Effectiveness of Teaching Standardized Protocol on Safe Medication Administration Process Upon the Level of Knowledge among Nurses at a Tertiary Care Hospital, Chennai

Strategies to improve medication safety focused on acute care settings. Twenty-six studies and descriptions of quality improvement projects were identified. Strategies used to focus on recommendations to prevent medication errors at various stages, from a nationwide voluntary organization to improve safety of patients and empower education system of nurses and other health care providers in safe practices in health care system and vast growing technology

Medication Reconciliation

The Institute of Medicine (IOM) stated that preventable medication errors are the most common type of errors in healthcare. It is of fundamental significance when building a safer care continuum, as it highlights the reason for continuous and more vigilant medication reconciliation and required effort at all interfaces of care, including community. Without a robust medication reconciliation process, the potential for catastrophic outcomes remains a constant concern. Prevention of medication errors is essential through strategies that are based in evidence of medication reconciliation strategies on medication errors in community

Proton Magnetic Resonance Spectroscopy of Intracranial Lesions: Assessment of differences between Tumours and Tumour like Lesions and Its applicability in Brain Lesion Characterization

Intracranial lesions are a significant health problem and present several imaging challenges. The role of imaging is no longer limited to merely providing anatomic details of the exact location of the pathology. Advanced Magnetic Resonance Imaging (MRI) techniques allow insight into the chemical makeup of certain compounds within these pathologic lesions. In vivo Proton MR Spectroscopy (1H MRS), a non-invasive technique which provides metabolic information can complement the anatomical changes found in radiological examinations of various intracranial lesions increasing diagnostic specificity. The present investigation was carried out a) To determine if there are specific MRS findings which could help differentiate between neoplastic and non –neoplastic lesions and also to identify the presence or absence of MRS features which could help differentiate one neoplasm from another. b)to determine if MRS findings could help grade gliomas pre operatively. c) To determine if MRS findings could help differentiate irradiated residual/recurrent tumours from radiation necrosis. d) To determine if MRS findings could help differentiate necrotic tumours from infective lesions such as abscesses. CONCLUSION: MR Spectroscopy in addition to appropriate conventional MRI sequences provides useful supplementary information and has a potential to validate treatment strategies. This could influence decision making with respect to prognosis and therapy in patients with intracranial lesions. Current Neuro - Imaging techniques enable use of multiple modalities to enhance the accuracy of non-invasive diagnosis. This study emphasizes the utility and validity of a simple add on technique of MRS over MRI to provide additional information in establishing the possible aetiological diagnosis of intracranial lesions. This study helps radiologists to improve diagnostic accuracy of MRI using the additional modality of MRS. MRS could help in clinical decision making in difficult cases e.g.in distinguishing neoplastic from non-neoplastic lesions. During the last few years there has been an exponential growth in MRS. The phenomenal advances in neuroimaging of the brain are resulting in a paradigm change in the clinician’s approach to diagnosing and managing intracranial conditions. Advances in the ultra precise delineation of anatomical changes in the brain have resulted in increasing precision in separating normal from abnormal brain tissue. However this has not kept pace with identifying the nature of the abnormal brain tissue. For several decades humankind has preferred non-invasive methods in establishing a definite pathological diagnosis. This is particularly true for cerebral lesions. This study appears to indicate, that one is now justified, in carrying out larger studies to confirm the present findings that MRS could be a valuable diagnostic tool in identifying certain types of cerebral pathology. CLINICAL APPLICATIONS & SUGGESTIONS: This study has enabled development of a few guidelines in the use of MR spectroscopy, as an add-on modality, to improve diagnostic accuracy, in certain categories of lesions i.e. neoplasm versus nonneoplasm, high grade tumours versus low grade tumours, high grade tumours versus metastases, recurrent tumours versus radiation necrosis, cystic non-tumoural lesions versus cystic tumours and improved follow up of polyphasic demyelinating conditions i.e. multiple sclerosis. 1. It is desirable that all patients with intra cranial space occupying lesions referred for MRI also undergo MRS, to provide additional information which may help differentiate a neoplasm from nonneoplasms. This could avoid surgical treatment in some instances. 2. MRS can be considered as a suitable, complementary modality to be used when a doubt exists in defining whether a tumour is low or high grade. 3. Solitary metastasis always is difficult to diagnose and may be confused with other high grade tumours. While it is challenging to use single voxel MRS technique to distinguish between the two, MV-MRS technique would be more useful to differentiate metastasis from high grade glioma. 4. In follow up of treated patients of brain tumour, especially after surgery, radiotherapy and/or chemotherapy, the differentiation between recurrent tumour and radiation necrosis can be difficult. Making this distinction is critical for treatment and MRS appears to be a useful tool to distinguish between the two. 5. In analyzing the use of MRS in tuberculous and pyogenic abscess, MRS was found to be useful in distinguishing tuberculous from pyogenic abscesses. 6. In polyphasic demyelinating conditions such as Multiple Sclerosis, MRS plays a valuable role not only in initial diagnosis but also in follow up. Degree of neuronal loss, a prognostic factor, can indirectly be titrated through MRS findings on follow up studies

