DRUG UTILIZATION STUDY IN A RADIOTHERAPY UNIT OF A TERTIARY CARE TEACHING HOSPITAL IN RURAL WEST BENGAL, INDIA

Objective: Drug utilization studies lay special emphasis on the medical social and economic consequences of use of medications in special settings. This study was undertaken to identify the pattern of drugs prescribed frequently among patients attending the radiotherapy department. Methods: This is a prospective study undertaken between January 1, 2018, and December 31, 2018. Prescriptions and patient records were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Results: We encountered a total of 618 patients during the study period. Among them, 340 (55.01%) were female. The most common age groups presenting were between 21 and 60 years. Carcinoma breast was the most common type encountered (total cases 181, 29.28%), followed by carcinoma lung (total cases 92, 14.88%), carcinoma cervix, hematological malignancies, carcinoma prostate, and carcinoma rectum. Total number of drugs prescribed was 3008 in total 618 prescriptions making it 4.86 drugs per prescription on average. Among them on average per prescription, 2.82 drugs were cytotoxic drugs (1745 total), whereas 2.04 drugs were supportive or adjunct drugs (1263 total). Among the drugs prescribed, 96.24% were in generic names, 6.95% prescriptions contained antibiotics, and 96.44% (596) prescriptions contained injections. About 85.23% of drugs were prescribed from essential drug list. Average consulting was 8.2 min and dispensing time for adjunct drugs was 4 min on average. On average, 52.42% of patients (324) had complete correct knowledge of the dosage and schedule prescribed. Adverse drug reactions were common, out of 618 patients, 542 (87.7%) experienced ADRs most common being gastrointestinal and dermatological ADRs. The most common implicated drug was cisplatin. Six serious adverse events were encountered. Conclusions: This study provides a clear picture of drug use in this special clinic in rural Bengal and paves the way for larger and long-term study

Pattern Synthesis in Time-Modulated Arrays Using Heuristic Approach

Time-modulation principle evolves as an emerging technology for easy realization of the desired array patterns with the help of an additional degree of freedom, namely, “time.” To the antenna community, the topic, time-modulated antenna array (TMAA) or 4D antenna arrays, has got much attention during the last two decades. However, population-based, stochastic, heuristic evolutionary algorithm plays as an important protagonist to meet the essential requirements on synthesizing the desired array patterns. This chapter is basically devoted to understand the theory of different time-modulation principles and the application of optimization techniques in solving different antenna array synthesis problems. As a first step, the theory of time-modulation principles and the behaviors of the sideband radiation (SBR) that appeared due to time modulation have been studied. Then, different important aspects associated with TMAA synthesis problems have been discussed. These include conflicting parameters, the need of evolutionary algorithms, multiple objectives and their optimization, cost function formation, and selection of weighting factors. After that, a novel approach to design a time modulator for synthesizing TMAAs is presented. Finally, discussing the working principle of an efficient heuristic approach, namely, artificial bee colony (ABC) algorithm, the effectiveness of the time modulator and potentiality of the algorithm are presented through representative numerical examples

Probing the Fermi surface and magnetotransport properties in MoAs2_{2}

Transition metal dipnictides (TMDs) have recently been identified as possible candidates to host topology protected electronic band structure. These materials belong to an isostructural family and show several exotic transport properties. Especially, the large values of magnetoresistance (MR) and carrier mobility have drawn significant attention from the perspective of technological applications. In this report, we have investigated the magnetotransport and Fermi surface properties of single crystalline MoAs$_{2}$, another member of this group of compounds. Field induced resistivity plateau and a large MR have been observed, which are comparable to several topological systems. Interestingly, in contrast to other isostructural materials, the carrier density in MoAs$_{2}$ is quite high and shows single-band dominated transport. The Fermi pockets, which have been identified from the quantum oscillation, are largest among the members of this group and have significant anisotropy with crystallographic direction. Our first-principles calculations reveal a substantial difference between the band structures of MoAs$_{2}$ and other TMDs. The calculated Fermi surface consists of one electron pocket and another 'open-orbit' hole pocket, which has not been observed in TMDs so far.Comment: 8 pages, 9 figure

