An increasing number of non steroidal anti inflammatory drugs NSAIDs is available for clinical use each year. This article reviews significant differences between NSAIDs currently available in worldwide, and helps the clinician to evaluate new NSAIDs. While their mechanism of action and efficacy are similar, side effects and cost vary considerably from one agent to another. Because all NSAIDs can produce adverse effects, patients, especially if they are elderly, should be selected carefully for treatment with a particular agent. Sachin Korde | Jugal Vyas ""A Comprehensive Review on Clinical Pharmacology of Non-Steroidal Anti-Inflammatory Drugs"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-2 , February 2020,
URL: https://www.ijtsrd.com/papers/ijtsrd30018.pdf
Paper Url : https://www.ijtsrd.com/pharmacy/pharmacology-/30018/a-comprehensive-review-on-clinical-pharmacology-of-non-steroidal-anti-inflammatory-drugs/sachin-korde
anti oxidant & anti inflammatory from pine bark to help improving on cardiovascular health, diabetes, erectile dysfunction, melasma, muscle cramp, osteoarthritis, retinopathy
steeroids are commonly prescribed drugs for the patients for various conditions. Side effects of these steroids on the eye are discussed in these slides
anti oxidant & anti inflammatory from pine bark to help improving on cardiovascular health, diabetes, erectile dysfunction, melasma, muscle cramp, osteoarthritis, retinopathy
steeroids are commonly prescribed drugs for the patients for various conditions. Side effects of these steroids on the eye are discussed in these slides
“The Evolution of Pharmaceutical Biotechnology – Science, Strategies, Products, and Regulations”
Shows the latest developments in pharmaceutical biotechnology and provides a broad overview of biotherapeutic & biosimilar regulations globally and in the EU
Hypersensitivity reactions to nonsteroidal anti-inflammatory drugsNatacha Santos
Reis-Ferreira A, Santos N, Botelho C, Castro E, Cernadas JR. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: single versus multiple reactors. Allergy 2011;66(Suppl.94):51-52.
This 20-slide slide set created with PowerPoint describes prostanoid synthesis and their effects on the body; mechanisms of action, beneficial and adverse effects of NSAIDS; the difference between the effects of low and high dose aspirin; and the effects and toxicity of paracetamol (acetaminophen). This is an introduction to the topic of NSAIDS which would be appropriate for beginners. Contributed by Christopher Fowler, Umeå University, Sweden.
Adverse drug reaction- Drug Interaction .pptxMangeshBansod2
Classifications - Excessive pharmacological effects, secondary pharmacological effects, idiosyncrasy, allergic drug reactions, genetically determined toxicity, toxicity following sudden withdrawal of drugs, Drug interaction- beneficial interactions, adverse interactions, and pharmacokinetic drug interactions, Methods for detecting drug interactions,
spontaneous case reports and record linkage studies, and Adverse drug reaction reporting and management.
Clinical trials established in 2005 the efficacy of Ranibizumab (Lucentis, Genentech) for the treatment of neovascular age-related macular degeneration (wetAMD), the leading cause of legal blindness in the United States.This disease is affecting people over the age of 65 with a prevalence of 1.6 million and 200000 new cases per year in the USA .While awaiting approval for ranibizumab from the Food and Drug Administration, ophthalmologists began treating neovascular AMD with off-label use of bevacizumab (Avastin, Genentech), since the drug had a target specificity similar to that of ranibizumab and was available at low cost for about 50$ per monthly injection Vs 1950$ for Lucentis monthly injection.
Ranibizumab received the FDA approuval in 2006 to treat specifically the wetAMD,there was a huge debate about the cost effectiveness and the reimbursement of Lucentis in comparaison with Avastin for treating the eye disease.
This paper explores the dilemma from different angles.First,it make the emphasize on the need of realizing a head to head comparative study between the two drugs and the means to finance and to launch this study since many roadblocks have been identified.
Then, it explores and analyzes the Genentech reaction facing this problem and their strategy to emphasize on the higher risk of death with Avastin, as compared to Lucentis in one hand and in the other hand their strategy to extend the ophthalmologic indications for Lucentis, including diabetic macula edema (DME).
Finally it explores what value should be put on safety in health technology assessments HTAs by developing that we can’t just consider the dollar value of medicine alone but we need to consider the cost of adverse events caused by the treatment and the cost of living with these adverse events
Exploring Molecular Targets for Repositioning of Hypertensive DrugsYogeshIJTSRD
Drug repositioning or drug repurposing or drug profiling is the discovery of new applications for approved or failed drug.. Drug repositioning is the development of new approved drug applications. The cost of bringing a medicine to the market is around one million which include clinical and preclinical trials. Repositioning of drugs help in cutting down costs as well as time involve in intial validation and authorization. The procedure involved in Drug repositioning is generally performed during the drug development phase to modify or extend an active molecules distribution line. On a fundamental level, repositioning opportunities exist because drugs perturb multiple biological entities and engage themselves in multiple biological processes. Therefore, a drug can play multiple roles or perform a various mode of actions that are responsible for its pharmacology. Hypertension, is a condition that causes increase in the risk of cardiovascular diseases. In this study an attempt has been made to reposition hypertensive drugs for different diseases by exploring molecular targets of hypertensive drugs. Consider that they often need to be administered for long periods of time, often over whole life time Side effects although present, have been found safe enough to be used for such long durations, hence repurposing these drugs for other diseases may be beneficial with limited side effects. Bhawna Singh | Asmita Das "Exploring Molecular Targets for Repositioning of Hypertensive Drugs" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39910.pdf Paper URL: https://www.ijtsrd.com/biological-science/bioinformatics/39910/exploring-molecular-targets-for-repositioning-of-hypertensive-drugs/bhawna-singh
Drug repurposing is the process of applying already-approved drugs and compounds to treat a different disease. Also synonymously called drug repositioning; however, there is a difference. Identifying, developing, and commercializing new uses for existing or abandoned drugs Finding new uses outside the scope of the original medical indication for existing drugs or developing new indications for existing drugs or biologics
“The Evolution of Pharmaceutical Biotechnology – Science, Strategies, Products, and Regulations”
Shows the latest developments in pharmaceutical biotechnology and provides a broad overview of biotherapeutic & biosimilar regulations globally and in the EU
Hypersensitivity reactions to nonsteroidal anti-inflammatory drugsNatacha Santos
Reis-Ferreira A, Santos N, Botelho C, Castro E, Cernadas JR. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: single versus multiple reactors. Allergy 2011;66(Suppl.94):51-52.
This 20-slide slide set created with PowerPoint describes prostanoid synthesis and their effects on the body; mechanisms of action, beneficial and adverse effects of NSAIDS; the difference between the effects of low and high dose aspirin; and the effects and toxicity of paracetamol (acetaminophen). This is an introduction to the topic of NSAIDS which would be appropriate for beginners. Contributed by Christopher Fowler, Umeå University, Sweden.
