Medication adherence: the critical step towards better patient outcome

Medication adherence is defined as patient’s adherence to take their medications as prescribed and continue to take the prescribed medication for stipulated time frame. Medication non-adherence is a growing concern to physicians, healthcare systems, and other stakeholders (e.g., payers) and there is an increasing evidence of its prevalence and is associated with adverse clinical outcomes eventually resulting into higher costs of care. The cost of non-adherence has been estimated at $100 billion to$300 billion annually, including costs from avoidable hospitalizations, nursing home admissions, and premature deaths. Improving adherence to medication is critical to improve the quality of health care, to encourage better chronic care management, and promote better health outcomes. Reasons for non-adherence are multiple and complex. Studies have reported that poor adherence to drug dosage is due to patient perception that the disease is non-significant, adverse drug effects, lack of treatment effectiveness, and the patient’s poor or incomplete knowledge of the disease and (cost). A multifactorial approach is required to tackle this complex problem as a single approach will be ineffective for all patients. The most effective intervention is to use a combination of approaches and address literacy, behavior, and organizational issues. There are challenges as well as opportunities in addressing the public health issue of medication adherence. Changing healthcare reforms, advances in digital health media, social media and modern technologies can now provide alternatives to tackle this issue

Medical devices in India: a perspective of guidelines and the way forward

In recent times, emerging countries including India have become favored destination for medical device companies to leverage the growth opportunities. However, the Indian regulatory system is not ready to meet the challenges that may come up with growing medical device business. It needs major amendments to current Drugs and Cosmetic Act 1940, to include medical device as a separate entity. Like in developed world, the challenges could be addressed by defining medical devices, risk based classification of devices, guidelines for device safety surveillance, and clinical trials for medical devices. Drugs and Cosmetic (Amendment) Bill 2013, which is yet to be released has addressed the concerns to some extent. However, it needs a major revamp to establish effective regulatory framework for medical devices

Uterine Pseudoaneurysm: A rare cause of delayed postpartum haemorrhage managed with uterine artery embolisation

MEDICAL IMAG

Drug utilisation in medical intensive care unit: a retrospective analysis from a tertiary care teaching hospital

Background: The World Health Organisation has defined drug utilization study as “the marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. The objective was to evaluate drug utilization pattern in medical intensive care unit (MICU) in a tertiary care teaching hospital.Methods: A retrospective observational study was conducted in MICU for adult patients admitted from October to December 2013. Data collected was analysed for demographics, indication, duration of stay, World Health Organisation (WHO) prescribing indicators including anatomical therapeutic chemical classification and defined daily dose (DDD).Results: A six hundred encounters from 63 male and 44 female patients with a mean age of 60.88±16.87 were studied. Average duration of stay was 5.61±3.88 days. The common indications for admission were dyspnoea 20 (18.69%), upper gastrointestinal bleed 16 (14.95%), cerebrovascular accident 14 (13.08%) and sepsis 13 (12.15%). Total number of drugs prescribed was 246. Total drug encounters were 7695. Average number of drugs per encounter was 12.83. Percentage of drugs prescribed by generic name was 38.21%, 44.7% and 40.65% of the drugs were prescribed from National and WHO essential medicine list respectively. Among the drugs prescribed 65.44%, 32.93% and 17.48% were oral, injectable and fixed dose combination preparations respectively. Percentage of encounters resulting in prescription of an antibiotic and an injection were 59% and 85.83% respectively. The most commonly prescribed drugs were pantoprazole (100%), human regular insulin (52.83%), piperacillin + tazobactam (45%) and ceftriaxone (38%). Their DDD/100 bed days were found to be 83.79, 12.78, 12.50, and 17.81 respectively.Conclusions: Overall the prescribing pattern seems to be rational but may be further strengthened by increasing generic drug prescription, judicious use of pantoprazole and periodic longitudinal surveillance studies

Ultrasound in the diagnosis of cystic intra-abdominal lesions in children - a cross-sectional study from a tertiary care hospital in South India

Introduction: Pediatric abdominal cystic swellings are very common in clinical practice, with widely variable differential diagnoses. Demarcation of the organ of origin and possible nature of pathology is hence very essential. Objective: The objective of the study was to study the pattern of ultrasound diagnosed intra-abdominal cystic swellings in children and to evaluate the role of ultrasound as the primary imaging modality in these lesions. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis, of a Medical College of Kerala, India. Study participants were children below 12 years presenting with intra-abdominal cystic swellings who underwent abdominal ultrasonography. Direct visualization at the time of surgery or histopathological diagnosis was the gold standard. Percentage of concordance between radiological findings and final diagnosis was calculated. Significance of ultra-sonological findings associated to malignancy was assessed using Chi-square test. Results: In this study, the most common organ of origin for the cysts was the kidney, and the most common diagnosis was hydronephrosis. In 62 out of the total of 65 cases, ultrasound was able to rightly predict the pathology as to benign or malignant, with an overall accuracy of 95.3%. It had a sensitivity of 71.4%, specificity of 96.6%, and positive predictive value of 83.3%, and negative predictive value of 98.2% in determining the benign or malignant nature of a cyst. Conclusions: Ultrasound was found to be highly accurate in ascertaining the organ of origin, and in predicting whether a cyst is benign or malignant

