Geriatric prescription analysis with respect to “STOPP” and “START” criteria: a descriptive study in the Indian scenario

Background: Patients; sixty-five years of age and above, are a special risk group as far as drug prescribing is concerned. Prescription irregularities in such patients may be hazardous. STOPP/START criteria are considered as the most up to-date set of explicit criteria for evaluating geriatric prescriptions. To analyse geriatric prescriptions in a tertiary care centre with respect to STOPP/START criteria and WHO core drug prescribing indicators so as to get an idea of pattern of drug prescription in geriatric patients as well as frequency of potentially inappropriate prescriptions. Descriptive cross-sectional study in a tertiary care hospital.Methods: All inpatients aged 65 years and above who were prescribed at least one allopathic medication and consented to participate in the study were included and patients admitted for medical emergencies were excluded. Demographic data and details of drugs prescribed were collected from prescription chits and indoor case papers.Results: There was a high frequency of polypharmacy, prescription of antimicrobials and injections. Proportion of patients receiving at least one potentially inappropriate medication (PIM) as per STOPP criteria was 21.01%. Proportion of patients subjected to at least one potential prescribing omission (PPO) as per START criteria was 33.33%. Proportion of patients exposed to potentially inappropriate drug prescriptions as a whole (PIPs=PIMs+PPOs) was 46.37%. Statistical analysis used as descriptive statistics like numbers and percentages were used for data analysis.Conclusions: With regards to geriatric prescribing, adherence to WHO core prescribing indicators, prescription of drugs as per STOPP and START guidelines are indicative of scope for improvement

Longitudinal study of self-medication practices in 2nd year MBBS students through their internship

Background: Self-medication is common in medical students but few studies address the concern regarding knowledge of adverse drug reactions (ADRs) among them. None of the study compares the practice of self-medication among the same medical students as their level of education increases. Hence the study was planned to compare the pattern, source, reason of self- medication and assess the level of awareness about potential ADRs to the consumed drugs in medical students during second year through their internship.Methods: It was a longitudinal cross sectional questionnaire-based study conducted among under graduate second year MBBS students of a medical college and repeated during their internship few years later in order to avoid variability in questionnaire. Chi-square and Fischer’s exact test were used for testing statistical significance. p value less than 0.05 was considered to be statistically significant.Results: 80 students were present on the day of study during their IInd MBBS and 73 students during their internship. Comparatively more students self-medicated during their internship than during their IInd MBBS (68% vs 55%). Analgesics (56.8% and 80%) were most commonly used. 35(70%) of interns were aware of potential ADRs and was statistically very significant in comparison to their awareness during IInd MBBS [9(20.45%)]. Interns rely more on themselves (96%) for self-medication.Conclusions: The practice of self-medication begins early in the career of medical students and is carried forward into their future. Hence it is imperative to educate students regarding responsible self- medication very early in their curriculum

Use of anti-snake venom and clinical outcomes in snake envenomation: a prospective observational study

Background: The only effective measure to prevent or reverse most of the manifestations of venomous snake-bite is timely administration of antisnake venom (ASV) with or without adjunctive treatment as necessary in each case. But recently several concerns have been raised with regard to use of polyvalent ASV. Hence the present study was conducted to assess use of ASV, early adverse reactions to ASV, adjunctive treatment and clinical outcomes in snake-bite patients, which would help to identify areas of problem and provide basis for planning strategies to increase rational use of drugs.Methods: It was a prospective observational study approved by Institutional Ethics Committee. All indoor patients with systemic manifestations of snake envenomation were included in the study. All participants gave written informed consent. Data was obtained prospectively using a structured case record form. Descriptive statistics was used to express the results.Results: Among 52 patients, snake-bite predominantly affected males (59.62%) than females (40.38%). The most common site of snake-bite was lower limb (65.38%). The main indication for ASV administration was vasculotoxic snake-bite (59.62%). Mean dose of ASV use was 18.21±15.51 vials. Mortality was seen in one patient. Majority of patients (28/52, 53.85%) received ASV in the range of 1-10 vials for the management of snake-bite.Conclusions: The use and dose of ASV was appropriate in vasculotoxic snake-bite while few neurotoxic snake-bite patients needed higher than recommended dose.