Adverse drug reaction- Drug Interaction .pptxMangeshBansod2
Classifications - Excessive pharmacological effects, secondary pharmacological effects, idiosyncrasy, allergic drug reactions, genetically determined toxicity, toxicity following sudden withdrawal of drugs, Drug interaction- beneficial interactions, adverse interactions, and pharmacokinetic drug interactions, Methods for detecting drug interactions,
spontaneous case reports and record linkage studies, and Adverse drug reaction reporting and management.
Clinical trials established in 2005 the efficacy of Ranibizumab (Lucentis, Genentech) for the treatment of neovascular age-related macular degeneration (wetAMD), the leading cause of legal blindness in the United States.This disease is affecting people over the age of 65 with a prevalence of 1.6 million and 200000 new cases per year in the USA .While awaiting approval for ranibizumab from the Food and Drug Administration, ophthalmologists began treating neovascular AMD with off-label use of bevacizumab (Avastin, Genentech), since the drug had a target specificity similar to that of ranibizumab and was available at low cost for about 50$ per monthly injection Vs 1950$ for Lucentis monthly injection.
Ranibizumab received the FDA approuval in 2006 to treat specifically the wetAMD,there was a huge debate about the cost effectiveness and the reimbursement of Lucentis in comparaison with Avastin for treating the eye disease.
This paper explores the dilemma from different angles.First,it make the emphasize on the need of realizing a head to head comparative study between the two drugs and the means to finance and to launch this study since many roadblocks have been identified.
Then, it explores and analyzes the Genentech reaction facing this problem and their strategy to emphasize on the higher risk of death with Avastin, as compared to Lucentis in one hand and in the other hand their strategy to extend the ophthalmologic indications for Lucentis, including diabetic macula edema (DME).
Finally it explores what value should be put on safety in health technology assessments HTAs by developing that we can’t just consider the dollar value of medicine alone but we need to consider the cost of adverse events caused by the treatment and the cost of living with these adverse events
Exploring Molecular Targets for Repositioning of Hypertensive DrugsYogeshIJTSRD
Drug repositioning or drug repurposing or drug profiling is the discovery of new applications for approved or failed drug.. Drug repositioning is the development of new approved drug applications. The cost of bringing a medicine to the market is around one million which include clinical and preclinical trials. Repositioning of drugs help in cutting down costs as well as time involve in intial validation and authorization. The procedure involved in Drug repositioning is generally performed during the drug development phase to modify or extend an active molecules distribution line. On a fundamental level, repositioning opportunities exist because drugs perturb multiple biological entities and engage themselves in multiple biological processes. Therefore, a drug can play multiple roles or perform a various mode of actions that are responsible for its pharmacology. Hypertension, is a condition that causes increase in the risk of cardiovascular diseases. In this study an attempt has been made to reposition hypertensive drugs for different diseases by exploring molecular targets of hypertensive drugs. Consider that they often need to be administered for long periods of time, often over whole life time Side effects although present, have been found safe enough to be used for such long durations, hence repurposing these drugs for other diseases may be beneficial with limited side effects. Bhawna Singh | Asmita Das "Exploring Molecular Targets for Repositioning of Hypertensive Drugs" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39910.pdf Paper URL: https://www.ijtsrd.com/biological-science/bioinformatics/39910/exploring-molecular-targets-for-repositioning-of-hypertensive-drugs/bhawna-singh
Drug repurposing is the process of applying already-approved drugs and compounds to treat a different disease. Also synonymously called drug repositioning; however, there is a difference. Identifying, developing, and commercializing new uses for existing or abandoned drugs Finding new uses outside the scope of the original medical indication for existing drugs or developing new indications for existing drugs or biologics
A study on drug utilization evaluation of anticoagulant therapy INA tertiary ...SriramNagarajan16
Objectives
Evaluation of a prospective observational study of the Anticoagulants used in tertiary care hospital, to provide
information and correct rationale pertaining to Anticoagulants which also describes various distribution wise of
Anticoagulants by age groups, genders, pattern of prescription, drug wise, dose, route, class and department to assess
the statistical incidence regarding usage and its right provision.
Methodology
Study site was at SUNSHINE HOSPITALS, conducted for a period of 6 months. Both male and female individuals of
age group 16-75years were included.
Results
Study included assessment of utilization of Anticoagulants with total of 200 prescriptions; of which males (54.5%),
females (44.67%), age groups of 60-69 (34%) followed by age groups 70-80(27.5%), parenteral SC route (59%) and
followed by intravenous route. (38%) and oral route was rare (3%), orthopaedics (64, 32%), followed by cardiology
(43, 21.5%), neurology (29, 14.5%), pulmonology (22, 11%).
Conclusion
To conclude with, Anticoagulants are effective drugs in an array of treatment of diseases involving careful
consideration of factors such as potency, formulation, responsiveness and cost. Anticoagulanting agents were mostly
given in cases of post or pre operative care followed by prophylaxis for thrombosis for better patient outcome.
