Prescribing pattern in outpatient department of neurosurgery in a tertiary care hospital of North India

Background: The neurosurgical disorders are amongst the leading cause of global mortality and morbidity. Though surgical intervention is thought to be the main management protocol in the neurosurgical setup but drugs are being equally used especially in the outpatient setting. The present study was carried out in view of the sparse data available on prescribing pattern in neurosurgery.Methods: The present study was conducted by the department of pharmacology in outpatient department of neurosurgery in a tertiary care centre to look into the prescription pattern among these patients.Results: In 268 patients analyzed, mean age was 43.02±15.93 years and 52.23% were females. Majority of our participants (44%) were found to be of young to middle age group (21-40 years). The diagnosis among the study population was spread over large number of diseases. Lumbar Disc Prolapse (LDP) was found to be the leading cause of neurosurgical morbidity, amounting to 32%. As far as the prescription of various drugs in the outpatient of neurosurgery is concerned, Analgesics were the most common drugs prescribed constituting about 48% of the total drugs prescribed followed by GABA analogues and multivitamins which equally formed 41% of the total prescribed drugs.Conclusions: Although the prescription pattern studies among the outpatient neurosurgery patients are very scant, the analysis of prescription studies will be helpful to encourage the rational drug prescribing pattern

Drug Storage and Self-medication Practices in Kashmir, India: A Cross-sectional Study

Introduction: Among the various potential health risks, self-medication and inappropriate storage of medicines at home are found to be very important. Inappropriate storage conditions and irrational use of medication without medical consultation may result in serious health problems. Worldwide there has been an increase in the self-medication rate, which can lead to waste of resources and serious adverse reactions. Aim: To assess the practice of self-medication and household storage of medicines amongst the study population. Materials and Methods: This was a cross-sectional and questionnaire based study conducted in the southern district of Kashmir, India from 1st September 2021 to 28th February 2022. A total of 471 households were included and interviewed to determine the practice of home storage of medicines and self-medication pattern. Quantitative data was presented as means and standard deviation (mean±SD) and qualitative data as frequency and 95% Confidence Interval (CI). Results: Almost three quarters of the households were having monthly income of less than 20,000 INR whereas 219 (46.50%) of them were illiterate. Proton pump inhibitors, minerals and vitamins, antibiotics and analgesics were the most common medicines stored at home. Drawer was the most common place used for storage of medicines whereas the refrigerator was used in less than 1% of cases for the same. Solid dosage forms were mostly used by the householders and the injectables were least used for household storage purposes. Conclusion: The study revealed that the studied householders stored large amount of medicines in homes, often under inappropriate storage conditions. There is a need for better public knowledge and information about the risks of reuse of prescribed medications

EVALUATION OF PHARMACOECONOMICS AWARENESS AND ITS APPLICATION AMONG POSTGRADUATES OF A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Objectives: Pharmacoeconomics (PE) is a branch of health economics which focuses particularly on the cost and benefit of drug therapy. Postgraduatestudents form the first line of the health care delivery system, especially in government run hospitals; therefore, it is essential that they need to beaware of the concept of PE. The main objective of the study was to assess the extent of knowledge and awareness of PE and its methods of applicationamong medical professionals who are doing postgraduation in various departments.Methods: This study was conducted at Sheri Maharaja Hari Singh (SMHS) Hospital, a tertiary care hospital associated with Government MedicalCollege, Srinagar. Self-administered questionnaire was distributed among 100 students, out of which 78 completely filled questionnaires were finallyused for statistical analysis. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 19, Chicago, IL, USA).Results: It was observed that most of the participants were willing to participate in the study, and a good proportion of them (45%) were awareabout the concept of PE. However, the majority of the respondents had little knowledge about the principles of PE and only 16% of them respondedpositively. When it comes to the application of PE, it was found that only 9% are applying these principles in their day to day clinical practice.Conclusion: There is need to sensitize the health care providers to the concept of PE at undergraduate level so that they will be able to utilize theirknowledge of PE, in their clinical practice in the future.Keywords: Pharmacoeconomics, Postgraduate students, Level of knowledge, Methods of application

