Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524121EnglishN-0001November30HealthcareOCULAR INSERTS: A REVIEW English0316N. K. SahaneEnglish S. K. BanarjeeEnglish D. D. GaikwadEnglish S. L. JadhavEnglish R. M. ThoratEnglishOphthalmic drug delivery is one of the most interesting and challenging endeavors facing the pharmaceutical scientist. The anatomy, physiology and biochemistry of the eye render this organ exquisitely impervious to foreign substances. The challenge to the formulator is to circumvent the protective barriers of the eye without causing permanent tissue damage. Newer delivery system is being explored to develop extended duration and controlled release strategy. Some of the newer, sensitive and successful ocular delivery system like inserts, biodegradable polymeric system, and collagen shields are being developed in order to attain better ocular bioavailability and sustained action of ocular drugs. EnglishDiffusional inserts, Osmotic inserts, Contact lenses, Soluble inserts, Bioerodible inserts.INTRODUCTION Eye, as a portal for drug delivery is generally used for the local therapy as against systemic therapy in order to avoid the risk of eye damage from high blood concentrations of drug which are not intended for eye. Newer delivery systems are being explored to develop extended duration and controlled release strategy. Some of the newer, sensitive and successful ocular delivery systems like inserts, biodegradable polymeric systems, collagen shields are being developed in order to attain better ocular bioavailability and sustained action of ocular drugs. The following recent trends are in vogue : a) Mucoadhesive dosage forms b) Ocular inserts c) Collagen shields d) Drug presoaked hydrogel type contact lens and pledgets. e) Ocular iontophoresis f) Phase transition systems g) Microspheres and nanoparticles h) Chemical delivery systems vesicular systems. Utilization of the principle of controlled release as embodied by ocular inserts therefore offers an attractive alternative approach to the difficult problem of prolonging pre-corneal drug residence time14. Recentaly, drug-presoaked hydrogel contact lenses and pledgets have gained some popularity in an attempt to bypass the need for repeatative drug dosing and to avoid the peak and valley activity time curve resulted from periodic application of eye drops and ointment. A micropump type delivery system have also been developed for the continuous administration of fluid to dry eyes or medication to infected eyes. These drug delivery system have successed in significantly reducing the frequency of dosing and also in remarkably improving the therapeutic efficacy of ophthalmic drug 5 . Ocular disposition and elimination of a therapeutic agent is dependent upon its physicochemical properties as well as the relevant ocular anatomy and physiology 6 . The successful design of a drug delivery system, therefore, requires an integrated knowledge of the drug entity and the constraints to delivery offered by the ocular route of administration. mechanism of ocular drug absorption Topical delivery into the cul-de-sac is, by far, the most common route of ocular drug delivery. Absorption from this site may, i. Corneal ii. Non-cornea The non-corneal route of absorption involves penetration across the sclera and conjunctiva into the intraocular tissues. This mechanism of absorption is usually not productive, as drug penetrating the surface of the eye beyond the corneal-sclera limbs is picked up by local capillary beds and removed to the general circulation. This non-corneal absorption in general precludes entry into the aqueous humor. The non-corneal route of administration may be significant for drug molecules with poor corneal permeability. Studies with Insulin, Timolol Maleate, Gentamycin suggest that these drugs gain intraocular access by diffusion across the conjunctiva and sclera 7 . Corneal absorption Represents the major mechanism of absorption for most therapeutic entities. Topical absorption of these agents, then is, considered to be rate limited by the cornea. The anatomical structures of the cornea exert unique differential solubility requirements for drug candidates. Cornea can be viewed as a trilaminate structure consisting of these major diffusional barriers. a) Epithelium b) Stroma c) Endothelium Out of three, the epithelium and endothelium contains on the order of 100 fold the most of lipid material than stroma. Depending on the physicochemical properties of the drug entity, the diffusional resistance offered by the tissues varies greatly . The outermost layer, the epithelium, represents the rate limiting barrier for transcorneal diffusion of most hydrophilic drugs. The flattened epithelial cells preclude paracellular transport of most ophthalmic drugs and limits lateral movement within the anterior epithelium. Corneal surface epithelial intracellular pore size has been estimated to be about 60 A0 . Hence small ionic and hydrophilic molecules appear theogain access to the anterior chamber through these pores. However, for most drugs, paracellular transport is precluded by the interjunctional complexes. The stroma comprises 85-90% of the total corneal mass and is composed mainly of hydrated collagen. The stroma exerts a diffusional barrier to highly lipophilic drugs owing to its hydrophilic nature. There are no tight junction complexes in the stroma, and paracellular transport through this tissue is possible. The innermost endothelium is lipoidal in nature; however, it does not offer a significant barrier to the transcorneal diffusion of most drugs. Studies have shown that endothelial permeability depends solely on molecular weight and not the charge or hydrophilic nature of the compound. Transcellular transport across the corneal epithelium and stroma is the major mechanism of ocular absorption of topically applied ophthalmic pharmaceuticals. This type of Fickian diffusion is dependent upon many factors i.e., surface area, diffusivity, the concentration gradient established and the period over which the concentration gradient can be maintained. The productive absorption of most ophthalmic drugs results from diffusional process across the corneal membrane. The efficiency of the absorption process is a function of the rate and extent at which the transport processes occur. The flux of any drug molecule across a biological membrane depends on the physicochemical properties of the permeating molecule and its interaction with the membrane. The absorption process is also a function of the physiological mechanism of pre-corneal fluid drainage or turnover 8 . FACTORS AFFECTING CORNEAL TRANSPORT The physicochemical properties of the drug substance like ionization constants, aqueous, oil/water partition coefficients. 