DRUG UTILISATION EVALUATION OF ANTIHYPERTENSIVES IN GERIATRIC PATIENTS IN A TERTIARY CARE HOSPITAL

Objective: Hypertension is a leading contributor to the global burden of cardiovascular morbidity and mortality. The main objective of the present study was to assess the drug utilization patterns of antihypertensives in geriatric patients in a teaching hospital. Methods: A Single centre Prospective Observational study was carried out for a period of three months in an out-patient department of Owaisi Hospital & Research Centre. Elderly patients who have been diagnosed with hypertension as per JNC-7 guidelines and patients receiving or prescribed with antihypertensive drugs were included. Results: A total of 100 prescriptions were analyzed during the three month study period. 72% of the patients were in the age group of 65-67 years and this was found to be higher in men 68%. During the study period 80% of the patients were Pre-Hypertensive systolic (80-89 mmHg) and Diastolic (120-139 mmHg) followed by Stage-I Hypertension and Stage-II Hypertension. The most common drug classes involved in the study was Calcium Channel Blockers 37% followed by Angiotensin II receptor antagonists 21% and the most commonly prescribed drugs in the study population were Amlodipine 37%, Losartan 11% and Telmisartan 10%. The most common anti-hypertensive fixed dose combination therapy involved in the study was Telmisartan + Hydrochlorothiazide 15% and most common two drug combination therapy involved in the study was Amlodipine + Atenolol 7% followed by Metoprolol + Amlodipine 1%. Conclusion: Our study shows that the most commonly prescribed drug classes involved were Calcium Channel Blockers followed by Angiotensin II receptor antagonists and the anti-hypertensive drug combinations among hypertensive patients were considerable and this practice positively impacted on the overall blood pressure control

Evaluating endothelial function during neurovascular coupling in awake behaving mice using advanced imaging technologies

Local neuronal activity in the brain results in increased blood flow and is called neurovascular coupling. Such blood flow changes result in the blood-oxygen level dependent (BOLD) fluctuations detectable by functional magnetic resonance imaging (fMRI). The hemodynamic response is also an essential component of brain health and is impaired in various models of cognitive dysfunction. However, we still do not understand why functional hyperemia in the brain is important. To understand this question, various groups have studied brain metabolic activity as well as the mechanisms underlying neurovascular coupling. Over the years, several cell types have been proposed to contribute to functional hyperemia in the brain, including neurons, astrocytes and pericytes. However, the picture remains incomplete – controversies abound regarding the exact role of astrocytes, and pericytes in neurovascular coupling. Our lab has studies the mechanisms of neurovascular coupling from a mesoscopic perspective, as vasodilation in the rodent cortex involves capillaries and diving arterioles in the brain parenchyma as well as surface vasculature in the brain. We proposed that the vascular endothelium itself might provide a continuous conduit for transmitting vasodilatory signals initiated at the capillary level due to local neuronal activity. Given that systemic endothelial dysfunction could contribute to decreased neurovascular function, this hypothesis raised important concerns regarding endothelial vulnerabilities in common diseases like hypertension and diabetes and its role in diminished cognitive function and neurodegeneration. Based on findings from vascular research in other organ systems, we hypothesized that two distinct mechanisms of endothelium-derived vasodilation significantly contribute to neurovascular coupling the brain. These two mechanisms were expected to consist of fast long-range endothelium-derived hyperpolarization (EDH) dependent vasodilation (conducted vasodilation) and slower, more localized endothelium calcium-wave dependent vasodilation (propagated vasodilation). Together, we expected these mechanisms to shape the spatio-temporal evolution of hemodynamic responses in the brain. This dual mechanism of endothelial control of the hyperemic response in the brain might explain the complex spatiotemporal properties and non-linearities of the fMRI blood oxygen level dependent (BOLD) signal. My initial experiments were conducted in anesthetized rats, where I pharmacologically inhibited endothelial dependent vasodilation during functional hyperemia in the somatosensory cortex under a hind-paw electrical stimulus paradigm. While the results gleaned from these experiments were very revealing, it was important to consider the effect of the pharmacological manipulations on neuronal activity in the brain. In addition, neurovascular coupling and overall brain blood flow in anesthetized animals is dramatically altered when compared to awake animals. In order to accomplish these goals, I built a wide-field optical imaging system that could simultaneously measure fluorescence-based neuronal activity and reflectance-based hemodynamic activity in awake head-restrained mice. I then used non-blood brain barrier permeable pharmacology to study endothelial mechanisms of neurovascular coupling in awake Thy1-GCaMP6f mice, which express the calcium fluorophore in a subset of excitatory neurons in the cortex. I found that using this pharmacology I could dissect out the hypothesized two spatiotemporally distinct components of whisker-stimulus evoked neurovascular coupling in awake mice. With simultaneous recording of the neuronal activity driving this blood flow, I was able to build a mathematical model for neurovascular coupling that accounted for these two mechanisms by allowing for the superposition of a time-invariant, constant hemodynamic response with a hemodynamic response obtained by convolving the underlying neuronal response with a hemodynamic response function (HRF). I was able to linearize these apparent non-linearities in the hemodynamic response by studying the properties of deconvolved HRFs for stimuli of different durations before and after pharmacological manipulation of endothelial activity. Two important considerations remain. Firstly, our wide-field, mesoscopic view of the brain prevents observations of endothelial function (hyperpolarization and calcium activity) and the propagation dynamics of dilation best observed at the microscopic level. To accomplish this task, ongoing experiments currently use our high-speed volumetric imaging technology (SCAPE – Swept Confocally Aligned Planar Excitation microscopy) to study stimulus-evoked vascular dynamics in mouse lines expressing GFP and GCaMP8 in endothelial cells. Secondly, our longitudinal imaging of these animals is ideal for studying the acute and long-term effects of endothelial dysfunction on cognitive function. This requires adequate study of changes in mouse behavior during manipulations of endothelial function longitudinally in awake mice. Future experiments should involve the development and implementation of appropriate task-based behavior experiments, and analysis methods for more carefully exploring changes in neuronal activity in the mouse brain during stimulus and non-stimulus dependent activity