RECENT ADVANCES IN THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASEPARUL UNIVERSITY
Medical treatment for inflammatory bowel disease (IBD) has progressed significantly over the past decade to achieve and maintain clinical remission in patients & to overcome the side effects of existing drugs for IBD. Conventional therapy for IBD include the use of Amino salicylates, corticosteroids & Anti-microbials. Patients who fail to respond to the conventional therapy are treated with agents such as Calcineurin inhibitor (Cyclosporine), and Biologics like TNF-α inhibitors (Infliximab or Adalimumab) or Anti-cell adhesion molecules (Vedolizumab, natalizumab). These agents are targeted against pro-inflammatory cytokines such as Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2) and Cell Surface Adhesion Molecules Integrin α4β7. In this review, we provide an overview on the recent advances in the treatment for IBD such as newer Biologics, Small Molecule drugs and Biosimilars effective for IBD and the role of other therapies like Probiotics, Prebiotics, Stem cell transplant and Faecal microbiota transplant and Microbiome targeting diet in the management of IBD
Anti-Inflamatorios No Esteroideos (AINES) - Non Steroidal Anti-Inflammatory D...Jorge Ramírez
Pharmacology of NSAIDs
Farmacología de los AINES
---
1. Salicilatos: Acido acetilsalicilico
2. Indoles: Indometacina
3. Pirazoles: Fenilbutazona
4. Fenamatos: Acido mefenamico
5. Derivados del acido propionico: Ibuprofeno, Ketoprofeno, Flurbiprofeno, Naproxeno 6. Derivados del acido fenilacetico: Diclofenaco, Aceclofenac
7. Oxicam: Piroxicam, Tenoxicam, Meloxicam 8. Sulphonanilide: Nimesulide
9.Coxibs (COX-2 selectivos): Celecoxib,Rofecoxib,Valdecoxib, Lumiracoxib (nota: diclofenaco también tiene mayor selectividad a COX-2 -> es como si fuera un « coxib »)
—-
No son AINEs - pero sí son analgésicos y antipiréticos:
- Para-aminofenol: Acetaminofen (no es un AINE) - Pirazolonas: dipirona (no es un AINE)
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
‘Six Sigma Technique’ A Journey Through its Implementationijtsrd
The manufacturing industries all over the world are facing tough challenges for growth, development and sustainability in today’s competitive environment. They have to achieve apex position by adapting with the global competitive environment by delivering goods and services at low cost, prime quality and better price to increase wealth and consumer satisfaction. Cost Management ensures profit, growth and sustainability of the business with implementation of Continuous Improvement Technique like Six Sigma. This leads to optimize Business performance. The method drives for customer satisfaction, low variation, reduction in waste and cycle time resulting into a competitive advantage over other industries which did not implement it. The main objective of this paper ‘Six Sigma Technique A Journey Through Its Implementation’ is to conceptualize the effectiveness of Six Sigma Technique through the journey of its implementation. Aditi Sunilkumar Ghosalkar "‘Six Sigma Technique’: A Journey Through its Implementation" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64546.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/64546/‘six-sigma-technique’-a-journey-through-its-implementation/aditi-sunilkumar-ghosalkar
Edge Computing in Space Enhancing Data Processing and Communication for Space...ijtsrd
Edge computing, a paradigm that involves processing data closer to its source, has gained significant attention for its potential to revolutionize data processing and communication in space missions. With the increasing complexity and data volume generated by modern space missions, traditional centralized computing approaches face challenges related to latency, bandwidth, and security. Edge computing in space, involving on board processing and analysis of data, offers promising solutions to these challenges. This paper explores the concept of edge computing in space, its benefits, applications, and future prospects in enhancing space missions. Manish Verma "Edge Computing in Space: Enhancing Data Processing and Communication for Space Missions" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64541.pdf Paper Url: https://www.ijtsrd.com/computer-science/artificial-intelligence/64541/edge-computing-in-space-enhancing-data-processing-and-communication-for-space-missions/manish-verma
Dynamics of Communal Politics in 21st Century India Challenges and Prospectsijtsrd
Communal politics in India has evolved through centuries, weaving a complex tapestry shaped by historical legacies, colonial influences, and contemporary socio political transformations. This research comprehensively examines the dynamics of communal politics in 21st century India, emphasizing its historical roots, socio political dynamics, economic implications, challenges, and prospects for mitigation. The historical perspective unravels the intricate interplay of religious identities and power dynamics from ancient civilizations to the impact of colonial rule, providing insights into the evolution of communalism. The socio political dynamics section delves into the contemporary manifestations, exploring the roles of identity politics, socio economic disparities, and globalization. The economic implications section highlights how communal politics intersects with economic issues, perpetuating disparities and influencing resource allocation. Challenges posed by communal politics are scrutinized, revealing multifaceted issues ranging from social fragmentation to threats against democratic values. The prospects for mitigation present a multifaceted approach, incorporating policy interventions, community engagement, and educational initiatives. The paper conducts a comparative analysis with international examples, identifying common patterns such as identity politics and economic disparities. It also examines unique challenges, emphasizing Indias diverse religious landscape, historical legacy, and secular framework. Lessons for effective strategies are drawn from international experiences, offering insights into inclusive policies, interfaith dialogue, media regulation, and global cooperation. By scrutinizing historical epochs, contemporary dynamics, economic implications, and international comparisons, this research provides a comprehensive understanding of communal politics in India. The proposed strategies for mitigation underscore the importance of a holistic approach to foster social harmony, inclusivity, and democratic values. Rose Hossain "Dynamics of Communal Politics in 21st Century India: Challenges and Prospects" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64528.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/history/64528/dynamics-of-communal-politics-in-21st-century-india-challenges-and-prospects/rose-hossain
Assess Perspective and Knowledge of Healthcare Providers Towards Elehealth in...ijtsrd
Background and Objective Telehealth has become a well known tool for the delivery of health care in Saudi Arabia, and the perspective and knowledge of healthcare providers are influential in the implementation, adoption and advancement of the method. This systematic review was conducted to examine the current literature base regarding telehealth and the related healthcare professional perspective and knowledge in the Kingdom of Saudi Arabia. Materials and Methods This systematic review was conducted by searching 7 databases including, MEDLINE, CINHAL, Web of Science, Scopus, PubMed, PsycINFO, and ProQuest Central. Studies on healthcare practitioners telehealth knowledge and perspectives published in English in Saudi Arabia from 2000 to 2023 were included. Boland directed this comprehensive review. The researchers examined each connected study using the AXIS tool, which evaluates cross sectional systematic reviews. Narrative synthesis was used to summarise and convey the data. Results Out of 1840 search results, 10 studies were included. Positive outlook and limited knowledge among providers were seen across trials. Healthcare professionals like telehealth for its ability to improve quality, access, and delivery, save time and money, and be successful. Age, gender, occupation, and work experience also affect health workers knowledge. In Saudi Arabia, healthcare professionals face inadequate expert assistance, patient privacy, internet connection concerns, lack of training courses, lack of telehealth understanding, and high costs while performing telemedicine. Conclusions Healthcare practitioners telehealth perceptions and knowledge were examined in this systematic study. Its collection of concerned experts different personal attitudes and expertise would help enhance telehealths implementation in Saudi Arabia, develop its healthcare delivery alternative, and eliminate frequent problems. Badriah Mousa I Mulayhi | Dr. Jomin George | Judy Jenkins "Assess Perspective and Knowledge of Healthcare Providers Towards Elehealth in Saudi Arabia: A Systematic Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64535.pdf Paper Url: https://www.ijtsrd.com/medicine/other/64535/assess-perspective-and-knowledge-of-healthcare-providers-towards-elehealth-in-saudi-arabia-a-systematic-review/badriah-mousa-i-mulayhi
The Impact of Digital Media on the Decentralization of Power and the Erosion ...ijtsrd
