Antibiotic prescribing pattern among paediatric patients attending tertiary care hospital in South India

Background: The usage of antibiotics among paediatric age group in India is on the higher side, that more than 60% of children in the age group 0 to 4 years received antibiotics. The higher use of antibiotics results in antibiotic resistance, increased health care costs, adverse drug reaction and may complicate the treatment of infections in future. There is a continuous need to monitor the prescription of antibiotics at all health care levels to prevent antibiotic resistance.Methods: A prospective and descriptive study was conducted in one of the pharmacies which dispenses the paediatric prescriptions in a tertiary hospital. The prescriptions used to treat infection were collected and analysed. A total of 500 prescriptions were collected and analysed.Results: The prescriptions were analysed for the WHO prescribing indicators. The average number of drugs per prescription is 1.84 with 21% of the prescriptions containing antibiotics. The most commonly prescribed antibiotics were penicillin like amoxycillin, phenoxymethyl penicillin followed by cotrimoxazole and cephalosporin group of antibiotics. The antibiotics prescribed belonged to the access group of antibiotics. The percentage of the prescriptions with drugs form essential drugs list and prescribed with generic name is 65.8% and 67% respectively. There were no injections prescribed.Conclusions: The antibiotic prescribing pattern and the average drugs per prescription falls with the WHO range indicating reduced use of antibiotics and absence of polypharmacy. However, the prescription of generic drugs and the drugs from the essential drug list is less

Therapeutic drug targets for COVID-19

Covid 19, caused by Corona virus started in Wuhan, China on December 2019 and the disease has spread rapidly among 210 countries. Corona virus disease, a RNA virus infection affected millions of people and caused death in many patients. The symptoms include fever, sneezing, coughing and other respiratory symptoms. The disease can highly affect the elderly, immunocompromised and the fatality rate is increased among these people. There is no definitive treatment till now and patients are treated symptomatically. The steps involved in the pathogenesis including attachment of the virus to the host cell, replication, protease action, assembly of nucleocapsid, release by exocytosis and they are the potential targets for the drugs. There are various trials ongoing to evaluate the efficacy of antiviral drugs, chloroquine, hydroxychloroquine, convalescent plasma and monoclonal antibodies. This review gives a summary of the most important drugs and drug targets used in the management of Covid 19

An Observational study to Determine whether Uncomplicated Phacoemulsification is a Protective Factor in Subjects with Primary Narrow Angle

INTRODUCTION: ‘Cataract’ and ‘Glaucoma’ are the leading causes of blindness in the world (8% and 51% respectively). Cataract and glaucoma usually coexist together. Major modifiable factor for glaucoma is raised IOP. IOP depends on aqueous humour dynamics. Voluminous cataractous lens also affects the aqueous outflow by altering the angle of anterior chamber.Cataract surgery is one of the most commonly performed surgeries. So phacoemulsification alone in a significant cataract results in opening of angles and further reduction in IOP. AIM OF THE STUDY: To study the reduction in Intraocular pressure (IOP) by applanation tonometry and change in angle morphology by ultrasound biomicroscopy after uncomplicated phacoemulsification surgery. OBJECTIVES: To assess whether uncomplicated phacoemulsification reduces the risk of progression of angle closure by opening the angle. METHODOLOGY: This is a Prospective observational study conducted for a period of 6 months in Department of Ophthalmology, Government Rajaji Hospital, Madurai. 50 patients with Age 40-70years having visually significant cataract with IOP between 16-24 mmhg were taken. And Excluding the patients with secondary / complicated cataract, &co existent corneal pathology / retinal pathology. Patients complete history and examinations likes lit lamp examination, gonioscopy. Corrected IOP, fields & fundus were done. Based on angle structures, patients are categorised into two groups. Group A: subjects with open angle, Group B: subjects with primary narrow angle. IOP and angle morphology by UBM were assessed before and after phacoemulsification.The datas were analyzed with SPSS statistical software package. SUMMARY OF RESULTS: Out of 50 patients 25 in group A and 25 in group B. There was almost an equal number of male : male and female : female between two groups. In my study IOP reduction was significant in both groups, but the reduction was more in narrow angle patients. (20.48±2.58 to 18.32 ±1.6 vs of 20.8±2.34 to 16.08 ±1.03). Similarly the angle parameters like ACD(,3.028±0.12 to 3.1±0.10 vs2.13 ± 0.351 to 3.22 ± 0.22), AOD (284.6±41.25 to 357.8±24.08 vs 259.8 ± 85.84 to 381.16 ± 29.27), INF TIA (34.92±6.37 to 37.04±5.48 vs 12.04 ± 1.69 to 39.88 ± 3.88) were increased in both the groups, but more in narrow angle group.ILCD (803.28 ± 144.21 to -200.68 ± 10.135 vs 1001.84 ± 160.42 to -200.4 ± 10.20) decreased in both the groups significantly. SUP TIA (30.2±6.083 to 31.92±5.93 vs10.08 ± 1.44 to 32.12 ± 5.73) increased significantly in narrow angle group. But no such difference in open angle. Finally the IT (450.4± 28.55 to 451.48 ± 29.20 vs 450.04 ± 29.91 to 451.36 ± 29.00) shows no significant changes in both the group. CONCLUSION: Uncomplicated phacoemulsification with in-the-bag PCIOL implantation significantly lowers IOP and widens the angle together with visual restoration in primary narrow angle subjects with visually significant cataract when compared to open angle subjects. Thus phacoemulsification have dual role both in visual restoration and prevents the progression of angle closure disease in narrow angle subjects