Effect of a directionally porous wing tip on tip vortex

This paper presents an experimental study of the effect of a directionally porous wing tip on the tip vortex using particle image velocimetry (PIV) on a half wing model with NACA 653218 as its airfoil section. Four different configurations of the directionally porous wing tip are tested. The vortex generated by the wing tips are examined at four different measuring planes downstream perpendicular to the flow axis. The flow field over the porous wing tip surface along the streamwise direction is obtained as well to understand the effects of the porosity on the flow which in the end affects the vortex downstream. Furthermore, the aerodynamic performance of all different configurations is compared to study their effects on the aerodynamic coefficients of the wing. The results show a high reduction in vorticity, up to 90%; tangential velocity reduction up to 67% and a significant reduction in vortex circulation in the near-far field. Effect on the lift to drag ratio is up to 20 %

HEALTH RELATED QUALITY OF LIFE ASSESSMENT USING ST. GEORGE'S RESPIRATORY QUESTIONNAIRE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS ON COMBINED INHALED CORTICOSTEROIDS AND BRONCHODILATORS

Objective: Chronic diseases like COPD have significant effects on patient's health-related quality of life (HRQoL). HRQoL measures additional indices as compared to objective measurements like spirometry. Our aim is to assess and compare the disease-specific quality of life in Chronic Obstructive Pulmonary Disease patients using St. George's Respiratory Questionnaire (SGRQ-C) receiving Salmeterol/Fluticasone (SF), Formoterol/Budesonide (FB), Formoterol/Fluticasone (FF).Methods: A prospective, open-label, randomized, parallel group study conducted at a tertiary care teaching hospital in South India. A 6-months follow-up of 90 patients with severe and very severe COPD randomized to receive Salmeterol/Fluticasone, Formoterol/Budesonide, and Formoterol/Fluticasone in appropriate doses according to their global initiative for chronic obstructive lung disease (GOLD) severity. After spirometry, St. George's Respiratory Questionnaire (SGRQ-C) was administered at baseline and after 180 d to assess improvement in lung function and HRQoL. Statistical analysis used: Data analyzed using SPSS version: 13.0. General linear repeated measures using the post-hoc Bonferroni method assessed significance between treatment groups.Results: Significant decrease (P<0.05) in each SGRQ-C domains and total scores as well as improvement in FEV1 (P<0.05) was observed in all study subjects. The mean SGRQ-C total score for the group I subjects (SF) at the initial visit was 86.69 and the scores reduced to 58.78 at final visit (i.e. after using SF for 6 mo). This reduction was highly significant statistically (t=10.989, p=0.000) at 95% CI. The mean SGRQ-C total scores for group II subjects (FB) at initial visit were 85.85 and the scores reduced to 67.98 at the final visit. This reduction was highly significant statistically (t=9.669, p=0.000) at 95% CI. The mean SGRQ-C total scores for group III subjects (FF) at initial visit were 83.96 and the scores reduced to 70.37 at final visit (after 6 mo). This reduction was highly significant statistically (t=12.285, p=0.000) at 95% CI.Conclusion: Maximum improvement in HRQoL (P<0.05) was noted in patients receiving Salmeterol/Fluticasone with respect to SGRQ-C (activity, impact and total) scores and FEV1. This improvement with SF was due to its greater effect in patients with severe and very severe chronic obstructive pulmonary disease. There was a significant improvement in QoL with SF as compared to FB and FF in severe and very severe COPD patients. Subsequently, the three combined inhaled corticosteroids and bronchodilators showed similar improvements in lung functions and Health related quality of life throughout the study.Â

