A prospective study on evaluation of antibiotics usage in patients with sepsis at a tertiary care hospital

Background: Most developing countries are adopting antibiotic usage in sepsis. This study was conducted to evaluate the antibiotic usage in patients and to study medical adherence in high-risk patients. The study in particular aims to evaluate antibiotic usage in sepsis patients along with their related ADR’s. The study also aims to optimize the usage of antibiotics in high-risk patients at a tertiary care hospital. Methods: Study was prospective and observational review of patients record in the hospital. Clinical notes, medication chart and electronic data management system at the hospital were used to analyse usage of antibiotics. Culture and sensitivity reports were obtained from relevant departments. Observations were then compiled and documented. Results: Out of 40 cases collected 22 (55%) patients were male and 18 (45%) were female. Majority of the study population belongs to 71 years and above with 15 (37.5%) followed by age group of 41-60 years with 14 (35%). Most frequently prescribed antibiotics were found to be meropenem 16 (21.33%) and piperacillin tazobactam 14 (18.67%). The most resistant antibiotic was found to be cotrimazole in 35 (87.5%). ADRs were found in 35% of all cases. Conclusions: Prescribing patterns for antibiotics need to be optimized. Adherence to and update of the policy is also recommended. It was found that the adherence to hospital antibiotic policy is low

Non-cirrhotic hyperammonemia in a newly diagnosed diabetic patient presenting in diabetic ketoacidosis

Hyperammonemia, a known cause of encephalopathy, is commonly seen in patients with liver disease. Non-cirrhotic hyperammonemia is an uncommon condition. Patients with uncontrolled diabetes can have elevated levels of ammonia. Diabetic ketoacidosis is a life threatening complication in diabetes. This is a case of a middle-aged male who presented in encephalopathy. He was found to have diabetic ketoacidosis with hyperammonemia. Encephalopathy as a result of hyperammonemia in diabetes mellitus is a rare scenario

A study on drug utilization pattern of anticoagulants in post-cardiac surgeries at a tertiary care hospital

Background: The study is being carried out mainly to understand the prevention of coagulation of blood after a patient undergoing various types of cardiac surgeries, using different anticoagulation therapies suitable to particular types of cardiac surgery. This study was conducted to know the types of anticoagulants prescribed to patients who have undergone different types of cardiac surgeries along with the prescribed anticoagulants. Methods: The study method used was a retrospective and prospective observational study carried out on 50 patients who underwent cardiac surgeries in the department of cardiology and medicine. Results: A total of 50 patients were enrolled for this study who satisfied the inclusion criteria, out of which 64% of patients were males, and 36% were females. The highest number of patients were found to be in between the age group of 61-70 yrs (34%), whereas age group between 51-60 yrs (28%), age group 71 and above (18%), 41-50 (14%), 21-30 yrs (4%) and 18-20 yrs (2%) respectively. Most of the patients had undergone Coronary Artery bypass grafting. It was seen that the highest Anticoagulant being prescribed was Heparin in most of the post-cardiac surgeries. Whereas drugs like dalteparin, acenocoumarol, and warfarin were prescribed the majority in valvular heart surgeries. Conclusions: Various cardiac surgeries were taken into consideration for the study. The most common anticoagulants prescribed were heparin, dalteparin, acenocoumarol, and warfarin in coronary artery bypass surgery and valvular heart surgeries respectively

Is Clinical Decision Making Skills are Developed through Academic Nurturing? A Review Based on Available Literature

Introduction: Today’s nurses are having challenges, demanding their ability to the profession. Nursing education should concentrate on educating competent health care providers to handle complex health care technology with fundamental implications for latest generation of patients. This paper aims to identify the various strategies used to enhance the clinical decision making ability among nurses. Methods: A comprehensive systematic review of published literature and journal articles from PubMed and Cinhal databases was done. Search strategy specific to each database was used. During initial search 6808 titles were retrieved and after screening 12 articles were selected for full text screening. Finally 12 research articles were selected based on the inclusion criteria. Results: Out of 12 articles, 7 research studies supported that clinical decision making can be developed using different types of simulation (such as human patient simulators, simulated clinical experiences, simulation to create rubric assessment). Two of those studies propose clinical reasoning abilities can be acquired through Outcome-Present state Test (OPT) model. Individual studies used strategies like concept mapping, educational interventions, analogy guided learning experiences, structured reflection in education and workshops can develop clinical decision making. Computer based and multimedia computer simulation program did not showing any clear outcome. Conclusion: Clinical decision making is an abstract skill which can be developed by using different strategies in different specialities and different situations.  Since situational factors and time constraints are evident in practice, findings were supportive for clinical decision making(CDM) skill. The ideal setting for students to learn CDM skills is real clinical practice environment, especially when facilitated by opportunities for immediate feedback and reflection. CDM is necessary for providing quality patient care and favouring patient satisfaction. Keywords: Decision making, Nurses, Judgement, Clinical Competenc