EFFECT OF LUTEIN IN HYPERCHOLESTEROLEMIA INDUCED OXIDATIVE STRESS IN MALE WISTAR RATS

Objective: Oxidative stress induced by reactive oxygen species (ROS) plays an important role in the etiology of several diseases, including atherosclerosis and coronary heart disease. Hypercholesterolemia is reported to be associated with the oxidative stress that results from the increased production of ROS or impairment of the antioxidant system. Hence the objective of this study was to evaluate the antioxidant effect of lutein in hypercholesterolemiainduced oxidative stress in male wistar rats. Methods: Male Wistar rats were divided into 6 groups of 6 each. Group I served as control. Group II III, IV, V & VI rats were received high cholesterol diet. Group III was treated with Atorvastatin 5 mg/kg. Group IV, V & VI rats was treated with 25 mg/kg, 50 mg/kg & 100 mg/kg of Lutein. After 16 weeks, blood samples &liver tissue samples were collected from all the groups of animals to evaluate antioxidant levels in blood & tissue samples. Results: Catalase, superoxide dismutase, glutathione peroxidase, glutathione levels significantly increased in both plasma & liver in lutein treated groups. TBARs level is increased in plasma in hypercholesterolemicrats and Malondialdehyde level in the liver tissue is also significantly increased in hypercholesterolemic rats. Conclusion: The results of this study indicate Lutein is an effective nutritional supplement to prevent oxidative stress in hypercholesterolemia

A comparative study between open and laparoscopic cholecystectomy in K.A.P. Viswanatham Government Medical College, Trichy

INTRODUCTION: Laparoscopic cholecystectomy is removal of the gallbladder through small incision made in the abdomen, about 500000 minimally invasive cholecystectomy has been performed throughout the world annually. Laparoscopic cholecystectomy is the procedure of choice for asymptomatic and symptomatic gall bladder disease. Professor Muhe of Boblingen, Germany performed the first laparoscopic cholecystectomy on September 12, 1985. He used a side viewing endoscope with an instrumentation channel inserted through the umbilicus after creating pneumoperitoneum using a Veress needle. HISTORY OF OPEN CHOLECYSTECTOMY: The history of gall bladder surgery starts with Jean Louis Petit over 250 yrs ago (1674- 1750). He performed puncture and removal of the gall bladder stones. First choledocholithotomy was performed by Ludwig George Courvoisier (1890). First elective cholecystostomy was performed by John Stough Bobbs in Indianapolis for hydrops of gall bladder. Carl Langenbuch performed the first cholecystectomy in Berlin. AIM OF THE STUDY: The aim of this study is to compare laparoscopic cholecystectomy with that of open cholecystectomy by the factors of 1. technique of surgery, 2. duration of surgery, 3. post operative morbidity, 4. analgesic requirement, 5. antibiotic requirement, 6. post operative hospital stay, 7. complications, 8. duration for normal diet, 9. duration for return to normal activity 10. cosmetic effect of laparoscopic surgery over open surgery. MATERIALS AND METHODS: In our KAPV Govt medical college hospital we are performing both laparoscopic and open cholecystectomy. This study is conducted between Jan 2012- Dec 2013. This study is a comparative study. I have selected 25 cases in laparoscopic cholecystectomy and 25 cases in open cholecystectomy and compared both. The indications are cholelithiasis, chronic calculous cholecystitis, biliary colic, acute cholecystitis and acalculous cholecystitis. CONCLUSION: In our study laparoscopic cholecystectomy succeeded the open procedure by the following: 1. Better visualisation and magnification of anatomy of Callots triangle. 2. Reduced post operative morbidity. 3. Shorter duration of requirement of analgesia. 4. Shorter duration of requirement of antibiotics. 5. Reduced wound infection. 6. Early resumption of normal diet. 7. Early ambulation and return to normal activity. 8. Shorter post-operative stay in hospital. 9. Best cosmetic effect. The only disadvantage of laparoscopic procedure is increased time duration

