Drug utilization pattern of antimicrobial drugs in intensive care unit of a tertiary care hospital attached with a medical college

Background: A number of antimicrobial drugs are prescribed to the patients in Intensive Care Unit (ICU). Drug utilization research was defined by WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. There is lack of information about the use of antimicrobial agents in the ICU at GGGH till date. So we decided to conduct this type of study.Methods: A prospective observational study was carried out for 12 months. Patients of age >18 of both sexes who was admitted in ICU were included in the study while pregnant and lactating women excluded. The prescribing pattern was analyzed by using World Health Organization basic drug indicators. Results: Among 611 patients, 373 (61.04%) were male and 238 (38.95%) were female. The most common emergency was post-operative 204 (33.38%).The most common prescribed antimicrobial drug group and drug was antiamoebic drugs and metronidazole respectively in 437 (24.04%) out of total drugs prescribed. The numbers of antimicrobial drugs prescribed per patient were 2.97. 68% drugs were prescribed from WHO and national EML list. Total 57.26% drugs were prescribed by generic name. Average antimicrobial drug cost per patient was 1805.34 rs.Conclusions: Despite of limitations of present study it gives important conclusion about how antimicrobial drugs are used in GGGH ICU. This information can be used for improvement of current treatment strategies

Drug utilization study of psychotropic drugs in outdoor patients in a tertiary care hospital attached with a medical college

Background: Psychotropic drugs have a great importance in psychiatric practice. Today many newer drug like selective serotonin reuptake inhibitors and atypical antipsychotic drugs has changed treatment protocol. Hence, the study was carried out to find morbidity pattern of psychiatric illness and prescribing pattern of psychiatric illness.Methods: A prospective cross-sectional study was carried out for 12 months. Patients of all ages and both sexes were included in the study while inpatients and referred patients were excluded. The prescribing pattern was analyzed by using World Health Organization (WHO) basic drug indicators.Results: Among 600 patients, male patient were 291 (48.50%) and female patient were 309 (51.50%). The most common disorder was depression 208 (34.66%) followed by schizophrenia 192 (32.00%). The numbers of psychotropic drugs prescribed a patient were 2.51. 39.39% drugs were prescribed from the WHO essential medicines list. Total 89.18% drugs were prescribed by generic name. Benzodiazepines were the most common prescribed drugs. Atypical antipsychotic drugs were commonly used than typical antipsychotic drugs. Central anticholinergic drug was used in 43.15% patients receiving antipsychotic drugs.Conclusion: Overall, the drugs were prescribed rationally. Benzodiazepine should be prescribed only for short-term duration. Use of central acting anticholinergic drugs with all antipsychotic drugs was not justified

Arp2/3- and Cofilin-coordinated Actin Dynamics Is Required for Insulin-mediated GLUT4 Translocation to the Surface of Muscle Cells

Insulin increases GLUT4 at the muscle cell surface, and this process requires actin remodeling. We show that a dynamic cycle of actin polymerization and severing is induced by insulin, governed by Arp2/3 and dephosphorylation of cofilin, respectively. The cycle is self-perpetuating and is essential for GLUT4 translocation

Mesodermal fate decisions of a stem cell: the Wnt switch

Stem cells are a powerful resource for cell-based transplantation therapies in osteodegenerative disorders, but before some kinds of stem cells can be applied clinically, several aspects of their expansion and differentiation need to be better controlled. Wnt molecules and members of the Wnt signaling cascade have been ascribed a role in both these processes in vitro as well as normal development in vivo. However some results are controversial. In this review we will present the hypothesis that both canonical and non-canonical signaling are involved in mesenchymal cell fate regulation, such as adipogenesis, chondrogenesis and osteogenesis, and that in vitro it is a timely switch between the two that specifies the identity of the differentiating cell. We will specifically focus on the in vitro differentiation of adipocytes, chondrocytes and osteoblasts contrasting embryonic and mesenchymal stem cells as well as the role of Wnts in mesenchymal fate specification during embryogenesis

Effect of Micronutrients Intake and Physical Activity on Depression and Anxiety: A Review

Depression and anxiety are increasing at global and national level at the rampant rate and hence are the main reason for deterioration in mental health. This, in turn, leads to a poor physical health. With the increase in the incidence of the rate of both the disorder, it is a silent killer as well. There are many medical and non-medical treatments are available for the cure of anxiety and depression. A few nutrients such as zinc, selenium, iron, magnesium, iodine, and Vitamin A, B complex, D, and Vitamin C have also shown a beneficial role in the improvement of anxiety and depression symptoms. There is a possible role of optimal physical activity in reduction of symptoms of anxiety and depression. Very few studies are available on the role of these micronutrient intakes and physical activity on anxiety and depression. Hence more research is required in this field of study