1) The formulation in which the drug is prepared e.g. pH of the solution, types and concentrations of buffers, viscosity inducing agents and stabilizers. 2) The corneal structure and integrity 9 . OCULAR BIOAVAILABILITY The topical application of ophthalmically active drugs to the eye is the most prescribed route of administration for the treatment of various ocular disorders. It is generally agreed that the intraocular bioavailability of topically applied drugs is extremely poor. Upon instillation of an ophthalmic solution, most of the instilled, volume is eliminated from the pre-corneal area1,10. This loss is mainly due to drainage of the excess fluid by the nasolacrimal duct and dilution and elimination of the solution by tear turnover and results in poor ocular bioavailability. Ocular bioavailability of drugs is an important parameter influencing efficacy of ophthalmic preparations. It has long been recognized that the vehicle or drug delivery system can affect bioavailability. This has been well established by invasive pharmacokinetic techniques11-13 Factors affecting intraocular bioavailability i. The presence of lacrimal fluid in the cul-de-sac dilutes the drug solution instilled into the pre-corneal area of the eye, and the continual inflow and outflow of lacrimal fluid can also cause a significant loss of applied drug. ii. Drug kinetics in the conjunctival culde-sac i.e. pre-corneal 9 . iii. The efficient nasolacrimal drainage, acts as a conduct through which an instilled drug solution may be drained away from the pre-corneal area. iv. The substances like protein present in the lacrimal fluid can interact with and/or degrade the drugs introduced into the ocular cavity. v. The permeability of the cornea to drug species (Corneal). vi. The rate at which drug is eliminated from the eye (post corneal) 9 . vii. The productive and non-productive absorption to topically applied drugs into various ocular tissues, most notably the cornea and conjunctiva. viii. The high corneal permeability corresponding to lipophilic compounds produces the highest bioavailability, and is relatively unaffected by drug volume14 . ix. By making the dosage volume sufficiently small, a bioavailability factor of 4 can be obtained for drugs with low corneal permeability. x. Ocular availability of the topically administered drug is dependent on the contact time that a drug has with the absorbing corneal surface 10 . Ocular Pharmacokinetics and Pharmacodynamics The study of pharmacokinetic processes called absorption, distribution and elimination, are fundamentals to determine the appropriate dosing regimen. These have also been indispensable in designing an improved therapeutic agent. When classic pharmacokinetic approaches have been applied to ophthalmic drugs, a number of limitations have been found to restrict the usefulness of pharmacokinetics in the practice of ophthalmology.l Limitations to the practical use of classic modeling The most significant reason for not conducting ocular pharmacokinetic studies in the human eye is the inability to sample tissues or fluids from the intact eye without risking pain and/or injury. Predicting human ocular pharmacokinetics from a rabbit data may not be precise for certain drugs. Moreover, samples, from eye tissues cannot be continuously sampled over time. Although a number of tissues can be removed quickly and precisely from the rabbit eye, one animal must be used to determine drug concentration at a single time point. Therefore, in order to construct a kinetic profile of drug concentration over time, a number of rabbits must be sacrificed at each time interval 15. Ocular Pharmacokinetic Modeling The classic pharmacokinetic approach of expressing the concentration-time curve into a sum of exponential has been applied to the eye,16 but much less extensively than other routes of administration. In the eye aqueous humor is most often assigned the central compartment, which is reversibly connected to one or more peripheral compartments and/or a reservoir compartments. Drugs instilled topically on the eye primarily reach the first third of the eye. These drugs do not reach the retina in significant concentrations. The following is the scheme that is most commonly applied to ophthalmic drugs following topical application.l Englishhttp://ijcrr.com/abstract.php?article_id=2279http://ijcrr.com/article_html.php?did=2279

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524121EnglishN-0001November30HealthcareDERIVATIVE SPECTROPHOTOMETRIC ESTIMATION OF NEVIRAPINE IN BULK DRUG AND PHARMACEUTICAL DOSAGE FORMS English1727Jawade S. K.English Khanage S.G.English Mohite P.B.English Deshmukh V.K.EnglishA simple, accurate and precise spectrophotometric method has been developed and validated for the estimation of nevirapine from bulk drug and tablet formulations. Nevirapine shows a sharp peak at 241.0 nm in first order derivative spectrum with n =1. The drug follow Beer-Lambert?s law in the concentration range of 4-24 μg/ml in this method. Result of the analysis was validated statistically and found accurate. The method was successfully applied for determination of drug in tablets, wherein no interference from tablet excipients was observed, indicating the specificity of the developed method. Thus the proposed method can be used successfully for routine analysis of nevirapine from capsule and tablet formulations. EnglishNevirapine, Ultraviolate Spectroscopy, Derivative spectroscopy, validation, precise, accurate .INTRODUCTION Nevirapine (Fig.1), 11-cyclopropyl-4- methyl-5, 11-dihydro-6H-dipyrido [3, 2-b: 2?, 3?