlation between PM2.5 and AOD was found (r = 0.65) in 2021. The hotspot region accounts for almost 50% (2019), 47.51% (2020), 57.91% (2021) and 36.61% (2022) of the total fire events. A statistically significant negative non-linear correlation (r) was observed between wind speed (WS) and both AOD and PM2.5 concentration, influencing air quality over the region. HYSPLIT model and Windrose result show the movement of air masses predominated from the North and North-West direction during PMS. This study suggest to promotes strategies such as alternative waste management, encouraging modern agricultural practices in hot-spot regions, and enforcing strict emission norms for industries and vehicles to reducing air pollution and its detrimental effects on public health in the region and also highlights the need for future possibilities of research to attract the global attention.


Assuntos
Aerossóis , Poluentes Atmosféricos , Monitoramento Ambiental , Material Particulado , Índia , Aerossóis/análise , Material Particulado/análise , Poluentes Atmosféricos/análise , Monitoramento Ambiental/métodos , Estações do Ano , Poluição do Ar/análise , Incêndios , Produtos Agrícolas
2.
Drug Dev Ind Pharm ; 50(6): 481-494, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38717346

RESUMO

OBJECTIVES: In this research paper, an investigation has been made to assess the simultaneous effect of a solubility enhancement approach, i.e., hydrotropy on the solubility and apparent permeability of piroxicam. The solubility of piroxicam (PRX) a BCS (biopharmaceutics classification system) class II drug has been increased using a mixed hydrotropy approach. This study is based on identifying the pattern of solubility-permeability interplay and confirming whether every solubility gain results in a concomitant decrease in permeability or permeability remains unaffected. METHOD: Solid dispersions of PRX were formulated using two hydrotropes, viz., sodium benzoate (SB) and piperazine (PP) by solvent evaporation method. A comprehensive 32factorial design was employed to study the effect of hydrotropes on the solubility and permeability of PRX. Subsequently, PRX tablets containing these solid dispersions were formulated and evaluated. KEY FINDINGS: SB and PP displayed a significant increase in the solubility of PRX ranging from 0.99 to 2.21 mg/mL for F1-F9 batches attributed to the synergistic effect of hydrotropes. However, there is a reduction in PRX permeability with increasing hydrotrope levels. The decline in permeability was notably less pronounced compared to the simultaneous rise in aqueous solubility of PRX. CONCLUSION: An evident tradeoff between permeability and solubility emerged through the mixed hydrotropic solubilization for PRX. As PRX has generally higher intrinsic permeability, it has been assumed that this permeability loss will not affect the overall absorption of PRX. However, it may affect the absorption of drugs with limited permeability. Therefore, solubility permeability interplay should be investigated during solubility enhancement.


Assuntos
Permeabilidade , Piroxicam , Solubilidade , Piroxicam/química , Química Farmacêutica/métodos , Comprimidos , Excipientes/química , Solventes/química
3.
Acta Neurochir (Wien) ; 165(11): 3217-3227, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37747570

RESUMO

PURPOSE: Evidence regarding the effect of surgery in traumatic intracerebral hematoma (t-ICH) is limited and relies on the STITCH(Trauma) trial. This study is aimed at comparing the effectiveness of early surgery to conservative treatment in patients with a t-ICH. METHODS: In a prospective cohort, we included patients with a large t-ICH (< 48 h of injury). Primary outcome was the Glasgow Outcome Scale Extended (GOSE) at 6 months, analyzed with multivariable proportional odds logistic regression. Subgroups included injury severity and isolated vs. non-isolated t-ICH. RESULTS: A total of 367 patients with a large t-ICH were included, of whom 160 received early surgery and 207 received conservative treatment. Patients receiving early surgery were younger (median age 54 vs. 58 years) and more severely injured (median Glasgow Coma Scale 7 vs. 10) compared to those treated conservatively. In the overall cohort, early surgery was not associated with better functional outcome (adjusted odds ratio (AOR) 1.1, (95% CI, 0.6-1.7)) compared to conservative treatment. Early surgery was associated with better outcome for patients with moderate TBI and isolated t-ICH (AOR 1.5 (95% CI, 1.1-2.0); P value for interaction 0.71, and AOR 1.8 (95% CI, 1.3-2.5); P value for interaction 0.004). Conversely, in mild TBI and those with a smaller t-ICH (< 33 cc), conservative treatment was associated with better outcome (AOR 0.6 (95% CI, 0.4-0.9); P value for interaction 0.71, and AOR 0.8 (95% CI, 0.5-1.0); P value for interaction 0.32). CONCLUSIONS: Early surgery in t-ICH might benefit those with moderate TBI and isolated t-ICH, comparable with results of the STITCH(Trauma) trial.


