Study of drug utilization trends in respiratory tract infections in a tertiary care teaching hospital: a retrospective study

Background: Drug utilization studies play crucial role in the health sector and ultimately it provides insight into the efficiency of drug use and results of such research can be used to help to set priorities for the rational use of medicines and allocation of health care budgets. Respiratory tract infections (RTIs) contributing to significant mortality and morbidity of populations especially in developing countries like India. Polypharmacy and irrational prescription are significant negative fallouts in treatment of RTIs. Keeping in view of this, our study was undertaken to analyze the drug utilization pattern of RTIs.Methods: The study was conducted at Gandhi Hospital, after obtaining permission from the Institutional Ethics Committee. We have collected data of 600 case records of the patients diagnosed with respiratory tract infection and evaluated for prescribing patterns in consonance with WHO indicators.Results: Out of the total case records 348 (58%) were of male patients and 252 (42%) of female patients. Age wise distribution was done; 79 (13.16%) 0-15 years, 46 (7.67%) 16-30 years, 123 (20.50%) 31-45 years, 194 (32.33%) 46-60 years and 158 (26.33%) patients belongs to >60 years of age group respectively. A total of 4682 drugs were prescribed, 2468 (52.71%) antibiotics, 768 (16.4%) bronchodilators, 581 (12.4%) corticosteroids, 323 (6.89%) antacids, 542 (11.57%) in miscellaneous category respectively. With regard to formulations 2463 (52.60%) oral, 1463 (31.24%) injectable and 756 (16.14%) inhalational drugs were prescribed. Numbers of Fixed dose combinations were 712 (15.20%). 7.8 drugs were prescribed per prescription. 2493 (53.24%) drugs were prescribed from National Essential Medicine List. 4168 (89.02%) drugs were prescribed by their brand names.Conclusions: Prescription of drugs with branded names, Irrational prescribing, poly pharmacy were observed in our study. So there is an urgent need for creating awareness among the health care professionals regarding rational prescription by using data from from drug utilization studies.

Longitudinal MRI assessment: the identification of relevant features in the development of posterior fossa syndrome in children

Up to 25% of children who undergo brain tumour resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterised by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in lobes within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Intra-operative MRI (IoMRI) is used during surgical procedures at the Alder Hey Children’s Hospital, Liverpool, England, in the treatment of Posterior Fossa tumours and allows visualisation of the brain during surgery. The final MR scan on the IoMRI allows early assessment of the ION immediately after the surgical procedure. The longitudinal MRI data of 28 patients was analysed in a collaborative study with Alder Hey Children’s Hospital, in order to identify the most relevant imaging features that relate to the development of PFS, specifically related to HOD. A semi-automated segmentation process was carried out to delineate the ION on each MRI. Feature selection techniques were used to identify the most relevant features amongst the MRI data, demographics and clinical data provided by the hospital. A support vector machine (SVM) was used to analyse the discriminative ability of the selected features. The results indicate the presence of HOD as the most efficient feature that correlates with the development of PFS, followed by the change in intensity and size of the ION and whether HOD occurred bilaterally or unilaterally

Identifying quantitative imaging features of posterior fossa syndrome in longitudinal MRI

Up to 25% of children who undergo brain tumor resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterized by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in structures within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Longitudinal MRI datasets of 28 patients were acquired consisting of pre-, intra-, and postoperative scans. A semiautomated segmentation process was used to segment the ION on each MR image. A full set of imaging features describing the first- and second-order statistics and size of the ION were extracted for each image. Feature selection techniques were used to identify the most relevant features among the MRI features, demographics, and data based on neuroradiological assessment. A support vector machine was used to analyze the discriminative features selected by a generative k-nearest neighbor algorithm. The results indicate the presence of hyperintensity in the left ION as the most diagnostically relevant feature, providing a statistically significant improvement in the classification of patients (p=0.01) when using this feature alone

Determination of Fatty Acid Methyl Esters Derived from Algae Scenedesmus dimorphus Biomass by GC-MS with One-step Esterification of Free Fatty Acids and Transesterification of Glycerolipids