The impact of digital media on the distribution of power and the weakening of traditional gatekeepers has gained considerable attention in recent years. The adoption of digital technologies and the internet has resulted in declining influence and power for traditional gatekeepers such as publishing houses and news organizations. Simultaneously, digital media has facilitated the emergence of new voices and players in the media industry. Digital medias impact on power decentralization and gatekeeper erosion is visible in several ways. One significant aspect is the democratization of information, which enables anyone with an internet connection to publish and share content globally, leading to citizen journalism and bypassing traditional gatekeepers. Another aspect is the disruption of conventional media industry business models, as traditional organizations struggle to adjust to the decrease in advertising revenue and the rise of digital platforms. Alternative business models, such as subscription models and crowdfunding, have become more prevalent, leading to the emergence of new players. Overall, the impact of digital media on the distribution of power and the weakening of traditional gatekeepers has brought about significant changes in the media landscape and the way information is shared. Further research is required to fully comprehend the implications of these changes and their impact on society. Dr. Kusum Lata "The Impact of Digital Media on the Decentralization of Power and the Erosion of Traditional Gatekeepers" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64544.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/political-science/64544/the-impact-of-digital-media-on-the-decentralization-of-power-and-the-erosion-of-traditional-gatekeepers/dr-kusum-lata
Online Voices, Offline Impact Ambedkars Ideals and Socio Political Inclusion ...ijtsrd
This research investigates the nexus between online discussions on Dr. B.R. Ambedkars ideals and their impact on social inclusion among college students in Gurugram, Haryana. Surveying 240 students from 12 government colleges, findings indicate that 65 actively engage in online discussions, with 80 demonstrating moderate to high awareness of Ambedkars ideals. Statistically significant correlations reveal that higher online engagement correlates with increased awareness p 0.05 and perceived social inclusion. Variations across colleges and a notable effect of college type on perceived social inclusion highlight the influence of contextual factors. Furthermore, the intersectional analysis underscores nuanced differences based on gender, caste, and socio economic status. Dr. Kusum Lata "Online Voices, Offline Impact: Ambedkar's Ideals and Socio-Political Inclusion - A Study of Gurugram District" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64543.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/political-science/64543/online-voices-offline-impact-ambedkars-ideals-and-sociopolitical-inclusion--a-study-of-gurugram-district/dr-kusum-lata
Problems and Challenges of Agro Entreprenurship A Studyijtsrd
Noting calls for contextualizing Agro entrepreneurs problems and challenges of the agro entrepreneurs and for greater attention to the Role of entrepreneurs in agro entrepreneurship research, we conduct a systematic literature review of extent research in agriculture entrepreneurship to overcome the study objectives of complications of agro entrepreneurs through various factors, Development of agriculture products is a key factor for the overall economic growth of agro entrepreneurs Agro Entrepreneurs produces firsthand large scale employment, utilizes the labor and natural resources, This research outlines the problems of Weather and Soil Erosions, Market price fluctuation, stimulates labor cost problems, reduces concentration of Price volatility, Dependency on Intermediaries, induces Limited Bargaining Power, and Storage and Transportation Costs. This paper mainly devoted to highlight Problems and challenges faced for the sustainable of Agro Entrepreneurs in India. Vinay Prasad B "Problems and Challenges of Agro Entreprenurship - A Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64540.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/64540/problems-and-challenges-of-agro-entreprenurship--a-study/vinay-prasad-b
Comparative Analysis of Total Corporate Disclosure of Selected IT Companies o...ijtsrd
Disclosure is a process through which a business enterprise communicates with external parties. A corporate disclosure is communication of financial and non financial information of the activities of a business enterprise to the interested entities. Corporate disclosure is done through publishing annual reports. So corporate disclosure through annual reports plays a vital role in the life of all the companies and provides valuable information to investors. The basic objectives of corporate disclosure is to give a true and fair view of companies to the parties related either directly or indirectly like owner, government, creditors, shareholders etc. in the companies act, provisions have been made about mandatory and voluntary disclosure. The IT sector in India is rapidly growing, the trend to invest in the IT sector is rising and employment opportunities in IT sectors are also increasing. Therefore the IT sector is expected to have fair, full and adequate disclosure of all information. Unfair and incomplete disclosure may adversely affect the entire economy. A research study on disclosure practices of IT companies could play an important role in this regard. Hence, the present research study has been done to study and review comparative analysis of total corporate disclosure of selected IT companies of India and to put forward overall findings and suggestions with a view to increase disclosure score of these companies. The researcher hopes that the present research study will be helpful to all selected Companies for improving level of corporate disclosure through annual reports as well as the government, creditors, investors, all business organizations and upcoming researcher for comparative analyses of level of corporate disclosure with special reference to selected IT companies. Dr. Vaibhavi D. Thaker "Comparative Analysis of Total Corporate Disclosure of Selected IT Companies of India" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64539.pdf Paper Url: https://www.ijtsrd.com/other-scientific-research-area/other/64539/comparative-analysis-of-total-corporate-disclosure-of-selected-it-companies-of-india/dr-vaibhavi-d-thaker
The Impact of Educational Background and Professional Training on Human Right...ijtsrd
This study investigated the impact of educational background and professional training on human rights awareness among secondary school teachers in the Marathwada region of Maharashtra, India. The key findings reveal that higher levels of education, particularly a master’s degree, and fields of study related to education, humanities, or social sciences are associated with greater human rights awareness among teachers. Additionally, both pre service teacher training and in service professional development programs focused on human rights education significantly enhance teacher’s knowledge, skills, and competencies in promoting human rights principles in their classrooms. Baig Ameer Bee Mirza Abdul Aziz | Dr. Syed Azaz Ali Amjad Ali "The Impact of Educational Background and Professional Training on Human Rights Awareness among Secondary School Teachers" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64529.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/education/64529/the-impact-of-educational-background-and-professional-training-on-human-rights-awareness-among-secondary-school-teachers/baig-ameer-bee-mirza-abdul-aziz
A Study on the Effective Teaching Learning Process in English Curriculum at t...ijtsrd
“One Language sets you in a corridor for life. Two languages open every door along the way” Frank Smith English as a foreign language or as a second language has been ruling in India since the period of Lord Macaulay. But the question is how much we teach or learn English properly in our culture. Is there any scope to use English as a language rather than a subject How much we learn or teach English without any interference of mother language specially in the classroom teaching learning scenario in West Bengal By considering all these issues the researcher has attempted in this article to focus on the effective teaching learning process comparing to other traditional strategies in the field of English curriculum at the secondary level to investigate whether they fulfill the present teaching learning requirements or not by examining the validity of the present curriculum of English. The purpose of this study is to focus on the effectiveness of the systematic, scientific, sequential and logical transaction of the course between the teachers and the learners in the perspective of the 5Es programme that is engage, explore, explain, extend and evaluate. Sanchali Mondal | Santinath Sarkar "A Study on the Effective Teaching Learning Process in English Curriculum at the Secondary Level of West Bengal" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd62412.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/education/62412/a-study-on-the-effective-teaching-learning-process-in-english-curriculum-at-the-secondary-level-of-west-bengal/sanchali-mondal
