Background:This study aims at simplifying the practical patient management and offers some general indications for pharmacotherapeutic choice by the implementation of (Global Initiative for Chronic Lung Disease) guidelines. This study was designed to evaluate the clinical and economic consequences of salmeterol/fluticasone (SF), formoterol/budesonide (FB), and formoterol/fluticasone (FF) in severe and very severe chronic obstructive pulmonary disease (COPD) patients.Objectives:The aim was to find out the most cost-effective drug combination between the three combinations (SF/FB/FF) in COPD patients.Materials and Methods:A prospective observational comparative study (cost-effectiveness analysis), in which 90 severe (30 ≤ forced expiratory volume in 1 s [FEV1] <50% predicted) and very severe (FEV1 < 30% predicted) COPD patients (outpatients/inpatients) who are prescribed with any one of the following combinations (SF/FB/FF) were selected. In our study, we have divided 90 COPD patients into three groups (Group I, Group II, and Group III) each group consisting of 30 patients. Group I was prescribed with medication SF, Group II with medication FB, and Group III with medication FF. We used five different parameters such as spirometry test (mean FEV1 initial and final visit), number of symptom-free days (SFDs), number of moderate and severe exacerbations, Number of days of hospitalization and direct, indirect, and total cost to assess the cost-effectiveness of SF/FB/FF. Comparison of cost and effects was done during the period of 6 months of using SF/FB/FF.Results:The average FEV1 for Group I, Group II, and Group III subjects at initial visit was 33.47%, 33.73%, and 33.20% and was increased to 36.60%, 35.8%, and 33.4%, respectively. A 3% increment in FEV1 was reported for Group I subjects (SF) and was highly significant statistically (t = −8.833, P = 0.000) at 95% CI. For Group II subjects (FB), a 2% increment in FEV1 was reported and was highly significant statistically (t = −9.001, P = 0.000) at 95% CI. For Group III (FF) subjects 0.2% increment in FEV1. The overall mean total cost for Group I, Group II, and Group III subjects during the 6 months period was found to be Rs. 29,725/-, Rs. 32,602/- and Rs. 37,155/-. Incremental cost-effectiveness of FB versus SF was Rs. 37,781/- per avoided exacerbation and Rs. 661/-per SFD.Conclusion:This study highlights the favorable therapeutic performance of combined inhaled bronchodilators and corticosteroids (SF/FB/FF), thus suggesting that healthcare costs would be also affected positively. Results from our study showed that SF and FB were the most effective strategies in the treatment of COPD, with a slight clinical superiority of SF. The FF strategy was not much effective (i.e. associated with fewer outcomes and higher costs).

The compressive strength of C/SiC composite at different strain rates, off-axis orientations and after high-velocity impact was studied. The compressive strength was found to be 137 ± 23, 130 ± 46 and 162 ± 33 MPa at a strain rate of 3.3 × 10−5, 3.3 × 10−3, 3.3 × 10−3 s−1, respectively. On the other hand, the compressive strength was found to be 130 ± 46, 99 ± 23 and 87 ± 9 MPa for 0°/90°, 30°/60° and 45°/45° fibre orientations to loading direction, respectively. After high-velocity impact, the residual compressive strength of C/SiC composite was found to be 58 ± 26, 44 ± 18 and 36 ± 3.5 MPa after impact with 100, 150 and 190 m/s, respectively. The formation of kink bands in fibre bundles was found to be dominant micro-mechanism for compressive failure of C/SiC composite for 0°/90° orientation. On the other hand, delamination and the fibre bundles rotation were found to be the dominant mechanism for off-axis failure of composite.

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OPAT it is a frequent source of questions and formal infectious diseases consultations. OPAT is always less expensive than inpatient therapy. Financial savings have been found with OPAT when compared with in hospital stays. The use of intravenous (IV) antibiotics for the treatment of serious infections has become common around the world. It is accepted as the standard treatment for many infectious diseases including other chronic infection like sepsis, meningitis, endocarditis etc. The goals of OPAT program are to provide expert care to patients on IV antibiotics, manage side effects and infections, reduces the need for hospital readmissions. The OPAT having a series of program patient care team includes doctors, nurses, and clinical and hospital pharmacists who are skilled in management of infectious diseases. Intravenous therapy outside the hospital, has only recently become possible, with the introduction of new Antibiotics, better catheters for vascular access, and improved infusion devices. Health care professionals have pioneered the development of OPAT and worked together to develop safe and effective programs. The antibiotics used for OPAT care are chosen for safety, effectiveness and ease of administration and money saving. The IV delivery system needed in the home is much simpler than the large, complicated IV pumps you see in the hospital. OPAT allows suitable patients on intravenous (IV) antibiotics to be discharged early from hospital and treated in their home or community setting by a team of specialist nurses.