Assessment of the knowledge, attitude and practice of self medication among second year undergraduate medical students in a tertiary care teaching hospital

Background: Inappropriate self-medication is a cause of concern as it can result in wasteful expenditure, prolonged suffering, drug dependence, resistance and increase in morbidity. Self medication assumes significance among medical students as they have knowledge about ailments and medicines. The aim of the study was to assess the knowledge, attitude and practice of self-medication among undergraduate medical students.Methods: The present study was conducted in December 2017 among second professional undergraduate medical students in the Department of Pharmacology and Therapeutics, GMC Jammu after obtaining approval from the Institutional Ethics Committee of GMC, Jammu. A total of 123 students who took self-medication during last six months were included and given a questionnaire that included open and close ended questions about self-medication. Data was analysed using Microsoft Excel and presented as number and percentages.Results: Total of 123 second professional undergraduate MBBS students were analysed. 72 (58.53%) were males and 51 (41.46%) were females. 96 (78%) students practised self-medication. Allopathic drugs were most commonly used for self medication (93.5%), followed by Ayurvedic drugs. Fever and headache were common ailments treated with self medication. Common class of drugs used for self medication were antipyretics (66.6%), antibiotics (42.2%). Adverse drug reactions were perceived as the most common disadvantage of self medication. Analysis of source of information revealed that old prescriptions (33%), internet (18%) were the main sources of information. Regarding prevention of self medication, many students perceived that enhancing awareness was the most effective solution (72.3%) followed by stoppage of supply of medicines without prescription(39.8%).Conclusions: Self medication is practised by a majority of students. As responsible self medication is now increasingly being considered as a component of self-care, there is need for review of educational programs especially teaching of rational and judicious use of medicines to the undergraduate medical students

Evaluation of eosinophil count and neutrophil-lymphocyte count ratio versus C-reactive protein levels in patients with sepsis

Background: One major problem encountered in the intensive care unit is differentiating the inflammatory response from an infective process. Clinical and standard laboratory tests are not very helpful because most critically ill patients develop some degree of inflammatory response, whether or not they have sepsis. Numerous biomarkers have been evaluated to predict mortality in critically ill patients, although none have proved entirely useful. Objective of the study was to evaluate eosinophil count and neutrophil-lymphocyte count ratio with C-reactive protein levels in patients with sepsis.Methods: 71 patients >18 years of age of either sex with a diagnosis of sepsis were enrolled in this one-year observational study. Patients were classified according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine into sepsis group (n=50) and no sepsis group (n=21). Sepsis group were further divided into subgroups: sepsis (n=19), severe sepsis (n=16) and septic shock (n=15). Absolute eosinophil cell, neutrophil and lymphocyte counts for first 4 consecutive days and then on alternate days up to one week were also noted down. C-reactive protein levels on day 3 were also noted down.Results: In the sepsis group, mean eosinophil count was significantly (p<0.0001) low, mean neutrophil/lymphocyte count ratio was significantly (p<0.0001) high, mean CRP count was significantly (p=0.019) more as compared to that of no sepsis group. Among 16 mortalities, significant (p<0.05) decrease was noted in mean eosinophil count from day 3 onwards in patients of sepsis and septic shock subgroups. Mean N/L ratio showed no significant difference in patients of sepsis, severe sepsis or septic shock. Mean CRP count showed significant (p<0.05) increase in severe sepsis patients and mean Apache II score showed significant (p<0.05) deterioration in patients of septic shock.Conclusions: Neutrophil/lymphocyte count ratio (NLCR) and absolute eosinophil count (AEC) came out as better independent biomarker of sepsis in critically ill patients with infection admitted in intensive care unit. Diagnostic performance was better in these two diagnostic markers as compared to CRP marker. NLCR presented with sensitivity of 89.58%, AEC with 82.35% and CRP with 80.77%. Outcomes of NLCR and AEC were quick, easy and economical in establishing diagnosis of sepsis

Adjuvant effect of biopolymeric fraction from Picrorhiza kurroa to promote both Th1 and Th2 immune responses

