Conservative treatment of spinal tuberculosis and its outcome: an observational study

Background: Spinal tuberculosis or Pott’s spine occurs in about 1-2% of patients with tuberculosis and accounts for 40-50% of musculoskeletal tuberculosis.It is caused due to the infection of the bone by Mycobacterium tuberculosis bacteria with the combination of spread through haematogenous route as well as lymphatic drainage.Methods: This observational study was done for a period of 2 years from Jan 2016 to Jan 2018. The total number of study participants was 51. The functional outcome was assessed using modified McCormick’s scale.Results: Majority of study participants were females accounting for 60.7% compared to males (39.21%). The main complaint of study participants was back pain (39.21%) which was followed by fever in 21.5%. Loss of appetite was the most prominent symptom seen in 15.6%. Thoracolumbar vertebrae were the site of involvement in 37.2%.Conclusions: Patients responded well with anti-tubercular treatment in mild and moderate cases of spinal TB, if there was no gross neurological deficit. Thus it is very important to identify the early symptoms of spinal TB so that timely prompt treatment should be initiated

Study of the prescription pattern of anti-depressants in a tertiary care hospital: a prospective observational study

Background: One of the most important public health priorities are psychiatric disorders. Prescribing medications play a crucial role in providing good health care. Therefore, there is a need to understand prescription patterns at regular intervals. Methods: This was a prospective, cross-sectional, observational study conducted at the psychiatry department OPD of Government Medical College, Aurangabad (Maharashtra, India) from January 2021 to June 2022. Records of prescriptions were collected from the hospital management information system. Results: N=417 prescriptions were analysed. The male: female ratio was 1.25. Among total prescriptions analysed, selective serotonin reuptake inhibitors (SSRIs) were the most prescribed drug class (32.18%) followed by benzodiazepines (25.19%) and atypical antipsychotics (19.97%). Drugs prescribed as fixed dose combinations (FDC) were 2.10%. Most of the patients received polytherapy in which most patients constituted of two drug therapy (46.28%) and 34.53% of patients received monotherapy. In the patients managed by monotherapy, SSRIs were the most prescribed (29.16%), followed by atypical anti-psychotics (26.38%) and benzodiazepines (24.30%). Prescriptions with generic names were 93.12%. The average number of drugs per encounter was 1.88. Drugs prescribed from the essential drugs list (India) were 41.66%. Drugs prescribed from the essential medicines list (WHO) were 47%. The total number of prescriptions with injections 0.23%. Conclusions: Prescribing patterns were according to the WHO-DUS parameters. Most patients were prescribed generic medicines. SSRIs, benzodiazepines and tricyclic antidepressants were the most prescribed drug class

Prescription pattern of antibiotics in neonatal intensive care unit of tertiary care hospital

Background: Recurrent and prolonged courses of antibiotics exposure have resulted in an increase in the prevalence of hospital acquired infections and antibiotic resistant profile. The objective of this study was to quantify the use of antibiotics in a neonatal intensive care unit (NICU) of Govt. Medical College and Hospital, Aurangabad, Maharashtra, a tertiary health care centre.Methods: A total of 260 neonates admitted in NICU from August 2017 to February 2018 were enrolled in the study and fulfilling inclusion criteria of the study. Demographic details, data on antibiotic prescriptions (name, dose, frequency, route of administration) was recorded on pre-tested structured Performa.Results: A total of 248 neonates received the antibiotics. EOS pneumonia was most common i.e. 29.8% followed by LOS pneumonia (20.6%). Sepsis, pneumonia Meningitis, NEC, were common indications for admission in NICU. Among the antibiotic combinations amoxicillin + clavulanate (38.99%), was most commonly prescribed followed by gentamicin (37.89%) and piperacillin (11.01%) respectively. Other antibiotics like, linezolide (0.94%), fluconazole (5.97%), meropenem (4.42%), vancomycine (0.77%) were also used less commonly in NICU. About fifty of the medicine prescribed were in compliance with the national list of essential medicines 2011.Conclusions: In tertiary care setup of NICU amoxicillin + clavulanate and gentamicin are most commonly used antibiotics in NICU. The study concludes that the antibiotic prescription pattern at NICU of our tertiary care hospital was found rational