A study of adverse drug reactions in patients receiving treatment for multi-drug resistant tuberculosis

Background: A high frequency of adverse drug reactions (ADRs) is one of the major challenges in the treatment of Multi-drug resistant tuberculosis (MDR-TB). Patients may refuse to continue treatment if ADRs are not properly addressed, drugs may be stopped unnecessarily and treatment may be terminated prematurely by inexperienced health workers, resulting in a high proportion of failure.Methods: Patients diagnosed for MDR-TB and registered in Drug Resistant TB centre (DR-TB) of tertiary care hospital during period of July 2014 to June 2015 were enrolled in the study. Data of patients hospitalized for the complaints of ADR in DR-TB centre during study period was collected.Results: Out of 468 patients, 60 (12.82%) patients developed at least one adverse reaction and were hospitalised for the same. Among 109 reported ADRs, Gastrointestinal upset was the most common ADR reported (5.98%) followed by psychosis (4.91%) and ototoxicity (2.99%).Conclusions: The health providers, the patients and their relatives should be sensitised about these ADRs for early detection and treatment. It can also be suggested that the setup of DR-TB centre should be integrated with psychiatry and ENT specialities, with all the provisions of early detection of ADR and treatment

An Empirical Study of Awareness and Use of ICT by School Teachers Before and During Lockdown Due to COVID-19 Pandemic

The COVID-19 pandemic has taken almost all the countries across the globe by surprise. It was this time a year ago when the sudden outbreak of the coronavirus forced the closure of educational institutions resulting billions of children out of the classroom. Like many countries worldwide, India also faced the challenges of unexpectedly switching to online classes. Given to this background the study aims at understanding the practical experiences of teachers who were part of the teaching which undertook remotely and on digital platforms. This is a quantitative research using survey technique through a questionnaire that comprised demographic variables, ICT awareness and use before and during lockdown and most importantly their opinion on integration of ICT in teaching and learning. A total of 209 returned questionnaires formed the datasets which have been analyzed based on the objectives of the study. The findings showed that ICT competency was instrumental in adapting to online teaching during COVID-19 school closures

Estimation of urinary δ Aminolevulinic Acid Levels (δ-ALA) in children of age group 1 to 5 years as an index of lead exposure

Background: Lead poisoning is very much common in India and has significant negative impact on general health of children. Lead inhibits necessary enzymes required for heme synthesis, this results in increased levels of delta aminolevulinic acid excretion through urine. Objective: To find out the prevalence of lead poisoning among the age group 1 to 5 years, in a suburban Mumbai, Maharashtra, India. Methods: This is cross-sectional pilot study in Mumbai suburban localities. The study was done on 60 randomly chosen children of age group 1 to 5 years with their brief history related with lead exposure. Their urine samples were analyzed for δ ALA by Ehrlich method. Results: According to our observation it was found that out of 60 urine samples 20 samples have urinary δ-ALA levels below 0.2 mg/dl, while 40 samples showed increased urinary δ-ALA levels. Prevalence of lead exposure among our study population is 66.66% hence lead exposure is a serious public health issue. Conclusion: we conclude that there is high prevalence of lead exposure in Mumbai and necessary precautions to be taken to avoid it

Association of various factors related to mastoid buffer and middle ear ventilation in etiopathogenesis of squamous chronic otitis media—a cross-sectional study

