Study of rationality and utilization pattern of antimicrobials in ear, nose, throat outpatient department of Tertiary Care Hospital, Nanded

Background: Antimicrobials are most commonly prescribed drugs worldwide. Around 50% of the prescriptions of antimicrobial drugs are either not needed, inappropriate or in wrong doses. With the widespread use of antimicrobial agents (AMAs), the prevalence of resistance has increased. To evaluate the prescription pattern and utilization of AMA in ear, nose, throat (ENT) outpatient department (OPD) of Tertiary Care Hospital, Nanded.Methods: This prospective study was conducted in ENT OPD of Dr. Shankarrao Chavan Government Medical College, Nanded over a period of 3 months. During this period, approximately 1100 patients visited ENT OPD and 600 prescriptions were evaluated. The excluded patients were of post-operative follow-up and of patients undergoing medical examination for fitness and handicap certificate. Data were collected by using specially designed case report form. Appropriateness of AMA was assessed by Kunin’s modified criteria.Results: Total 600 prescriptions were analyzed out of which (91%) consist of AMA. Most of them reported with upper respiratory tract infections (URTI) (30.4%), chronic suppurative otitis media (21.4%), acute suppurative otitis media (10.4%), tonsillitis (3.3%), sinusitis (2.7%), and others (15%). Amoxicillin (43.9%) was preferred AMA followed by ciprofloxacin (30.6%), cotrimoxazole (5.8%), azithromycin (3.2%), doxycycline (3.2%) cefixime + clavulanate (3.2%), and amoxicillin + clavulanate (1.8%). Single antibiotic was preferred in all prescriptions. In the concomitant medications, antihistaminics were prescribed in 97.22% of patients, non-steroidal anti-inflammatory drugs in 94.96% of patients, and antacids in 87.76% of patients. Fixed-dose combinations were used in 10% of prescriptions. Brand names of AMA were used in 10% of prescriptions. As per the Kunin’s modified criteria, 83% of patients received AMA therapy appropriately, while 17% patients inappropriately.Conclusions: Amoxicillin is the most common AMA prescribed and URTI is the most common diagnosis made. All AMAs should be prescribed only when needed and should be used in proper dose and for proper duration. Institution wise antibiotic policy should be used to contain resistance. Proper training and regular orientation programs of the juniors’ doctors for judicial use of AMAs will foster the habit of rational prescribing of AMA

Scaling in the Bombay Stock Exchange Index

In this paper we study BSE Index financial time series for fractal and multifractal behaviour. We show that Bombay stock Exchange (BSE)Index time series is mono-fractal and can be represented by a fractional Brownian motion.Comment: 11 pages,3 figure

Multifractal Scaling, Geometrical Diversity, and Hierarchical Structure in the Cool Interstellar Medium

Multifractal scaling (MFS) refers to structures that can be described as a collection of interwoven fractal subsets which exhibit power-law spatial scaling behavior with a range of scaling exponents (concentration, or singularity, strengths) and dimensions. The existence of MFS implies an underlying multiplicative (or hierarchical, or cascade) process. Panoramic column density images of several nearby star- forming cloud complexes, constructed from IRAS data and justified in an appendix, are shown to exhibit such multifractal scaling, which we interpret as indirect but quantitative evidence for nested hierarchical structure. The relation between the dimensions of the subsets and their concentration strengths (the "multifractal spectrum'') appears to satisfactorily order the observed regions in terms of the mixture of geometries present: strong point-like concentrations, line- like filaments or fronts, and space-filling diffuse structures. This multifractal spectrum is a global property of the regions studied, and does not rely on any operational definition of "clouds.'' The range of forms of the multifractal spectrum among the regions studied implies that the column density structures do not form a universality class, in contrast to indications for velocity and passive scalar fields in incompressible turbulence, providing another indication that the physics of highly compressible interstellar gas dynamics differs fundamentally from incompressible turbulence. (Abstract truncated)Comment: 27 pages, (LaTeX), 13 figures, 1 table, submitted to Astrophysical Journa

Flow induced by a sphere settling in an aging yield-stress fluid

We have studied the flow induced by a macroscopic spherical particle settling in a Laponite suspension that exhibits a yield-stress, thixotropy and shear-thinning. We show that the fluid thixotropy (or aging) induces an increase with time of both the apparent yield stress and shear-thinning properties but also a breaking of the flow fore-aft symmetry predicted in Hershel-Bulkley fluids (yield-stress, shear-thinning fluids with no thixotropy). We have also varied the stress exerted by the particles on the fluid by using particles of different densities. Although the stresses exerted by the particles are of the same order of magnitude, the velocity field presents utterly different features: whereas the flow around the lighter particle shows a confinement similar to the one observed in shear-thinning fluids, the wake of the heavier particle is characterized by an upward motion of the fluid ("negative wake"), whatever the fluid's age. We compare the features of this negative wake to the one observed in viscoelastic shear-thinning fluids (polymeric or micelle solutions). Although the flows around the two particles strongly differ, their settling behaviors display no apparent difference which constitutes an intriguing result and evidences the complexity of the dependence of the drag factor on flow field