Algae can synthesize, accumulate and store large amounts of lipids in its cells, which holds immense potential as a renewable source of biodiesel. In this work, we have developed and validated a GC–MS method for quantitation of fatty acids and glycerolipids in forms of fatty acid methyl esters derived from algae biomass. Algae Scenedesmus dimorphus drymass was pulverized by mortar and pestle, then extracted by the modified Folch method and fractionated into free fatty acids and glycerolipids on aminopropyl solid-phase extraction cartridges. Fatty acid methyl esters were produced by an optimized one-step esterification of fatty acids and transesterification of glycerolipids with boron trichloride/methanol. The matrix effect, recoveries and stability of fatty acids and glycerolipids in algal matrix were first evaluated by spiking stable isotopes of pentadecanoic-2,2-d2 acid and glyceryl tri(hexadecanoate-2,2-d2) as surrogate analytes and tridecanoic-2,2-d2 acid as internal standard into algal matrix prior to sample extraction. Later, the method was validated in terms of lower limits of quantitation, linear calibration ranges, intra- and inter-assay precision and accuracy using tridecanoic-2,2-d2 acid as internal standard. The method developed has been applied to the quantitation of fatty acid methyl esters from free fatty acid and glycerolipid fractions of algae Scenedesmus dimorphus

Fully-automated identification of imaging biomarkers for post-operative cerebellar mutism syndrome using longitudinal paediatric MRI

Post-operative cerebellar mutism syndrome (POPCMS) in children is a post- surgical complication which occurs following the resection of tumors within the brain stem and cerebellum. High resolution brain magnetic resonance (MR) images acquired at multiple time points across a patient’s treatment allow the quantification of localized changes caused by the progression of this syndrome. However, MR images are not necessarily acquired at regular intervals throughout treatment and are often not volumetric. This restricts the analysis to 2D space and causes difficulty in intra- and inter-subject comparison. To address these challenges, we have developed an automated image processing and analysis pipeline. Multi-slice 2D MR image slices are interpolated in space and time to produce a 4D volumetric MR image dataset providing a longitudinal representation of the cerebellum and brain stem at specific time points across treatment. The deformations within the brain over time are represented using a novel metric known as the Jacobian of deformations determinant. This metric, together with the changing grey-level intensity of areas within the brain over time, are analyzed using machine learning techniques in order to identify biomarkers that correspond with the development of POPCMS following tumor resection. This study makes use of a fully automated approach which is not hypothesis-driven. As a result, we were able to automatically detect six potential biomarkers that are related to the development of POPCMS following tumor resection in the posterior fossa

Pneumopericardium, pneumomediastinum and air travel: A case report in a patient with Gardner syndrome

© 2020 The Author(s) Onboard aircraft medical emergencies are on the rise as commercial air traffic is increasing. However, thoracic injury secondary to air travel is extremely rare and, most reported injuries are cases of pneumothoraces. Spontaneous pneumomediastinum and pneumopericardium have been barely reported in the medical literature as a complication of air travel. We are reporting a case of spontaneous pneumopericardium and pneumomediastinum in a patient with Gardner\u27s Syndrome after a flight from Central America to New York City. The patient presented with chest discomfort. He was managed conservatively with oxygen therapy as he was hemodynamically stable throughout his stay in the hospital. A thorough work up in hospital including and esophagogram and a CT scan of the chest were none revealing of the cause. However, the patient was noted to have metastatic rectal cancer with lung involvement. The patient was discharged with instructions to avoid air travel

Locked-In with COVID-19

© 2020 Elsevier Ltd Coronavirus Disease 2019 (COVID-19) can be associated with various neurological manifestations including acute strokes. Hyper acute diagnosis and treatment are key factors which decrease mortality and morbidity in stroke patients. The COVID-19 pandemic has introduced a great strain on the healthcare system, and as a result clinicians are facing several barriers in diagnosing and treating strokes. Delayed presentation of strokes is a problem as some in the general population defer the decision to seek immediate medical attention fearing contracting the virus. Also playing a role is the paucity of healthcare professionals available during a pandemic. Recent literature demonstrates the association of acute strokes in young patients with COVID-19. Lack of clear pathophysiology of the neurological manifestations from COVID-19 intensifies the problem. A thorough examination of the intensive care unit patient has always been a challenge owing to several factors including use of sedatives, sepsis, uremia, and encephalopathy secondary to medications. Locked-In Syndrome (LIS) secondary to stroke is much more challenging to diagnose as patients are unable to communicate or elicit any motor functions apart from certain ocular movements. We present the case of a 25 year old patient with no known history of coagulopathy, but had developed COVID-19 cytokine storm which culminated in LIS secondary to pontine strokes

