Analysis of gastrointestinal drugs in patients admitted in CCU and ICCU of a tertiary care hospital in Goa, India

Background: Gastrointestinal (GI) diseases are a common problem worldwide. They are frequently encountered in non-critical as well as in critically ill hospitalized patients.Methods: This was a prospective and observational study conducted on patients admitted in CCU and ICCU of Goa Medical College and Hospital. Data was collected from the patients’ case records and was analysed referring to WHO prescribing indicators. Data was represented as Mean±SD, number and frequency.Results: A total of 2250 drugs were prescribed, out of which 376 (16.71%) were gastrointestinal drugs. Most common route of administration was oral 323 (85.90%). Prescription patterns of GI drugs were:  275 (73.14%) from National List of Essential Medicines, 20 (5.31%) as fixed dose combinations and 4 (1.06%) by generic names. Pantoprazole 183 (48.67%) was the most frequently prescribed drug for peptic ulcer in present study.Conclusions: From the findings of this study we noted that among the GI drugs used, those for peptic ulcer were the most commonly prescribed. Also majority were from the essential drug list. But prescribing by generic names was low. Review of drug utilization trends is a necessary aid to formulate and modify existing protocols and guidelines to improve treatment outcomes in a given setting

Perception and practice of self-medication amongst second year medical students in a tertiary care teaching hospital

Background: Management of medical ailments requires sound knowledge of diseases and drugs. Medical students are more likely to practice self-medication due to easy access to information. Inappropriate and inadequate treatment can lead to morbidity and mortality. Thus, the current study was carried out to understand the perception and practice of self-medication in medical students so that habit of ethical practice can be inculcated in them.Methods: A self-developed and prevalidated questionnaire was distributed amongst 145 students of second MBBS after approval from Institutional ethics Committee. Data was collected; analysed using MS Excel and the results were expressed as counts and percentages.Results: In this study authors noted 136 (93.79%) out of the 145 students practised self-medication. The commonest reason being effectiveness of medications for similar conditions in the past 92 (69.17%). 111 (81.61%) students reported fever as the most common indication. Analgesics/anti-pyretics 117 (86.02%) were the most frequently used drug groups. Majority 87 (63.97%) obtained information from friends and relatives. Adverse effects of self-medication were noted in 20 (14.70%).Conclusions: This study indicates higher prevalence of self-medication in medical students of Goa. Students can be sensitised and made aware about possible adverse effects and drug interactions with self-medication and how simple looking illness may take an ugly turn. Students being future doctors will continue this chain of spread of awareness of self-medication. Easy access to healthcare can also solve these problems

Changes in the source and transport mechanism of terrigenous input to the Indian sector of southern ocean during the late quaternary and its palaeoceanographic implications

Changes in the terrigenous sediment source and transport mechanisms during the late Quaternary have been investigated using four sediment cores within the Indian sector of Southern Ocean, using the magnetic susceptibility (MS) and sedimentological records. Sediments deposited during the Holocene and other interglacial periods were characterised by low MS, low sand content, reduced ice-rafted detritus (IRD) input and increased illite possibly transported via hydrographic advection from the south. The glacial intervals are characterised by high MS, high sand content, increased IRD input and reduced illite clays, derived from both local as well as Antarctic sources. Significant reduction in clay fraction and illite content during glacials suggests that the erosive and transporting capabilities of the deep and bottom waters could have reduced compared to the interglacial times. The changes in terrigenous influx to this region were significantly influenced by the rhythmic glacial–interglacial fluctuations in bottom circulation and the position of the Polar Front

Recurrence of Primary Sclerosing Cholangitis After Liver Transplant in Children : An International Observational Study