Assuntos
Tratamento Conservador , Hemorragia Intracraniana Traumática , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Escala de Coma de Glasgow , Hematoma/cirurgia , Hemorragia Cerebral/cirurgia
4.
J Am Pharm Assoc (2003) ; 63(6): 1722-1730.e3, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37611896

RESUMO

BACKGROUND: Primary care pharmacists are uniquely positioned to improve care quality by intervening within care transitions in the postdischarge period. However, additional evidence is required to demonstrate that pharmacist-led interventions can reduce health care utilization in a cost-effective manner. The study's objective was to evaluate the clinical and economic effectiveness of a pharmacy-led transition of care (TOC) program within a primary care setting. METHODS: This cluster randomized trial was conducted between 2019 and 2021 and included three primary care practices. Eligible patients were ≥18 years of age and at high risk of readmission. The multifaceted pharmacy intervention included medication reconciliation, comprehensive medication review, and patient and provider follow-up. The primary composite endpoint included hospital readmissions and emergency department (ED) visits within 30 days of discharge. Differences in outcomes were modeled using a generalized estimated equations approach and outcomes were assumed to be distributed as a Poisson random variable. A cost-benefit analysis was embedded within the study and estimated economic outcomes from a provider group/health system perspective. Cost measures included: net benefit, benefit to cost ratio (BCR), and return on investment (ROI). RESULTS: Of 300 eligible patients, 36 were in the intervention group and 264 in the control group. The intervention significantly reduced the primary composite outcome of all-cause readmissions and ED visits within 30 days (adjusted incidence rate ratio [aIRR], 0.54; 95% CI, 0.44-0.66; P < 0.001). There were significant reductions in both 30-day all-cause readmissions (aIRR, 0.64; 95% CI, 0.60-0.67; P < 0.001) and ED visits (aIRR, 0.25; 95% CI, 0.20, 0.31; P < 0.001) between groups. The net benefit of the intervention was $9,078, with a BCR of 2.11 and a ROI of 111%. Sensitivity analyses were robust to changes in economic inputs. CONCLUSION: This care transition program had positive clinical and economic benefits, providing further support for the essential role pharmacists demonstrate in providing TOC services.


Assuntos
Serviço de Farmácia Hospitalar , Farmácia , Humanos , Transferência de Pacientes , Alta do Paciente , Assistência ao Convalescente , Readmissão do Paciente , Reconciliação de Medicamentos , Farmacêuticos
5.
Curr Microbiol ; 79(2): 53, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982252

RESUMO

The present study was performed to evaluate the efficacy of selected potential nitrogen-fixing cyanobacterial strain (Anabaena sp.), isolated from rhizospheric soil of rice plants on growth, pigments, N uptake, root architecture, and image-based phenotypic traits of rice crop using co-cultivation approach under controlled sand culture conditions. We studied the beneficial interaction of cyanobacterium to rice using sensor image-based Phenomics approach as well as conventional methods. Co-cultivation experiment revealed that inoculation with Anabaena sp. significantly improved plant growth, chlorophyll, leaf area, % nitrogen, and protein of rice by ~ 70%, ~ 22%, ~ 60%, and ~ 25% under 100% nitrogen input in comparison with un-inoculated control. Further, comparative evaluation revealed superior performance of Anabaena sp. at 100% and 75% N followed by 50% N input improving below-ground parameters as well as phenotypic traits as compared to control treatment. Hence, inoculation performed better with inorganic nitrogen input for overall growth of rice crop. Therefore, cyanobacterial strain can be used as an efficient bio-inoculant for sustainable rice production under integrated nutrient management.