Effect of Lutein in the expression of PPARα and LDLR in hypercholesterolemic male Wistar Rats

Background: Hyperlipidemia is a well known risk factor for cardiovascular disease, especially atherosclerotic coronary artery disease. Peroxisome proliferator activated receptor α (PPARα), a member of this nuclear receptor family, has emerged as an important player in this scenario, with evidence supporting a central co-ordinated role in the regulation of fatty acid oxidation, lipid and lipoprotein metabolism and inflammatory and vascular responses, all of which would be predicted to reduce atherosclerotic risk. The low-density lipoprotein (LDL) receptor (LDLR) is the primary pathway for removal of cholesterol from the circulation, and its activity is meticulously governed by intracellular cholesterol levels. Hence in this study we investigated the effect of Lutein on PPARα and LDLR expression in liver of wistar rats.Methods: Male Wistar rats were divided into 6 groups of 6 each. Group I served as control. Group II III, IV, V and VI rats were received high cholesterol diet. Group III was treated with Atorvastatin 5mg/kg. Group IV, V and VI rats were treated with 25mg/kg, 50mg/kg and 100mg/kg of Lutein. After 16 weeks, liver tissue samples were collected from all the groups of animals to evaluate the expression of PPARα and LDLR.Results: The expression of Peroxisome proliferator activated receptor α and low-density lipoprotein (LDL) receptor (LDLR) was significantly increased in Lutein treated hypercholesterolemic male wistar rats.Conclusions: The results of this study indicate that Lutein activates LDL receptor and PPARα in hypercholesterolemic male wistar rats

Ayurvedic herbal medicine and lead poisoning

Although the majority of published cases of lead poisoning come from occupational exposures, some traditional remedies may also contain toxic amounts of lead. Ayurveda is a system of traditional medicine that is native to India and is used in many parts of world as an alternative to standard treatment regimens. Here, we report the case of a 58-year-old woman who presented with abdominal pain, anemia, liver function abnormalities, and an elevated blood lead level. The patient was found to have been taking the Ayurvedic medicine Jambrulin prior to presentation. Chemical analysis of the medication showed high levels of lead. Following treatment with an oral chelating agent, the patient's symptoms resolved and laboratory abnormalities normalized. This case highlights the need for increased awareness that some Ayurvedic medicines may contain potentially harmful levels of heavy metals and people who use them are at risk of developing associated toxicities

Immunohistochemical and Molecular Features of Melanomas Exhibiting Intratumor and Intertumor Histomorphologic Heterogeneity

Melanoma is a heterogeneous neoplasm at the histomorphologic, immunophenotypic, and molecular levels. Melanoma with extreme histomorphologic heterogeneity can pose a diagnostic challenge in which the diagnosis may predominantly rely on its immunophenotypic profile. However, tumor survival and response to therapy are linked to tumor genetic heterogeneity rather than tumor morphology. Therefore, understating the molecular characteristics of such melanomas become indispensable. In this study, DNA was extracted from 11 morphologically distinct regions in eight formalin-fixed, paraffin-embedded melanomas. In each region, mutations in 50 cancer-related genes were tested using next-generation sequencing (NGS). A tumor was considered genetically heterogeneous if at least one non-overlapping mutation was identified either between the histologically distinct regions of the same tumor (intratumor heterogeneity) or among the histologically distinct regions of the paired primary and metastatic tumors within the same patient (intertumor heterogeneity). Our results revealed that genetic heterogeneity existed in all tumors as non-overlapping mutations were detected in every tested tumor (n = 5, 100%; intratumor: n = 2, 40%; intertumor: n = 3, 60%). Conversely, overlapping mutations were also detected in all the tested regions (n = 11, 100%). Melanomas exhibiting histomorphologic heterogeneity are often associated with genetic heterogeneity, which might contribute to tumor survival and poor response to therapy