Kodaikanal Digitized White-light Data Archive (1921-2011): Analysis of various solar cycle features

Long-term sunspot observations are key to understand and predict the solar activities and its effects on the space weather.Consistent observations which are crucial for long-term variations studies,are generally not available due to upgradation/modifications of observatories over the course of time. We present the data for a period of 90 years acquired from persistent observation at the Kodaikanal observatory in India. We use an advanced semi-automated algorithm to detect the sunspots form each calibrated white-light image. Area, longitude and latitude of each of the detected sunspots are derived. Implementation of a semi-automated method is very necessary in such studies as it minimizes the human bias in the detection procedure. Daily, monthly and yearly sunspot area variations obtained from the Kodaikanal, compared well with the Greenwich sunspot area data. We find an exponentially decaying distribution for the individual sunspot area for each of the solar cycles. Analyzing the histograms of the latitudinal distribution of the detected sunspots, we find Gaussian distributions, in both the hemispheres, with the centers at $\sim$15$^{\circ}$ latitude. The height of the Gaussian distributions are different for the two hemispheres for a particular cycle. Using our data, we show clear presence of Waldmeier effect which correlates the rise time with the cycle amplitude. Using the wavelet analysis, we explored different periodicities of different time scales present in the sunspot area times series.Comment: Accepted for Publication in A&

Analysis of IS6110 insertion sites provide a glimpse into genome evolution of Mycobacterium tuberculosis

Insertion sequence (IS) 6110 is found at multiple sites in the Mycobacterium tuberculosis genome and displays a high degree of polymorphism with respect to copy number and insertion sites. Therefore, IS6110 is considered to be a useful molecular marker for diagnosis and strain typing of M. tuberculosis. Generally IS6110 elements are identified using experimental methods, useful for analysis of a limited number of isolates. Since short read genome sequences generated using next-generation sequencing (NGS) platforms are available for a large number of isolates, a computational pipeline for identification of IS6110 elements from these datasets was developed. This study shows results from analysis of NGS data of 1377 M. tuberculosis isolates. These isolates represent all seven major global lineages of M. tuberculosis. Lineage specific copy number patterns and preferential insertion regions were observed. Intra-lineage differences were further analyzed for identifying spoligotype specific variations. Copy number distribution and preferential locations of IS6110 in different lineages imply independent evolution of IS6110, governed mainly through ancestral insertion, fitness (gene truncation, promoter activity) and recombinational loss of some copies. A phylogenetic tree based on IS6110 insertion data of different isolates was constructed in order to understand genome level variations of different markers across different lineages

Fluoxetine enhances maximal electroshock seizure threshold in Albino rat model when compared to phenytoin

Background: Individuals with epilepsy have a higher incidence of psychiatric disorders than person without epilepsy. Epidemiological studies have shown that the co-morbidity of epilepsy and depression to be high as 50%. The conventional anti-depressants are believed to lower the seizure threshold making it difficult to treat the co-morbid depression, but animal studies have shown SSRIs, a common anti-depressant, to have anti-convulsant properties. So, we propose to study the anticonvulsant effects of fluoxetine, a SSRI, in albino rats against maximal electroshock seizure and to compare against a standard antiepileptic drug phenytoin.Methods: The anticonvulsant effect of fluoxetine was observed in model of maximal electroconvulsive seizure threshold in albino rats. The animals were divided into 3 groups having 6 animals each, receiving distilled water, fluoxetine and phenytoin respectively. The drugs were given orally, and the effect was observed on day 7, 14 and 21. Tonic hind-limb extension was taken as the parameter of electroshock seizure. The effects were compared against a standard anti-seizure drug phenytoin.Results: Fluoxetine showed significant elevation of the seizure threshold following 14 days of administration (P value 0.031). The effect was comparable to phenytoin with no significant difference after 7, 14 and 21 days of treatment (P-value 0.485, 0.699 and 0.818 respectively) though phenytoin showed significant anti-seizure effect since day 7 of treatment.Conclusions: Fluoxetine showed significant anti-seizure activity against electroconvulsive seizure in albino rats