Evaluation of serum mineral micronutrients (Zn, Cu, Fe, Mg) and their correlation with clinical parameters (gingival index, probing pocket depth, clinical attachment loss) in chronic periodontitis patients

Background: Nutrition especially micro-mineral nutrients plays a major role in the etiology of chronic periodontitis. Serum levels of micro-mineral nutrients can be used as markers for the incidence of periodontitis and may also be used as indicators for dietary supplementation. Aims and Objectives: The aim of the study was to estimate the serum levels of Zn, Cu, Fe, and Mg of chronic periodontitis patients and normal healthy controls., to measure the clinical parameters (gingival index, probing pocket depth [PPD], and clinical attachment loss) in chronic periodontitis patients and normal healthy controls., to compare the levels of serum Zn, Cu, Fe, and Mg levels of chronic periodontitis patients and healthy controls and to correlate the levels of serum micronutrients with clinical parameters (gingival index, PPD, and clinical attachment loss) in chronic periodontitis patients and healthy controls. Materials and Methods: A total of 110 subjects, 55 subjects with chronic periodontitis and 55 healthy control subjects in the age group 35–65 years were selected for the study. Serum micronutrient levels of Cu, Fe, Zn, Mg, and the clinical parameters were measured. Results: Serum concentrations of Cu and Fe showed statistically significant increase and serum Zn and Mg showed a significant decrease in peridontitis patients as compared to normal healthy controls. Copper and Fe showed a significant positive correlation and Zn and Mg showed a significant negative correlation with clinical parameters (gingival index, PPD, and clinical attachment loss). Conclusion: The present study supports and extends the view that the assessment of serum mineral micronutrient can serve as possible biomarkers or indicators for an inflammatory condition like chronic periodontitis

Temporal Fluctuations in Interparticle Interactions Drive the Formation of Transiently Stable Nanoparticle Precipitates

The pH and ionic strength dependence of electrostatic interactions was explored to introduce temporal fluctuations in the strengths of interparticle interactions and choreograph a transient self-assembly response in plasmonic nanoparticles. The assembly process was triggered by the electrostatic attraction between positively-charged gold nanoparticles (AuNPs) and an aggregating agent, ethylenediaminetetraacetic acid (EDTA). The autonomous changes in the pH and ionic strength of the solution, under the influence of atmospheric CO2, weaken the aggregating ability of EDTA and initiate the complete disassembly of [+] AuNP - EDTA precipitates. The non-destructive way of disassembly minimizes the generation of waste, which helped in achieving some of the desirable feats in the area of dynamic self-assembly like easy removal of waste, transiently stable precipitates and negligible dampness. The chemical strategy adopted in the present work, to introduce transientness, can act as a generic tool in creating the next generation of complex matter.</p

Emergence of Selectivity in Inherently Nonselective Gold Nanoparticles Through Preferential Breaking of Interparticle Interactions

We demonstrate a fundamentally unique identification strategy to impart selectivity to a traditionally and inherently nonselective carboxylate-functionalized gold-nanoparticles ([-] AuNPs), without the aid of any analyte specific ligands. The common practice is to use the ability of divalent ions to trigger the aggregation process in a kinetically trapped dispersed solution of [-] AuNPs. Aggregation of NPs being a thermodynamically favourable process will result in a uniform and nonselective turn-off response from most of the strongly binding divalent ions. Our approach is to use the abilities of various divalent ions to break a thermodynamically stable inter-nanoparticle precipitates containing [+] and [-] AuNPs (nanoionic precipitates), as the means of identification. Importantly both [+] and [-] AuNPs, independently, were ‘blind’ in terms of selectivity towards divalent ions. Remarkably, a hybrid-system composed of such nonselective nanoparticles was able to discriminate between the hard-to-distinguish pair of Pb2+ and Cd2+ ions. The rationale is that only the strongest of strongly binding ions will be able to break the interactions between the NP precipitates (thermodynamically stable state) and re-disperse them back in solution (kinetically trapped state). This is in stark contrast with the conventional idea of forming an interaction between NPs and divalent ions, with the help of analyte-specific ligands.</p

Revealing the Role of Electrostatics in Gold-Nanoparticle-Catalyzed Reduction of Charged Substrates

The potency of electrostatic effects arising from nanoparticle (NP) surface in Au-NP-catalyzed reduction of charged substrates are presented. The electrostatic potential around Au NPs is controlled by varying the nature of ligands and ionic strength of the medium. Favorable interactions arising from the attraction between oppositely charged Au NP and substrates results in the channeling of substrates to the NP surface, which in turn enhances the catalytic reduction. The positively charged ([+]) Au NP outperformed other NP systems despite having comparable or even lower surface area for adsorption, proving the exclusivity of electrostatics in catalysis. At least an order of magnitude higher concentration of negatively charged ([−]) Au NP is required to compete with the catalytic activity of [+] Au NP