Hepatoprotective Activity of Cnidoscolus Chayamansa against Rifampicin and Isoniazide Induced Toxicity in Wistar Rats

ABSTRACT The purpose of this study was to assess the effect of ethanolic extract of Cnidoscolus chayamansa leaves in experimentally drug induced hepatitis in rats. Rats were divided into five different groups each having six. Group 1 served as a control, Group 2 received Rifampicin (RIF) (100 mg/kg, i.p.) and coadministered with Isoniazid (INH) (100 mg/kg, i.p.), in sterile water, group 4 and 5 served as extract treatment groups and received 200 & 400 mg/kg, orally, ethanolic extract of Cnidoscolus chayamansa and group 3 served as standard group and received Silymarin 2.5 mg/kg orally. All the treatment protocols followed 21 days and after which rats were sacrificed, blood and liver were taken for biochemical and histological studies, respectively. The Rifampicin (RIF) and Isoniazid INH treated group rats (G2) showed variable increase in serum AST, ALT, ALP, total protein and total bilirubin levels. Administration of ethanolic extracts of Cnidoscolus chayamansa significantly prevented Rifampicin-Isoniazidinduced elevation in the levels of serum diagnostic liver marker enzymes aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALP) level in experimental groups of rats. Moreover, total protein and total albumin levels were significantly increased in treatment groups. The effect of extract was compared with a standard drug, Silymarin. The changes in biochemical parameters were supported by histological profile. It is concluded that the ethanolic extract of Cnidoscolus chayamansa protects against rifampicin and Isoniazid-induced oxidative liver injury in rats

Evaluation and Quantification of Angiogenesis Activity of Terminalia Bellirica Roxb, by Mice Sponge Implantation Method

Angiogenesis represents an excellent therapeutic target for the treatment of cardiovascular diseases. It is a potent physiological process that underlies the natural manner in which our bodies respond to a diminution of blood supply to vital organs, namely the production of new collateral vessels to overcome the ischemic state. This present study is aimed to evaluate and quantify the Angiogenic potential of Terminalia bellirica Roxb, by in vivo mice sponge implantation assay. Here, gelatin sponge with or without Ethanolic extract of Terminalia bellirica leaf (EETB - 0.3 mg and 0.5 mg, respectively) were subcutaneously injected into Swiss albino mice, and 14 days later, the implanted sponges was excised and histologically examined. The stained section showed that sponge containing EETB had produced more vessels in gels than sponges alone. The new vessels were abundantly filled with intact Red blood corpuscles (RBCs), which indicate the formation of a functional vasculature inside the sponges and blood circulation in newly formed vessels by angiogenesis which is induced by EETB. It also measured that the hemoglobin content inside the sponges: Whereas, hemoglobin in control was nearly 0.3 μg, EETB cases the hemoglobin quantity was markedly enhanced to about 17 μg. Taken together, it demonstrated that Ethanolic extract of Terminalia bellirica leaf exhibited a profound angiogenic activity in vivo. The phytochemical screening and qualitative instrumental analysis of EETB reveals the presence of proteins and Phytosterols. The promising angiogenic potential may be due to the presence of the above chemical constituents. Further study is required to define more precisely the molecular mechanisms by which Ethanolic extract of Terminalia bellirica leaf modulates endothelial cell function and gene expression, as well as the pathological relevance of these findings