In this study, the plant based biopolymeric fraction RLJ-NE-205 isolated from Picrorhiza kurroa were evaluated for its potential ability as an adjuvant effect on the immune responses to Ovalbumin (specific antigen) in mice. Immunization in Balb/C mice with variable doses of RLJ-NE-205 (10 – 80 g) with optimized dose of Ovalbumin (100 g) dissolved in phosphate buffered saline or containing alum (200 g) on Days 1 and 15. After two weeks of the challenging dose, OVA specific antibodies in serum, spleen cell proliferation assay, estimation of Th1 (IL-2/IFN-gamma) and Th2 (IL-4) cytokines in serum, CD3/CD4/CD8/CD19 surface markers of T and B cell, costimulatory molecules (CD80/CD86) in spleen cells and safety studies were observed. The results suggest that OVA mediated specific antibody levels (IgG, IgG1 and IgG2a) in serum were significantly enhanced by RLJ-NE-205 (20 g) containing 100 g OVA compared with OVA control group. Moreover, RLJ-NE-205 (20 g) containing 100 g OVA on IgG, IgG1, and IgG2a antibody responses to OVA in mice were more significant than those of alum. RLJ-NE-205 (20 g) significantly enhanced the OVA induced spleen cell proliferation and estimation of Th1 and Th2 cytokines in the OVA immunized mice. However, no significant differences were observed among the OVA group and OVA/alum group. At the dose of 100 g OVA containing 20 g RLJ-NE-205, there was a significant increase in the Th1 and Th2 cytokines in serum and CD3/CD4/CD8/CD19 surface markers and costimulatory molecules (CD80/CD86) in the spleen cell by flow cytometry were observed

Histomorphological spectrum of prostatic lesions: a retrospective analysis of transurethral resection of prostate specimens

Background: Prostatic diseases like inflammation, benign prostatic hyperplasia and tumors are important causes of mortality and morbidity in males. The incidence of these lesions increases with advancing age. The second most common cancer among males is prostate cancer, next to lung cancer worldwide. Transurethral resection of prostate (TURP) is most frequently preformed surgical procedure in the clinical practice. The purpose of the study is to evaluate histomorphological spectrum of prostate lesions in TURP specimen with focus on premalignant lesions and incidental carcinomas.Methods: The present study includes 245 cases of TURP specimen from January 2015 to December 2016 received in the post graduate department of pathology, ASCOMS and Hospital. H and E stained sections were examined. The relevant clinical details pertaining to age, clinical complaints and microscopic details were analysed and compared with other similar studies.Results: Of the total 245 TURP specimen, 223 (91.02%) were of nodular hyperplasia, 14 (5.71%) were of prostatic intraepithelial neoplasia and 8 (3.26%) cases were malignant. Benign hyperplasia of prostate (BHP) alone accounted for 91.02% of TURP specimen. Less frequent findings were granulomatous prostatitis in 3.70% and atypical adenomatous hyperplasia (1.22%). All the 8 cases of prostate cancer were incidental carcinoma, 5 of which were poorly differentiated and 3 were moderately differentiated adenocarcinoma.Conclusions: The present study showed that non-neoplastic lesions of prostate are more common than neoplastic ones. The most frequently encountered prostatic lesion was BHP, commonly seen in the age group of 61-70 years. The malignant lesions were common among the males of more than 60 years. TURP can be helpful in early identification of premalignant lesions and incidental prostate cancer which can improve the treatment outcome of patients

Histopathological patterns of head and neck lesions - a two year retrospective hospital based study

Background: Head and neck lesions include a spectrum of pathological lesions ranging from simple benign to highly malignant entities. These lesions contribute significantly to morbidity and mortality of patients. The aim of this study was to determine the histological patterns of head and neck lesions, both non- neoplastic and neoplastic and to analyse the data in relation to age, gender, topography.Methods: A two year retrospective study was conducted in the Post Graduate Department of Pathology, ASCOMS and Hospital and histopathological data pertaining to all head and neck lesions was reviewed. Each case was analysed with respect to age, gender, site and histological type.Results: One hundred and forty-five cases from the head and neck region were analysed during this two-year period. Age range was from 3 months to 85 years with maximum cases in the age group of 21-50 years (51.03%). The Male: Female ratio was 1.37:1. In our study, 53.79% benign, 24.13% inflammatory and 22.06% malignant cases were recorded. Maximum number of benign lesions was in the age group of 21-50 years. Malignancies were noted to be higher in ages 51 years and above.  Squamous cell carcinoma was the most common malignancy observed.Conclusions: We conclude that site specific data like this is helpful in evaluating patterns of head and neck lesions and augment the base line data of institute and the region

A comparison of outcomes between finger and pulp replantation/revascularization in a single centre