- e][1,4] diazepin-6-one is a reverse transcriptase (RT) inhibitor of human immunodeficiency virus type 1 (HIV-1)1,2. Nevirapine inhibits replication of HIV-1 by interfering with viral RNAdirected DNA polymerase (reverse transcriptase). It binds directly to herodimeric HIV-1 reverse transcriptase and exerts a virustatic effect by acting as a specific, noncompetitive HIV-1 reverse transcriptase inhibitor; it appears to inhibit viral RNA- and DNAdependent DNA polymerase activities by disrupting the catalytic site of the enzyme3 . Literature survey reveals that there are analytical methods available for determination of nevirapine from biological matrices 4-14, bulk drug and dosage forms 15-17, and analytical methods for determination of nevirapine with combination of other antiviral drugs 18-52 Literature survey further revealed that there were very few reported RP-HPLC and spectrophotometric estimation methods for the analysis of nevirapine. Thus, an appropriate analytical procedure for the quantitative determination of nevirapine from bulk drugs is of considerable importance. Keeping this objective in mind an attempt has been made to develop and validate UV estimation method for the analysis of nevirapine which would be highly sensitive, having good resolution and reproducible. Various validation aspects of the analysis, accuracy, precision, recovery and the limits of detection and quantification etc., have been measured. Material and Methods The working standard of nevirapine was procured from Cipla Ltd., India. analytical grade Hydrochloric acid. 0.1N HCl prepared in distilled water used as solvent. JASCO V-630 UV/VIS spectrophotometer was used with 1cm matched quartz cells. Tablets of 200 mg strength were procured from local pharmacy (Nevimune-200). Accurately about 100mg of the pure drug was weighed and dissolved in sufficient quantity of 0.1N HCl and volume made up to100ml with 0.1N HCl to give standard stock solution (1 RESULTS AND DISCUSSION The solvent chosen for UV must take into account the chemical nature and polarity of the drug molecule. Nevirapine is practically insoluble in water, soluble in 0.1 N hydroclodic acid, dichloromethane, dimethylsulphoxide and dimethylformamide, slightly soluble in methanol. Calibrator solutions were prepared in 0.1N HCl. The method developed was validated for limit of detection (LOD) and limit of quantitation (LOQ) in order to determine and ensure sensitivity of the developed method. The method was found to be linear over the range 4-24 μg/ml per spot with coefficient of mg/ml). Aliquots of standard stock solution were pipette out and suitably diluted with 0.1N HCl to get final concentration of 4-24μg/ml of standard solution. The solution were scanned in the spectrum mode from 400 nm to 200 nm wavelength range and the first order derivative spectra were obtained at n =1 (Method A) a sharp peak was obtained at 241nm (Figure-1). The absorbance difference at n=1 (dA/dλ) was calculated by the inbuilt software of the instrument which is directly proportional to the concentration of the standard solution .A calibration curve was plotted taking the absorbance difference (dA/dλ) against the concentration of the standard solutions. The method was applied for the sample solution of known concentration and was found be satisfactory for analysis of tablet formulation. correlation 0.9987. (Table 1) Intra-day and inter-day precision studies showed a % RSD was less than 5.00%, indicating the method was precise. The accuracy values obtained, in the range 98.53 – 100.73 % for drug are indicative of excellent accuracy and recovery. This indicates the method is specific. Stability studies were carried out for standard. It was found to be stable in sample solution, prior to development and after development. The developed method was then validated and successfully applied for quantitation of nevirapine from the formulation. To ensure accuracy of the method, recovery studies were performed by standard addition method at 80%, 100% and 120% level, to the pre-analyzed samples and the subsequent solutions were re-analyzed. At each level, three determinations were performed and the results obtained are shown in Table 3. The results of recovery studies were within the specified limits of ICH guidelines54. Lower values of %RSD reflect the accuracy of the method. Precision, expressed in terms of %RSD was determined in terms of intra-day and interday precisions, analyzing the drug at six different concentrations, determining each concentration thrice. The sample solutions were analyzed using the method for 3 consecutive days, repeating the process twice a day at different period. The results obtained are summarized in Table 3 and reflect high degree of precision. Two different analysts performed assay on marketed tablets of the drug, in similar operational and environmental conditions, using the developed method to determine its ruggedness. A typical absorbance spectrum of the drug is shown in Fig.1. CONCLUSION The developed and validated UV estimation method reported here is rapid, simple, accurate, sensitive and specific. The method was also successfully used for quantitative estimation and analysis of Nevirapine from formulation. Thus the reported method is of considerable importance and has great industrial applicability for quality control and analysis of Nevirapine from bulk drug and formulations. ACKNOWLEDGEMENT Authors thank Cipla Ltd., India for supplying the authenticated standard of Nevirapine and Mr. Ajay Pise for his moral support. Also thanks to M.E.S. College of Pharmacy for providing the requirements.       