The Role of Mentoring and Its Influence on the Effectiveness of the Teaching ...ijtsrd
This paper reports on a study which was conducted to investigate the role of mentoring and its influence on the effectiveness of the teaching of Physics in secondary schools in the South West Region of Cameroon. The study adopted the convergent parallel mixed methods design, focusing on respondents in secondary schools in the South West Region of Cameroon. Both quantitative and qualitative data were collected, analysed separately, and the results were compared to see if the findings confirm or disconfirm each other. The quantitative analysis found that majority of the respondents 72 of Physics teachers affirmed that they had more experienced colleagues as mentors to help build their confidence, improve their teaching, and help them improve their effectiveness and efficiency in guiding learners’ achievements. Only 28 of the respondents disagreed with these statements. With majority respondents 72 agreeing with the statements, it implies that in most secondary schools, experienced Physics teachers act as mentors to build teachers’ confidence in teaching and improving students’ learning. The interview qualitative data analysis summarized how secondary school Principals use meetings with mentors and mentees to promote mentorship in the school milieu. This has helped strengthen teachers’ classroom practices in secondary schools in the South West Region of Cameroon. With the results confirming each other, the study recommends that mentoring should focus on helping teachers employ social interactions and instructional practices feedback and clarity in teaching that have direct measurable impact on students’ learning achievements. Andrew Ngeim Sumba | Frederick Ebot Ashu | Peter Agborbechem Tambi "The Role of Mentoring and Its Influence on the Effectiveness of the Teaching of Physics in Secondary Schools in the South West Region of Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64524.pdf Paper Url: https://www.ijtsrd.com/management/management-development/64524/the-role-of-mentoring-and-its-influence-on-the-effectiveness-of-the-teaching-of-physics-in-secondary-schools-in-the-south-west-region-of-cameroon/andrew-ngeim-sumba
Design Simulation and Hardware Construction of an Arduino Microcontroller Bas...ijtsrd
This study primarily focuses on the design of a high side buck converter using an Arduino microcontroller. The converter is specifically intended for use in DC DC applications, particularly in standalone solar PV systems where the PV output voltage exceeds the load or battery voltage. To evaluate the performance of the converter, simulation experiments are conducted using Proteus Software. These simulations provide insights into the input and output voltages, currents, powers, and efficiency under different state of charge SoC conditions of a 12V,70Ah rechargeable lead acid battery. Additionally, the hardware design of the converter is implemented, and practical data is collected through operation, monitoring, and recording. By comparing the simulation results with the practical results, the efficiency and performance of the designed converter are assessed. The findings indicate that while the buck converter is suitable for practical use in standalone PV systems, its efficiency is compromised due to a lower output current. Chan Myae Aung | Dr. Ei Mon "Design Simulation and Hardware Construction of an Arduino-Microcontroller Based DC-DC High-Side Buck Converter for Standalone PV System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64518.pdf Paper Url: https://www.ijtsrd.com/engineering/mechanical-engineering/64518/design-simulation-and-hardware-construction-of-an-arduinomicrocontroller-based-dcdc-highside-buck-converter-for-standalone-pv-system/chan-myae-aung
Sustainable Energy by Paul A. Adekunte | Matthew N. O. Sadiku | Janet O. Sadikuijtsrd
Energy becomes sustainable if it meets the needs of the present without compromising the ability of future generations to meet their own needs. Some of the definitions of sustainable energy include the considerations of environmental aspects such as greenhouse gas emissions, social, and economic aspects such as energy poverty. Generally far more sustainable than fossil fuel are renewable energy sources such as wind, hydroelectric power, solar, and geothermal energy sources. Worthy of note is that some renewable energy projects, like the clearing of forests to produce biofuels, can cause severe environmental damage. The sustainability of nuclear power which is a low carbon source is highly debated because of concerns about radioactive waste, nuclear proliferation, and accidents. The switching from coal to natural gas has environmental benefits, including a lower climate impact, but could lead to delay in switching to more sustainable options. “Carbon capture and storage” can be built into power plants to remove the carbon dioxide CO2 emissions, but this technology is expensive and has rarely been implemented. Leading non renewable energy sources around the world is fossil fuels, coal, petroleum, and natural gas. Nuclear energy is usually considered another non renewable energy source, although nuclear energy itself is a renewable energy source, but the material used in nuclear power plants is not. The paper addresses the issue of sustainable energy, its attendant benefits to the future generation, and humanity in general. Paul A. Adekunte | Matthew N. O. Sadiku | Janet O. Sadiku "Sustainable Energy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64534.pdf Paper Url: https://www.ijtsrd.com/engineering/electrical-engineering/64534/sustainable-energy/paul-a-adekunte
Concepts for Sudan Survey Act Implementations Executive Regulations and Stand...ijtsrd
This paper aims to outline the executive regulations, survey standards, and specifications required for the implementation of the Sudan Survey Act, and for regulating and organizing all surveying work activities in Sudan. The act has been discussed for more than 5 years. The Land Survey Act was initiated by the Sudan Survey Authority and all official legislations were headed by the Sudan Ministry of Justice till it was issued in 2022. The paper presents conceptual guidelines to be used for the Survey Act implementation and to regulate the survey work practice, standardizing the field surveys, processing, quality control, procedures, and the processes related to survey work carried out by the stakeholders and relevant authorities in Sudan. The conceptual guidelines are meant to improve the quality and harmonization of geospatial data and to aid decision making processes as well as geospatial information systems. The established comprehensive executive regulations will govern and regulate the implementation of the Sudan Survey Geomatics Act in all surveying and mapping practices undertaken by the Sudan Survey Authority SSA and state local survey departments for public or private sector organizations. The targeted standards and specifications include the reference frame, projection, coordinate systems, and the guidelines and specifications that must be followed in the field of survey work, processes, and mapping products. In the last few decades, there has been a growing awareness of the importance of geomatics activities and measurements on the Earths surface in space and time, together with observing and mapping the changes. In such cases, data must be captured promptly, standardized, and obtained with more accuracy and specified in much detail. The paper will also highlight the current situation in Sudan, the degree to which survey standards are used, the problems encountered, and the errors that arise from not using the standards and survey specifications. Kamal A. A. Sami "Concepts for Sudan Survey Act Implementations - Executive Regulations and Standards" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63484.pdf Paper Url: https://www.ijtsrd.com/engineering/civil-engineering/63484/concepts-for-sudan-survey-act-implementations--executive-regulations-and-standards/kamal-a-a-sami
Towards the Implementation of the Sudan Interpolated Geoid Model Khartoum Sta...ijtsrd