Assuntos
Cianobactérias , Oryza , Nitrogênio , Fixação de Nitrogênio , Microbiologia do Solo
6.
Acta Neurochir (Wien) ; 164(3): 599-613, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35098352

RESUMO

BACKGROUND: Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. METHODS: A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting long-term outcome ≥ 2 years after sTBI (GCS 3-8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool. RESULTS: Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18-75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21-27% of patients. Most surviving patients reported SF-36 scores lower than the general population. CONCLUSION: Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making. HIGHLIGHTS: 1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI). 2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high. 3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies. 4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Lesões Encefálicas/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Humanos
7.
J Clin Pharm Ther ; 45(3): 453-461, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31873955

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Use of potentially inappropriate medications (PIMs) remains common in older adults, despite the easy availability of screening tools such as the Beers and Screening Tool of Older Person's Prescriptions (STOPP) criteria. Multiple published studies have implemented these screening tools to encourage deprescribing of PIMs, with mixed results. Little is known about the reasons behind the success or failure of these interventions, or what could be done to improve their impact. Implementation science (IS) provides a set of theories, models and frameworks to address these questions. The goal of this study was to conduct a focused narrative review of the deprescribing literature through an IS lens-to determine the extent to which implementation factors were identified and the intermediate steps in the intervention were measured. A better understanding of the existing literature, including its gaps, may provide a roadmap for future research. METHODS: PubMed search from 2000-2019 using appropriate MeSH headings. INCLUSION CRITERIA: controlled trials or prospective cohort studies intended to reduce PIMs in the elderly that used hospitalizations and/or emergency department visits as outcome measures. Studies were reviewed to identify potential implementation factors (known as determinants), using the Consolidated Framework for Implementation Research (CFIR) as a guide. In addition, intermediate outcomes were extracted. RESULTS AND DISCUSSION: Of the 548 reviewed abstracts, 14 studies met the inclusion criteria and underwent detailed analysis. Of the 14 studies, 10 acknowledged potential implementation determinants that could be mapped onto CFIR. The most commonly identified determinant was the degree of pharmacist integration into the medical team (seven of 14 studies), which mapped onto the CFIR construct of 'networks and communication'. Several important CFIR constructs were absent in the reviewed literature. Intermediate measures were captured by 12 of the 14 reviewed papers, but the choice of measures was inconsistent across studies. WHAT IS NEW AND CONCLUSION: In recent high-quality studies of deprescribing interventions, we found limited acknowledgement of factors known to be important to successful implementation and inconsistent reporting of intermediate outcomes. These findings indicate missed opportunities to understand the factors underlying study outcomes. As a result, we run the risk of rejecting worthwhile interventions due to negative results, when the correct interpretation might be that they failed in implementation. In other words, they were 'lost in translation'. Studies that rigorously examine and report on the implementation process are needed to tease apart this important distinction.


Assuntos
Desprescrições , Lista de Medicamentos Potencialmente Inapropriados , Padrões de Prática dos Farmacêuticos , Idoso , Humanos
8.
J Am Pharm Assoc (2003) ; 60(1): 105-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31690514

RESUMO

OBJECTIVE: To develop and pilot-test a model in which a community-based clinical pharmacist was incorporated as part of a Medicare Annual Wellness Visit (AWV) to make deprescribing recommendations targeted at potentially inappropriate medications (PIMs) in seniors. SETTING: A family medicine patient-centered medical home (PCMH) clinic in Buffalo, NY. PRACTICE DESCRIPTION: Implementation and evaluation of a pilot program incorporating a pharmacist-provided medication review targeting PIMs in seniors as part of a Medicare AWV. PRACTICE INNOVATION: A community pharmacy-based clinical pharmacist provided face-to-face medication reviews for patients older than 65 years as part of their AWV with a focus on deprescribing PIMs. No clinical pharmacy service existed at the practice when this program was implemented. EVALUATION: Identified PIMs, pharmacist recommendations, recommendation acceptance rate, time spent on intervention, health care utilization at 6 months postvisit, and barriers to implementation. RESULTS: Of the 21 patients enrolled, 13 unique patients received a total of 20 deprescribing recommendations from the pharmacist. The overall acceptance rate for pharmacist recommendations was 20%. The pharmacist spent a mean (± SD) of 34 (± 6) minutes per patient encounter. One patient in the intervention group was hospitalized, and 1 was seen in the emergency department (ED) during the 6-month follow-up period compared with 1 patient in the control group who had an ED visit. We identified multiple logistical and organizational barriers to the implementation of the intervention. CONCLUSION: In this prospective pilot study, a workflow to include a pharmacist medication review to facilitate deprescribing in the primary care setting was tested. We encountered several barriers to integrating the pharmacist into the AWV workflow to deliver the intervention. Future pragmatic clinical trials are warranted to improve provider awareness and comfort with deprescribing PIMs in seniors.


