ABSTRACT
INTRODUCTION: Direct oral anticoagulants (DOACs) have been available for clinical use since 2010 and offer the advantages of a lower bleeding risk with similar efficacy compared to Vitamin K antagonists (VKAs). However, no data is available on practice patterns anticoagulation usage and determinants of the same among physicians in India. METHODS: A cross-sectional survey was conducted using Google Forms comprising of 24 questions in 4 categories on baseline information, practice details, knowledge, and outlook. RESULTS: A total of 412 physicians were contacted, of which complete responses were received from 50 (12%). Majority had a subspecialist (58%) or a specialist (32%) qualification, with 54% working in a medical college. VKAs were the preferred first-line agent for 46%, with the most common perceived disadvantage being need of regular monitoring. The absence of regular blood testing was the most prominent advantage attributed to novel oral anticoagulants (NOACs) by 76% participants. Equivalent number of participants perceived efficacy to be similar in both groups, and 86% indicated NOACs to have better safety. Most participants responded to knowledge-based questions correctly and cited high costs of DOACs as the most common barrier to clinical use (78%). CONCLUSIONS: Our survey indicates VKAs as the preferred first-line agents despite perceived disadvantages. Among specialist physicians, high drug costs and not lack of knowledge or familiarity appear to be predominant factors precluding more frequent use of NOACs.
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Bioenergy may be a major replacement of fossil fuels which can make the path easier for sustainable development and decrease the dependency on conventional sources of energy. The main concern with the bioenergy is the availability of feedstock, dealing with its economics as well as its demand and supply chain management. This review deals with the finding of distinct potential of different Artificial Intelligence technologies focusing the challenges in bioenergy production system and its overall improvement in application. The study also highlights the contribution of Artificial Intelligence techniques for the prediction of energy from biomass and evaluates the computing-reasoning techniques for managing bioenergy production, biomass supply chain and optimization of process parameters for efficient bioconversion technologies.
Subject(s)
Artificial Intelligence , Biofuels , Biomass , Fossil Fuels , Physical PhenomenaABSTRACT
BACKGROUND: The nail changes caused by chemotherapy in cancer patients are difficult to assess and often overlooked by clinician. The present study was undertaken to study nail changes caused by various chemotherapeutic agents and various drug protocols most commonly associated with them. MATERIALS AND METHOD: Five hundred patients with malignancies receiving chemotherapy in the oncology ward and skin outpatient department were screened in this cross-sectional observational study from November 2018 to October 2019. RESULTS: Nail changes due to chemotherapy were observed in 37.6% patients. The most common condition observed was melanonychia (84.04%), followed by half and half nails (6.91%), erythronychia (5.31%), longitudinal grooves (2.12%), leukonychia (2.12%), Mees' lines (1.59%), Beau's lines (0.53%), pitting (0.53%), and subungual hyperkeratosis (0.53%). The usual protocol to cause melanonychia was platinum analogues + taxanes based combinations, half and half nails by platinum analogues + taxanes + 5 fluorouracil (5FU) based polypharmacy, and erythronychia by cisplatin-based adjuvants. CONCLUSION: The knowledge of the nail changes caused by chemotherapy will help in counseling of already worried patients with malignancy. It will also improve patient compliance and enrich the clinicians' knowledge pertaining to chemotherapy-induced nail changes.
ABSTRACT
Objective Silicosis is one of the common occupational lung diseases caused by crystalline silica respiration. Pneumothorax is one of the most common and morbid complications of silicosis involving lung pleura. It is commonly seen unilaterally in chronic silicosis and can often be lethal. The purpose of this study is to report secondary spontaneous pneumothorax (SSP) in critically ill patients with silicosis. Methods A cross-sectional study was done between January 2019 and June 2019 at Sawai Man Singh (SMS) Medical College in Jaipur, India. A cohort of 50 patients with dyspnea and a history of silicosis were studied. A chest X-ray and sputum for acid fast bacilli were checked on all suspected cases. Results The present study showed that the mean age of patients was 38.7 years, all silicosis patients had dyspnea, and 96% of patients had severe chest pain. The results of chest X-rays concluded the evidence of silicosis. Bilateral pneumothorax was seen in three cases, right-sided pneumothorax in eight cases, and left-sided pneumothorax in 11 cases. The rate of pneumothorax incidence in silicosis patients was about 44%, which is higher than the current evidence. Six patients were managed conservatively with oxygen and bronchodilators, and 16 patients underwent through tube thoracostomy. Conclusion This study highlights the importance of considering spontaneous pneumothorax in patients who are presenting with shortness of breath and/or chest pain especially with a known history of silicosis, as the timely diagnosis can alter the management of this morbid condition which carries a high mortality rate if left untreated, compromising the lung expansion, venous return, cardiac output, oxygenation and eventually leading to death.