Perception of second professional undergraduate medical students and teachers about pharmacy practical classes in pharmacology curriculum

Background: The practice and teaching in the MBBS curriculum has changed over the last few decades and most of it caters to the making of the Indian Medical Graduate (IMG) and the first contact physician of the community. The most notable change in pharmacy in modern times has been the virtual disappearance of the preparation and compounding of medicines. Pharmacy practical classes still form a part of the MCI curriculum in Pharmacology undergraduate teaching in many states of India including West Bengal. This study was undertaken to assess the attitude of students as well as teachers towards continuation of these practical classes in the curriculum and possible alternatives.Methods: Second year pharmacology students were included in the study (n=143). Along with this 10 faculty members were provided a structured and pre-tested questionnaire to be answered anonymously.Results: It was seen that 89 percent students and 100 percent faculty members wanted these practical classes to be discontinued. The most popular alternative to these classes were ADR reporting from the faculty members (90%) and demonstration of clinical effects of drugs and dosage calculation (86%) among the students.Conclusions: Given the lessening importance and relevance of the pharmacy practical classes in today’s day to day practice, a change in curriculum and examination system in Pharmacology must be considered

Patient-reported outcomes with medical management of benign prostatic hyperplasia: a prospective study in a tertiary care teaching hospital of rural West Bengal, India

Background: Effectiveness of pharmacotherapy in benign prostatic hyperplasia (BPH) is generally evaluated by clinical measures. Outcome of the treatment from the patient’s perspective however cannot be evaluated which may result communication gap between the patient and the physician. Patient-Reported Outcomes (PRO) studies can bridge this gap. This study was undertaken to evaluate outcomes and to assess the impact of medical management of BPH on general health-related quality of life.Methods: In this prospective, observational study, eligible patients with BPH attending a Urology clinic in a tertiary care rural hospital of West Bengal were enrolled and followed up on third and sixth months from baseline. Symptom assessment of BPH were assessed through International Prostate Symptom Score (I-PSS), BPH Impact Index (BII) and Health Related Quality of life questionnaires. Tools of descriptive statistics were used for analysis of data.Results: In the study population of 66 patients, 50% were treated with monotherapy (alpha blockers) and 50% were treated with combinations (alpha blocker and 5alpha reductase inhibitors). After 6 months of medical management, I-PSS was decreased from 18.86±5.53 to 11.76±3.94 (p <0.001), BII score decreased from 9.65±2.59 to 5.89±2.24 (p <0.001) and VAS score increased from 51.44±10.03 to 54.24±11.38 (p <0.001).Conclusions: We found medical management definitely improved quality of life in BPH patients and significantly decreased symptoms. This study is a step in the direction of development of larger and longer term PRO studies in BPH management

Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal

Background: Dilated cardiomyopathy (DCM) is an important underlying cause of congestive heart failure and/or arrhythmias. The introduction of therapy combining diuretics, digoxin and angiotensin converting enzyme inhibitors (ACEI) has significantly decreased mortality and morbidity. The aim of the study was undertaken to identify the pattern of drugs most commonly prescribed for DCM and to assess the rationality behind such use.Methods: This was a prospective study undertaken between 1st July and 31st August 2015. Prescriptions were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Rationality and cost of therapy per prescription was also evaluated.Results: We encountered 78 patients of DCM in the OPD of Cardiology (prevalence of 4.94%). The average number of drugs per prescription was 6.64. Generic prescriptions were made in 90% encounters. As part of therapy, diuretics and ACE inhibitors or angiotensin receptor blockers, were prescribed in all cases. Our results show a distinctive drug use pattern where beta blockers were used more commonly than digoxin. Other commonly prescribed agents were antiplatelet drugs and statins. Antibiotics were prescribed in 8.7% cases and no injectable drug was prescribed. Average drug cost per encounter was 10.63 INR.Conclusions: To conclude, we found a typical and rational pattern of drug use. Diuretics, ACEI and beta blockers were found to be most commonly used agents. This study provides a clear picture of drug use in this special clinical condition in rural Bengal and paves the way for larger and long term studies