Assuntos
Desprescrições , Farmacêuticos , Idoso , Humanos , Medicare , Projetos Piloto , Atenção Primária à Saúde , Estudos Prospectivos , Estados Unidos
9.
BMC Pediatr ; 19(1): 174, 2019 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142302

RESUMO

BACKGROUND: Prolonged neonatal jaundice (PNNJ) is often caused by breast milk jaundice, but it could also point to other serious conditions (biliary atresia, congenital hypothyroidism). When babies with PNNJ receive a routine set of laboratory investigations to detect serious but uncommon conditions, there is always a tendency to over-investigate a large number of well, breastfed babies. A local unpublished survey in Perak state of Malaysia revealed that the diagnostic criteria and initial management of PNNJ were not standardized. This study aims to evaluate and improve the current management of PNNJ in the administrative region of Perak. METHODS: A 3-phase quasi-experimental community study was conducted from April 2012 to June 2013. Phase l was a cross-sectional study to review the current practice of PNNJ management. Phase ll was an interventional phase involving the implementation of a new protocol. Phase lll was a 6 months post-interventional audit. A registry of PNNJ was implemented to record the incidence rate. A self-reporting surveillance system was put in place to receive any reports of biliary atresia, urinary tract infection, or congenital hypothyroidism cases. RESULTS: In Phase I, 12 hospitals responded, and 199 case notes were reviewed. In Phase II, a new protocol was developed and implemented in all government health facilities in Perak. In Phase III, the 6-month post-intervention audit showed that there were significant improvements when comparing mean scores of pre- and post-intervention: history taking scores (p < 0.001), family history details (p < 0.05), physical examination documentation (p < 0.001), and total investigations done per patient (from 9.01 to 5.81, p < 0.001). The total number of patient visits reduced from 2.46 to 2.2 per patient. The incidence of PNNJ was found to be high (incidence rate of 158 per 1000 live births). CONCLUSIONS: The new protocol standardized and improved the quality of care with better clinical assessment and a reduction in unnecessary laboratory investigations. TRIAL REGISTRATION: Research registration number: NMRR-12-105-11288 .


Assuntos
Auditoria Clínica , Protocolos Clínicos/normas , Gerenciamento Clínico , Icterícia Neonatal , Melhoria de Qualidade , Algoritmos , Atresia Biliar/complicações , Atresia Biliar/diagnóstico , Estudos Transversais , Saúde da Família , Humanos , Recém-Nascido , Icterícia Neonatal/diagnóstico , Icterícia Neonatal/etiologia , Icterícia Neonatal/terapia , Malásia , Anamnese , Prontuários Médicos , Triagem Neonatal/normas , Exame Físico , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Sistema de Registros/estatística & dados numéricos
10.
J Liposome Res ; 29(2): 103-113, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30156120

RESUMO

Skin, the largest organ of the body serves as a potential route of drug delivery for local and systemic effects. However, the outermost layer of skin, the stratum corneum (SC) acts as a tough barrier that prevents penetration of hydrophilic and high molecular weight drugs. Ethosomes are a novel phospholipid vesicular carrier containing high ethanol concentrations and offer improved skin permeability and efficient bioavailability due to their structure and composition. This article gives a review of ethosomes including their compositions, types, mechanism of drug delivery, stability, and safety behaviour. This article also provides a detailed overview of drug delivery applications of ethosomes in various diseases.