The discussions between ellipsoid and geoid have invoked many researchers during the recent decades, especially during the GNSS technology era, which had witnessed a great deal of development but still geoid undulation requires more investigations. To figure out a solution for Sudans local geoid, this research has tried to intake the possibility of determining the geoid model by following two approaches, gravimetric and geometrical geoid model determination, by making use of GNSS leveling benchmarks at Khartoum state. The Benchmarks are well distributed in the study area, in which, the horizontal coordinates and the height above the ellipsoid have been observed by GNSS while orthometric heights were carried out using precise leveling. The Global Geopotential Model GGM represented in EGM2008 has been exploited to figure out the geoid undulation at the benchmarks in the study area. This is followed by a fitting process, that has been done to suit the geoid undulation data which has been computed using GNSS leveling data and geoid undulation inspired by the EGM2008. Two geoid surfaces were created after the fitting process to ensure that they are identical and both of them could be counted for getting the same geoid undulation with an acceptable accuracy. In this respect, statistical operation played an important role in ensuring the consistency and integrity of the model by applying cross validation techniques splitting the data into training and testing datasets for building the geoid model and testing its eligibility. The geometrical solution for geoid undulation computation has been utilized by applying straightforward equations that facilitate the calculation of the geoid undulation directly through applying statistical techniques for the GNSS leveling data of the study area to get the common equation parameters values that could be utilized to calculate geoid undulation of any position in the study area within the claimed accuracy. Both systems were checked and proved eligible to be used within the study area with acceptable accuracy which may contribute to solving the geoid undulation problem in the Khartoum area, and be further generalized to determine the geoid model over the entire country, and this could be considered in the future, for regional and continental geoid model. Ahmed M. A. Mohammed. | Kamal A. A. Sami "Towards the Implementation of the Sudan Interpolated Geoid Model (Khartoum State Case Study)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63483.pdf Paper Url: https://www.ijtsrd.com/engineering/civil-engineering/63483/towards-the-implementation-of-the-sudan-interpolated-geoid-model-khartoum-state-case-study/ahmed-m-a-mohammed
Activating Geospatial Information for Sudans Sustainable Investment Mapijtsrd
Sudan is witnessing an acceleration in the processes of development and transformation in the performance of government institutions to raise the productivity and investment efficiency of the government sector. The development plans and investment opportunities have focused on achieving national goals in various sectors. This paper aims to illuminate the path to the future and provide geospatial data and information to develop the investment climate and environment for all sized businesses, and to bridge the development gap between the Sudan states. The Sudan Survey Authority SSA is the main advisor to the Sudan Government in conducting surveying, mappings, designing, and developing systems related to geospatial data and information. In recent years, SSA made a strategic partnership with the Ministry of Investment to activate Geospatial Information for Sudans Sustainable Investment and in particular, for the preparation and implementation of the Sudan investment map, based on the directives and objectives of the Ministry of Investment MI in Sudan. This paper comes within the framework of activating the efforts of the Ministry of Investment to develop technical investment services by applying techniques adopted by the Ministry and its strategic partners for advancing investment processes in the country. Kamal A. A. Sami "Activating Geospatial Information for Sudan's Sustainable Investment Map" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63482.pdf Paper Url: https://www.ijtsrd.com/engineering/information-technology/63482/activating-geospatial-information-for-sudans-sustainable-investment-map/kamal-a-a-sami
Educational Unity Embracing Diversity for a Stronger Societyijtsrd
In a rapidly changing global landscape, the importance of education as a unifying force cannot be overstated. This paper explores the crucial role of educational unity in fostering a stronger and more inclusive society through the embrace of diversity. By examining the benefits of diverse learning environments, the paper aims to highlight the positive impact on societal strength. The discussion encompasses various dimensions, from curriculum design to classroom dynamics, and emphasizes the need for educational institutions to become catalysts for unity in diversity. It highlights the need for a paradigm shift in educational policies, curricula, and pedagogical approaches to ensure that they are reflective of the diverse fabric of society. This paper also addresses the challenges associated with implementing inclusive educational practices and offers practical strategies for overcoming barriers. It advocates for collaborative efforts between educational institutions, policymakers, and communities to create a supportive ecosystem that promotes diversity and unity. Mr. Amit Adhikari | Madhumita Teli | Gopal Adhikari "Educational Unity: Embracing Diversity for a Stronger Society" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64525.pdf Paper Url: https://www.ijtsrd.com/humanities-and-the-arts/education/64525/educational-unity-embracing-diversity-for-a-stronger-society/mr-amit-adhikari
Integration of Indian Indigenous Knowledge System in Management Prospects and...ijtsrd
The diversity of indigenous knowledge systems in India is vast and can vary significantly between different communities and regions. Preserving and respecting these knowledge systems is crucial for maintaining cultural heritage, promoting sustainable practices, and fostering cross cultural understanding. In this paper, an overview of the prospects and challenges associated with incorporating Indian indigenous knowledge into management is explored. It is found that IIKS helps in management in many areas like sustainable development, tourism, food security, natural resource management, cultural preservation and innovation, etc. However, IIKS integration with management faces some challenges in the form of a lack of documentation, cultural sensitivity, language barriers legal framework, etc. Savita Lathwal "Integration of Indian Indigenous Knowledge System in Management: Prospects and Challenges" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63500.pdf Paper Url: https://www.ijtsrd.com/management/accounting-and-finance/63500/integration-of-indian-indigenous-knowledge-system-in-management-prospects-and-challenges/savita-lathwal
DeepMask Transforming Face Mask Identification for Better Pandemic Control in...ijtsrd
The COVID 19 pandemic has highlighted the crucial need of preventive measures, with widespread use of face masks being a key method for slowing the viruss spread. This research investigates face mask identification using deep learning as a technological solution to be reducing the risk of coronavirus transmission. The proposed method uses state of the art convolutional neural networks CNNs and transfer learning to automatically recognize persons who are not wearing masks in a variety of circumstances. We discuss how this strategy improves public health and safety by providing an efficient manner of enforcing mask wearing standards. The report also discusses the obstacles, ethical concerns, and prospective applications of face mask detection systems in the ongoing fight against the pandemic. Dilip Kumar Sharma | Aaditya Yadav "DeepMask: Transforming Face Mask Identification for Better Pandemic Control in the COVID-19 Era" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd64522.pdf Paper Url: https://www.ijtsrd.com/engineering/electronics-and-communication-engineering/64522/deepmask-transforming-face-mask-identification-for-better-pandemic-control-in-the-covid19-era/dilip-kumar-sharma
Streamlining Data Collection eCRF Design and Machine Learningijtsrd
Efficient and accurate data collection is paramount in clinical trials, and the design of Electronic Case Report Forms eCRFs plays a pivotal role in streamlining this process. This paper explores the integration of machine learning techniques in the design and implementation of eCRFs to enhance data collection efficiency. We delve into the synergies between eCRF design principles and machine learning algorithms, aiming to optimize data quality, reduce errors, and expedite the overall data collection process. The application of machine learning in eCRF design brings forth innovative approaches to data validation, anomaly detection, and real time adaptability. This paper discusses the benefits, challenges, and future prospects of leveraging machine learning in eCRF design for streamlined and advanced data collection in clinical trials. Dhanalakshmi D | Vijaya Lakshmi Kannareddy "Streamlining Data Collection: eCRF Design and Machine Learning" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63515.pdf Paper Url: https://www.ijtsrd.com/biological-science/biotechnology/63515/streamlining-data-collection-ecrf-design-and-machine-learning/dhanalakshmi-d
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
2. International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470
@ IJTSRD | Unique Paper ID – IJTSRD30018 | Volume – 4 | Issue – 2 | January-February 2020 Page 976
POTENCY
The reader may be familiar with television commercials advertising 'extra-strength' analgesics and analgesics containing an
extra 325 mg of pain reliever. Common sense dictates that three 325 mg tablets will deliver as·much active ingredient as one
'extra strength' 975 mg tablet. The same is true of NSAIDs. Moreover, side effects are seldom related to the number of
milligrams of NSAID when a therapeutic dose is administered; that is, 50 mg of diclofenac will not necessarily produce fewer
side effects than 1,000 mg of ASA. In short, potency is an irrelevant issue which should not be confused with efficacy, a
measure of how well the drug works.