Trigeminal neuralgia and persistent trigeminal artery

We report a case of trigeminal neuralgia caused by persistent trigeminal artery (PTA) associated with asymptomatic left temporal cavernoma. Our patient presented unstable blood hypertension and the pain of typical trigeminal neuralgia over the second and third divisions of the nerve in the right side of the face. The attacks were often precipitated during physical exertion. MRI and Angio-MRI revealed the persistent carotid basilar anastomosis and occasionally left parietal cavernoma. After drug treatment of blood hypertension, spontaneous recovery of neuralgia was observed and we planned surgical treatment of left temporal cavernoma

Suitability of external controls for drug evaluation in Duchenne muscular dystrophy

OBJECTIVE: To evaluate the suitability of real-world data (RWD) and natural history data (NHD) for use as external controls in drug evaluations for ambulatory Duchenne muscular dystrophy (DMD). METHODS: The consistency of changes in the 6-minute walk distance (Δ6MWD) was assessed across multiple clinical trial placebo arms and sources of NHD/RWD. Six placebo arms reporting 48-week Δ6MWD were identified via literature review and represented 4 sets of inclusion/exclusion criteria (n = 383 patients in total). Five sources of RWD/NHD were contributed by Universitaire Ziekenhuizen Leuven, DMD Italian Group, The Cooperative International Neuromuscular Research Group, ImagingDMD, and the PRO-DMD-01 study (n = 430 patients, in total). Mean Δ6MWD was compared between each placebo arm and RWD/NHD source after subjecting the latter to the inclusion/exclusion criteria of the trial for baseline age, ambulatory function, and steroid use. Baseline covariate adjustment was investigated in a subset of patients with available data. RESULTS: Analyses included ∼1,200 patient-years of follow-up. Differences in mean Δ6MWD between trial placebo arms and RWD/NHD cohorts ranged from -19.4 m (i.e., better outcomes in RWD/NHD) to 19.5 m (i.e., worse outcomes in RWD/NHD) and were not statistically significant before or after covariate adjustment. CONCLUSIONS: We found that Δ6MWD was consistent between placebo arms and RWD/NHD subjected to equivalent inclusion/exclusion criteria. No evidence for systematic bias was detected. These findings are encouraging for the use of RWD/NHD to augment, or possibly replace, placebo controls in DMD trials. Multi-institution collaboration through the Collaborative Trajectory Analysis Project rendered this study feasible

Proton Magnetic Resonance Spectroscopy of Intracranial Lesions: Assessment of differences between Tumours and Tumour like Lesions and Its applicability in Brain Lesion Characterization