Assuntos
Lipossomos/química , Fosfolipídeos/química , Administração Cutânea , Animais , Química Farmacêutica , Liberação Controlada de Fármacos , Tratamento Farmacológico , Etanol/química , Humanos , Interações Hidrofóbicas e Hidrofílicas , Lipossomos/efeitos adversos , Permeabilidade , Absorção Cutânea
11.
Med Res Rev ; 38(4): 1126-1158, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28697282

RESUMO

Neurodegeneration is a complex process, which leads to progressive brain damage due to loss of neurons. Despite exhaustive research, the cause of neuronal loss in various degenerative disorders is not entirely understood. Neuroprotective steroids constitute an important line of attack, which could play a major role against the common mechanisms associated with various neurodegenerative disorders like Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. Natural endogenous steroids induce the neuroprotection by protecting the nerve cells from neuronal injury through multiple mechanisms, therefore the structural modifications of the endogenous steroids could be helpful in the generation of new therapeutically useful neuroprotective agents. The review article will keep the readers apprised of the detailed description of natural as well as synthetic neuroprotective steroids from the medicinal chemistry point of view, which would be helpful in drug discovery efforts aimed toward neurodegenerative diseases.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Lesões Encefálicas/tratamento farmacológico , Neuroproteção , Fármacos Neuroprotetores/uso terapêutico , Esteroides/fisiologia , Esclerose Lateral Amiotrófica/tratamento farmacológico , Animais , Antioxidantes/química , Apoptose , Lesões Encefálicas Traumáticas/tratamento farmacológico , Neuropatias Diabéticas/tratamento farmacológico , Descoberta de Drogas , Humanos , Doença de Huntington/tratamento farmacológico , Inflamação , Esclerose Múltipla/tratamento farmacológico , Estresse Oxidativo , Doença de Parkinson/tratamento farmacológico , Esteroides/farmacologia , Acidente Vascular Cerebral/tratamento farmacológico
12.
Indian J Med Res ; 148(1): 25-34, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30264751

RESUMO

Recourse to litigation and positive judicial interventions is one of the most effective tools to meet public health objectives. The present review envisions compiling litigation and judicial measures in Southeast Asia Region (SEAR) while assessing their role in advancing smokeless tobacco (SLT) control, and equally highlighting, how tobacco industry has used litigation to undermine tobacco control efforts in the Region. The litigation, especially from the SEAR, up to 2017, that have facilitated SLT control or have been used by the tobacco industry to challenge an SLT control policy decision were reviewed. Most of the litigation related to SLT control from the Region are on pictorial health warnings. Bhutan has imposed a complete prohibition on sale, manufacture and import of all kinds of tobacco products and the litigation there relates to the prosecution of offenders for violating the ban. Judiciary in the Region is well informed about the ill-effects of tobacco use and remains positive to tobacco control initiatives in the interest of public health. In India, several SLT-specific litigation helped in better regulation of SLT products in the country. Litigation has compelled governments for effective enforcement of the domestic tobacco control laws and the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). Parties to the WHO FCTC must now use Treaty Article 19 to strengthen their legal procedures and make the tobacco industry liable, for both criminal and civil wrongs.


Assuntos
Indústria do Tabaco , Tabaco sem Fumaça/legislação & jurisprudência , Sudeste Asiático , Índia , Fumar
13.
BMC Fam Pract ; 19(1): 120, 2018 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-30025534

