Drug utilization pattern of antimicrobials in intensive care unit of a tertiary care teaching hospital

Background: The intensive care unit is a setting where the multiple medications are prescribed to patients. Antimicrobials are heavily prescribed in the ICUs, which in turn enhance the risk of antimicrobial resistance, increase the side effects and increases the cost of treatment. Drug utilization study is a component of medical auditing that aims to monitor and evaluate the drug prescription patterns and to suggest necessary modifications in the prescribing practices to achieve rational therapeutic practice.Methods: A cross-sectional study was conducted in which data of patients admitted to ICU during the period from June 2019 to August 2019 was collected from the Medical Record Section of the hospital. Drug utilization pattern of antimicrobials in ICU was analyzed.Results: Out of 90 patients, 60 were males and 30 were females. The average duration of stay in ICU was 7.53 days. The most common antibiotic prescribed was ceftriaxone followed by piperacillin and tazobactam with DDD/100 bed days of 24.2 and 17.3 respectively.Conclusions: In this study, the results appeared to be similar to those reported in previous studies. However, prescription protocols need to be addressed to guide appropriate use of antimicrobials in the ICU setting. Therefore, it is necessary to conduct drug utilization research to understand the drug consumption and for implementation of protocols to improve the quality of healthcare.

Proper acceleration, geometric tachyon and dynamics of a fundamental string near Dpp branes

We present a detailed analysis of our recent observation that the origin of the geometric tachyon, which arises when a D$p$-brane propagates in the vicinity of a stack of coincident NS5-branes, is due to the proper acceleration generated by the background dilaton field. We show that when a fundamental string (F-string), described by the Nambu-Goto action, is moving in the background of a stack of coincident D$p$-branes, the geometric tachyon mode can also appear since the overall conformal mode of the induced metric for the string can act as a source for proper acceleration. We also studied the detailed dynamics of the F-string as well as the instability by mapping the Nambu-Goto action of the F-string to the tachyon effective action of the non-BPS D-string. We qualitatively argue that the condensation of the geometric tachyon is responsible for the (F,D$p$) bound state formation.Comment: 26 pages, v2: added references, v3: one ref. updated, to appear in Class. and Quant. Gravit

Optimized Hydrophobic Interactions and Hydrogen Bonding at the Target-Ligand Interface Leads the Pathways of Drug-Designing

Weak intermolecular interactions such as hydrogen bonding and hydrophobic interactions are key players in stabilizing energetically-favored ligands, in an open conformational environment of protein structures. However, it is still poorly understood how the binding parameters associated with these interactions facilitate a drug-lead to recognize a specific target and improve drugs efficacy. To understand this, comprehensive analysis of hydrophobic interactions, hydrogen bonding and binding affinity have been analyzed at the interface of c-Src and c-Abl kinases and 4-amino substituted 1H-pyrazolo [3, 4-d] pyrimidine compounds.In-silico docking studies were performed, using Discovery Studio software modules LigandFit, CDOCKER and ZDOCK, to investigate the role of ligand binding affinity at the hydrophobic pocket of c-Src and c-Abl kinase. Hydrophobic and hydrogen bonding interactions of docked molecules were compared using LigPlot program. Furthermore, 3D-QSAR and MFA calculations were scrutinized to quantify the role of weak interactions in binding affinity and drug efficacy.The in-silico method has enabled us to reveal that a multi-targeted small molecule binds with low affinity to its respective targets. But its binding affinity can be altered by integrating the conformationally favored functional groups at the active site of the ligand-target interface. Docking studies of 4-amino-substituted molecules at the bioactive cascade of the c-Src and c-Abl have concluded that 3D structural folding at the protein-ligand groove is also a hallmark for molecular recognition of multi-targeted compounds and for predicting their biological activity. The results presented here demonstrate that hydrogen bonding and optimized hydrophobic interactions both stabilize the ligands at the target site, and help alter binding affinity and drug efficacy

EVALUATION OF ANTIHYPERGLYCAEMIC EFFECT OF BUTEA MONOSPERMA LEAF EXTRACT ON ADRENALIN INDUCED AND HIGH GLUCOSE FEED ANIMAL MODEL

Objective: As per the ethnopharmacological information has Butea monosperma been used to treat diabetes mellitus by the tribal people of tropical and subtropical areas. However, there is no much more scientific report available about the antidiabetic property of the leaves of the plant. Hence, the study was undertaken to evaluate the antidiabetic effect of ethanolic extract of B. monosperma on blood levels of adrenaline-induced and glucose feed diabetic rabbits.Methods: The three different doses of the extracts (100, 200, and 400 mg/kg) were administered orally to an experimental animal. The animals were induced diabetics by adrenaline and high glucose diet. Blood glucose level was measured accordingly. For antidiabetic activity, photocolorimeter was used to monitoring the blood glucose level with crest kit box (GOP-POD method).Results: The extracts showed considerable dose-dependent activity. However, the dose 400 mg/kg showed considerable lower of blood glucose level. p<0.01 indicates the significance result. 8 hrs reading 182.5±3.83 for 400 mg does is most effective for reducing blood sugar.Conclusion: The study indicates that the ethanolic extract of B. monosperma leaves possesses antidiabetic properties which suggest the presence of biologically active components