Abstract Background Active squamous chronic otitis media (COM) is an entity with a deep retraction pocket of the pars tensa or flaccida that has retained debris of squamous epithelial where the fundus cannot be visualized involving the pars flaccida or pars tensa, associated with cholesteatoma. Eustachian tube dysfunction (ETD) is a known etiological factor for squamous COM, based on Wittmack’s theory; however, there are very few recent studies in this regard. Contracted mastoid pneumatisation (diploic or primary sclerosis) and presence of Korner’s septum have also been implicated to be associated with middle ear pathology, with conflicting results. Hence, the present study was undertaken to find out the association of three important factors, namely eustachian tube dysfunction, type of mastoid pneumatisation, and Korner’s septum related to mastoid buffer and middle ear ventilation in etiopathogenesis of active squamous chronic otitis media. The study also attempted to identify various conditions of nose and nasopharynx associated with ETD. This would enable us in appropriate surgical decision making with long term benefits in term of hearing and disease outcomes. Results Out of the total 37 patients, with active squamous chronic otitis media, it was observed that Eustachian tube dysfunction was found to be associated with 23 (62.16%). The majority of patients had a diploic/primary sclerosed mastoid pneumatization pattern which is 32 (86.48%) of patients. Korner’s septum was found to be associated with 13 (35.13%) patients of the total 37 patients with active squamous chronic otitis media. All these findings were found to be statistically significant. Conclusion In this study, we found that there was a statistically significant positive association of all etiological factors namely Eustachian tube dysfunction, contracted mastoid (diploic/primary sclerotic mastoid), and the presence of Korner’s septum with causation of active squamous otitis media. Out of these factors, occurrence of diploic mastoid seemed to be the most constant association. Eustachian tube dysfunction of mechanical type, associated with various nasal pathologies, most common was, deviated nasal septum

Resistive switching and synaptic properties modifications in gallium-doped zinc oxide memristive devices

The massively parallel computing capabilities of the human brain can be mimicked with the help of neuromorphic computing approach and this can be achieved by developing the electronic synaptic device. In the present work, we have synthesized gallium-doped ZnO thin films using a cost-effective hydrothermal method and characterized the thin films using field-emission scanning electron microscopy and energy-dispersive X-ray spectroscopy. Furthermore, gallium-doped ZnO memristive devices were developed using standard procedure and electrically characterized for the neuromorphic application. In particular, resistive switching and synaptic properties of gallium-doped ZnO thin films were investigated. The bipolar resistive switching with an analog memory like behavior was observed in the developed memristive devices. In the present case, good synaptic properties, endurance, and retention characteristics were observed for 0.5% Ga doped memristive device. Our results suggested that the synaptic weight, potentiation-depression, and symmetric Hebbian learning can be tuned with properly engineering the ZnO memristive device with appropriate gallium doping. The detailed analysis of I-V results suggested that resistive switching is occurred due to Ohmic and Schottky conduction mechanisms. Keywords: Memristive device, Resistive switching, Gallium doped ZnO, Electronic synapse, Potentiation and depression, Hebbian learnin

Preferentially oriented m-tuned WO3 thin-films photocatalysts for the multitargeted degradation of organic molecules

In this work, morphology-tuned tungsten oxide (m-tuned WO3) thin films are deposited on a glass substrate by a simple and cost-effective chemical bath deposition (CBD) method. The deposition pH is varied to tune the physicochemical properties of m-tuned WO3 thin films. The m-tuned WO3 thin films show an orthorhombic crystal structure with a preferred orientation along the (020) plane. The morphological study demonstrated the conversion of ‘rice hull’ to ‘interlocked nanosheets’ to ‘reticulated nanosheets composed of nanorods’ upon changing pH, highlighting the significant role of pH in m-tuned WO3 thin film synthesis. The m-tuned WO3 thin films show good absorption in the visible-light region (390–780 nm) of the solar spectrum. The m-tuned WO3 thin films are used for the visible light active photocatalytic degradation of organic molecules such as methylene blue (MB), rhodamine B (Rh B), and tetracycline hydrochloride (TC). The optimized m-tuned WO3 thin film shows maximum photocatalytic performance of 95, 94, and 86 % in 180 min for MB, Rh B, and TC, respectively. The present study demonstrates the usefulness of the CBD method for the deposition of m-tuned WO3 and improved photocatalytic performance