An evaluation of knowledge, attitude and perception about adverse drug reactions and pharmacovigilance among intern doctors in a medical college teaching hospital of Sangli

Background: Underreporting of various adverse drug reactions (ADRs) by consultants is a common incurable problem. National pharmacovigilance program is one of the ongoing programs to monitor the adverse drug reactions & reporting at the earliest to the nearby AMCs. As medical interns are budding doctors, the focus of this study was to evaluate the knowledge, attitude and perception about ADRs and pharmacovigilance in them.Methods: A cross section questionnaire-based study was conducted after approval by our institutional ethics committee pretested and validated questions consisting of 20 questions (knowledge, attitude, perception) were administrated to medical interns. The filled questionnaires were collected and analysed.Results: In our study, medical interns have fair enough idea about ADR and pharmacovigilance. In knowledge domain they were aware of term ADRs (100%), pharmacovigilance (72.6%). In attitude domain majority of interns (80.6%) known availability of ADR forms, compulsory of pharmacovigilance unit (90.3%). In perception domain very poor response from interns, not even a single intern had reported any ADR filled form and they don’t know meaning of re-challenge and de-challenge, very few interns (9.7%) know how to manage the ADRs in emergency conditions.Conclusions: Under reporting problem can be improved by doing more teaching activities at undergraduate level and intern’s level including various workshops, CMEs, problem-based teaching of adverse reactions in their curriculum. These exercises will improve their reporting frequency and sensitize the interns from the undergraduate days itself in their upcoming clinical practice in community

AN APPLICATION OF THE PHOSPHORUS CONSISTENT RULE FOR ENVIRONMENTALLY ACCEPTABLE COST-EFFICIENT MANAGEMENT OF BROILER LITTER IN CROP PRODUCTION

We calculated the profitability of using broiler litter as a source of plant nutrients using the phosphorus consistent litter application rule. The cost saving by using litter is 37% over the use of chemical fertilizer alone to meet the nutrient needs of major crops grown in Alabama. In the optimal solution, only a few routes of all the possible routes developed were used for inter- and intra- county litter hauling. If litter is not adopted as the sole source of crop nutrients, the best environmental policy may be to pair the phosphorus consistent rule with taxes, marketable permits, and subsidies.Environmental Economics and Policy, Production Economics,

Use of proton pump inhibitors in dialysis unit in tertiary care hospital: a pharmaco-epidemiological study

Background: Proton pump inhibitors (PPI) are generally thought to be safer drug with fewer adverse effects. Though this class of the drug is thought to be well tolerated, a detail study about actual use of these agents in nephrology department is still awaited in many parts of India. There had been case reports and case series which were reporting PPIs producing acute interstitial nephritis progressing to acute renal failure. The risk of PPI treatment in haemodialysis patients remains unexplored. The aim of the study was to evaluate a drug utilization of PPI in patient undergoing haemodialysis procedure.Methods: In this study every day visit to the dialysis units of the hospitals was carried out. After taking consent from the patients, the information from the case-report form was noted like; age, sex, diagnosis, laboratory reports and drug prescried. No personally identifiable information about patient or physician was collected. After this an interview of patients was taken.Results: In this study, out of 126 patients 76.6% were male and 23.4% were female. Out of these 126 patients 88.89% patients were on PPI. Nearly 54% were using PPI for more than six months. Nearly 29% patients were using PPI for more than 12 months.Conclusions: As many case-reports and studies are suggesting, there is co-relation of PPI and acute interstitial nephritis from this study we suggest that especially in nephrology unit patients’, more caution must be exercised while using PPI

Procalcitonin as a marker for the diagnosis of sepsis

Background: Quick diagnosis of sepsis in intensive care unit patients is challenging for physicians.Methods: The prospective study was conducted at our hospital. We studied the efficacy of procalcitonin as a marker of sepsis in 87 adults admitted to our intensive care unit with symptoms of systemic infection. The study samples included all patients aged above 18 years with acute sepsis. Statistical analyses were done using SPSS. PCT and various other relevant factors were measured in all study subjects. PCT levels of less than 0.1 ng/ml were considered negative; all other levels were considered positive.Results: PCT proved to be an excellent indicator of sepsis. Serum PCT levels predicts mortality in the present study.Conclusions: PCT is among the most promising sepsis markers capable of completing clinical signs and routine lab parameters suggestive of severe infection

Balancing Bounded Treewidth Circuits

Algorithmic tools for graphs of small treewidth are used to address questions in complexity theory. For both arithmetic and Boolean circuits, it is shown that any circuit of size $n^{O(1)}$ and treewidth $O(\log^i n)$ can be simulated by a circuit of width $O(\log^{i+1} n)$ and size $n^c$, where $c = O(1)$, if $i=0$, and $c=O(\log \log n)$ otherwise. For our main construction, we prove that multiplicatively disjoint arithmetic circuits of size $n^{O(1)}$ and treewidth $k$ can be simulated by bounded fan-in arithmetic formulas of depth $O(k^2\log n)$. From this we derive the analogous statement for syntactically multilinear arithmetic circuits, which strengthens a theorem of Mahajan and Rao. As another application, we derive that constant width arithmetic circuits of size $n^{O(1)}$ can be balanced to depth $O(\log n)$, provided certain restrictions are made on the use of iterated multiplication. Also from our main construction, we derive that Boolean bounded fan-in circuits of size $n^{O(1)}$ and treewidth $k$ can be simulated by bounded fan-in formulas of depth $O(k^2\log n)$. This strengthens in the non-uniform setting the known inclusion that $SC^0 \subseteq NC^1$. Finally, we apply our construction to show that {\sc reachability} for directed graphs of bounded treewidth is in $LogDCFL$