EFFICACY
The efficacy of a drug can be assessed only through well-designed randomized clinical trials. Unfortunately,veryfewclinical
trials of NSAIDs have been rigorous enough to truly differentiateagents;the resultis considerable difficultyininterpreting and
evaluating their conclusions. Nevertheless, a review of the literature indicates that there are no large differences in efficacy
between NSAIDs used in the treatment of rheumatoid arthritis, osteoarthritis and (for those NSAIDs studied) the
seronegative arthropathies and gout. The initial choice of drug must therefore be based on side effects and cost.
PHARMACOKINETIC
Absorption
Almost all currently available NSAIDs are rapidly, and virtually completely absorbed after oral ingestion. It takes longer for
enteric-coated ASA to be completely absorbed than non-enteric-coated ASA, but the minor disadvantage of a slight delay in
achieving therapeutic serum concentrations is offset by a significant decrease in the incidence of gastric erosions.
Moreover, speed of absorption does not equal speed of onset of therapeutic effect. Maximum therapeutic effect may take
considerably longer to achieve than maximum serum concentration.Thus, the clinical significance of manufacturers claims
about rapid absorption should be interpreted critically.
Distribution
All NSAIDs which have been investigated have been found in joint fluid in concentrations high enough to inhibit
prostaglandin production. How ever, there is no good evidence that synovial fluid concentrations correlate with clinical
response, so at present no one drug is preferable to another in this respect.
Biotransformation and excretion
Aspirin, phenylbutazone and sulindac are the only NSAIDs which have therapeuticallyactivemetabolites.When both parent
compound and metabolite have anti-inflammatory actions, the drug's benefits and adverse effects are prolonged. In theory,
this may lengthen the dosage interval for such drugs. In practice, the presence of active metabolites becomes important
only in cases of serious overdose. The exception to this is sulindac, which is in itself virtually inactive; itssulfidemetabolite is
the therapeutically active compound. One might expect that the parent compound's inactivity would result in a lower
incidence of gastrointestinal side effects-a finding that is not borne out in practice (see 'Side Effects', below)."
Salicylates demand special consideration because of their peculiar elimination kinetics."ASA is metabolized to salicylic acid
by esterases in the gut lumen. Salicylate is then metabolized through four simultaneous pathways. The two majorpathways
have limited capacity to convert salicylic acid to its metabolites, and whenthis capacity is overwhelmed by a moderateIylarge
amount of ingested salicylate, the result is a metabolic 'backlog' and an increase in the serumhalf-life of the active compound,
salicylate. Thus, the half-life of elimination of salicylate varies from three hours at low dose (one gram) to 16-20 hours at
recommended anti-inflammatory doses (three to six grams a day).
Half life
The half life of a drug is the time it takes for the serum concentration to be reduced by half. This may or may not correlate
with the length of time between doses. In the case of NSAIDs, direct correlation is rare; diclofenac for example, has a half life
of one hour, but clinical experience has shown that it can be effective when given twice or even once a day. Similarly,
manufacturers claims about the benefits of a drug with a longer half life should be interpreted cautiously; only randomized
controlled trials can determine optimal dosage regimens.
MECHANISM OF ACTION
NSAIDs acts by the inhibition of COX no matter what structural diversity they have. Prostaglandins are produced by the COX
pathway which are the end products of fatty acid metabolism. They are the major physiological mediators in the therapeutic
areas like pain, inflammation, cancer, pyrexia and neurological disease.
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Fig: 2 Mechanism of action of NSAIDs
SIDE EFFECTS
All NSAIDs causes side effects. These side effects should be identified as those that virtuallyprohibitdruguse, thosefor which
patients should be closely monitored and those which are common but not life-threatening.
Table1: Adverse effects of NSAIDs on various systems
Cardiovascular side effects Edema
Hypertention
Congestive heart failure
Myocardial infarction
Stroke and other thrombotic events
Gastrointestinal toxicity Dyspepsia
Gastroduodenal ulcer
GI bleeding and perforation
Nephrotoxicity Electrolytic imbalance
Sodium retention
Edema
Reduce glomerular filtration rate
Nephrotic syndrome
Acute interstitial nephritis
Renal papillary necrosis
Chronic kidney disease
Side effects that virtuallyprohibit use
Blood dyscrasias (aplastic anemia and agranulocytosis) may occur with phenylbutazone and fall into the first category.Ithas
been estimated that there is one fatal blood dyscrasia for every 250,000 patient/months with this drug. Oxyphenbutazone is
probably no safer than phenylbutazone and both these drugs should be used as a last resort for patients who have not
responded to any other NSAID after an appropriate therapeutic trial.
Side effectsfor close monitoring
Fenoprofen has also been linked with aplastic anemia, but to date only two cases have been reported. This drug should be
used cautiously, and patients should be closely monitored. Virtually all NSAIDs may precipitate asthma in susceptible
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patients that is, 8.2% of patients with pre-existing asthma or sensitivity to ASA (rhinitis and nasal polyps).Patients who have
asthma, or patients in whom asthma has developed following the use of NSAIDs, should be referred to a pulmonary function
laboratory for sensitivity testing. While the exacerbation of asthma by NSAIDs is rare, it can be fatal in highly sensitive
patients. Acetaminophen and non-acetylated salicylate (e.g., choline magnesium trisalicylate) can be tried in most of these
patients. It is safest to start with half a tablet and to observe the patient for two to three hours. Four percent of patients who
are sensitive to ASA will also be sensitive to acetaminophen. Renal dysfunction has been reported as a side effect for virtually
all NSAIDs. Monitoring serum creatinine and urine protein should be started when therapy begins, and then at three to six
month intervals. Patients should be instructed to notify the physician if they gain weight, or develop edema, muscle
weakness, anorexia or decreased micturition. It is not clear from the literature whether patients who develop renal
impairment can be safely treated with alternative NSAIDs. A reasonable approach is a cautious trial with an NSAID from a
different chemical class (see Table 1), with close monitoring of renal function.
Idiosyncratic adverse effects
Two NSAIDs have been reported to cause idiosyncratic adverse effects that are not typical ofthis group of drugs.Tolmetin has
been reported to produce a much higher incidence of anaphylactoid reactions than any of the other NSAID's. This reaction
usually appears after anuneventful first course of treatment. Sulindac has been associated with a variety of rare multisystem
adverse reactions, including hypersensitivity, pneumonitis, fever, abnormal liver function, lymphadenopathy and bone
marrow and skin involvement. Of the four patients reported to have developed these adversereactions to sulindac, onedied
of coagulopathy. Pancreatitis associated with sulindac has also been reported.