Role of Bioadsorbents in Reducing Toxic Metals

Industrialization and urbanization have led to the release of increasing amounts of heavy metals into the environment. Metal ion contamination of drinking water and waste water is a serious ongoing problem especially with high toxic metals such as lead and cadmium and less toxic metals such as copper and zinc. Several biological materials have attracted many researchers and scientists as they offer both cheap and effective removal of heavy metals from waste water. Therefore it is urgent to study and explore all possible sources of agrobased inexpensive adsorbents for their feasibility in the removal of heavy metals. The objective was to study inexpensive adsorbents like various agricultural wastes such as sugarcane bagasse, rice husk, oil palm shell, coconut shell, and coconut husk in eliminating heavy metals from waste water and their utilization possibilities based on our research and literature survey. It also shows the significance of developing and evaluating new potential biosorbents in the near future with higher adsorption capacity and greater reusable options

Role of Bioadsorbents in Reducing Toxic Metals

Industrialization and urbanization have led to the release of increasing amounts of heavy metals into the environment. Metal ion contamination of drinking water and waste water is a serious ongoing problem especially with high toxic metals such as lead and cadmium and less toxic metals such as copper and zinc. Several biological materials have attracted many researchers and scientists as they offer both cheap and effective removal of heavy metals from waste water. Therefore it is urgent to study and explore all possible sources of agrobased inexpensive adsorbents for their feasibility in the removal of heavy metals. The objective was to study inexpensive adsorbents like various agricultural wastes such as sugarcane bagasse, rice husk, oil palm shell, coconut shell, and coconut husk in eliminating heavy metals from waste water and their utilization possibilities based on our research and literature survey. It also shows the significance of developing and evaluating new potential biosorbents in the near future with higher adsorption capacity and greater reusable options

Pharmacogenomic Variants May Influence the Urinary Excretion of Novel Kidney Injury Biomarkers in Patients Receiving Cisplatin

Nephrotoxicity is a dose limiting side effect associated with the use of cisplatin in the treatment of solid tumors. The degree of nephrotoxicity is dictated by the selective accumulation of cisplatin in renal tubule cells due to: (1) uptake by organic cation transporter 2 (OCT2) and copper transporter 1 (CTR1); (2) metabolism by glutathione S-transferases (GSTs) and γ-glutamyltransferase 1 (GGT1); and (3) efflux by multidrug resistance-associated protein 2 (MRP2) and multidrug and toxin extrusion protein 1 (MATE1). The purpose of this study was to determine the significance of single nucleotide polymorphisms that regulate the expression and function of transporters and metabolism genes implicated in development of acute kidney injury (AKI) in cisplatin treated patients. Changes in the kidney function were assessed using novel urinary protein biomarkers and traditional markers. Genotyping was conducted by the QuantStudio 12K Flex Real-Time PCR System using a custom open array chip with metabolism, transport, and transcription factor polymorphisms of interest to cisplatin disposition and toxicity. Traditional and novel biomarker assays for kidney toxicity were assessed for differences according to genotype by ANOVA. Allele and genotype frequencies were determined based on Caucasian population frequencies. The polymorphisms rs596881 (SLC22A2/OCT2), and rs12686377 and rs7851395 (SLC31A1/CTR1) were associated with renoprotection and maintenance of estimated glomerular filtration rate (eGFR). Polymorphisms in SLC22A2/OCT2, SLC31A1/CTRI, SLC47A1/MATE1, ABCC2/MRP2, and GSTP1 were significantly associated with increases in the urinary excretion of novel AKI biomarkers: KIM-1, TFF3, MCP1, NGAL, clusterin, cystatin C, and calbindin. Knowledge concerning which genotypes in drug transporters are associated with cisplatin-induced nephrotoxicity may help to identify at-risk patients and initiate strategies, such as using lower or fractionated cisplatin doses or avoiding cisplatin altogether, in order to prevent AKI

Survival and Feeding Behavior of <i>Diaphorina citri</i> (Hemiptera: Liviidae) Adults on Common Cover Crops in Citrus

Asian citrus psyllid, Diaphorina citri, transmits Candidatus Liberibacter asiaticus (CLas), the bacterial pathogen responsible for citrus greening disease. To explore the possibility that cover crops in citrus groves may serve as refuges for this pathogen vector during unfavorable host conditions, psyllid feeding was investigated on six common cover crop species and citrus using electrical penetration graph (EPG) recordings and behavioral bioassays. EPG recordings showed that the proportion of time spent by D. citri feeding on xylem was similar or higher on all tested cover crops (17%–32%) compared to the positive control (12%), the preferred host, Citrus macrophylla. Very little to no phloem feeding was observed on cover crops by the adults. In the choice assays, more D. citri adults settled on buckwheat (Fagopyrum esculentum) and cowpea (Vigna unguiculata) than on the host, C. macrophylla, 24 h after release. No-choice assays showed that the citrus cover crop species evaluated extend the survival of D. citri up to 8 d because of xylem feeding. Our results indicate that some cover crop species may be less suitable refuge sites for D. citri than others, but none served as breeding sites or supported more than 8 d of survival