Background and Aims Recurrent primary sclerosing cholangitis (rPSC) following liver transplant (LT) has a negative impact on graft and patient survival; little is known about risk factors for rPSC or disease course in children. Approach and Results We retrospectively evaluated risk factors for rPSC in 140 children from the Pediatric PSC Consortium, a multicenter international registry. Recipients underwent LT for PSC and had >90 days of follow-up. The primary outcome, rPSC, was defined using Graziadei criteria. Median follow-up after LT was 3 years (interquartile range 1.1-6.1). rPSC occurred in 36 children, representing 10% and 27% of the subjects at 2 years and 5 years following LT, respectively. Subjects with rPSC were younger at LT (12.9 vs. 16.2 years), had faster progression from PSC diagnosis to LT (2.5 vs. 4.1 years), and had higher alanine aminotransferase (112 vs. 66 IU/L) at LT (all P < 0.01). Inflammatory bowel disease was more prevalent in the rPSC group (86% vs. 66%; P = 0.025). After LT, rPSC subjects had more episodes of biopsy-proved acute rejection (mean 3 vs. 1; P < 0.001), and higher prevalence of steroid-refractory rejection (41% vs. 20%; P = 0.04). In those with rPSC, 43% developed complications of portal hypertension, were relisted for LT, or died within 2 years of the diagnosis. Mortality was higher in the rPSC group (11.1% vs. 2.9%; P = 0.05). Conclusions The incidence of rPSC in this cohort was higher than previously reported, and was associated with increased morbidity and mortality. Patients with rPSC appeared to have a more aggressive, immune-reactive phenotype. These findings underscore the need to understand the immune mechanisms of rPSC, to lay the foundation for developing new therapies and improve outcomes in this challenging population.Peer reviewe

Human breast cancer-derived soluble factors facilitate CCL19-induced chemotaxis of human dendritic cells

Breast cancer remains as a challenging disease with high mortality in women. Increasing evidence points the importance of understanding a crosstalk between breast cancers and immune cells, but little is known about the effect of breast cancer-derived factors on the migratory properties of dendritic cells (DCs) and their consequent capability in inducing T cell immune responses. Utilizing a unique 3D microfluidic device, we here showed that breast cancers (MCF-7, MDA-MB-231, MDA-MB-436 and SK-BR-3)-derived soluble factors increase the migration of DCs toward CCL19. The enhanced migration of DCs was mainly mediated via the highly activated JNK/c-Jun signaling pathway, increasing their directional persistence, while the velocity of DCs was not influenced, particularly when they were co-cultured with triple negative breast cancer cells (TNBCs or MDA-MB-231 and MDA-MB-436). The DCs up-regulated inflammatory cytokines IL-1?? and IL-6 and induced T cells more proliferative and resistant against activation-induced cell death (AICD), which secret high levels of inflammatory cytokines IL-1??, IL-6 and IFN-??. This study demonstrated new possible evasion strategy of TNBCs utilizing their soluble factors that exploit the directionality of DCs toward chemokine responses, leading to the building of inflammatory milieu which may support their own growth.ope

Bone Marrow Derived Mesenchymal Stem Cells Inhibit Inflammation and Preserve Vascular Endothelial Integrity in the Lungs after Hemorrhagic Shock

Hemorrhagic shock (HS) and trauma is currently the leading cause of death in young adults worldwide. Morbidity and mortality after HS and trauma is often the result of multi-organ failure such as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), conditions with few therapeutic options. Bone marrow derived mesenchymal stem cells (MSCs) are a multipotent stem cell population that has shown therapeutic promise in numerous pre-clinical and clinical models of disease. In this paper, in vitro studies with pulmonary endothelial cells (PECs) reveal that conditioned media (CM) from MSCs and MSC-PEC co-cultures inhibits PEC permeability by preserving adherens junctions (VE-cadherin and β-catenin). Leukocyte adhesion and adhesion molecule expression (VCAM-1 and ICAM-1) are inhibited in PECs treated with CM from MSC-PEC co-cultures. Further support for the modulatory effects of MSCs on pulmonary endothelial function and inflammation is demonstrated in our in vivo studies on HS in the rat. In a rat “fixed volume” model of mild HS, we show that MSCs administered IV potently inhibit systemic levels of inflammatory cytokines and chemokines in the serum of treated animals. In vivo MSCs also inhibit pulmonary endothelial permeability and lung edema with concurrent preservation of the vascular endothelial barrier proteins: VE-cadherin, Claudin-1, and Occludin-1. Leukocyte infiltrates (CD68 and MPO positive cells) are also decreased in lungs with MSC treatment. Taken together, these data suggest that MSCs, acting directly and through soluble factors, are potent stabilizers of the vascular endothelium and inflammation. These data are the first to demonstrate the therapeutic potential of MSCs in HS and have implications for the potential use of MSCs as a cellular therapy in HS-induced lung injury