A study of assessment of knowledge, attitude and practice of antibiotic stewardship among healthcare providers in a tertiary care hospital of Sangli

Background: Antimicrobials are routinely used for variety of clinical conditions but are also misused leading to drug resistance bacteria in clinical practice. Consultants can gain the knowledge about it and can also have the depth of problem faced, their prescribing behavior mainly depends on their attitude and understanding of condition. Our aim of this study is to evaluate the knowledge and beliefs about antibiotics prescribing among health care workers in a tertiary care hospital of Sangli. Methods: Our present study was conducted in the Bharati hospital, BV (DU) medical college and hospital, Sangli. Ethical clearance from the institutional ethics committee was obtained and it was, cross-sectional questionnaire-based study carried out in the form of a survey in which a pretested, semi-structured, validated questionnaire was provided to junior residents, senior residents and faculty of different specialties and responses were recorded. Questionnaire comprises of 9 in knowledge, 10 in attitude and 10 in practice section. Results: Out of all participants 84.5% believed that no need of antibiotics for running and blocked nose. Majority 89.6% were expressed that sample culture should be sent before starting antibiotics. 90.4% participants believed that education of patients will help. Only 76.8% strictly adhere to the antibiotic policy of our hospital. Conclusions: The present study on antibiotic usage gives useful information about the knowledge, attitudes and practices of prescribers and help plan suitable educational modifications that aim at improving the antimicrobial prescribing and minimizing the development of drug resistance in our developing country

Effect of nicotine on serotonin (5-HT) levels in brain of depressed rats

Background: Reduction in brain serotonin (5-HT) levels contributes to depression. Nicotine may have antidepressant properties and smokers self-medicate underlying depression. Epidemiological findings suggest that smokers more often demonstrate depressive symptoms than non-smokers and depressed patients are less likely to cease smoking. Therefore, the study was planned to evaluate the effect of nicotine on serotonin levels in brain of depressed rats.Methods: Antidepressant action of study drugs was evaluated using isolation induced hyperactivity model in rats. Rats were divided into five groups with six rats in each group. Study groups: Vehicle in normal rats 1 ml/kg (subcutaneous); vehicle after isolation 1ml/kg (subcutaneous); imipramine 10 mg/kg (intraperitoneal) for 7 consecutive days; single dose of nicotine 0.4 mg/kg (subcutaneous); single dose of nicotine 0.2 mg/kg (inhalational). Brain serotonin assay was carried out. The statistical significance was determined by ANOVA followed by Tukey test (p<0.05).Results: Serotonin levels (55.93ng/g of brain tissue) in rats after isolation were significantly less than in normal rats (335.87ng/g) (p<0.001). In imipramine treated group, serotonin levels (301.4ng/g) after isolation were highly significant as compared to serotonin levels in vehicle treated group after isolation (p<0.001). Nicotine administered by subcutaneous and inhalational route showed significantly higher brain serotonin levels, i.e. 175ng/g and 254.62ng/g respectively as compared to vehicle treated rats after isolation (p<0.001).Conclusions: Single dose nicotine (inhalational) produced significant antidepressant action comparable to that of seven days’ treatment of standard antidepressant drug imipramine in rats. In rats, nicotine by both routes i.e. subcutaneous and inhalational increased serotonergic activity

Significance Tests for Periodogram Peaks

We discuss methods currently in use for determining the significance of peaks in the periodograms of time series. We discuss some general methods for constructing significance tests, false alarm probability functions, and the role played in these by independent random variables and by empirical and theoretical cumulative distribution functions. We also discuss the concept of "independent frequencies" in periodogram analysis. We propose a practical method for estimating the significance of periodogram peaks, applicable to all time series irrespective of the spacing of the data. This method, based on Monte Carlo simulations, produces significance tests that are tailor-made for any given astronomical time series.Comment: 22 pages, 11 Encapsulated Postscript figures, AAS LaTeX v5.2 Submitted to Ap

Visualizing tephra deposits and sedimentary processes in the marine environment: The potential of X‐ray microtomography

Localized tephra deposition in marine sequences is the product of many complex primary and secondary depositional processes. These can significantly influence the potential applicability of tephra deposits as isochronous marker horizons and current techniques, used in isolation, may be insufficient to fully unravel these processes. Here we demonstrate the innovative application of X-ray microtomography (µCT) to successfully identify tephra deposits preserved within marine sediments and use these parameters to reconstruct their internal three-dimensional structure. Three-dimensional visualizations and animations of tephra dispersal in the sediment permit a more thorough assessment of postdepositional processes revealing a number of complex microsedimentological features that are not revealed by conventional methods. These features include bioturbation burrows and horizontally discontinuous tephra packages, which have important ramifications for the stratigraphic placement of the isochron in a sedimentary sequence. Our results demonstrate the potential for utilizing rigorous two and three-dimensional microsedimentological analysis of the ichnofabric to enhance and support the use of tephra deposits as isochronous marker horizons and to identify the stratigraphic position that best reflects the primary fallout of ash. The application also provides an exceptional insight into the style and rate of sedimentation processes and permits an assessment of the stratigraphic integrity of a tephra deposit. We discuss the possibility of applying these µCT methods to the identification of cryptotephras within various paleoclimatic sequences and to enhance our understanding of marine sedimentation processes