Effect of Hydration on Polytypism and Disorder in the Sulfate-Intercalated Layered Double Hydroxides of Li and Al

The double hydroxide of Li+ and Al3+ is an anionic clay comprising positively charged metal hydroxide layers and intercalated anions. While the structure of the iono-covalently bonded metal hydroxide layer is well known, relatively less knowledge is available regarding the manner in which the anions and water molecules are packed in the interlayer region. The sulfate ion is of special interest as it can potentially intercalate in a multiplicity of orientations and grow an extended hydration sphere. The sulfate-intercalated double hydroxide was synthesized by the imbibition of Li2SO4 into both the gibbsite and bayerite forms of Al(OH)3 to obtain layered double hydroxides with the nominal formula Li2Al4(OH)12SO4·nH2O (n = 4–8). The as-prepared compounds were poorly ordered and did not yield any structural information. Temperature-induced partial dehydration yielded ordered phases of different structures in the two systems. Simulation of the powder patterns of different model structures, followed by structure refinement in both direct and reciprocal spaces, showed that the gibbsite-derived phase yielded a two-layer polytype of hexagonal symmetry (space group P63/m). The local symmetry of the sulfate ion was close to D 2d with one of the C 2 axes of the SO4 2- being nearly parallel to the c axis of the crystal. The bayerite-derived phase yielded a one-layer polytype of monoclinic symmetry (space group C2/m). The sulfate ion was oriented with its C 3 axes tilted away from the stacking direction. Cooling and rehydration (relative humidity ∼70%) resulted in a reversible expansion of the basal spacing due to the ingress of water molecules from the ambient humidity into the interlayer region. Hydration in both cases resulted in turbostratic disorder. The disorder in the bayerite-derived phase was a result of random intergrowth of motifs with rhombohedral and monoclinic symmetries

Learner’s perspectives on competency-based medical education in pharmacology at a tertiary care teaching hospital in South India

Background: Competency based medical education (CBME) was implemented recently in India. The study was conducted to evaluate the perspectives of undergraduate medical students towards CBME curriculum in pharmacology at a tertiary care medical college in South India.Methods: After the completion of the curriculum, feedback was taken in a semi-structured, validated questionnaire. It was based on Kirkpatrik’s level 1 model of evaluation. Majority of the questions were framed on a 5-point Likert's scale (1 being poor to 5 being excellent). Qualitative data was collected by open ended question on additional comments.Results: The response rate was 72.8%. Majority of the participants rated the theory classes, practical classes, small group discussions, self-directed learning, integration, and assessments as good and excellent. More than 80% participants rated role play as an innovative and worthwhile concept towards mastering prescription communication. They felt that role play ignites team work, and provides confidence. Close to 90% of the participants rated the overview on emergency use authorization, orientation on drug regulators, perspectives on hydroxychloroquine prophylaxis as effective and excellent. More than 85% participants felt that AETCOM provided them insight on ethical issues, patient communication, and perspective of doctors as caregivers. 9.8% (16) participants provided comments to open ended question for feedback.Conclusions: The study provided an insight of medical undergraduates towards CBME curriculum. Further studies can be designed to look into the effectiveness of teaching learning methods based on the performance of the students, perspective of faculties with focus faculty development, and role of various stakeholders

Learner’s perspectives and outcomes of peer role play as a teaching learning method for prescription communication skills in second year medical students at a tertiary teaching hospital in India

