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Low doses of amitriptyline, pregabalin, and gabapentin are preferred for management of neuropathic pain in India: is there a need for revisiting dosing recommendations?

  • Kamble, Sanjay Vasant;Motlekar, Salman Abdulrehman;D'souza, Lyndon Lincoln;Kudrigikar, Vinay Nanda;Rao, Sameer Eknath
    • The Korean Journal of Pain
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    • v.30 no.3
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    • pp.183-191
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    • 2017
  • Background: Current therapy for the treatment of neuropathic pain is often unsatisfactory. Considerable variation in treatment pattern still exists in spite of availability of sufficient literature from various guidelines. Recent Indian market data suggested that the utilization (sale) of drugs such as amitriptyline, pregabalin, and gabapentin was more for low-dose unit packs than that of the high-dose unit packs, raising the belief that these drugs are prescribed at a lower dose than is actually recommended in the guidelines. To test this hypothesis, a survey was conducted across speciality throughout the country to observe the prescription pattern of these drugs amongst the health care providers in India. Methods: Three hundred fifty survey forms were distributed of which 281 forms were included for analysis. Results: It was observed that the commonly used initiation and maintenance dose for amitriptyline, pregabalin, and gabapentin was 5-10 mg/day, 50-75 mg/day, and 100-300 mg/day, respectively. The reason to select the lower dosages was to have a balancing effect to achieve good efficacy with minimum side effects. Care-givers reported no side effects/not many side effects as a reason in 22.2%, 16.88%, and 23.86% patients with amitriptyline, pregabalin, and gabapentin, respectively. Sedation and giddiness were commonly reported with all three drugs. Conclusions: Commonly prescribed drugs for management of neuropathic pain, such as amitriptyline, pregabalin, and gabapentin are preferred at lower doses in Indian clinical settings. Acceptable efficacy and low tolerance to the standard dosage is believed to be the reason behind the prescribed dose.

The analysis for the static and kinetic positioning accuracy of NDGPS (NDGPS의 정적 및 동적 측위 정확도 분석)

  • Song, Geul-Jae;Park, Kwon-Il;Kong, Hyun-Dong
    • Journal of Navigation and Port Research
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    • v.32 no.8
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    • pp.611-619
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    • 2008
  • The Ministry of Land, Transport and Maritime Affairs is working on the construction of Nationwide DGPS(NDGPS) with connection to Maritime DGPS Reference Stations and if Chun-cheon Reference Station is to be completed in 2008, DGPS positioning information is available in the whole area of Republic of Korea. Therefore to promote the usage of DGPS surveying information, we measured and panalyzed the accuracy of DGPS. In real-time DGPS positioning accuracy were 0.42m of planar Root Mean Square(RMS) error in static survey and 0.48m of planar RMS error in dynamic survey. We went abreast with RTK comparison measurement. According to these results. DGPS positioning information cannot be applied directly to the GIS construction field, but GIS application fields, requiring the real-time positioning information. can take advantage of it in variable cases.

Stereotactic radiotherapy of the prostate: fractionation and utilization in the United States

  • Weiner, Joseph P.;Schwartz, David;Shao, Meng;Osborn, Virginia;Choi, Kwang;Schreiber, David
    • Radiation Oncology Journal
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    • v.35 no.2
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    • pp.137-143
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    • 2017
  • Purpose: To analyze the utilization and fractionation of extreme hypofractionation via stereotactic body radiotherapy (SBRT) in the treatment of prostate cancer. Materials and Methods: Data was analyzed on men diagnosed with localized prostate cancer between 2004-2012 and treated with definitive-intent radiation therapy, as captured in the National Cancer Database. This database is a hospital-based registry that collects an estimated 70% of all diagnosed malignancies in the United States. Results: There were 299,186 patients identified, of which 4,962 (1.7%) were identified as receiving SBRT as primary treatment. Of those men, 2,082 had low risk disease (42.0%), 2,201 had intermediate risk disease (44.4%), and 679 had high risk disease (13.7%). The relative utilization of SBRT increased from 0.1% in 2004 to 4.0% in 2012. Initially SBRT was more commonly used in academic programs, though as time progressed there was a shift to favor an increased absolute number of men treated in the community setting. Delivery of five separate treatments was the most commonly utilized fractionation pattern, with 4,635 patients (91.3%) receiving this number of treatments. The most common dosing pattern was $725cGy{\times}5fractions$ (49.6%) followed by $700cGy{\times}5fractions$ (21.3%). Conclusions: Extreme hypofractionation via SBRT is slowly increasing acceptance. Currently $700-725cGy{\times}5fractions$ appears to be the most commonly employed scheme. As further long-term data regarding the safety and efficacy emerges, the relative utilization of this modality is expected to continue to increase.