Englishhttp://ijcrr.com/abstract.php?article_id=2280http://ijcrr.com/article_html.php?did=22801 Indian Pharmacopoeia (2007), Vol 3, Government of India Ministry of Health and Family Welfare, published by The Indian Pharmacopoeia Commission, Ghaziabad, pp 1433- 1434. 2 USP-NF (2009), Vol III, USP-NF The Official Compendia of Standards, published by The United States Pharmacopoeia Convention, City Press, Baltimore, US, pp 3072-3073. 3 Mirochnick M, Clarke DF, Dorenbaum A. 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Kaul N., Agrawal H., Paradkar A. R., Mahadik K. R., (2004) HPTLC method for determination of nevirapine in pharmaceutical dosage form. Talanta, 62, 843-852. 17. Li Q.C., Tougas T., Cohen K., Lee R., Meagan P., Corson M., Muchnick T., (2000) Validation of a HighPerformance Liquid Chromatography Method for the Assay of and Determination of Related Organic Impurities in Nevirapine Drug Substance. J. Chromatogr. Sci., 38, 246-254. 18. Aymard G., Legrand M., Trichereau N., Diquet B., (2000) Determination of twelve antiretroviral agents in human plasma sample using reversed-phase highperformance liquid chromatography. J. Chromatogr. B. Biomed. Sci. and Appl., 744, 227-240. 19. Dailly E., Raffi F., Jolliet P., (2004) Determination of atazanavir and other antiretroviral drugs (indinavir, amprenavir, nelfinavir and its active metabolite M8, saquinavir, ritonavir, lopinavir, nevirapine and efavirenz) plasma levels by high performance liquid chromatography with UV detection. J. Chromatogr. 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M., (2006) Full Validation of an Analytical Method for the HIV-Protease Inhibitor Atazanavir in Combination with Other Antiretroviral Agents and its Applicability to Therapeutic Drug Monitoring. Ther. Drug. Monit., 28, 517-525. 27. Tribut O., Verdier M.C., Arvieux C., Allain H., Michelet C., Bentue F. D., (2005) Simultaneous Quantitative Assay of Atazanavir and 6 Other HIV Protease Inhibitors by Isocratic Reversed-Phase Liquid Chromatography in Human Plasma. Ther. Drug. Monit., 27, 265-269. 28. Tribut O., Arvieux C., Michelet C., Chapplain J.M., Allain H., Bentue F.D., (2002) Simultaneous Quantitative Assay of Six HIV Protease Inhibitors, One Metabolite, And Two Non-Nucleoside Reverse Transcriptase Inhibitors in Human Plasma by Isocratic Reversed-Phase Liquid Chromatography. Ther. Drug. Monit., 24, 554–562. 29. Kappelhoff B.S., Rosing H., Huitema A.D.R, Beijnen J.H. 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L.Z., Christians U., EggeJacobsen W., Unger M., Niemann C.U., Baluom M., Hirai S., (2004) Automated, Fast, and Sensitive Quantification of Drugs in Human Plasma by LC/LC-MS: Quantification of 6 Protease Inhibitors and 3 Nonnucleoside Transcriptase Inhibitors. Ther. Drug. Monit., 26, 546-562 36. Pereira E.A., Micke G.A., Tavares M.F.M, (2005) Determination of antiretroviral agents in human serum by capillary electrophoresis. J. Chromatogr. A., 1091, 169-176. 37. Tuan N.D., Wolfgang G., Karin S., Heribert S., Barbara F., Manfred P.D., Andreas Z., (2003) Simultaneous separation of fifteen approved protease and reverse transcriptase inhibitors for human immunodeficiency virus therapy by capillary electrophoresis. Electrophoresis, 24, 662-670. 38. Fan B., Stewart J.T., (2001) Determination of zidovudine/zalcitabine/nevirapine in human plasma by ion-pair HPLC. J. Liq. Chrom. Relat. Tech., 2001, 24, 3017-3026. 39. Narang V.S., Lulla A., Malhotra G., Purandare S., (2005) A CombinedFormulation Tablet of Lamivudine/Nevirapine/Stavudine: Bioequivalence Compared With Concurren Administration of Lamivudine, Nevirapine, and Stavudine in Healthy Indian Subjects. J. Clinical. Pharmacology., 45, 265- 274. 40. Dailly E., Thomas L., Kergueris M. F., Jolliet P., Bourin M., (2001) Highperformance liquid chromatographic assay to determine the plasma levels of HIV-protease inhibitors (amprenavir, indinavir, nelfinavir, ritonavir and saquinavir) and the non-nucleoside reverse transcriptase inhibitor (nevirapine) after liquid–liquid extraction. J. Chromatogr. B. Biomed. Sci. and Appl. 758, 129-135. 41. Droste J.A.H., Verweij-van W.C.P.W.G.M., Burger D.M., (2003) Simultaneous Determination of the HIV Drugs Indinavir, Amprenavir, Saquinavir, Ritonavir, Lopinavir, Nelfinavir, the Nelfinavir Hydroxymetabolite M8, and Nevirapine in Human Plasma by Reversed-Phase High-Performance Liquid Chromatography. Ther. Drug. 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Sarkar M., Khandavilli S., Panchagnula R., (2006) Development and validation of RPHPLC and ultraviolet spectrophotometric methods of analysis for the quantitative estimation of antiretroviral drugs in pharmaceutical dosage forms. J. Chromatogr. B., 830, 349-354 . 51.Hamrapurkar P.D.*, Phale M. D., Shah N., (2009)Quantitative Estimation Of Nevirapine By High Performance Thin Layer Chromatography. J. Pharm. Research and H. Care., vol. 1, no.2, 197-216. 52. Venugopal K. ; Srinivasa Rao Y.; Nagogik. E. V.; Haritha G. ; Seshgirarao J. V. L. N(2005) A reversed phase high performance liquid chromatographic method for estimation of nevirapine in tablets. Indian J. Pharm. Sci., vol 63, no.1,130- 132. 53. Palanippan M., Sarkar D., Chaudhary T., Gauthaman K.(2008) A Simple and Rapid RP-HPLC Method for the Estimation of Nevirapine in Bulk and Pharmaceutical Dosage Forms. E-J Pharm., vol. 5, 1081-1086. 54. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524121EnglishN-0001November30HealthcareCHEST PHYSIOTHERAPY FOR ATELECTASIS IN NEONATE WITH PULMONARY HEMORRHAGE- A CASE REPORT English2831VaishaliEnglish Jithendra KumarEnglish V. PremEnglish Sushmitha.NEnglish Shailendra LendeEnglishChest physiotherapy is often used to correct Atelectasis in the neonatal intensive care unit. This case report describes about the importance and effectiveness of chest physiotherapy in a 24 days old neonate who presented with pulmonary haemorrhage and right upper lobe collapse. Chest physiotherapy was administered every four hours for three days. Chest X ray revealed full expansion after three days of physiotherapy intervention. EnglishINTRODUCTION Chest physiotherapy (CPT) has been used in many neonatal nurseries around the world to improve airway clearance and treat lung collapse; however, the evidence to support its use has been conflicting. There is not enough evidence to determine whether active chest physiotherapy is beneficial or harmful in neonates on mechanical ventilation. Babies who require mechanical ventilation are at risk of lung collapse from increased secretions. Chest physiotherapy (patting or vibrating the chest) is used to improve clearance of secretions from the airway to try to prevent lung collapse1 . Acute lobar Atelectasis is a common problem in infants receiving mechanical ventilation2 . Atelectasis contributes to morbidity in the neonatal nursery, necessitating prolongation of oxygen administration3 . In the neonatal population, CPT is used to prevent and treat lung collapse and consolidation. CPT in the neonates consists of a variety of techniques that include positioning, active techniques such as percussion and vibration, and suction1 . Case report - A 24 day old full term female baby admitted to the hospital on 5-07-2008, with the complaints of bleeding from the nose, scanty in quantity for about half an hour. There was no history of fall, cough, breathlessness or seizures. Baby with a normal natal history, normal vaginal delivery, birth weight 2.8 kgs, with APGAR score 8 at first minute. Baby was diagnosed to have pulmonary haemorrhage and respiratory distress by the Paediatrician. Chest x-ray on the day of admission showed non homogenous opacity and infiltrates suggestive of pulmonary haemorrhage (picture 1). CT scan confirmed the diagnosis of diffuse alveolar pulmonary haemorrhage. Baby was mechanically ventilated on the same day with the following settings: PSIMV, RR 40 per min, FiO2 – 50%, PEEP- 6, Peak inspiratory pressure (PIP)- 22, oxygen saturation-94%, and ABG showed uncompensated respiratory alkalosis. Haemoglobin-16.2 gm%, Total count-12060, platelets-2.51 lakhs, WBCs-high, Calcium-9.0, SGPT-51, Creatinine-0.3, CRP-negative, stool for occult blood- positive, Prothrombin time- test-13.6, control-13.5, INR-1. The next day (i.e.) on 6-07-2008, the ventilatory settings were P-SIMV, FiO2 – 30%, PEEP- 6, Flow rate- 7, PIP- 20, oxygen saturation- 95%.Heart rate 156 /min. Spontaneous respiratory rate was 40/ min. On auscultation, absence of breath sounds in right upper zone. ABG report showed respiratory alkalosis. Child was treated with IV antibiotics and supportive measures were given. In view of repeat chest x-ray on the next day which showed right upper lobe collapse and pneumonitis, the baby was referred for physiotherapy. Chest physiotherapy The baby was given chest physiotherapy from 6-07-2008 at 11 am. On observation, child skin colour was pink, no cyanosis, diminished chest movements on the right upper zone anteriorly, shallow breathing with respiratory rate 40/min. on palpation right upper zone chest asymmetry, no tracheal deviation, and positive tactile fremitus. On auscultation, diminished breath sounds in the right upper zone with occasional crepitations heard during expiration. Parameters were noted before and after chest physiotherapy sessions. The baby was positioned in upright with the help of towel rolls for 25 minutes. Proprioceptive neuromuscular facilitation (PNF) was given by tactile stimulation for five minutes on bare chest (tactile stimulation is a technique of placing therapist?s forefingers on baby?s chest i.e. on right upper zone).Gentle vibrations were given on the right upper zone with the help of three fingers (three finger technique i.e. with index, middle and ring fingers kept on the baby?s bare chest and vibrations were given for one minute during alternate expiration as the rate was high). Five sets of vibrations with one minute durations were carried out. After PNF for five minutes and vibrations for five minutes in the upright position, baby was positioned in supine, endotracheal (ET) and oral suctioning was done. The suctioning was terminated following no secretion removal from ET suctioning. All the parameters were noted. Five minutes post suction, the baby was positioned in the same upright position and PNF was given for five minutes. Position was maintained for two hours. Physiotherapy was given every six hourly. Same procedure was carried out six hourly for three days. On third day, there was an improvement in chest expansion, no asymmetry, decreased respiratory rate, improved breath sounds on right upper zone with expansion of right upper zone on chest x ray (picture 2). The ventilator parameters on the same day were as follows, P-SIMV, FiO2 30%, RR 26, HR 138/min, SpO2 100%, PIP-20, flow rate 4Lit. The baby was extubated the next day and was put on 2 litres of oxygen through face mask Picture 2: x ray showing re expansion of the lung on third day of physiotherapy intervention Discussion The aim of chest physiotherapy in this baby with pulmonary haemorrhage was to re expand the atelectatic lung and to improve the lung expansion. Positioning was used as it helps in optimizing oxygen transport through its effects of improving ventilation/perfusion (V/Q) matching, increasing lung volumes, reducing the work of breathing, minimizing the work of the heart, and enhancing mucociliary clearance. Upright position dimension of the chest wall is greatest, and the compression of heart and lungs is minimized. The Vibration technique used by us increased clearance of airway secretions by the transmission of an energy wave through the chest wall. Endotracheal Suctioning was used with the aim of removing secretions from the central airways and stimulating cough reflex. The proprioceptive and tactile stimuli selected by us produced expansion of the thoracic cage, reduced asymmetry and decreased respiratory ratewas used in this patient to maximize lung volumes and capacities, the vertical gravitational gradient is maximal, the anteroposterior. Future research Future studies with large sample size and randomized trials are needed. Conclusion Careful administration of chest physiotherapy can re expand the atelectatic lung in a pulmonary haemorrhage neonate. Englishhttp://ijcrr.com/abstract.php?article_id=2281http://ijcrr.com/article_html.php?did=2281 1. Chest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory support (Review) Hough JL, Flenady V, Johnston L, Woodgate PG, The Cochrane Library 2008, Issue 3 2. Who needs chest physiotherapy? Moving from anecdote to evidence, Colin Wallis and Ammani Prasad, Arch. Dis. Child. 