Background: Medical education in India is experiencing a positive shift from traditional curriculum to competency-based medical education. Among the different initiatives, inclusion of role-play with specific aim of improving prescription communication skills in the current curriculum, could lead to beneficial patient- response outcomes. This study aims to evaluate the undergraduate medical student’s perspectives on implementing role-play for learning about prescription communication. Methods: This was a cross-sectional observational study conducted in the department of pharmacology involving second-year medical students of Vydehi institute of medical science and research centre participating for a month-long duration. An internally validated questionnaire was used to assess students’ perspectives on role-play in prescription communication. The outcome was evaluated based on students’ performance in prescription writing and appropriate communication before and after the role-play session. The data obtained was analysed using the SPSS software. Results: The mean score for the overall benefit of role play for prescription communication for all responding participants (n=163) was 4.2 out of 5. In this study, 89.4% of students agreed that role-play in prescription communication should be an essential aspect of their training in the curriculum and is worth taking this additional effort. 84.6% of students found that, the sessions helped to understand and share the pharmacology concepts better. Mean pre and post role play prescription writing assessment scores in students was 7.59 and 9.01 out of 10 respectively. Conclusions: Role-play was well received by the students as a low-cost innovative teaching methodology for better understanding of Pharmacology concepts as mandated by the CBME curriculum. It helps in understanding the importance of teamwork and error-free prescription communication for future clinical practice. Overall, following appropriate demonstration, use of role-play showed significant improvement in student performance in prescription communication

A study of drug utilisation pattern in patients of chronic kidney disease at a tertiary care hospital

Background: Chronic kidney disease (CKD) is a major public health issue and widely prevalent non-communicable disease in India. CKD has a complex pharmacotherapy and it inevitably requires poly-pharmacy. CKD patients require to take medications for a lifelong period, which makes it very important to study the prescribing trends on a regular basis. The main objective of the study was to analyse current prescribing trends in the management of CKD patients and to know whether the prescribing rationality was maintained.Methods: After Institutional Ethics Committee approval, a prospective         Cross-sectional study was carried out at Nephrology department of a tertiary care hospital for a period of six months from 1st June 2017 to 30th November 2017. Patients diagnosed with CKD by treating Nephrologist were included and their prescriptions were analysed to study the prescribing patterns.Results: A total of 120 cases were analysed during the study, of which 81.7% were males and 18.3% were females. Analysis of WHO core drug prescribing indicators showed that the average number of drugs prescribed per patient was 5.13, percentage of drugs prescribed by generic name was 30.03%, percentage of patients with an injection prescribed was 16.6%, percentage of drugs prescribed from essential medicine list was 65.8% and percentage of patients prescribed with an antibiotic was 10.8%. Antihypertensive drugs (39.9%) were the most commonly used drugs, followed by, calcium salts (12.01%), multi-vitamins (7.6%), oral iron supplements (6.8%), erythropoietin (6.3%) and ulcer protectives (6.1%).Conclusions: Maximum number of drugs were prescribed from cardiovascular class of drugs. Calcium channel blockers and diuretics were the commonest group of antihypertensives prescribed. The principle of rational prescribing was followed

Well-being and perspective of second year MBBS students on online pharmacology classes held during COVID-19 pandemic in a tertiary care teaching hospital

Background: COVID-19 pandemic shifted all the classroom teaching to virtual online platforms. The overnight change in the teaching structure posed serious challenges especially for medical education. This study aims to assess the well-being of medical students undergoing online medical education during COVID-19 pandemic and their perspective on online pharmacology classes.Methods: World health organization (WHO-5) well-being index was used to assess well-being of students. An internally validated questionnaire was used to assess student’s perspective on online pharmacology classes. The questionnaire was administered to eligible consenting students online through Google forms. The data obtained was analysed by SPSS software.Results: The mean wellness score (%) for all participants, (n=118) was 48.87%. The mean wellness score for males (58.67%) was higher than for females (42.41%). The average score for overall benefit of conducting online pharmacology classes was 3.32 out of 5. Objectively assessed online interactions like formative assessment, polls and quiz were rated higher than subjective interactions like debate.Conclusions: COVID-19 pandemic has caused massive disruption in the life of many people. In our study, we report a decreased well-being score in medical students attending virtual classes. The findings on well-being of students have implications on planning redressal mechanism in such extreme situations. Our analysis of student’s perspective about online interactions has implications beyond online classes. Some of the interactions can be instituted into regular curriculum increasing the student’s participation

Reversible Hydration of the Perchlorate-Intercalated Layered Double Hydroxides of Li and Al: Structure Models for the Dehydrated Phases