Epidemiologic and Socioeconomic Status of Bladder Cancer in Mazandaran province, Northern Iran

  • Ahmadi, Mohammad;Ranjbaran, Hossein;Amiri, Marzeih Momeninejad;Nozari, Jamshid;Mirzajani, Mohammad Reza;Azadbakht, Mohammad;Hosseinimehr, Seyed Jalal
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.10
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    • pp.5053-5056
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    • 2012
  • Background: Bladder cancer is one the most common malignancies of the genitourinary tract. The present study aimed to assess the epidemiology, of bladder cancer in Mazandaran, a large province in northern Iran as high-incidence cancer area, during a 2-year period. Methods: The data for this study were obtained from the population-based cancer registry of the Vice-Chancellory for Health Affairs of Mazandaran University of Medical Sciences and Mazandaran hospitals between March 1, 2010 and March 1, 2011. Demographic data, including sex, age, residency and symptoms were investigated through careful review of medical records. Using a questionnaire protocol, several variables were assessed for these cases such as smoking, history of opium, vegetable consumption habits, and history of other cancers. Results: A total of 112 cases were analyzed, 98 (87.5%) in men and 14 (12.5%) in women (mean age of $68.0{\pm}14.6$ years). Urban and rural residence were 60.7% and 39.3%. Tobacco and opium use were found in 45.5% and 21.4% of patients, respectively. Approximately 60% consumed vegetables an average of fewer than one time per day. Hematuria was the first symptom in these cases which were mainly diagnosed as having bladder cancer by ultrasonography. Conclusion: The results showed that bladder cancer tends to be found in the elderly and the male to female ratio is high. Macroscopic hematuria is a very important symptom for indicating probably urothelial tumor that should be followed up patients with transabdominal ultrasonography as a routine modality.

Potential Zoonotic Trematodes Recovered in Stray Cats from Kuwait Municipality, Kuwait

  • El-Azazy, Osama Mohamed ElShfei;Abdou, Nadra-Elwgoud Mohamed Ibrahim;Khalil, Amal Iskander;Al-Batel, Maha Khaled;Majeed, Qais Abdulrazak Habeeb;Henedi, Adawia Abdul-Ruhman;Tahrani, Laila Mohamed Azad
    • Parasites, Hosts and Diseases
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    • v.53 no.3
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    • pp.279-287
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    • 2015
  • Stray cats are a common feature roaming the streets and alleys of Kuwait; they could be a source of parasites, including trematodes, that affect humans. A survey was conducted to identify feline trematodes and throw the light on their public health significance in Kuwait. Out of 240 stray cats trapped from different localities of Kuwait from June 2011 to May 2012, 59 (24.6%) were found to be infected with 14 species of trematodes. The most common were trematodes of the genus Heterophyes, particularly H. heterophyes and H. dispar that were found in respectively 15.8% and 10.8% of the cats examined. Other trematodes recorded, with lower prevalences, were Heterophyes nocens (2.9%), Haplorchis taichui (3.8%), Stictodora sawakinensis (2.1%), Stellantchasmus falcatus (1.6%), Echinochasmus japonicus (1.6%), and Mesostephanus dottrensi (1.3%). Centrocestus cuspidatus, Galactosomum fregatae, Ascocotyle sp., Mesostephanus appendiculatus, Haplorchis yokogawai, and Pygidiopsis genata showed the lowest prevalence (0.4%) and intensity. The majority of the trematodes are recorded for the first time in Kuwait and even in the Gulf region. The study reveals that stray cats are good indicators of fish-borne trematodes in the environment. As all trematodes recovered are zoonotic, their significance to public health should be considred.