Combined Pulmonary Fibrosis and Emphysema in a welder

Combined pulmonary fibrosis and emphysema (CPFE) syndrome is an uncommon entity characterised by emphysema of the upper lobes and diffuse fibrosis of the lower lobes and carries a bad prognosis with the onset of pulmonary hypertension. Lung involvement due to exposures suffered by welders is generally considered benign though, rarely, a diffuse interstitial fibrotic disease has been reported. CPFE syndrome has however never been reported in welders. A 65-year-old man, welder by occupation and an ex-smoker, presented with progressive exertional dyspnoea associated with dry cough noticed for the last four months. On examination, there was mild tachypnea, clubbing and bilateral basal velcro crepitations on chest auscultation. Lung function test revealed mild mixed ventilatory impairment with severe diffusion defect. HRCT chest showed bilateral upper lobe emphysema and diffuse interstitial fibrosis in the lower lobes. Transbronchial lung biopsy revealed interstitial fibrosis, chronic inflammation and iron deposits. A diagnosis of combined pulmonary fibrosis with emphysema (CPFE) with interstitial pulmonary siderofibrosis (IPS) was established. A review of literature did not show any other report of a similar nature

Structure of S. aureus HPPK and discovery of a new inhibitor

The first structural and biophysical data on the folate pathway enzyme and drug target, 6-hydroxymethyl-7,8-dihydropterin pyrophosphokinase (HPPK), from the pathogenic bacterium Staphylococcus aureus is presented. HPPK is the second essential enzyme in the folate biosynthesis pathway, responsible for catalysing pyrophosphoryl transfer from cofactor (ATP) to the substrate (6-hydroxymethyl- 7,8-dihydropterin, HMDP). In-silico screening led to the discovery of a substrate competitive inhibitor, San1, which was subsequently co-crystallised with HPPK. A 1.65 Å resolution x-ray structure showed this to bind at the pterin site sharing many of the key intermolecular interactions of the substrate. ITC and SPR measurements yielded an equilibrium binding constant, Kd, of ~13 μM for San1. An IC50 of ~12 μM was determined by means of a new convenient tri-enzyme-coupled spectrophotometric assay. ITC and SPR further showed that the San1 inhibitor has no requirement for magnesium or ATP cofactor for competitive binding to the substrate site. According to 15N heteronuclear NMR measurements, the fast motion of the pterin loop (L2) is partially dampened in the ternary complex between SaHPPK, HMDP and , -methylene adenosine 5-triphosphate (AMPCPP), but the ATP loop (L3) remains mobile on the μs timescale. In contrast, for the SaHPPK/San1/AMPCPP ternary complex, loop L2 becomes rigid on the fast timescale and loop L3 becomes more ordered which are supported by a large entropic penalty associated with San1 binding as revealed by ITC. Backbone assignments and chemical shift perturbations implicate the sulphur in San1 as a likely important loop L2/L3 stabilizing mediato

Breakdown of Simple Scaling in Abelian Sandpile Models in One Dimension

We study the abelian sandpile model on decorated one dimensional chains. We determine the structure and the asymptotic form of distribution of avalanche-sizes in these models, and show that these differ qualitatively from the behavior on a simple linear chain. We find that the probability distribution of the total number of topplings $s$ on a finite system of size $L$ is not described by a simple finite size scaling form, but by a linear combination of two simple scaling forms $Prob_L(s) = 1/L f_1(s/L) + 1/L^2 f_2(s/L^2)$, for large $L$, where $f_1$ and $f_2$ are some scaling functions of one argument.Comment: 10 pages, revtex, figures include

Size-selective concentration of chondrules and other small particles in protoplanetary nebula turbulence

Size-selective concentration of particles in a weakly turbulent protoplanetary nebula may be responsible for the initial collection of chondrules and other constituents into primitive body precursors. This paper presents the main elements of this process of turbulent concentration. In the terrestrial planet region, both the characteristic size and size distribution of chondrules are explained. "Fluffier" particles would be concentrated in nebula regions which were at a lower gas density and/or more intensely turbulent. The spatial distribution of concentrated particle density obeys multifractal scaling}, suggesting a close tie to the turbulent cascade process. This scaling behavior allows predictions of the probability distributions for concentration in the protoplanetary nebula to be made. Large concentration factors (>10^5) are readily obtained, implying that numerous zones of particle density significantly exceeding the gas density could exist. If most of the available solids were actually in chondrule sized particles, the ensuing particle mass density would become so large that the feedback effects on gas turbulence due to mass loading could no longer be neglected. This paper describes the process, presenting its basic elements and some implications, without including the effects of mass loading.Comment: 34 pages, 7 figures; in press for Astrophys. J; expected Jan 01 2001 issu

Self-Organized States in Cellular Automata: Exact Solution

The spatial structure, fluctuations as well as all state probabilities of self-organized (steady) states of cellular automata can be found (almost) exactly and {\em explicitly} from their Markovian dynamics. The method is shown on an example of a natural sand pile model with a gradient threshold.Comment: 4 pages (REVTeX), incl. 2 figures (PostScript