Exploring satisfaction and outcomes in rhinoplasty: experience from a tertiary care hospital in Kashmir valley, India

Background: Augmentation rhinoplasty is a popular yet challenging procedure that aims to improve both the nasal appearance and quality of life of patients. The purpose of this study was to examine the satisfaction and outcome after augmentation rhinoplasty at a tertiary care hospital in Kashmir valley. Methods: The study was conducted at a tertiary care hospital in Kashmir valley among patients who underwent the procedure using autologous cartilage grafts at the ENT department from October 2021 to December 2021. The sample size was 56. The patients age, gender, pre-operative findings, surgical techniques, post-operative outcomes, complications, and corrective interventions were recorded. The rhinoplasty outcome evaluation questionnaire was used to evaluate the patients' pre and post-operative status, with outcome assessed three months after surgery. Results: The present study included 56 patients which comprised of 39 (69.64%) males. The mean age of patients was 41±9.6 years. The indication for surgery was a mix of aesthetic and functional reasons in 56% subjects with 78% undergoing a primary surgery. The mean pre-operative score on the ROE questionnaire was 9.21±0.8 which improved to a mean score of 19.56±1.1 at three months after surgery. Overall 75% (42/56) patients reported a post operative ROE score of ≥80%. There was a significant improvement in all domains assessed by the ROE questionnaire, including appearance and function. Conclusions: Augmentation rhinoplasty can provide satisfactory aesthetic and functional outcomes for patients with nose deformities with consistent improvement across all domains related to aesthetics and functionality

Study prevalence of peripheral arterial disease in diabetics with coronary artery disease at a large tertiary care teaching hospital in North India

Background: Peripheral arterial disease and coronary artery disease have similar factors. The extent and severity of PAD is significantly associated with presence and severity of CAD.Methods: Patients were interviewed and clinical profile of patients including risk factors of coronary artery disease like diabetes, hypertension, smoking, dyslipidemia, obesity and family history of coronary artery disease were assessed and recorded in the proforma. Information regarding demographics, co morbidity, past history and family history was collected. Physical examination of each patient was carried and basic anthropometric data: height, weight, BMI and blood pressure, peripheral pulses calculated. Investigations both non- invasive and invasive including peripheral angiography were recorded.Results: In this prospective study fifty (50) type 2 diabetes patients admitted with CAD were studied whose mean age was 55.6+8.2 and mean duration of diabetes was 6.8+8.4. In this study none of the patients with PAD had single atherosclerosis risk factors including diabetes. 30% patients were having two risk factors. PAD in in patients with CAD is particularly enhanced by the concomitant occurrence of two or more of these risk factors (p=0.016). Hypertension as a predictor of PAD was statistically significant (p=0.0037). In this study the duration of diabetes was 10 years in 40% of patients with angiographically proven PAD.Conclusions: It was observed that presence and severity CAD was significantly associated with PAD

A descriptive study on drug prescribing pattern in hypertensive patients in a tertiary care teaching hospital

Background: Hypertension is highly prevalent and the goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Not many studies are conducted in this part of world regarding drug utilization of antihypertensive drugs and hence this study was planned.Methods: A descriptive cross-sectional study was conducted for a period 6 month in outpatient department of a tertiary care centre of Government Medical College, Srinagar, Jammu and Kashmir. The prescriptions containing antihypertensive drugs were collected from the patients attending the outpatient department.Results: During the study period a total of 230 prescriptions were collected, out of which 196 were included for the final analysis. Mean age was found to be 62.42±7.77 years. In majority of cases (44.89%), a combination of two drugs was prescribed and among the two-drug combination, Angiotensin Receptor Blockers (ARBs) and Calcium Channel Blockers (CCBs) were used most commonly (40.90%). Angiotension receptor blockers were used as single drug in most number of patients (41.66%). Proton pump inhibitors were the most common (35.71%) co-prescribed drug, followed by Anti platelet drugs (27.55%), Anti diabetics (16.32%) and Statins (16.32).Conclusions: Present study represents the current prescribing trend for antihypertensive agents. It implies that ARBs are the leading group of antihypertensive agents both when used singly and in combination. Further studies focused on the rationale for choice of drugs based on demographic data, economic status, associated comorbid conditions and complications would give additional insights into prescribing patterns in hypertension in India

