Use and inappropriate use of proton pump inhibitors in hospitalized patients

Background: The discovery of Helicobacter pylori infection in etiology of peptic ulcer disease and proton pump inhibitors (PPI) in management of upper gastrointestinal diseases had been the milestones in medical science. PPI are currently being both overused and misused. In countries like India, where over 500 branded formulations of PPI are available, probability of misuse and abuse increases exponentially. The aim of the study was to find out inappropriate use of PPI, among hospitalized patients.Methods: In order to find answer to the research question a cross sectional study was conducted in indoor patient of a tertiary care private hospital at Jaipur, Rajasthan. Patients of either sex, aged 18 years or above belonging to rural and urban communities were participating in study. The sample size was 500.Results: It was noted that Inappropriate PPI use was observed in most of the hospital admitted patients (78%). Most common diagnosis among inappropriate PPI use was dengue fever (due to increased number of dengue cases during study period), followed by cerebrovascular accidents and urinary tract infection. Most common indication for appropriate PPI use was stress ulcer prophylaxis, again in dengue case (due to cardinal manifestation of thrombocytopenia).Conclusions: Almost all patients were once prescribed PPI after admission and discharged on PPI (99.2%). Thus, we recommend evidence-based prescription of PPI, to reduce side effects and excess cost

Micro Raman imaging in two and three dimensions.

Microscopy using Raman scatter as a contrast principle provides chemical-state selective imaging. Because Raman scattering is an intrinsically weak effect, special techniques are required to provide high contrast, artifact-free images. We have developed artifact-removal computer programs for use with Hadamard transform Raman imaging, a multiplexing technique for spectroscopically resolved imaging using a conventional Raman spectrometer. We have also developed image reconstruction programs that provide sharp, confocal-like deblurred images. These programs were tested on images obtained both by the Hadamard technique and by direct imaging using narrow pass band tunable filters. A first-order correction was developed to remove echoes (ghost images) from Raman images obtained by the Hadamard multiplexing technique. The correction was designed to correct for errors in the fabrication of encoding masks. The correction algorithm assumed identical errors at each open/closed (1/0) boundary in the mask. It was demonstrated that the averaging properties of the Hadamard transformation allowed use of this approximation. The nearest-neighbor deblurring technique was implemented for restoration of the central member of stacks of three images obtained by serial sectioning. A fixed (0.4-0.45) fraction of the intensity of the first and third images was subtracted from the central image. Because the technique produces an image with lower signal/noise ratio than the originals, it could only be used on the strongest images available. In such cases, the processed images were sharper than the starting images. Constrained iterative deconvolution was used to process noisier images. Idealized (sinc\sp2) point spread functions were employed. Prior to deconvolution stacks of images were smoothed using the LOWESS algorithm. Unconstrained 2-dimensional (lateral) Fourier deconvolution was applied. Next, axial Fourier deconvolution was applied using a non-negativity constraint. Two or three iterations were necessary. The resulting images contained much less out-of-focus intensity than the starting images. They were of sufficiently high quality that they could be processed through conventional 3-dimensional rendering programs.Ph.D.ChemistryUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/104118/1/9500932.pdfDescription of 9500932.pdf : Restricted to UM users only

Compliance assessment of tobacco vendors of Ahmedabad city to India's Tobacco control legislation

<p><strong>Background</strong>: Many worldwide strategies and efforts have been made to tackle the menace of tobacco use and related morbidity and mortality. On similar lines, Government of India enacted a law in 2003, Cigarette and Other Tobacco Products Act (COTPA, 2003).  <strong>Aims &amp; Objectives</strong>: To measure compliance to Section 5 &amp; 6(a) of COTPA, 2003. <strong>Material &amp; Methods: </strong>A cross-sectional survey at 432 Point of Sale (POS) across Ahmedabad city using random sampling technique.  <strong>Results</strong>: Only 15.3% of the POS had complied with the size of their main display Board (MDB). Around one third (34%) of the shops had displayed the prescribed warning message on their MDB.  More than half (53%) of the shops did not display any tobacco advertisement. The proportion of shops with no backlit/illumination MDBs was 30.3%. None of the POS complied with Section 6(a). More than a quarter of the POS (28%) were partial tobacco vendors. Proportion of mobile tobacco vendors was 22.9%. <strong>Conclusion</strong>: There has been a gross violation of Sections 5 &amp; 6(a) of COTPA, 2003 across a majority of POS. This kind of laxity in compliance portrays a grim scenario of tobacco control and thus calls for immediate redressal by all the stakeholders involved.</p><p> </p

Usefulness of Endoscopic Ultrasound for the Detection of Asymptomatic Pancreatic Morphological Changes in Patients with Alcoholic Liver Disease: A Cross-sectional Study

Introduction: Although alcoholism is a common aetiological link between liver and pancreatic disorders, the frequency of coinciding pancreatic disease in patients with alcohol-related liver disease is not well understood. The present study mentions about the use of Endoscopic Ultrasound (EUS) with standardised criteria to assess asymptomatic or overt pancreatic pathology in patients with alcoholic liver disease. Aim: To determine the prevalence of asymptomatic Alcoholic Chronic Pancreatitis (ACP) in Indian patients affected by Alcoholic Liver Cirrhosis (ALC) using EUS. Materials and Methods: The present observational crosssectional study was conducted on patients attending the Outpatient Department of Gastroenterology at Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, Rajasthan, India. A total of 35 patients were screened with alcoholic liver disease for pancreatic abnormalities using EUS. The patients were recruited for the study over a period of 12 months, from September 2013 to August 2014. The prevalence of chronic pancreatitis (CP) was determined, and abnormalities were graded according to the Rosemont criteria. The severity of alcoholic liver disease, as indexed by Child Pugh Scoring (CPS) and Model for End-stage Liver Disease (MELD), was evaluated for any association with endosonographic findings of CP. The influence of various clinico-demographic factors on alcoholic liver and pancreatic diseases was analysed using the PSS Inc. Chicago, IL program. Results: A total of 35 male patients, aged 28 to 65 years with a mean age of 46.97 years, fulfilled the inclusion criteria. EUS revealed a prevalence of CP in 20% of patients. Three patients showed changes suggestive of CP, of which two had ALC and one had Alcoholic Hepatitis (AH). Four patients were prioritised in categorised as indeterminate for CP, with three having cirrhosis and one having Alcoholic Fatty Liver (ALF). No significant influence of clinico-demographic profiles on the final outcome parameters was observed. The patient with endoscopic changes had a MELD score of 12.85±5.11 compared to patients without changes of ACP (19.1±5.71) (p=0.013). ALC was found to be inversely related to EUS changes of ACP. Conclusion: The EUS is an effective screening tool for evaluating pancreatic abnormalities in patients with alcoholic liver disease. The present study provides a comprehensive review of previous findings in light of the varying facts and figures. As there is still a lack of experimental animal models for ALC and ACP, studies of this kind may shed light on hidden links in disease pathology