1999;80;393-397 3. Ehrlich R, Arnon RG. The intermittent endotracheal intubation technique for the treatment of recurrent atelectasis. Pediatrics 1972; 50:144–7 4. Jan Stephen Tecklin: Respiratory Failure in the Neonate. In Scot Irwin, Jan Stephen Tecklin, Cardiopulmonary Physical Therapy a Guide to Practice, ed 4, 2004, Mosby. 5. Jennifer A Pryor, Barbara A Webber Physiotherapy techniques. In: Jennifer A Pryor, S Ammani Prasad. Physiotherapy for respiratory and cardiac problems, adults and pediatrics. 3 rd edition, Elsevier, pg 161-234. 6. Elizabeth Dean Body positioning. In: Cardiovascular and Pulmonary Physical Therapy, Evidence and Practice. 4 th edition, Elsevier, pg 307-321.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524121EnglishN-0001November30HealthcareRECENT TRENDS AND FUTURE PERSPECTIVES IN INDIAN HEALTH CARE - AN OVERVIEW English3238Syed Sajjad HussenEnglish VasanthrajuEnglish Krishnamurthy BhatEnglish Kishore SamEnglish N. UdupaEnglishHealth care in India has always been a major challenge. Due to changing global economic and social conditions, advent of new advanced technology in the treatment of diseases and with new challenges arising in the field of healthcare, we feel the need to look at the recent trends and future perspectives of healthcare in a very vast and diverse perspective of India. Since independence India?s healthcare was concentrated on primary healthcare, where around eighty percent of Indian population is covered so that the problem of healthcare is handled at grass root levels. Diseases like Tuberculosis, polio which were very dangerous and their virility caused a number of deaths in the country, which we can attribute to lack of proper health care facilities available at the rural level. There was also lack of awareness about the diseases and a precautionary measure to be taken to prevent and cure them was one of the factors. Post liberalization, like all sectors the Indian healthcare scenario has undergone a sea change at a faster and more rapid level. Advanced technology made way to the traditional way of treating diseases, many super specialty hospitals were started in the Metros with advanced medical innovations to their utility. Slowly the tertiary healthcare started taking a more dramatic turn for good. Our study in this fast changing scenario of Indian healthcare is primarily focused on Medical Tourism and its effects on health sector, Reducing the health care expenditure in terms of hospital and medicines by health insurance, Vaccination for children and also study the economic feasibility of Combined vaccine for children and Major disease efforts made to contain and eradicate them by 2020 in India. EnglishMedical Tourism, Health insurance, combined vaccination, Primary health care Introduction: The enormous changes that India has seen since independence towards the bright future it is heading in many fields including the health sector, which is evolving to be the best in the world. Health is best understood as the indispensable basis for defining a person's sense of well being. Health care in India has always been a major challenge [1,9]. Over the last five decades, India has built up a vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors. Indian pharmaceutical majors have made enormous progress in generic formulations which resulted in decrease of medicine cost of many life saving drugs. The most notable change in the Indian health sector is the advent of Medical Tourism which is booming in the country and is supposed to reach the peak in the coming years [2,3,5], The amount of money that is generated by medical tourism is not only helping in the health care economy but also giving rich practical experience to the healthcare professionals of the country. Increase in hospital expenses and medicinal bills are also major areas of concern as health insurance in the country is not structured, but mostly concentrated to select few population and cities of the country resulting in around eighty percent of people are outside its benefits. Vaccination to children is still a distant dream as most vaccines are imported into the country from Global Multinational companies at higher cost which is borne by the government of India and the new entry of combined vaccines which promises a lot of benefits but will not stand true to its claims in many cases [7,8]. Despite the growth factors there are major challenges that are faced by the people of the country in terms of eradication of communicable and non communicable diseases where major steps are outlined in health vision planning in India by 2020 [9] . Review Methodology: Extensive secondary research was carried out over the World Wide Web, International publication in reputed journals and national journals along with planning of health care in India. The information gained were analyzed in results and discussion part and based on these understanding conclusion was drawn and recommendations were put forward regarding healthcare sector in India to make it more effective and beneficial to a wider group of people, the following chart indicates in detail. Results and Discussions: Medical Tourism which is currently the fastest growing healthcare sector in India. There are various major factors that are contributing to its growth, like Low cost but quality health care provided on par with western hospitals, highly qualified doctors with work exposure in western nations, No waiting period or queue for any type of surgery which is one of the major hindrances in the developed world where for a heart related ailments needs a waiting period of up to six