Imbibition of lithium sulphate into aluminium hydroxide is known to result in a sulphate-intercalated layered double hydroxide (LDH) of Li and Al. The perchlorate ion has the same size and molecular symmetry as the sulphate ion,but only half its charge. Consequently, twice the number of ClO$^−_4$ ions is needed to balance LDHs the charge on the metal hydroxide layer, compared to the SO$^{2−}_4$ ions. In this work, the ClO$^−_4$-intercalated LDHs were obtained from both the bayerite and gibbsite precursors. Inclusion of the hydration sphere along with the ClO$^−_4$ anion, induced turbostratic disorder in the stacking of the metal hydroxide layers. Temperature-induced dehydration ($T \sim 100$–140$^{\circ}$C) brought about a partial ordering in the interlayer region and the ClO$^−_4$ ion oriented itself with one of its $C_2$-axes parallel to the metal hydroxide layer. The close packing of ClO$^−_4$ ions could be realized by the complete dehydration of LDH and the distribution of the ClO$^−_4$ ions in all the available interlayer sites. In contrast, within the crystal of the sulphate analogue, the sulphate ions occupy only half the number of interlayer sites. The other half is occupied by the residual water molecules, as the sulphate analogue does not fully dehydrate even at elevated temperatures. This difference in the behaviour of the two LDHs has its origin in the largedifference in the hydration enthalpies of the two anions

HIV and Preconception- a Review

In the recent past there has been a significant improvement in the quality of life and vast reduction in Human Immunodeficiency Virus- related mortality rates. The advent of antiretroviral therapy has largely contributed to this drastic increase in the life expectancy of Human Immunodeficiency Virus -infected individuals. In this review we have discussed about fertility issues in -infected people, preconception, fertility desires, effect of Human Immunodeficiency Virus on pregnancy, factors affecting mother to child transmission, diet and advice in pre-conception, behavioural and psychological support, impact of preconception services and areas of future researches. Method- A internet based PUBMED, MD CONSULT, Science direct and African journals online search of all the articles dating from 1998 to 2012 available under the heading of Human Immunodeficiency Virus and preconception was carried out and a detailed review was presented. [Med-Science 2013; 2(2.000): 523-38

Reappraisal of Polytypism in Layered Double Hydroxides: Consequences of Cation Ordering in the Metal Hydroxide Layer

Recent diffraction studies on layered double hydroxides have shown that the three-layer polytypes that were thought to crystallize in rhombohedral symmetry are actually one-layer polytypes of monoclinic symmetry. However, the prevailing Bookin and Drits (1993) scheme of polytypism, which is based on the widely accepted cation-disordered structure model, fails to predict the occurrence of low symmetry (monoclinic and orthorhombic) polytypes among the layered double hydroxides. In this work, a cation-ordered metal hydroxide layer (layer group <i>p</i>3̅12/<i>m</i> or <i>c</i>12/<i>m</i>1) is chosen as the basic building block. Application of the structural synthon approach enables the description of the complete universe of polytypes comprising 1H, 1M_1–7, 2H, 2O, 3R, 3H, 6H, and 6R among others (M: monoclinic; O: orthorhombic). These polytypes are characterized by their unique stacking vectors. The polytypes of large unit cell volume are obtained by a combination of two or more stacking vectors. This work has relevance to the understanding of several mineral structures, especially those with large unit cells

Prevention of cardiovascular disease in India: Barriers and opportunities for nursing

Currently, the nursing profession lacks specialized training, to be a part of preventive cardiovascular healthcare team. The article aims to describe the obstacles Indian nurses face in becoming active and valued members of the cardiovascular healthcare team and to propose solutions. Cardiovascular disease (CVD) imposes substantial and increasing physical, psychological, societal, and financial burdens. More emphasis needs to be placed on preventive measures, which should be made available and affordable in rural as well as urban areas. Nurses are well positioned to be leaders in these initiatives. However, nurses in India face numerous obstacles in providing optimal care, including a significant shortage of trained personnel. Nursing education at advanced levels needs to be standardized and should reflect core competencies. Appropriate use of nursing resources in CVD prevention can allow physicians to treat the sickest patients, reduce cost of care, and help relieve the human burden of morbidity and mortality due to CVD