Search results for: H. Duggal

Authors: Vasuki Rayapati, Bhanu Duggal

Abstract:

Trans catheter aortic valve replacement (TAVR) is the recommended treatment over surgical aortic valve replacement (SAVR) for high-risk groups, patients >75 years of age with severe symptomatic Aortic stenosis (AS). In high income countries TAVR is more cost effective because of – i) Reduction in total length of stay including less number of days in ICU ii) Non-procedural costs like cost of general anaesthesia are higher for SAVR. In India, there are two kinds of hospitals – Public and Private. Most patients visit public sector hospitals than private sector hospitals. In a LMIC like India, especially in the Public health sector cost of TAVR is prohibitive. In a small study from three (public) hospitals in India, it was envisaged that cost of TAVR should decrease at least by 2/3 to be a cost effective option in Public health sector for severe AS.

Keywords: cost effectiveness, TAVR vs SAVR, LMIC, HTA

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Authors: Pratima Tatke, Archana Avhad, Bhanu Duggal, Meeta Rajivlochan, Sujata Saunik, Pradip Vyas, Nidhi Pandey, Aditee Dalvi, Jyothi Subramanian

Abstract:

Background: Smoking is well established risk factor for the development and progression of coronary artery disease. It is strongly related to morbidity and mortality from cardiovascular causes. The aim of this study is to observe effect of smoking status on percutaneous coronary intervention(PCI) after 1 year. Methods: 2527 patients who underwent PCI at different hospital of Maharashtra(India) from 2012 to 2015 under the health insurance scheme which is launched by Health department, Government of Maharashtra for below poverty line(BPL) families which covers cardiology. Informed consent of patients was taken .They were followed by telephonic survey after 6months to 1year of PCI . Outcomes of interest included myocardial infarction, restenosis, cardiac rehospitalization, death, and a composite of events after PCI. Made group of two non smokers-1861 and smokers (including patients who quit at time of PCI )-659. Results: Statistical Analysis using Pearson’s chi square test revealed that there was trend seen of increasing incidence of death, Myocardial infarction and Restenosis in smokers than non smokers .Smokers had a greater death risk compared to nonsmoker; 5.7% and 5.1% respectively p=0.518. Also Repeat procedures (2.1% vs. 1.5% p=0.222), breathlessness (17.8% vs. 18.20% p=0.1) and Myocardial Infarction (7.3% vs. 10%) high in smoker than non smokers. Conclusion: Major adverse cardiovascular events (MACE) were observed even after successful PCI in smokers. Patients undergoing percutaneous coronary intervention should be encouraged to stop smoking.

Keywords: coronary artery diseases, major adverse cardiovascular events, percutaneous coronary intervention, smoking

Procedia PDF Downloads 177

Authors: H. Duggal, G. Singh, G. Singh, A. Bhalla, S. Kumar, J. S. Shahi, D. Mehta

Abstract:

The total differential cross section for scattering of the 5.895 keV photons by various polymers has been measured at scattering angle of 135o. The experimental measurements were carried out using the energy dispersive setup involving annular source of the 55Fe radioisotope and a low energy germanium (LEGe) detector. The cross section values are measured for 20 polymer targets namely, Paraffin Wax, Polytetrafluoro ethylene (PTFE), Cellulose, Silicone oil, Polyvinyl alcohol (PVA), Polyvinyl purrolidone (PVP), Polymethyl methacrylate (PMMA), Kapton, Mylar, Chitosan, Polyvinyl chloride (PVC), Bakelite, Carbopol, Chlorobutyl rubber (CBR), Polyetylene glycol (PEG), Polysorbate-20, Nylon-6, Cetyl alcohol, Carboxyl methyl sodium cellulose and Sodium starch glucolate. The measurements were performed in vacuum so as to avoid scattering contribution due to air and strong absorption of low energy photons in the air column. In the present investigations, the geometrical factor and efficiency of the detector were determined by measuring the K x-rays emitted from the 22Ti and 23V targets excited by the Mn K x-rays in the same experimental set up. The measured scattering cross sections have been compared with the sum of theoretically calculated elastic and inelastic scattering cross sections. The theoretical elastic (Rayleigh) scattering cross sections based on the various form factor approximations, namely, non-relativistic form factor (NF), relativistic form factor (RF), modified form factor (MF), and MF with anomalous scattering factor (ASF) as well as the second order S-matrix formalisms, and the inelastic scattering differential cross sections based on the Klein-Nishina formula after including the inelastic scattering function (KN+ISF) have been calculated. The experimental results show fairly good agreement with theoretical cross sections.

Keywords: photon, polymers, elastic and inelastic, scattering cross sections

Procedia PDF Downloads 657

Authors: Drishti Sharma, Mona Duggal

Abstract:

Background: WhatsApp can serve as a cost-effective, scalable, convenient, and popular medium for public health management related communication in the developing world where the existing system of communication is top-down and slow. The product supports sending and receiving a variety of media: text, photos, videos, documents, and location, as well as voice/video calls. With growing number of users of smartphones and improving access and penetration of internet, the scope of information technology remains immense in resolving the hurdles faced by traditional public health system. Poor infrastructure, gap in digital literacy, faulty documentation, strict organizational hierarchy and slow movement of information across desks and offices- all these, make WhatsApp an efficient prospect to complement the existing system for communication, feedback and leadership for public health system in India. Objective: This study investigates the benefits, challenges and limitations associated with WhatsApp usage as a public health management tool. Methods: The study was conducted within the Chandigarh Union Territory. We used a qualitative approach and conducted individual semi-structured interviews and group interviews (n = 10). Participants included medical officers (n 20), Program managers (n = 4), academicians (n=2) and administrators (n=2). Thematic and content qualitative analyses were conducted. Message log of the WhatsApp group of one of the health program was assessed. Results: Medical Officers said that WhatsApp helped them remain in touch with the program officer. They could easily give feedback and highlight those challenges which needed immediate intervention from the program managers, hence they felt supported. Also, the application helped them share pictures of their activities (meetings and field activities) with the group which they thought inspired others and gave themselves immense satisfaction. Also, it helped build stronger relationships and better coordination among themselves, the same being important in team events. For program managers, it had become a portal for coordinating large scale campaigns. Its reach and the fact that the feedback is real-time make WhatsApp ideal for district level events. Though the easy informal connectivity made them answerable to their staff but it also provided them with flexibility in operations. It turned out to be an important portal for sharing outcome and goals related feedback (both positive and negative) to the team. To be sure, using WhatsApp for the purpose of public health program presents considerable challenges, including technological barriers, organizational challenges, gender issues, confidentiality concerns and unplanned aftereffects. Nevertheless, its advantages in a low-cost setting make it an efficient alternative. Conclusion: WhatsApp has become an integral part of our lives. Use of this app for public health program management within closed groups looks promising and useful. At the same time, addressing the challenges involved would make its usage safer.

Keywords: communication, mobile technology, public health management, WhatsApp

Procedia PDF Downloads 145