months or even more and due to which we end up paying more if the surgery is needed on immediate basis. All hospitals are well equipped with advanced machinery on par with western counterparts [5] . Nowadays language barrier is not a problem in India. Patients can communicate freely about their problems with doctors, nurses or every one concerned in health care , Ancient alternative therapy like Ayurveda, Yoga form the backbone in many areas and its an age old treatment to various health ailments. Certain states like Kerala are promoting it in a big way as an alternative type of medicine for various ailments. The government of India is also promoting Medical Tourism in a big way by introducing medical visa which can be extended without any hindrance, success rate for heart ailments is as high as 98.5%, the other big contributor to the healthcare sector is strong Indian pharmaceutical research and development of various Indian multi nationals which brings down the cost of medicines. The comparative cost advantage of various diseases and their treatment cost in developed world and other Asian destinations are given in table.1 which clearly shows India in an advantageous position in terms of cost. Health insurance is another sector which is seeing tremendous changes. The medical cost has gone up in India and is very difficult to manage with out a health insurance. As per the World Bank report 85% of Indians cannot arrange cash of 5 lakh rupees and 14% of Indians have liquid cash which will later lead to severe financial crisis and only 1% of Indians can arrange without any problem [15]. Many private and govt insurance agencies are offering variety of schemes as per patient needs, but if we evaluate the health insurance sector in India, it does not cater to wide set of population and certain policies are not covering major ailments suffered by people like lifestyle related diseases etc which make the health insurance ineffective which in turn increase the burden on the patients. Many major Private Hospitals like Apollo are also offering insurance to the patients. The need for health insurance is important because if we look at health insurance in various sectors across the wide spectrum of people in India we can come to a conclusion that 75% of the health care cost are borne by the people from their pocket as shown in the table.2 Vaccination: Vaccines are important preventive medicines for primary health care, and are a critical component of a nation's health security. This is particularly true for a huge and diverse developing country like India, with its population of more than 1 billion people and 25 million new births every year. The current Indian market for vaccines is estimated to be about US$260 million. India is among the major buyers and makers of vaccines, locally as well as globally, and has traditionally aimed at self-reliance in vaccine technologies and production. A new trend of combined vaccine is introduced, which is a result of complex R&D and clinical trials that claims to have a Major competitive advantage and improved product. Major advantage of combined vaccine: Fewer injections, lower administration costs, storage, transportation, material & equipment, reduced time, money, fewer side effects and related treatment, safety improvement are their advantages[6] . However on further study on combined vaccinations there are some interesting facts that are usually ignored under the influence of their advantages and further we can say that combined vaccinations are not always in expensive as they claimed to be as shown in Table.3 and in some cases the patients are forced to take vaccinations where it may not be necessary. Table-3: Combined Vaccination Major diseases to be eradicated by 2020 in India: Health care in India is primarily divided into three parts, Primary healthcare, Secondary health care and Tertiary healthcare. More than 80% of population as already discussed comes under primary healthcare which is focussed in rural India and comprises of Health care centres and basic ambulatory services with general physicians and cater to the day today needs of the population. It also plays a major role in creating awareness of communicable and non communicable diseases along with rapidly spreading diseases like AIDS. The major efforts taken by the government of India are reflected in primary health care centres. These centres are trying to educate people upon the importance of hygiene in day to day activities, awareness about AIDS, causes and means by which it is spread and try to remove the social stigma which is very prevalent with AIDS. People are also educated about the prevention and cure of various communicable diseases like malaria, Tuberculosis etc which are still prevalent in major parts of the country and also educate them about the importance of vaccination and its schedule to protect the infants at very young age. Pregnancy related mortality of the mother and child has drastically reduced which clearly reflects in the health policy of the planning commission of India. As far as the secondary health care is concerned it covers around 15% of the population and are mostly semi urban centric with better facilities compared to rural set up. Tertiary care is highly specialised and seeing a vast improvement in case of Medical Tourism. But this sector caters around 5% of population of the country and is very expensive in comparison to other healthcare setup. Recommendations: Medical Tourism which is growing at a fast pace, need to be regulated by a regulatory body by maintaining the standards. Health insurance needs more players in the market and cashless transactions need to be improved to a great extent, if not, the entire meaning of health insurance will be useless as people have to arrange money as loan and then claim it at a later stage. Combined vaccinations necessity should be evaluated and administered as per requirement, not by market pressure and a thorough research should be done on local conditions for the suitability and quality