Analysis of Financial Performance and Its Factors of Community Pharmacies in Korea: After the Introduction of the Separation of Drug Prescription and Dispensing (SPD) Policy (의약분업이후 약국 경영수지 및 관련 요인 분석)

  • Park, Hye-Kyung;Kwon, Chang-Ik;Eom, Tae-Hoon;Kim, Ye-Soon;Rho, Yeun-Sook;Jeong, Gyu-Hyeok;Lee, Eui-Kyoung
    • YAKHAK HOEJI
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    • v.52 no.6
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    • pp.507-513
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    • 2008
  • The purpose of this study is to analyze the factors affecting financial performance of community pharmacies after the implementation of the new drug policy in Korea: separation of drug prescription and dispensing (SPD). The online survey questionnaires were sent to the active pharmacists of the total 20,633 community pharmacies in Korea and 1,147 pharmacists responded to the survey (the response rate was 5.5%). The questionnaire asked simple financial data in order to compare their financial performances before and after the policy. With the SPSS package (version 12.0), two levels of data analysis were used: 1) descriptive statistics to see the financial status of the pharmacies; and 2) multiple regression analysis to find the factors. {or A multiple regression method was used for the data analysis.} The finding illustrated that the average net benefit of the pharmacies was 4,870 thousand won in August 2006, and the major factors affecting the net benefit were the location of pharmacy (geographical proximity to medical institutions), number of prescriptions, drug management services for patients, chain pharmacy membership. The findings of this study suggest that service improvement for patients, revitalization of non-prescription drug sales, professional management will contribute to promote community based pharmacy business.

Proportions of non-matching fund by local governments and central government subsidies in local government health budget: focused on 2020 Jeju Self-Governing Province Budget (지방자치단체 보건의료 사무의 세출예산 구성과 자체재원 비율 - 제주특별자치도 사례를 중심으로)

  • Yoo, Hyeyoung;Jeong, Ji Woon;Park, Hyeung-Keun
    • Journal of agricultural medicine and community health
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    • v.46 no.4
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    • pp.266-279
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    • 2021
  • Objectives: The purpose of the study was to classify the health and medical service affairs of local governments, and to analyze the proportions of non-matching fund by local governments and central government subsidies for local government health budget. Methods: First of all, health affairs of local governments were classified to categories based on health-related laws and previous studies by review of the authors. In order to specify the scale of local government-led health affairs, we allocated 1,916 budget units into 6 main and 24 sub categories of the health and medical service affairs of local governments for the 2020 health budget of Jeju Special Self-Governing Province. For each categories, we compared the total amounts and the percentages of the 'central government subsidies', 'local government budget - matching fund', and 'local government budget - non-matching fund'. Results: The total health budget of Jeju Special Self-Governing Province accounts for 1.2% of the total budget. Of the total health budget of Jeju Special Self-Governing Province, the proportion of central government subsidies was 39.6% and the proportions of local government budget-matching fund and non-matching fund were 33.8% and 26.6%, respectively. The proportions of non-matching fund by provincial and basic local governments were 37.3% and 19.9%, respectively. Conclusion: In order for local governments to deal with the health problems of residents, it is necessary to secure and spend more local government budget(i.e., non-matching fund by local government) for health affairs in their administrative jurisdiction.

Isolation and identification of canine adenovirus type 2 from a naturally infected dog in Korea

  • Yang, Dong-Kun;Kim, Ha-Hyun;Yoon, Soon-Seek;Lee, Hyunkyoung;Cho, In-Soo
    • Korean Journal of Veterinary Research
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    • v.58 no.4
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    • pp.177-182
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    • 2018
  • Canine adenovirus type 2 (CAV-2) infection results in significant respiratory illness in dogs. Isolating and culturing CAV-2 allows for investigations into its pathogenesis and the development of vaccines and diagnostic assays. In this study, we successfully isolated a virus from a naturally infected dog in Gyeonggi-do, Korea. The virus was propagated in Madin-Darby canine kidney (MDCK) and Vero cells and showed a specific cytopathic morphology that appeared similar to a bunch of grapes. The virus was first confirmed as CAV-2 based on these cytopathic effects, an immunofluorescence assay, hemagglutination assay, and electron microscopy. The viral titer of the isolate designated APQA1601 reached $10^{6.5}$ 50% tissue culture infections dose per mL in MDCK cells and exhibited no hemagglutination units with erythrocytes from guinea pig. The virus was also confirmed by polymerase chain reaction and next-generation sequencing. The APQA1601 strain had the highest similarity (~99.9%) with the Toronto A26/61 strain, which was isolated in Canada in 1976 when the nucleotide sequences of the full genome of the APQA1601 strain were compared with those of other CAV strains. Isolating CAV-2 will help elucidate the biological properties of CAV-2 circulating in Korean dogs.