Interventional Radiology: Management of Biliary Complications of Liver Transplantation

Major advances in the field of liver transplantation have led to an increase in both graft and patient survival rates. Despite increased graft survival rate, biliary complications lead to significant postoperative morbidity and even mortality. A multidisciplinary approach to these complications is critical. As part of the team approach, less invasive techniques used by the interventional radiologist have an increasing role in the management of complications after liver transplantation. This paper will review the current role of the interventionalist in management of biliary complications

Long-term outcomes after lower extremity bypass in the actively smoking claudicant.

OBJECTIVE: Smoking is known to increase complications, including poor wound healing, coagulation abnormalities, and cardiac and pulmonary ramifications. Across specialties, elective surgical procedures are commonly denied to active smokers. Given the base population of active smokers with vascular disease, smoking cessation is encouraged but is not required the way it is for elective general surgery procedures. We aim to study the outcomes of elective lower extremity bypass (LEB) in actively smoking claudicants. METHODS: We queried the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network LEB database from 2003 to 2019. In this database we found 609 (10.0%) never smokers (NS), 3388 (55.3%) former smokers (FS), and 2123 (34.7%) current smokers (CS) who underwent LEB for claudication. We performed two separate propensity score matches without replacement on 36 clinical variables (age, gender, race, ethnicity, obesity, insurance, hypertension, diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, previous coronary artery bypass graft, carotid endarterectomy, major amputation, inflow treatment, preoperative medications and treatment type), one of FS to NS and a second analysis of CS to FS. Primary outcomes included 5-year overall survival (OS), limb salvage (LS), freedom from reintervention (FR), and amputation-free survival (AFS). RESULTS: Propensity score matches resulted in 497 well-matched pairs of NS and FS. In this analysis we found no difference in terms of OS (HR, 0.93; 95% CI, 0.70-1.24; P = .61), LS (HR, 1.07; 95% CI, 0.63-1.82; P = .80), FR (HR, 0.9; 95% CI,0.71-1.21; P = .59), or AFS (HR, 0.93; 95% CI,0.71-1.22; P = .62). In the second analysis, we had 1451 well-matched pairs of CS and FS. There was no difference in LS (HR, 1.36; 95% CI,0.94-1.97; P = .11) or FR (HR, 1.02; 95% CI,0.88-1.19; P = .76). However, we did find a significant increase in OS (HR, 1.37; 95% CI,1.15-1.64, P <.001) and AFS (HR, 1.38; 95% CI,1.18-1.62; P < .001) in FS compared with CS. CONCLUSIONS: Claudicants represent a unique nonemergent vascular patient population that may require LEB. Our study found that FS have better OS and AFS when compared with CS. Additionally, FS mimic nonsmokers at 5-year outcomes for OS, LS, FR, and AFS. Therefore, structured smoking cessation should be a more prominent part of vascular office visits before elective LEB procedures in claudicants

Integrated Treatment Approach in Hemiplegic Stroke Patient: A Case Study

Hemiplegic stroke is one of the major prevalent mortality in many countries including India. In hemiplegic stroke spasticity, and muscle atrophy results in the inability to move certain muscles. Most post-stroke complications like inability and shoulder pain are a major concern for therapeutic interventions. Recent advances have been made in the interdisciplinary approach of rehabilitation, artificial intelligence, brain-computer interface, and much more mainly targeting post-stroke complications. In the present case report study 55-year-old male addicted to tobacco, altered HBA1c, elevated neutrophils, erythrocyte sedimentation rate, and C-reactive protein and CT scan report of mild cerebral atrophy suggestive of hemiplegic stroke. The patient was admitted on a stretcher with no sensation in his left hand and Vaksanga (impaired speech). After receiving the patient and family member's consent the integrated treatment was initiated. After 15 days of integrated treatment including T-AYU-HM Premium, significant improvement in the patient’s condition was noticed. The patient recovered from the impaired mobility of the left hand and remarkable improvement in slurred speech. This confirms that the intervention of Ayurvedic medicine in post-stroke management and prevention of stroke might play a crucial role. More such kinds of interventional case studies or trials should be warranted to justify the same