Post-operative pediatric cerebellar mutism syndrome and its association with hypertrophic olivary degeneration

Background: The dentato-thalamo-cortical (DTC) pathway is recognized as the anatomical substrate for postoperative pediatric cerebellar mutism (POPCMS), a well-recognized complication affecting up to 31% of children undergoing posterior fossa brain tumour resection. The proximal structures of the DTC pathway also form a segment of the Guillain and Mollaret triangle, a neural network which when disrupted causes hypertrophic olivary degeneration (HOD) of the inferior olivary nucleus (ION). We hypothesize that there is an association between the occurrence of POPCMS and HOD and aim to evaluate this on MR imaging using qualitative and quantitative analysis of the ION in children with and without POPCMS. Methods: In this retrospective study we qualitatively analysed the follow up MR imaging in 48 children who underwent posterior fossa tumour resection for presence of HOD. Quantitative analysis of the ION was possible in 28 children and was performed using semi-automated segmentation followed by feature extraction and feature selection techniques and relevance of the features to POPCMS were evaluated. The diagnosis of POPCMS was made independently based on clinical and nursing assessment notes. Results: There was significant association between POPCMS and bilateral HOD (P=0.002) but not unilateral HOD. Quantitative analysis showed that hyperintensity in the left ION was the most relevant feature in children with POPCMS. Conclusions: Bilateral HOD can serve as a reliable radiological indicator in establishing the diagnosis of POPCMS particularly in equivocal cases. The strong association of signal change due to HOD in the left ION suggests that injury to the right proximal efferent cerebellar pathway plays an important role in the causation of POPCMS. Keywords: Cerebellar mutism syndrome (CMS); hypertrophic olivary degeneration; posterior fossa syndrome (PFS); postoperative pediatric cerebellar mutism syndrom

Singular fractional technique for free convective Casson hybrid nanofluid with optically thick medium and shape effects

The transmission of heat in a time-dependent flow of a viscid non-Newtonian hybrid nanofluid comprising magnetite and copper oxide nanoparticles persuaded by an upright plate has been explored in regards to the effect of heat radiation and nanoparticle shape factors. The fluid flow phenomenon of the problem is constructed using the derivative of the Caputo fractional order 0 1. As a hybrid method, the dimensionless governing fractional partial differential equation was solved analytically using transforms such as Laplace and Fourier sine. With the Mittag-Leffler function, analytical solutions are achieved for fluid flow, energy distribution, rate of heat transmission, and shear stress. Moreover, limit-case solutions for classical PDEs were given for the derived governing flow model. Graphical depictions, tables, and bar graphs are constructed using "MATLAB" for a thorough examination of the problem. The graphical findings suggest that the efficiency of hybrid nanofluids is substantially better with the Caputofractional order approach than with ordinary derivatives. Finally, a comparison with existing literature results is performed and determined to be good

In situ gel of triamcinolone acetonide-loaded solid lipid nanoparticles for improved topical ocular delivery: Tear kinetics and ocular disposition studies

© 2019 The Authors Objective: The purpose of this systematic review is to summarize the best available evidence on interventions that could be implemented in the college environment to increase HPV vaccination uptake in college students who were not previously vaccinated. Methods: Pubmed, CINAHL, PsycINFO, Cochrane, and EBSCO were searched in December 2017 to identify all literature meeting the following criteria: human subjects, English language, HPV, HPV vaccination, and college. PRISMA recommendations were followed. We focused only on manuscripts that reported vaccine uptake, excluding studies that only reported vaccine intentions. We identified 2989 articles; 101 relevant after screening; nine eligible for final qualitative review. Results: Vaccine uptake rates ranged from 5% to 53%. Theory-based variables (e.g., perceived susceptibility and self-efficacy)were associated with vaccine uptake in most studies. A study exposing participants to a narrative video about HPV vaccination led by a combination of peers and medical experts produced the greatest difference in HPV vaccination initiation compared to a control group (21.8% vs 11.8%)of all the studies reviewed. Conclusions: Few interventions resulted in substantial HPV vaccine uptake. A combination of peer and provider encouragement may be the most effective method to increase vaccine uptake in this population