RESUMO

BACKGROUND: To evaluate the effectiveness of a structured prescription review and prescriber feedback program in reducing prescribing errors in government primary care clinics within an administrative region in Malaysia. METHODS: This was a three group, pragmatic, cluster randomised trial. In phase 1, we randomised 51 clinics to a full intervention group (prescription review and league tables plus authorised feedback letter), a partial intervention group (prescription review and league tables), and a control group (prescription review only). Prescribers in these clinics were the target of our intervention. Prescription reviews were performed by pharmacists; 20 handwritten prescriptions per prescriber were consecutively screened on a random day each month, and errors identified were recorded in a standardised data collection form. Prescribing performance feedback was conducted at the completion of each prescription review cycle. League tables benchmark prescribing errors across clinics and individual prescribers, while the authorised feedback letter detailed prescribing performance based on a rating scale. In phase 2, all clinics received the full intervention. Pharmacists were trained on data collection, and all data were audited by researchers as an implementation fidelity strategy. The primary outcome, percentage of prescriptions with at least one error, was displayed in p-charts to enable group comparison. RESULTS: A total of 32,200 prescriptions were reviewed. In the full intervention group, error reduction occurred gradually and was sustained throughout the 8-month study period. The process mean error rate of 40.7% (95% CI 27.4, 29.5%) in phase 1 reduced to 28.4% (95% CI 27.4, 29.5%) in phase 2. In the partial intervention group, error reduction was not well sustained and showed a seasonal pattern with larger process variability. The phase 1 error rate averaging 57.9% (95% CI 56.5, 59.3%) reduced to 44.8% (95% CI 43.3, 46.4%) in phase 2. There was no evidence of improvement in the control group, with phase 1 and phase 2 error rates averaging 41.1% (95% CI 39.6, 42.6%) and 39.3% (95% CI 37.8, 40.9%) respectively. CONCLUSIONS: The rate of prescribing errors in primary care settings is high, and routine prescriber feedback comprising league tables and a feedback letter can effectively reduce prescribing errors. TRIAL REGISTRATION: National Medical Research Register: NMRR-12-108-11,289 (5th March 2012).


Assuntos
Retroalimentação , Erros de Medicação/prevenção & controle , Padrões de Prática Médica , Atenção Primária à Saúde , Assistência Ambulatorial , Prescrições de Medicamentos/normas , Humanos , Malásia
14.
Indian J Public Health ; 61(Suppl 1): S25-S28, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28928315

RESUMO

The Indian notion of "Public Interest Litigation (PIL)" represents a moral and humane process for providing justice to an individual or a group in matters relating to infringement of fundamental rights or denial of civil privileges. The goal of PIL in India is to counter governmental lawlessness, administrative deviance, and exploitation of disadvantaged groups by denying them their rights and entitlements. Although this paper selectively describes the use of the PIL mechanism for ensuring implementation of large graphic health warnings on packages of tobacco products in India, there is a sufficient published literature to corroborate the successful use of this mechanism in India in different tobacco control settings. In fact, over the years, this legal tool has allowed the tobacco control community in India, to extensively promote human rights approach to tobacco control. In the wake of growing interference of tobacco industry worldwide, this paper explores PIL as a potent and effective tool for claiming public health rights related to tobacco control. The PIL has considerable potential to be used for enforcement of tobacco control measures and for stopping tobacco industry from engaging in activities which are detrimental to the health of the people at large. It is important to continuously identify potential avenues through which lessons and recommendations pertaining to PIL could be incorporated into the WHO Framework Convention on Tobacco Control implementation plans and guidelines, with special focus on different intercessional mechanisms that are available from time to time. To set the ball rolling, the authors suggest two such avenues.


Assuntos
Direitos Humanos , Saúde Pública , Prevenção do Hábito de Fumar/legislação & jurisprudência , Índia , Indústria do Tabaco
15.
Pharm Biol ; 54(3): 494-502, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26030463

RESUMO

CONTEXT: Carum copticum seeds have been prescribed in the traditional system of medicine for the treatment of immune disorders, such as asthma and rheumatism. OBJECTIVE: The objective of this study was to determine immunomodulatory effects of the alcoholic extract and isolated compounds in Swiss albino mice. MATERIALS AND METHODS: Seeds of C. copticum were extracted with 95% v/v alcohol. The immunomodulatory activity of the crude extract was evaluated at the doses of 100, 300, and 500 mg/kg body weight of mice, administered in mice once daily (orally) for 25 days. Volatile oil of C. copticum was isolated by steam distillation and was characterized by GLC and HPLC. Bio-assay-guided fractionation and isolation were carried out and the isolated compounds were characterized and subjected to immunomodulatory activity studies. RESULTS: The n-hexane fraction yielded p-cymene, carvacrol, and α-pinene. The LD50 value of the crude extract was found to be 4500 mg/kg and the values reported for p-cymene, carvacrol, and α-pinene in the literature were 4750, 810, and 3700 mg/kg, respectively. The oral administration of crude extract, n-hexane fraction (HEF), and isolated oils at the dose of 500, 150, and 50 mg/kg body weight, respectively, showed a significant increase in the HA titers, DTH-response, and phagocytosis. The stimulatory effect observed, on humoral and cellular immunity, was compared with the standard (levamisole treated) and control groups. DISCUSSION AND CONCLUSION: The results obtained in the study endorse the traditional use of the seeds of C. copticum and the isolated constituents act as immunostimulants.