Diversity, Interspecific Interaction and Abundance of Undergrowth in Monocultures and Integrated Systems of Natural Rubber Plantation in Danzhou, Southern China

  • Chima, Uzoma Darlington;Qi, Dongling;Wu, Zhixiang;Lan, Guoyu;Chen, Li
    • Journal of Forest and Environmental Science
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    • v.38 no.2
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    • pp.75-89
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    • 2022
  • The negative impact of monoculture rubber plantations on biodiversity and associated ecological processes/ecosystem services has led to suggestions on the use of integrated land use systems for rubber cultivation and production in order to ensure environmental sustainability. However, there is paucity of information on the effect of such integrated land use systems on the diversity and abundance of the rubber plantation undergrowth. We evaluated and compared undergrowth plant species composition, richness, abundance, diversity and interaction, in three integrated systems (Rubber-Strelitzia reginae Integrated System - RSrIS, Rubber-Podocarpus nagi Integrated System - RPnIS & Naturally Managed Rubber Plantation - NMRP) with three Rubber Monoculture Plantations (RMP1, RMP2 & RMP3) adjacent to the integrated systems, respectively, at the Investigation and Experiment Station of Tropical Crops, Danzhou, Hainan, China. Undergrowth species density was higher in the rubber monocultures than in the integrated systems except in RSrIS. Species richness and diversity were also higher in the monocultures except in NMRP. Species similarity/interaction between the monocultures and the integrated systems was highest between RMP3 and NMRP. The NRMP proved to be the best model of natural rubber integrated system for the conservation of undergrowth species richness, diversity and interspecific interaction. However, the conservation of undergrowth species in other forms of integrated natural systems can be enhanced by considering the ecology of species to be integrated in terms of their growth characteristics, competitive nature, and ability to grow in association with other species.

Neurosurgical Management of Cerebrospinal Tumors in the Era of Artificial Intelligence : A Scoping Review

  • Kuchalambal Agadi;Asimina Dominari;Sameer Saleem Tebha;Asma Mohammadi;Samina Zahid
    • Journal of Korean Neurosurgical Society
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    • v.66 no.6
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    • pp.632-641
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    • 2023
  • Central nervous system tumors are identified as tumors of the brain and spinal cord. The associated morbidity and mortality of cerebrospinal tumors are disproportionately high compared to other malignancies. While minimally invasive techniques have initiated a revolution in neurosurgery, artificial intelligence (AI) is expediting it. Our study aims to analyze AI's role in the neurosurgical management of cerebrospinal tumors. We conducted a scoping review using the Arksey and O'Malley framework. Upon screening, data extraction and analysis were focused on exploring all potential implications of AI, classification of these implications in the management of cerebrospinal tumors. AI has enhanced the precision of diagnosis of these tumors, enables surgeons to excise the tumor margins completely, thereby reducing the risk of recurrence, and helps to make a more accurate prediction of the patient's prognosis than the conventional methods. AI also offers real-time training to neurosurgeons using virtual and 3D simulation, thereby increasing their confidence and skills during procedures. In addition, robotics is integrated into neurosurgery and identified to increase patient outcomes by making surgery less invasive. AI, including machine learning, is rigorously considered for its applications in the neurosurgical management of cerebrospinal tumors. This field requires further research focused on areas clinically essential in improving the outcome that is also economically feasible for clinical use. The authors suggest that data analysts and neurosurgeons collaborate to explore the full potential of AI.