IntroductionAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is frequently encountered as a medical emergency. AECOPD is the third leading medical cause of hospitalization due to acute respiratory failure (ARF). The utilization of ventilators for patients with ARF secondary to AECOPD has increased. There has been a major inclination towards utilization of non-invasive positive pressure ventilation (NIPPV) and sparing invasive positive pressure ventilation (IPPV) for life-threatening respiratory distress and/or in patients where NIPPV failure is observed. The aim of this observational study was to compare the clinical and laboratory parameters patients with chronic obstructive pulmonary disease (COPD) complicated by ARF admitted in the intensive care unit (ICU).MethodsIn the prospective observational study with known cases of COPD complicated by ARF, patients were grouped into NIPPV and IPPV groups based on their clinical and laboratory parameters. Thirty patients were included in each group. Demographic data was collected. Clinical and laboratory parameters were evaluated at baseline and at 24 hours of ventilation. The outcome was assessed in terms of duration of ventilation, hospital and ICU stay and overall mortality. Data was entered and analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY).ResultsBoth IPPV and NIPPV groups demonstrated marked reduction in partial pressure of carbon dioxide (PaCO2) with 24 hours of ventilation (for IPPV: 78.1 ± 20.2 vs. 69.1 ± 20.2; p=0.08) (for NIPPV: 68.1 ± 17.8 vs. 57.2 ± 21.5; p=0.03). In NIPPV group, there was significant improvement in partial pressure of oxygen (PaO2) (p=0.009), respiratory rate (p=0.008), heart rate (p<0.0001), systolic blood pressure (p=0.03), and diastolic blood pressure (p<0.0001). These parameters did not improve significantly in the IPPV group except for systolic blood pressure (p=0.008). The NIPPV failure rate was 20%. NIPPV patients had a significantly shorter duration of ventilation, ICU stay, and hospital stay. In-ICU mortality was significantly lower in the NIPPV group as compared to IPPV (13% vs. 40%; p=0.01). There was no difference in post-ICU in-hospital mortality between the two groups (6.7% vs. 16.7%; p=0.13).ConclusionBoth NIPPV and IPPV are effective in normalizing acidosis and hypercapnia in patients with COPD complicated by ARF. Patients managed with non-invasive mode of ventilation have a shorter duration of ICU as well as hospital stay. Survival rates are also better as compared to patients managed with invasive ventilation.

Background: India is fast becoming the diabetic capital in the world according to a recent report. Patients with diabetes are at increased risk of mortality due to diabetic complications, which has enormous implications for the health budget. Objectives: The main objective of this review is to provide an overview of the work carried out in the world, including modern and traditional approaches for the prevention and management of diabetes and reducing the chances of onset of further complications via cost-effective lifestyle interventions and integrative medicine. Material and Methods: We performed a literature search from various databases like PubMed, Scopus, Google scholar, etc., using the keywords diabetes, prediabetes, MCI and prediabetes, diabetes and yoga, diabetes. Results: Upon reviewing the published articles, it was noticed that one of the most neglected complications of diabetes, namely cognitive dysfunction, which is characterized by a pattern of vascular dementia and Alzheimer disease (AD), has been largely ignored, and there has been no large study investigating the role of yoga intervention in diabetes and/or associated cognitive impairment. Conclusion: The review article opens new paradigms for researchers to evaluate the connection between diabetes and AD through a yoga-based national campaign on diabetes. This paves the way towards the goal of integrative medicine.

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Human beings have been in search of security right from nomadic days. The history of mankind is a history of the search for security. Man had to face dangers and risk which threatened his very existence. As an individual he would have found it difficult to combat these external dangers. He therefore started living in a group, thereby ensuring group security and cover against possible external dangers. The greatest risk was of course, that of death, from wild animals, snakes, crocodiles and other crawling creatures and also from natural calamities, such as floods, fires and earthquakes. The function of insurance is to protect one against losses he cannot afford. This is done by transferring the risks of a person, business, or organization known as, the "insured" to an insurance company, known as the "insurer". The insurer then reimburses the insured for "covered" losses i.e; those losses it pays for under the terms of the policy. In India, insurance has a deep-rooted history. It finds mention in the writings of Manu (Manusmrithi), Yagnavalkya (Dharamasastra) and Kautilya (Arthasastra). The writings talk in terms of pooling of resources that could be redistributed in times of calamities such as fire, floods, epidemics and famine. This was probably a precursor to modern day insurance. Ancient Indian history has preserved the earliest traces of insurances in the form of marine trade loans and carriers contracts. Insurance in India has evolved overtime heavily drawing from other countries, England in particular.