Assuntos
Carum , Cromatografia Gasosa-Espectrometria de Massas , Imunidade Celular/efeitos dos fármacos , Fatores Imunológicos/farmacologia , Óleos Voláteis/farmacologia , Extratos Vegetais/farmacologia , Animais , Imunidade Celular/imunologia , Fatores Imunológicos/isolamento & purificação , Masculino , Camundongos , Óleos Voláteis/isolamento & purificação , Fagocitose/efeitos dos fármacos , Fagocitose/imunologia , Compostos Fitoquímicos/isolamento & purificação , Compostos Fitoquímicos/farmacologia , Extratos Vegetais/isolamento & purificação , Sementes
16.
ScientificWorldJournal ; 2015: 541510, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25861680

RESUMO

The present study aimed to develop and optimize a nanoemulsifying preconcentrate formulation of curcumin with good emulsification ability and optimal globule size, for controlled targeting in colon. Content of formulation variables, namely, X1 (Peceol), X2 (Cremophor-EL), and X3 (Transcutol HP), were optimized by Box-Behnken design of experiments for its impact on mean globule size (Y1), emulsification time (Y2), and time required for drug release (85%) in phosphate buffer (pH 7.2), t 85% (Y3). Transmission electron micrographs confirmed that there is no coalescence among globules, with size range concordant with the globule size analysis by dynamic light scattering technique (100 nm). 3D plots indicated that concentration of formulation ingredients significantly influences the formulation properties (globule size, emulsification time, and drug release). In vitro release profile (in phosphate buffer; pH 7.2) represents the fact that more than 50% of the drug was released within initial 15 min whereas in vivo release showed limited systemic absorption (C max 200 ng/mL) of curcumin. Stability study ensures the protection of drug in alkaline media which may further confirm the localised delivery of drug to colonic region. Study demonstrated that the nanoemulsifying preconcentrate can be a promising system for the colon specific delivery of curcumin to treat local pathologies.


Assuntos
Colo/efeitos dos fármacos , Curcumina/administração & dosagem , Emulsões , Nanoestruturas , Varredura Diferencial de Calorimetria , Curcumina/uso terapêutico , Humanos , Difração de Raios X
17.
ScientificWorldJournal ; 2014: 705259, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25383377

RESUMO

Multiple-unit-type oral floating hollow microspheres of 5-fluorouracil (5-Fu) were developed using modified solvent evaporation technique to prolong gastric residence time, to target stomach cancer, and to increase drug bioavailability. The prepared microspheres were characterized for micromeritic properties, floating behavior, entrapment efficiency, and scanning electron microscopy (SEM). The in vitro drug release and floating behavior were studied in simulated gastric fluid (SGF) at pH 1.2. The yield of microspheres was obtained up to 84.46 ± 6.47%. Microspheres showed passable flow properties. Based on optical microscopy, particle size was found to be ranging from 158.65 ± 12.02 to 198.67 ± 17.45 µm. SEM confirmed spherical size, perforated smooth surface, and a hollow cavity inside the microspheres. Different kinetic models for drug release were also applied on selected batches.


Assuntos
Disponibilidade Biológica , Sistemas de Liberação de Medicamentos , Fluoruracila/administração & dosagem , Neoplasias Gástricas/tratamento farmacológico , Fluoruracila/química , Humanos , Cinética , Microesferas , Tamanho da Partícula , Neoplasias Gástricas/patologia
18.
ScientificWorldJournal ; 2014: 516069, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25525620