Background: Supermicrosurgery has allowed the replantation/revascularization of the pulp, but how does this currently compare with more proximal digit replantation/revascularization? Methods: In a retrospective case study over a 5-year period at our institute, a total of 21 patients (n = 21) had either finger or pulp replantation-revascularization posttrauma. All pulp replants had a single-vessel anastomosis viz., “artery-to-artery” or “artery-to-vein” only, with venous outflow dependent on the skin-shave technique, while more proximal replants had both arterial and venous anastomoses. Age, sex, ischemic time, handedness, smoker status, and injury-replant interval were compared between the two groups, with all procedures performed by a single surgeon. The outcome parameters studied were length of hospital stay, timeline for wound healing, viability, and functional outcomes. Results: Our patients consisted of 18 men and three women, of which 14.3% were smokers and 85.7% were right-handed. There were 11 finger replantation/revascularizations (n = 11) versus 10 pulp replantation/revascularizations (n = 10). The average age of digit replantation/revascularization patients was 44.8 years compared with 26.4 years in pulp replantation/revascularization patients (Student t test, P = 0.04). Mean ischemia time in digital replants was 67 minutes versus 32.3 minutes in pulp replantation/revascularization (Student t test, P = 0.056). Digital replantation/revascularization was viable in 72% of cases versus a 90% viability in the pulp subcohort. Conclusions: In our patient cohort, pulp replantation/revascularizations produced better postoperative viability. Where supermicrosurgery expertise is available, pulp replantation/revascularization should be considered a worthwhile option when compared with digital replantation/revascularization

Illustrating a new global-scale approach to estimating potential reduction in fish species richness due to flow alteration

Changes in river discharge due to human activities and climate change would affect the sustainability of freshwater ecosystems. To globally assess how changes in river discharge will affect the future status of freshwater ecosystems, global-scale hydrological simulations need to be connected with a model to estimate the durability of freshwater ecosystems. However, the development of this specific modelling combination for the global scale is still in its infancy. In this study, two statistical methods are introduced to link flow regimes to fish species richness (FSR): one is based on a linear relationship between FSR and mean river discharge (hereafter, FSR-MAD method), and the other is based on a multi-linear relationship between FSR and ecologically relevant flow indices involving several other flow characteristics and mean river discharge (FSR-FLVAR method). The FSR-MAD method has been used previously in global simulation studies. The FSR-FLVAR method is newly introduced here. These statistical methods for estimating FSR were combined with a set of global river discharge simulations to evaluate the potential impact of climate-change-induced flow alterations on FSR changes. Generally, future reductions in FSR with the FSR-FLVAR method are greater and much more scattered than with the FSR-MAD method. In arid regions, both methods indicate reductions in FSR because mean discharge is projected to decrease from past to future, although the magnitude of reductions in FSR is different between the two methods. In contrast, in heavy-snow regions a large reduction in FSR is shown by the FSR-FLVAR method due to increases in the frequency of low and high flows. Although further research is clearly needed to conclude which method is more appropriate, this study demonstrates that the FSR-FLVAR method could produce considerably different results when assessing the global role of flow alterations in changing freshwater ecosystems

Accelerating circular economy solutions to achieve the 2030 agenda for sustainable development goals

Circular economy seems a vital enabler for sustainable use of natural resources which is also important for achieving the 2030 agenda for sustainable development goals. Therefore, a special session addressing issues of "sustainable solutions and remarkable practices in circular economy focusing materials downstream" was held at the 16th International Conference on Waste Management and Technology, where researchers and attendees worldwide were convened to share their experiences and visions. Presentations focusing on many key points such as new strategies, innovative technologies, management methods, and practical cases were discussed during the session. Accordingly, this article compiled all these distinctive presentations and gave insights into the pathway of circular economy towards the sustainable development goals. We summarized that the transition to circular economy can keep the value of resources and products at a high level and minimize waste production; the focus of governmental policies and plans with the involvement of public-private-partnership on 3Rs (reduce, reuse, and recycle) helps to improve the use of natural resources and take a step ahead to approach or achieve the sustainability

Synthesis, FT-IR, UV-VIS, DFT studies and SCXRD structure of 1-(tert-butyl) 3-ethyl-3-(hydroxy(thiophen-2-yl)methyl)piperidine-1,3-dicarboxylate

The crystal structure of 1-(tert-butyl) 3-ethyl 3-(hydroxy(thiophen-2-yl)methyl)piperidine-1,3-dicarboxylate (C18H25NO5S) I has been determined by Single Crystal X-ray Diffraction (SCXRD) techniques. It crystallizes in the orthorhombic space group Pca21 with unit cell parameters a = 19.4502(13)Å, b= 6.3571(4)Å, c= 15.2577(10) Å and number of molecules per unit cell, z = 4. The intensity data have been collected at room température (293 K) and the structure has been solved by direct methods. The full matrix least-squares refinement has converged the final R-value to 0.035 for 2251 observed reflections. The piperidine ring adopts a chair conformation. The structure is stabilized by two C–H…O (intermolecular interactions) and five C–H…O (intramolecular interactions). The structural and spectral studies of 1-(tert-butyl) 3-ethyl 3-(hydroxy(thiophen-2-yl)methyl)piperidine-1,3-dicarboxylate have been carried out by using both experimental and quantum chemical techniques