Intracranial lesions are a significant health problem and present several imaging challenges. The role of imaging is no longer limited to merely providing anatomic details of the exact location of the pathology. Advanced Magnetic Resonance Imaging (MRI) techniques allow insight into the chemical makeup of certain compounds within these pathologic lesions. In vivo Proton MR Spectroscopy (1H MRS), a non-invasive technique which provides metabolic information can complement the anatomical changes found in radiological examinations of various intracranial lesions increasing diagnostic specificity. The present investigation was carried out a) To determine if there are specific MRS findings which could help differentiate between neoplastic and non –neoplastic lesions and also to identify the presence or absence of MRS features which could help differentiate one neoplasm from another. b)to determine if MRS findings could help grade gliomas pre operatively. c) To determine if MRS findings could help differentiate irradiated residual/recurrent tumours from radiation necrosis. d) To determine if MRS findings could help differentiate necrotic tumours from infective lesions such as abscesses. CONCLUSION: MR Spectroscopy in addition to appropriate conventional MRI sequences provides useful supplementary information and has a potential to validate treatment strategies. This could influence decision making with respect to prognosis and therapy in patients with intracranial lesions. Current Neuro - Imaging techniques enable use of multiple modalities to enhance the accuracy of non-invasive diagnosis. This study emphasizes the utility and validity of a simple add on technique of MRS over MRI to provide additional information in establishing the possible aetiological diagnosis of intracranial lesions. This study helps radiologists to improve diagnostic accuracy of MRI using the additional modality of MRS. MRS could help in clinical decision making in difficult cases e.g.in distinguishing neoplastic from non-neoplastic lesions. During the last few years there has been an exponential growth in MRS. The phenomenal advances in neuroimaging of the brain are resulting in a paradigm change in the clinician’s approach to diagnosing and managing intracranial conditions. Advances in the ultra precise delineation of anatomical changes in the brain have resulted in increasing precision in separating normal from abnormal brain tissue. However this has not kept pace with identifying the nature of the abnormal brain tissue. For several decades humankind has preferred non-invasive methods in establishing a definite pathological diagnosis. This is particularly true for cerebral lesions. This study appears to indicate, that one is now justified, in carrying out larger studies to confirm the present findings that MRS could be a valuable diagnostic tool in identifying certain types of cerebral pathology. CLINICAL APPLICATIONS & SUGGESTIONS: This study has enabled development of a few guidelines in the use of MR spectroscopy, as an add-on modality, to improve diagnostic accuracy, in certain categories of lesions i.e. neoplasm versus nonneoplasm, high grade tumours versus low grade tumours, high grade tumours versus metastases, recurrent tumours versus radiation necrosis, cystic non-tumoural lesions versus cystic tumours and improved follow up of polyphasic demyelinating conditions i.e. multiple sclerosis. 1. It is desirable that all patients with intra cranial space occupying lesions referred for MRI also undergo MRS, to provide additional information which may help differentiate a neoplasm from nonneoplasms. This could avoid surgical treatment in some instances. 2. MRS can be considered as a suitable, complementary modality to be used when a doubt exists in defining whether a tumour is low or high grade. 3. Solitary metastasis always is difficult to diagnose and may be confused with other high grade tumours. While it is challenging to use single voxel MRS technique to distinguish between the two, MV-MRS technique would be more useful to differentiate metastasis from high grade glioma. 4. In follow up of treated patients of brain tumour, especially after surgery, radiotherapy and/or chemotherapy, the differentiation between recurrent tumour and radiation necrosis can be difficult. Making this distinction is critical for treatment and MRS appears to be a useful tool to distinguish between the two. 5. In analyzing the use of MRS in tuberculous and pyogenic abscess, MRS was found to be useful in distinguishing tuberculous from pyogenic abscesses. 6. In polyphasic demyelinating conditions such as Multiple Sclerosis, MRS plays a valuable role not only in initial diagnosis but also in follow up. Degree of neuronal loss, a prognostic factor, can indirectly be titrated through MRS findings on follow up studies

Discovery of some novel imines of 2-amino, 5-thio, 1,3,4-thiadiazole as mucomembranous protector. Synthesis, anti-oxidant activity and in silico PASS approach

A series of some novel imines (6a–f) of 2-amino, 5-thio 1,3,4-thiadiazole connected to benzimidazole chalcones were prepared. The structures of the final imines were ascertained by IR, 1HNMR, mass and elemental analyses. Predicted activity spectra of all the final derivatives were determined in the category of mucomembranous protector nature with a Pa value more than 0.7. All the newly synthesized compounds were screened for their antiulcer activity in the pylorus-ligated rats. Free radical scavenging activity of all final derivatives was determined by DPPH method.Compounds 6e, 6a and 6b showed a percentage protection of (73.47, 72.17 and 70.43 at a dose of 10mg/kgb.w.) when compared to standard omeprazole (77.37%, 2mg/kgb.w.). Compounds 6e, 6a and 6b showed free radical scavenging activity with an IC50 of 0.32, 0.39 and 0.49mM respectively. Scanning of stomach specimens using electron microscope revealed that the mice treated with standard and synthetic derivatives had no injury observed in stomach mucosa, which is identical to that of the control animal. It has been concluded that ulcer healing properties of the imines are probably due to their antioxidant action