RESUMO

The purpose of the present study was to formulate polymeric self-emulsifying curcumin nanocapsules with high encapsulation efficiency, good emulsification ability, and optimal globule size for localized targeting in the colon. Formulations were prepared using modified quasiemulsion solvent diffusion method. Concentration of formulation variables, namely, X1 (oil), X2 (polymeric emulsifier), and X3 (adsorbent), was optimized by design of experiments using Box-Behnken design, for its impact on mean globule size (Y1) and encapsulation efficiency (Y2) of the formulation. Polymeric nanocapsules with an average diameter of 100-180 nm and an encapsulation efficiency of 64.85±0.12% were obtained. In vitro studies revealed that formulations released the drug after 5 h lag time corresponding to the time to reach the colonic region. Pronounced localized action was inferred from the plasma concentration profile (C max 200 ng/mL) that depicts limited systemic absorption. Roentgenography study confirms the localized presence of carrier (0-2 h in upper GIT; 2-4 h in small intestine; and 4-24 h in the lower intestine). Optimized formulation showed significantly higher cytotoxicity (IC50 value 20.32 µM) in HT 29 colonic cancer cell line. The present study demonstrates systematic development of polymeric self-emulsifying nanocapsule formulation of curcumin for localized targeting in colon.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Emulsificantes/química , Nanocápsulas/química , Polímeros/química , Animais , Varredura Diferencial de Calorimetria , Sobrevivência Celular/efeitos dos fármacos , Química Farmacêutica , Curcumina/farmacologia , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/efeitos dos fármacos , Cobaias , Células HT29 , Humanos , Metilcelulose/análogos & derivados , Metilcelulose/química , Radiografia , Análise de Regressão , Solubilidade , Difração de Raios X
19.
Int J Occup Saf Ergon ; 20(2): 363-73, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24934431

RESUMO

The main aim of this paper was to identify job stressors, gender responses and association of psychosocial work stressors with prevalence of work related musculoskeletal disorders (MSDs) among foundry workers. The data were obtained with ergonomics checklist using Likert scale. The results of this study showed a high prevalence of MSDs among workers. The male workers were more prone to pain in neck while the female workers were more prone to MSDs in upper back and shoulders. Correlation analysis showed significant relationship of dimensions of work aspects with pain and discomfort. It proved that the work-related MSDs are the results of interaction of multiple stressors associated with work and work environment, and other personal factors. ANOVA indicated that the perception of work aspects as stressors differed significantly between male and female workers.


Assuntos
Metalurgia/estatística & dados numéricos , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Saúde Ocupacional , Adulto , Transtornos Traumáticos Cumulativos/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Cervicalgia/epidemiologia , Prevalência , Fatores Sexuais , Local de Trabalho
20.
Dalton Trans ; 53(2): 724-737, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38086687

RESUMO

A selenonium organic counter ion has been used in polyoxometalate chemistry to develop a new aryl selenonium polyoxometalate (POM) hybrid, and its photocatalytic properties have been explored in comparison with an aryl sulfonium POM-hybrid counterpart for the first time. The chalcogenonium counterions, namely, methyldiphenylsulfonium trifluoromethane sulfonate (MDPST) and methyldiphenylselenonium trifluoromethane sulfonate (MDPSeT), and their octamolybdate ([Mo8O26]4-) hybrids, 1 and 2, with the general formula (C13H13X)4[Mo8O26] (where X = S for 1 and Se for 2) were synthesized and characterized. Hybrids 1 and 2 vary in their chalcogenonium cationic center (S+vs. Se+), which enabled a direct comparison of their photocatalytic properties as a function of the cationic center. The photocatalytic activities of hybrids 1 and 2 were tested using the reduction of dichromate (Cr2O72-) as a model reaction under UV irradiation. A 99% photocatalytic reduction of Cr2O72- with a rate constant of 0.0305 min-1 was achieved with hybrid 2, while only a 67% reduction with a rate constant of 0.0062 min-1 was observed with hybrid 1 in 180 minutes. The better catalytic performance of hybrid 2 may be correlated to the larger atomic radii of Se than S, which helps in better stabilizing the photogenerated electron-hole (e--h+) pair on the POM cluster by polarizing its lone pair more efficiently compared to S. The catalytic recyclability was tested for up to 4 cycles using hybrid 2, and up to 98% reduction was obtained even after the 4th cycle. Recyclability tests and control experiments also indicated the generation of some elemental Se through possible cleavage of some C-Se bonds of MDPSe under prolonged UV exposure during catalysis, and the Se thus generated was found to contribute to the catalytic reduction of dichromate. This study, therefore, opens new avenues for aryl selenonium moieties and their POM hybrids for potential catalytic applications.

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