Background: Nearly 15% of diabetic patients will suffer from DFU in their life span. Conventional treatment is not effective against the non-healing DFUs so in recent days so many adjuvant therapies which have been tried to stimulate healing process are in use. LLLT, is a non-invasive, pain-free method is considered as a possible treatment option for the diabetic foot syndrome. Aim of this study is to study the role of low level laser therapy on diabetic ulcers, i.e. Reduction in size of the ulcer, faster wound healing, control of infection, cost effectiveness and if secondary procedures like split skin grafting can be avoided.Methods: A total of 100 patients with Diabetic foot ulcer fitting the inclusion criteria was included in the study and they were randomly categorized into control and study group. Patients in the study group received treatment with LLLT. Ulcer bed with edge was irradiated locally with red light (660nm), about 4-8J/cm2 for 20 minutes was delivered for 15 days on daily basis. Conventional dressing was preferred for covering after irradiation and controls were treated with conventional therapy alone which includes dressings with betadine or wet with saline, Course of antibiotic treatment and sloughs removed whenever needed. The size, grade and culture status of the ulcer was assessed on Day 1 and day 15. Duration of stay in hospital was noted to assess cost effectiveness.Results: In LLLT group, after completing 15 days treatment complete wound healing was achieved in 66.6% of grade-1 ulcers and 4.4% of grade-2 ulcers and 96.6% of grade-2 ulcers improved to grade-1. In contrary only 3.4% of grade-2 ulcers improved to Grade 1 and a majority of ulcers remained as such. Reduction in Mean area of ulcer at day-15 was statistically significant in LLLT group (13.74±11.88 to 3.97±5.41cm2 and P<0.001) whereas reduction of mean ulcer area among controls was statistically not significant (19.09±15.03cm2 to 18.80±17.70cm2 and P=0.859). Mean total cost of the treatment was less compared to conventional treatment group. (2264.3±140 Vs 3588.4±68 Rs).Conclusions: Laser therapy is painless, cost effective procedure which induces faster granulation, wound contraction and reepithelialisation, thus accelerates complete wound healing hence avoiding secondary procedures like split skin grafting. Control of infection was also better compared to control group.

A 1 -A 3 1 8 a median age of 41 years old. Median spending per patient with medicines was USD 490.56. All patients used antipsychotics, which accounted by 93.8% of the total spending with high cost drugs and had a median spending USD 516.40, followed by anti-dementia drugs (5.8% of patients; 3.6% of spending; and median spending USD 635.77); dopaminergic agents (2.0%; 0.6%; and USD 107.95) and antiepileptics (2.8%; 0.6%; and USD 209.48). ConClusions: Spending on atypical antipsychotics suggests that the use of these medicines needs to be carefully evaluated and monitored to optimize health resources allocation. Furthermore, the SUS may be reaching good results in terms of coverage of these drugs for patients, considering the number of identified patients, the Brazilian population and the prevalence of schizophrenia in the world. The use of dopaminergic agents can be associated with adverse reactions caused by the use of antipsychotics. More specific studies are necessary to determine the relationship between schizophrenia and the use of anti-dementia drugs.objeCtives: Managing schizophrenia remains challenging because ~25% of patients do not respond to antipsychotics while ~15% have intolerable side effects. Prescribers lack tools to determine the cause of these complicated treatment courses and respond appropriately. We estimate the potential cost savings from having point-of-care access to antipsychotic plasma levels to guide treatment decisions. Methods: Based on literature estimates nonresponse is caused by poor adherence (80% of patients), true treatment resistance (16%) and rapid drug metabolism (4%), and intolerable side effects are caused by slow metabolism (73%) and high sensitivity (27%). We assumed that in the absence of plasma level information, prescribers cannot ascertain those root causes but employ two heuristics to manage these patients, one attributing all cases to the most common cause, the other randomly applying the underlying distribution of causes. We calculated the proportion of patients in whom heuristic-based decisions would be incorrect and assumed that the outcome would be poor symptom control, whereas correctly managed patients would have well controlled schizophrenia. We used published costs of well versus poorly controlled schizophrenia to estimate potential savings from point-of-care access to plasma levels. Results: Without antipsychotic plasma levels, prescribers would make incorrect decisions in 20% to 34% of nonresponders and 27% to 39% of patients with intolerable side effects. Annual healthcare costs for well and poorly controlled patients are $15,318 and $49,589 in 2015 dollars, respectively, suggesting avoidable costs of $34,271 in incorrectly managed patients. Access to plasma level Information would reduce annual cost between $6,854 and $13,366 for each patient with complicated treatment course. ConClusions: Access to point-of-care antipsychotic plasma levels would reduce incorrect management decisions for one to two-fifths of the ~40% of patients with complicated treatme...