Distinguishing autofluorescence of normal, benign, and cancerous breast tissues through wavelet domain correlation studies

Using the multiresolution ability of wavelets and effectiveness of singular value decomposition (SVD) to identify statistically robust parameters, we find a number of local and global features, capturing spectral correlations in the co- and cross-polarized channels, at different scales (of human breast tissues). The copolarized component, being sensitive to intrinsic fluorescence, shows different behavior for normal, benign, and cancerous tissues, in the emission domain of known fluorophores, whereas the perpendicular component, being more prone to the diffusive effect of scattering, points out differences in the Kernel-Smoother density estimate employed to the principal components, between malignant, normal, and benign tissues. The eigenvectors, corresponding to the dominant eigenvalues of the correlation matrix in SVD, also exhibit significant differences between the three tissue types, which clearly reflects the differences in the spectral correlation behavior. Interestingly, the most significant distinguishing feature manifests in the perpendicular component, corresponding to porphyrin emission range in the cancerous tissue. The fact that perpendicular component is strongly influenced by depolarization, and porphyrin emissions in cancerous tissue has been found to be strongly depolarized, may be the possible cause of the above observation

Effects of oral Lactobacillus GG on enteric microflora in low-irth-weight neonates.

Background: Colonization patterns, especially by anaerobic flora, may play an important role in neonatal gut function. Probiotics could affect disease risk either directly through colonization or indirectly by promoting changes in gut microbial ecology. Methods: To study the ability of Lactobacillus GG(LGG) to colonize the neonatal gut and modify its microbial ecology, a prospective, randomized study was performed in 71 preterm infants of less than 2000 g birth weight. Infants less than 1500 g (24 treated, 15 control) received 10(9) LGG orally twice daily for 21 days. Those infants weighing 1500 to 1999 g (23 treated, 9 control) were treated for 8 days. Stools were collected before treatment and on day 7 to 8 (and day 14 and 21, in the infants weighing less than 1500 g) for quantitative aerobic and anaerobic cultures. Results: Colonization with LGG occurred in 5 of 24 (21%) infants who weighed less than 1500 g versus 11 of 23 (47%) in larger infants. Colonization was limited to infants who were not on antibiotics within 7 days of treatment with LGG. There was a paucity of bacterial species at baseline, although larger infants had more bacterial species (1.59 +/- 0.13 (SEM) vs 1.11 +/- 0.12; P < 0.03) and higher mean log colony forming units (CFU) (8.79 +/- 0.43 vs 7.22 +/- 0.63; P < 0.05) compared with infants weighing less than 1500 g LGG. Treatment in infants weighing less than 1500 g resulted in a significant increase in species number by day 7, with further increases by day 21. This increase was mainly the result of increased Gram (+) and anaerobic species. No difference in species number was noted in controls. Mean log CFU of Gram (-) bacteria did not change in treated infants weighing less than 1500 g. However, Gram (+) mean log CFU showed a significant increase on day 21 (6.1 +/- 0.9) compared with day 0 (3.5 +/- 0.9) (P < 0.05). No significant changes in species number or quantitative counts were noted after LGG treatment in the infants weighing 1500 to 1999 g LGG was well tolerated in all infants. Conclusion: The neonatal response to a probiotic preparation is dependent on gestational and post-natal age and prior antibiotic exposure. Although LGG is a relatively poor colonizer in infants, especially those infants weighing less than 1500 g at birth, it does appear to affect neonatal intestinal colonization patterns

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Fragility Hip Fractures in Elderly Patients in Bhubaneswar, India (2012-2014)

Elderly patients with hip fracture constitute Single Largest Group of Emergency Orthopaedics Admissions. In 2050, 6.26 million hip fractures worldwide, approximately 50%, will occur in Asia. Only small number of reports on incidence of hip fractures in the Asian population exist. India lacks data registry for fragility hip fractures, therefore, the magnitude and standard of patient care are not known. A prospective multicenter study was conducted from January 2012 to April 2014 to describe population-based longitudinal trends, namely, age-specific incidence, fracture type, timing of presentation, kilometers traveled, timing of surgery, hospital stay, man hours lost, pressure ulcers, weight bearing, 30-day return, 3-month mortality, and so on, of fragility hip fractures. A total of 1031 patients were included with 59.7% females and 40.3% of male patients, with a female–male ratio of 1.5:1. Commonest mode: Falls 45%. 56.4% IT fractures. 66.2%patients operated, Operative/Conservative Ratio of 2.8:1. Patients travel a mean distance of 86.4 kilometers for quality treatment. Of the patients, 85.9 % presented late due to ignorance and misguiding quack practice. Incidence of delayed surgery was 69.3%. Persistent electrolytes imbalance and hyperglycemia normalized in 81.2% by second or third postoperative day. The man hours lost was 157.85 hours/person. Medical complications was more (90%) in patients who had delays in surgeries and presentation. Mortality rate was 6.2 %. Patients travel long for quality treatment, most of them are misguided, present late with significant complications and sufferings, and their pockets half drained depriving them off best treatment. Early presentation and operation have better prognosis and rehabilitation, facilitates early return to work, and independence. Increased pressure sores, infections, hospital stay, treatment cost, depression, and mortality are directly related to delays in surgeries and presentation. Estimated losses according to lost man hours may go up to 10 million dollars

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