Making rainfed agriculture sustainable through environmental friendly technologies in Pakistan: A review

Abstract:Pakistan is an agricultural country spreading over an area of about 79. 6 million hectares (Mha) with an arid and semi arid climate. Of 79. 6 Mha, about 23 Mha is suitable for crop production and nearly 25 percent of the total cultivated area is designated for rainfed agriculture. Unfortunately, rain-fed agriculture is constrained with multifarious problems such as moisture stress, soil erosion and crusting, nutrient deficiency, depletion and poor nutrient use efficiency, and weed infestation limiting the yield potential of these lands. In addition, deforestation and poor crop husbandry techniques are commonly noticed features. To meet the food requirements, farmers bring all the available pieces of lands under plough including steep slopes. Farming on steep slopes if not managed on scientific lines, results in severe erosion. The problems faced by the farmers are due to the unsustainable practices they adopt to practice dryland agriculture, limiting the productive potential of these important ecosystems. However, their potential can be improved by adopting suitable rainwater harvesting techniques; employing scientific soil and water conservation methods and using sustainable agricultural practices. This paper highlights some important issues associated with the rainfed agriculture of Pakistan. Working strategies for realizing optimum and sustainable yields have been outlined while conserving both land and water resources

Evaluation of validity and reliability of multiple-choice questions in second MBBS competency-based medical education-based pharmacology examination of medical institute of India

Background: Multiple choice questions (MCQs) are most commonly used assessment tool in undergraduate medical examination. Assessment method must be reliable and valid. To improve quality of MCQs, item analysis was carried out by determining their validity and reliability using parameters like difficulty index, discrimination index, distractor efficiency and Cronbach’s alpha value.Methods: Study was carried out among 193 second year medical students. Each student was given 40 MCQs of 1 mark each. After assessment of MCQs, validity of test was analyzed by using difficulty index, discrimination index and distractor efficiency while reliability was analyzed by using Cronbach’s alpha.Results: Mean ± SD of difficulty index, discrimination index, functioning and non-functioning distractors were 59.80±23.38, 0.25±0.12, 1.98±0.92 and 13.25±13.05 respectively with reliability value of 0.7. About 47.5% items had moderate difficulty index, 22.5% items have excellent discrimination index with 35% items having 100% distractor efficiency. Reliability of test as measured by Cronbach’s alpha value was 0.7. There was weak correlation between difficulty index and discrimination index.Conclusions: It is concluded from study that given MCQs test have reliability but not validity and needs to improve quality of MCQs. Validity of test is improved by improving difficulty index, discrimination index, distractor efficiency of items

Drug utilization study of antihypertensive drugs used in the treatment of second and third trimester of pregnancy in tertiary care hospital

Background: Hypertensive disorders are major cause of the perinatal and maternal mortality and morbidity worldwide. Aim of study was to evaluate current trend of antihypertensive drugs and to assess frequency and distribution of antihypertensive drugs in pregnancy.Methods: A retrospective observational study was conducted in a tertiary care hospital for period of six months in collaboration with department of obstetrics and gynaecology. Patients data recorded in case report form and analysed to study prescription pattern and related information.Results: Total of 104 cases were enrolled in this study. Prescribed antihypertensive drugs in pregnancy were Labetalol, Nifedipine, MgSO4 and furosemide. Most commonly prescribed drug was labetalol. In this study, Gestational hypertension was most common diagnosis in hypertensive disorder. Majority of drug prescribed from category C and A. In present study, Single drug therapy was most commonly prescribed for hypertension in pregnancy was 64.42% whereas multiple drug therapy was 35.57%. Most common maternal complication was anaemia i.e. 54.05% followed by placental abruption in 24.3%. Neonatal outcome was low birth weight i.e.36% followed by preterm birth i.e.24%.Conclusions: Labetalol found to be most common prescribed drug. Single drug therapy prescription was high as compared to multiple drug therapy prescription in hypertensive disorders in pregnancy. Gestational hypertension was most common cause of hypertensive disorder. Anaemia was found to be most common maternal complication encountered in hypertensive disorders in pregnancy. Most common adverse neonatal outcome was low birth weight

Analysis of neuro-theatre utilisation and reasons for cancellation to improve efficiency and productivity