Bacteriological profile of wound infections and antimicrobial resistance in selected gram-negative bacteria

Background: Managing wound infections is a challenging task. Understanding their resistance pattern is an essential step at reducing its burden in hospital settings. Objective: To determine the bacteriological diversity of wound infections and the antimicrobial resistance exhibited by a selected Gram-negative bacterium in the Aljouf region of Saudi Arabia. Methods: The study retrospectively analysed the antibiograms of wound infections from hospitalized patients for the year 2019. The European Centre for Disease Control guidelines were adopted for the classification of resistant bacteria. Multidrug-, extensive drug-, and carbapenem-resistant isolates are presented as frequencies and percentages. Results: A total of 295 non-duplicate wound swab antibiograms were retrieved, 64.4% (190) and 35.6% (105) isolates were Gram-negative and Gram-positive bacterial infections respectively. Predominant pathogens included Staphylococcus species 21.0% (62), E. coli 16.3% (48) and K. pneumoniae 13.5% (40). 148 (77.9%), 42 (22.1%) and 43 (22.6%) of the Gram-negative isolates were multidrug-, extensively drug- and carbapenem-resistant. The antibiotic resistance exhibited by gram-negative bacteria was 43.4% (234/539), 59.1% (224/379) and 53.7% (101/188) towards carbapenems, 3rd - and 4th – generation cephalosporins. Conclusions: The majority of wound infections are caused by multidrug-, extensively drug- and carbapenem-resistant Gram-negative bacteria. Further studies should focus on the molecular basis of this resistance. Keywords: Wound infections; hospital; Gram-negative bacteria; antibiograms; multidrug-resistance; E. coli

Management of diabetes and arthritis –A systematic review

Purpose: Diabetes is a metabolic syndrome with reported musculoskeletal  effects. This systemic review aimed to identify a relationship between  diabetes and arthritis; disease-related risk factors, the effect of diet in disease management and the effect of anti-arthritic drugs on diabetes  treatment.Methods: This study analysed 20 articles identified and selected according to the study criteria. PRISMA guidelines were used for identification and screening of literature. Data search covered several primary databases, including Pubmed, Wiley library, Scopus, Clinical Trial Registry, etc.Results: The study findings suggest a significant correlation between  diabetes and arthritis. Obesity, impaired glucose tolerance (MS  components), vascular cell adhesion molecule 1 (VCAM-1) hypertension and dyslipidemia are the most common risk factors leading to disease progression. Omega -3-fatty acid showed no protective effect on disease condition.Conclusion: The findings indicate that anti-tumor necrosis factor (Tnf)-α, disease modifying antirheumatic drugs, and Interleukin receptors  antagonist improved the efficacy of diabetic medication and maintained blood sugar levels. However, Tnf-α reduced glucose intolerance, and therefore, its therapeutic use in conjunction with diabetic medications should be limited.Keywords: Diabetes, Arthritis, Risk factors, Diet, Pathogenesis, Disease progression, Medicatio

Elastic nailing of the femoral fractures in the 6-10 year age: a study from Kashmir

Background: Fractures of the femur are amongst the most common paediatric orthopaedic injuries. The aim of this study was to assess the efficacy of the stainless steel elastic nail in the management of these fractures in the 6-10 year age group.Methods: Fifty patients in the age group of 6-10 years with displaced diaphyseal femoral fractures were stabilized with these nails. Patients were followed up clinically and radiologically for a minimum period of 1 year.Results: There were 64% excellent and 34% satisfactory results. 2% patients had poor result.Conclusions: These nails are a relatively easy to use, minimally invasive, physeal-protective implant system with high rate of satisfactory and excellent outcomes in children aged 6-10 years

An unusual case of frost bite autoamputation of toes

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