ABSTRACT
Background: Lower urinary tract symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is a common problem among aging men. Several classes of drugs are efficacious and safe, but the first-line treatment is with alpha-1 adrenergic blockers. They provide symptomatic relief and have to be taken for a longer duration to sustain the effect. The preferred alpha-blockers among the stockpile should be efficacious, tolerable, and also cost-effective. Aim and Objective: This study focuses to compare the cost-effectiveness of various alpha blockers prescribed in patients with LUTS-BPH. Materials and Methods: An observational study of 78 patients who were newly diagnosed with LUTS-BPH from April 2014 to May 2015 was conducted. Patients were followed up at 4 weeks and at 12 weeks after the drugs had been prescribed. Efficacy assessment was done on basis of change in International Prostate Symptom Score (IPSS) score over 12 weeks. Average cost-effectiveness ratio of different alpha-blockers prescribed was evaluated and compared with Mann-Whitney U test in order to find the most cost-effective alpha-blocker in the study. Results: All patients were prescribed alpha-blockers either alone or in combination with other drugs. Tamsulosin was prescribed to n = 46, Silodosin to n = 16 and Alfuzosin to n = 16. The efficacy in terms of Mean change in IPSS after 12 weeks of study was 11.34 ± 5.23 for Tamsulosin, 11.70 ± 5.9 for Silodosin and 10.87 ± 4.77 for Alfuzosin and average cost-effectiveness ratio was 108.74, 183.07 and 127.50 for Tamsulosin, Silodosin, and Alfuzosin, respectively. Conclusion: Tamsulosin was the most cost-effective drug among the prescribed alpha-blockers. Since all the prescribed alpha-blockers had comparable efficacy so we concluded that the most cost-effective drug should be preferred for long-duration treatment.
ABSTRACT
Aim: The study aimed to identify the optimum tillage and source of nitrogen for refining yields, yield sustainability and rainwater-use efficiency, and to develop predictive models explaining the relationship between crop yield and monthly rainfall with main goal of reduced cost of cultivation and increased profitability for long-term sustainability of maize-wheat system. Methodology: A long-term field experiment on maize-wheat system was conducted from 2000 to 2012 at Regional Research Station, Ballowal Saunkhri, Punjab Agricultural University, Ludhiana in split plot design with three replications. The treatment included three tillage practices, viz., conventional tillage (CT), reduced tillage (RT1) and RT1 + herbicide (RT2) in the main plots and three nitrogen (N) management practices, viz., 100% N from organic source (F1), 50% N from organic + 50% N from inorganic source (F2) and 100% N from inorganic source (F3) in the sub-plots. The parameters included maize and wheat yield, rainwater use efficiency, economics, sustainability yield index to develop predictive models. Results: Prediction models expressing relation between yield and monthly rainfall showed beneficial effect of rainfall in June, July and September months on maize and January and February in wheat on crop productivity. RT2 gave highest mean maize grain yield (2264 kg ha−1) with 13.8 and 1.8% yield superiority over RT1 and CT, respectively. However, in wheat, CT recorded highest grain yield (2110 kg ha−1) with 7.9 and 1.7% higher yield than RT1 and RT2, respectively. The RT2F3 gave highest net returns of US$ 222.60 ha−1 with benefit-cost ratio (B:C) of 1.88, rain water use efficiency (RWUE) of 4.78 kg ha−1 mm−1 and a sustainable yield index (SYI) of 60.7% in maize, whereas in wheat it provided net returns of US$315.45 ha−1 with B:C of 2.28, RWUE of 23.0 kg ha−1 mm−1 and SYI of 47.4%. Interpretation: The efficient rainwater use and optimum yields of rainfed maize-wheat system can be realised with reduced tillage + herbicide based weed management along with application of recommended nitrogen. The study suggests the shift from conventional tillage practices to reduced/conservation tillage practices.
ABSTRACT
Airway management of panfacial fractures is complicated. Treatment of fractures of such bones presents a certain difficulty as in not only do the fracture fragments have to be aligned but the teeth have to be kept in proper occlusion as well. To achieve a proper pre-traumatic occlusion, the occlusion has to be maintained and checked at all times during the surgery. There are many options for the airway management of such cases. We present a case of panfacial fracture which was managed successfully with submental intubation.