Non life-threatening side effects
Adverse reactions that are common and not life-threatening, are well known to most clinicians. Gastrointestinal upset of
varying severity is common with all NSAIDs. Gastrointestinal (GI) ulceration is associated with NSAID use, but it is not clear
whether ulceration is a manifestation of rheumatoid arthritis as a multisystem disease process, or ulcerationiscausedbythe
inhibition of prostaglandins, which are cytoprotective in the gastric mucosa, or ulcers are present but asymptomatic until
NSAIDs exacerbate them. Thus, although patients who develop gastric or duodenal ulceration while receiving NSAIDs should
receive anti-ulcer treatment, the presence of ulceration does not necessarily preclude use of NSAIDs. In a study of healthy
volunteers, enteric-coated ASA caused fewer endoscopically apparent gastric erosions than uncoated or 'buffered' ASA,but
the relevance of this to patients with rheumatic disease is not known. Gastrointestinal bleeding at the rate of one to two
milliliters a day is common with all NSAIDs. However, frank gastrointestinal hemorrhage is probably rare. Duggan has
estimated the risk of serious gastrointestinal hemorrhage to be one episode per two million doses of ASA. It has also been
estimated that there are 1 5 episodes of major bleeding per 100,000 patients taking ASA more frequently than fourdays per
week, and frank GI bleeding may also be a particular concern when patients are taking piroxicam. GI distress may be
reduced if the medication is taken with meals. Severe frontal headache is more common than GI distress in patients taking
indomethacin, but it may be less severe at lower doses. Tinnitus may occur frequently with ASA use and we have observed
that hyperventilation and deafness may alsobea sideeffectinelderlypatients.ASA-induced tinnitus and deafnessmayrespond
to a lower dose of ASA, but a different agent may be required if a therapeutic effect cannot be elicited at the lower dose. All
NSAIDs except ibuprofen22 and naproxen have clinically significant antiplatelet effects. Because all NSAIDs can produce
adverse effects, all patients-especially elderly ones-should be selected carefully for treatment. It is also important to limit
the use of NSAIDs to conditions for which they are clearly indicated. Indiscriminate prescribing will increasethe frequency of
adverse reactions in a population for whom the drug was never intended.
DRUG INTERACTION OF NSAIDs
Adverse drug reactions are very commonly shown in NSAIDs so as the age and no. of medication increases NSAIDs should
prescribe with caution.
Table2: Drug interactions with NSAIDs
Medicaments Interactions
Antiplatelets (aspirin, clopidogrel) Risk of GI bleeding
Angiotensin-converting-enzyme inhibitor (ACEI)
and Angiotensin Receptor Blockers (ARB)
Increases in blood pressure by attenuating antihypertensive effects
Beta blockers Increases in blood pressure by attenuating antihypertensive effects
Calcium antagonists Increases in blood pressure by attenuating antihypertensive effects
Corticosteroids Increases risk of GI bleeding
Digitalis glycosides Increase serum digoxin level
Diuretics Increases in blood pressure by attenuating antihypertensive effects
Methotrexate
NSAIDs reduce renal excretion of methotrexate, causing ethotrexate
toxicity.
Selective serotonin reuptake inhibitors (SSRIs) Increases risk of GI bleeding
Warfarin and other anticoagulants Increases risk of GI bleeding
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COMPLIANCE
It is important to remember that NSAIDSs reduce joint
inflammation, but do not alter the course of rheumatoid
arthritis, that their side effects range from distressing to
disastrous, and that if symptoms are reasonably controlled
with a lower dose, it is pointless to insist on 'full
compliance'.With this in mind, however, it is obvious that
patients who never take their drugs or who take them
inefficiently, will not gain optimum benefits. Factors which
affect compliance in patients with rheumatoid arthritis
have not been extensively studied. Overall drug
compliance has been reported as 64%,a figure similar to
the compliance rate of patients taking antihypertensive
medications.Demographic factors such as age, sex, race and
socioeconomic status appear to have no effect on
compliance. In general, there is no clear relationship
between disease severity and compliance for conditions
other than rheumatic diseases, and while evidence suggests
that a complex drug regimen makes patients with other
diseases less compliant, this evidence has not been
consistently reproduced in patients with rheumatoid
arthritis. Nor is it clear that the length of time between
doses has any effect on compliance contrary totheclaimsof
many manufacturers. However, patient compliance does
appear to vary according to the drug used; mean drug
specific compliance rates for the major anti-inflammatory
drugs prescribed over a six-month period have been
reported as follows: penicillamine, 84%; prednisone 82%;
naproxen 72%; ASA 69%; ibuprofen 61 %; and
indomethacin 58%. In one study which documented drop-
out rates at the end of one year of treatment, 84% of
patients taking ASA had stopped taking their medication,
compared to 64% of patients taking indomethacin or
naproxen and 57% of patients taking flurbiprofen. Finally,
diagnosis appears to have an effect on compliance: the
compliance rate was 73% for patients with rheumatoid
arthritis; 53% for patients with osteoarthritis; 51 % for
patients with ankylosing spondylitis, and 65% for patients
with gout.
PRACTICAL PRISCRIBING
The practical prescribing of NSAIDs has been covered in
depth in recent publications. The following steps may be
useful for prescribing NSAIDs:
1. Determine if the patient responded to a particular
NSAID previously. If so, prescribe it again unless the
patient suffered an adverse effect that precludes itsuse.
2. Select an NSAID based on your experience, the cost to
the patient, and how likely the patient is to experience
an adverse effect.
3. Choose a dose appropriate to the patient's symptoms.
There is no point in prescribing maximum doses of
NSAIDs if the patient has only mild or moderately
severe symptoms. Moreover, the likelihood of side
effects may be increased at higher doses. In patients
with severe symptoms, titrate medication against pain,
disability and side effects.
4. In general, avoid combinations of NSAIDs.Naproxenor
ibuprofen may be more effective when given with ASA,
but other combinations have not been shown to be
more effective than singleagents.Again,thelikelihoodof
side effects is increased with combination therapy, and
the cost may be prohibitive.
5. Do not change from one NSAID to another until the
patient has received treatment for at least one week.
Optimum results may not be achieved until he has
been taking the NSAID for one to three weeks.
6. Patients may believe that drug therapy has failed when,
in fact, their disease has become more severe. A short
drug holiday followed by reinstatement of the same
drug may help to determine whether the disease is
more severe, or the drug therapy isineffective. Itmay be
appropriate to temporarily increase doses or to add
analgesics to control symptoms.
7. Be alert for adverse effects from NSAIDs. When you
suspect there are adverse effects, take the patient off
the drug and select another, (see Adverse Effects').
Suspected adverse reactions should also be reportedto
the provincial Medical Association or to the Health
Protection Branch.
ACKNOWLEDGEMENT
no conflicts of interest
COCNCLUSION
In order to provide an instant remedy and comprehensive
care to the patient by knowing the exact mechanism of
action, adverse drug reactions and pleiotropic effects are
very important. Non – steroidal anti-inflammatorydrugsare
the mostly common drugs which are prescribed. And by the
clinical study it was revealed that these drugs should be
prescribed for the shorter duration of time as well with
lowest effective dose and under the care with monitoringGI,
renal and cardiovascular toxicity.
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