Utilization pattern of drugs among patients attending geriatric outpatient department in a tertiary care hospital in Kashmir

Background: Quality and safety of prescribing in older people remains a global healthcare concern and inappropriate prescribing is a major public health issue because of its direct association with morbidity, mortality and wastage of health resources in this age group. Very limited data is available on the drug utilization pattern in geriatric population and the present study was carried out to see the prescription pattern in geriatric population in this part of the world.Methods: The present study was conducted by the department of pharmacology in outpatient department of geriatrics in a tertiary care centre to look into the prescription pattern among geriatric age group.Results: A total of 237 prescriptions were collected, out of which 108 (45.56%) were males and 129 (54.44%) were females. The majority of the patients were in the age group of 60-69 years (n=141, 59.5%). The most commonly found comorbidity was hypertension (63.29%) and antihypertensive agents (74.68%) were the most frequently prescribed class of drugs. Calcium (37.57%), budesonide (32.91%), thyroxine (27.84%) and pantoprazole (25.31%) were the most common individual drugs prescribed.Conclusions: Like other studies on geriatric population polypharmacy was also observed in the present study and periodic therapeutic audit is essential to ensure rational medicine use

Quantum Field Theory in de Sitter spacetime

In this paper we will analyse quantum field theory on de Sitter spacetime. We will analyse a general scalar and vector field theory on de Sitter spacetime. This is done by first calculating these propagators on four-Sphere and then analytically continuing it to de Sitter spacetime

Compliance with Standard Precautions and Associated Factors among Critical Care Nurses in Peshawar, Pakistan and Kunming, China: Comparative Cross-Sectional Study

OBJECTIVES To find the level of compliance and the associated factors of compliance with standard precautions among registered nurses. METHODOLOGY Cross-sectional study was conducted during March and August 2020 in four hospitals, two from each country; Pakistan and China. Data was gathered through a modified version of the adopted questionnaire from 424 registered nurses, selected by a simple random sampling technique. Data were analyzed by SPSS version 26. RESULTSThe overall compliance with SPs among registered nurses in Pakistan was 57.1%, and among the respondents from China was 75.2%. Gender, age and working area were associated with the compliance of SPs. Female nurses from China are 1.72 times less compliant, while the increasing age of Pakistani nurses increases the risk for non-compliance with SPs by 1.7 times. Participants working in Emergency Department in Pakistan were 2.07 times less compliant than those working in Intensive Care Unit/Coronary Care Unit (ICU/CCU). Lack of training increases the risk of being 2.9 times more non-compliant. For Chinese Nurses, less knowledge and a lack of resources were associated with non-compliance in both countries nurses. CONCLUSION Noteworthy numbers of nurses were found non-compliant with standard precaution practices in both study populations. Therefore, strategies like regular training on standard precautions, availability of Personal Protective Equipment and policymaking may improve compliance with SPs practice

Chimera states in a multi-weighted neuronal network

There are multiple types of interactions among neurons, each of which has a remarkable effect on the neurons' behavior. Due to the significance of chimeras in neural processes, in this paper, we study the impact of different electrical, chemical, and ephaptic couplings on the emergence of chimera. Consequently, a multi-weighted small-world network of neurons is considered. The simultaneous effects of two and three couplings are explored on the chimera and complete synchronization. The results represent that the synchronization is achieved in very small coupling strengths in the absence of chemical synapses. In contrast, without electrical synapses, the neurons only exhibit chimera behavior. In the three-weighted network, the synchronization is enhanced for special chemical coupling strengths. The network with directed links is also examined. The general behaviors of the directed and undirected networks are the same; however, the directed links lead to lower synchronization error