Aim: In neurosurgery, much emphasis has recently been placed on theatre cancellation and time utilization as a key hospital management performance indicator. We sought to evaluate our unit’s theatre throughput efficiency, and identify the causes of elective surgery cancellations. Methods: We retrospectively audited all scheduled elective neurosurgical procedures over a period of 9 months. Results: Mean theatre utilization time was 47.0%. The common causes of cancellations were lack of theatre time (32%), non-availability of beds in recovery room (18.6%), and insufficient preoperative patient preparation (5.5%). Discussion: Inefficiencies were noted in turnover of patients and inaccurate prediction of operative time. Our theatre utilization time is consistent with available literature, however cancellations of elective surgery waste valuable operative time and resources. Conclusions: A multi- dimensional approach must be taken to improve theatre utilization and reduce cancellation rates. A pre-assessment clinic has been introduced in order to reduce cancellation rates

Patients’ Knowledge and Pharmacists’ Practice Regarding the Long-Term Side Effects of Proton Pump Inhibitors; a Cross-sectional Study

Introduction: Proton pump inhibitors (PPI) are a commonly prescribed medication, but recent evidence suggests that their long-term use may lead to several adverse events. To address this issue, our study aims to assess patient awareness and pharmacist practices in educating patients about the potential risks associated with prolonged PPI use.  Methods: Two questionnaires were developed by researchers and administered in the United Arab Emirates from June to August 2021 to gather insights from patients and pharmacists about the use of PPIs, their knowledge of potential side effects, and their experiences and attitudes toward receiving education about PPI side effects. The patients' knowledge was evaluated based on their cumulative correct answers to questions related to PPI’s long-term adverse effects including increased fracture risk and hypocalcemia, vitamin B12 deficiency, hypomagnesemia, and the caution of abrupt withdrawal. All statistical analyses were conducted using SPSS 25.0 software. Results: Overall, 348 participants with a median age of 40 years participated in the survey, among them, 91 (26.14%) used various forms of PPI with 38% of users taking PPI as over-the-counter drugs. Patients had low knowledge about PPI side effects and their proper discontinuation with a median knowledge score of 0 (Interquartile range: 0-2) and only 22.2% of patients were familiar with at least three out of five asked harms. Those with lower knowledge were more likely to be Emirati compared to other nations (p=0.004) and aged over 30 years compared to their younger counterparts (p = 0.016). Few patients have obtained the relevant information from their physicians (25%) or pharmacists (7%). Inquiring 136 pharmacists, it was shown that the most common education was concerning vitamin B12 deficiency (62.5%) followed by fracture risk (58.09%) yet less than half (48%) of pharmacists instructed patients about the potential risk of hypomagnesemia. Almost all pharmacists (99%) agreed that there is a requirement for additional education on the possible harmful consequences of PPIs. Conclusion: The present study has established that a considerable proportion of PPI users in the UAE lack the necessary awareness about the potential adverse effects of PPI despite their extensive use in this country. The current pharmacist practice is inefficient for inculcating the potential harms of chronic PPI use and they are required to optimize their efforts to educate patients and bridge the knowledge gaps

Impact of Sewage on Health, Economic and Social Life of Rural People in Al-Hair - Kingdom of Saudi Arabia

This paper aimed to evaluate the health, social and economic effects of sewage on rural people's life in Al-Hair, Saudi Arabia. A total of 90 rural people, representing about 1% of the population of the study area, were interviewed using a questionnaire. Percentages, arithmetic means, and standard deviations were calculated.  The study revealed that 26.7% of the respondents had expressed a high degree of health impact from sewage and high social and economic effect with the percentages of 85.6% and 84.4% respectively. The interrelation between the perception of the diverse effects of sewage and people's personal characteristics indicate that age, gender, household size and education level, are key determinants of rural people’ perception on health, social and economic-related risks due to sewage. Therefore, there is need to sensitize rural people about risk-reduction measures of sewage. Additional research is required to suggest intervention framework for dealing with sewage in the study area with collaboration from different stakeholders. This will provide additional information to decision-makers for policy formulation in sewage treatment by considering the adverse effects on people's life and different potential roles from all partners.DOI: https://doi.org/10.5281/zenodo.81000