of the vaccines. Primary level healthcare needs a serious look and awareness reaches a large section of people like organizing health camps and street plays about various health ailments and their prevention so that a large section of population are benefited. Conclusion: Medical tourism in countries like India has been on the rise in few selected hospitals, giving them the much needed global recognition and exposure to different medical demands, which will not only help in the health economy but also increase in the expertise of the health care professionals. Indian pharmaceutical majors have made enormous progress in generic formulations which resulted in decrease of medicine cost of many life saving drugs like in the recent case of swine flu drug made by Cipla. Health insurance sector has also seen unprecedented growth in recent times and includes both private and government players offering different types of insurance for the people to get down the cost. Combination of vaccine is also rarely investigated for its benefits and other advantages which has to be thoroughly investigated. Primary health care sector which is largest in India should be taken care as it will address a huge population which will benefit in the long run and should be given proper importance and implementation at grass root level. Acknowledgements: Special thanks to Manipal University for encouragement and support, Special thanks to Dr H Meer Azad, General manager, Indian Immunologicals, Hyderabad for his support throughout this project, Dilavez and all anonymous contributors for this review. Englishhttp://ijcrr.com/abstract.php?article_id=2282http://ijcrr.com/article_html.php?did=22821. R. Srinivisan “Health Care in India - Vision 2020, Issues and Prospects”, cited on July 20 2009 available from http://planningcommission.gov.in /reports/genrep/bkpap2020/26_b g2020.doc 2. Medical Tourism India, cited on 24 August 2009 available from http://www.medical-tourismindia.com/medical_tourism_india .htm 3. Medical Tourism India, cited on 24 August 2009 available from http://www.indiamedicaltourism. net/medical_tourism_india_medi cal_tourism/index.html 4. Healthcare system in India, cited on 25 August 2009 available from http://www.recoverdiscover.com/ healthcare_system.php 5. Need for Medicinal Tourism, cited on 25 August 2009 available from http://www.indiamedical-tourism.info/healthwellness-tours.php 6. Philippe Beutels, Economic aspects of combined vaccine ppt, Malta Oct 2001 Centre for the Evaluation of Vaccination, WHO collaborating centre for the prevention and control of viral hepatitis Epidemiology and Community Medicine, University of Antwerp, Belgium. 7. Y.Madhavi, New combination vaccine: Back door entry into India?s Immunisation program? Cited on June 10 2006 http://www.ias.ac.in/currsci/1465 .pdf 8. Y.Madhavi, vaccine policy in India Published online 2005 May 31. doi: 10.1371/journal.pmed.0020127. 9. R. Srinivisan Health Insurance in India Health and population Perspectives and Issues 24(2) P.65-72. 10. Rajeev Ahuja : Health Insurance for the Poor in India March 2004 paper presented 17th March 2003 at ICRIER workshop New Delhi. 11. N. Devadasan and Sunil Nandraj Health Insurance in India Chapter.1 PDF. 12. K.Sujatha Rao Health Insurance in India cited on 25 August 2009 available from http://www.whoindia.org/LinkFil es/Commision_on_Macroecono mic_and_Health_Health_insuran ce_in_India.pdf 13. Dr Rahul S.Nair Medical Tourism in India Manorama Year Book 2009 P.No 572. 14. Ashvin Parekh Appropriate Model for Health Insurance in India PPT. Presentation for Federation of Indian Chambers of Commerce & Industry 16th October 2003. 15. International Health Regulations (2005) Second edition WHO Library, World Health Organization.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524121EnglishN-0001November30HealthcareAPPROCH TO THE DIAGNOSIS AND TREATMENT OF ANEMIA English4059Sachin V. TembhurneEnglish Dinesh M SakarkarEnglishIt is important to understand that anemia is not a disease by itself, but the result of a malfunction somewhere in the body. It is a quite common condition, particularly in female; estimates suggest that around one in five menstruating women and half of all pregnant women are anemic. A wide range of events, including certain diseases, specific conditions and modifications, can cause anemia. Anemia means that either the level of red blood cells or the level of haemoglobin is lower than normal. This means the red blood cells have to work harder to get oxygen around the body. Each red blood cell contains a complicated protein called haemoglobin. This protein gives red blood cell their characteristics color. It is state that when value of haemoglobin fall 5 to 6 mg/dl the person immediately gets startled and anxious then it understands that the person is anemic. Haemoglobin value is not providing sufficient information to understand the anemia because it is not a simple condition that can be merely defined by just one parameter. This article try to explain the various facets of anemia, its diagnosis, the approach, test involved, the treatment to be given and the prevention should to be taken. Englishanemia, RBC, haemoglobin, types, causes, symptoms, diagnosis, treatment, prevention.INTRODUCTION Anaemia is not a disease by itself but only a manifestation of disease which resulted to the reduction in the number of circulating red blood cells, or the hemoglobin concentration in the blood. Hemoglobin carries oxygen from the lungs to the rest of the body. In anemia, the blood does not carry enough oxygen to the rest of the body. As a result, people with anemia can face variety of complications, including fatigue and stress on bodily organs. In severe or prolonged cases of anemia, the lack of oxygen in the blood can cause serious and sometimes fatal damage to the heart and other organs of the body (1, 2). World Health Organization (WHO) defined it as a hemoglobin (Hb) level Englishhttp://ijcrr.com/abstract.php?article_id=2283http://ijcrr.com/article_html.php?did=2283