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

Serum lipid profile in non-polycystic ovary syndrome and polycystic ovary syndrome women: a comparative and correlational study

Background: Polycystic ovary syndrome (PCOS), in addition to impaired ovulation, also affects metabolic pathways. Dyslipidemia, occurring in PCOS women leads to cardiovascular diseases in them. The purpose of the present study was to compare lipid profile and its correlation with biochemical and hormonal parameters in PCOS and non PCOS women, to analyse the correlation of lipid profile with hirsutism and body mass index (BMI) in PCOS women.Methods: The present study includes 68 women divided into non PCOS groups (n=30) and PCOS (n=38) as defined by Rotterdam criteria. PCOS group further divided into overweight / obese (n=23) and normal weight subgroups (n=15). Lipid profile, fasting blood glucose and hormonal profile were done in all the groups.Results: TG and TC/HDL ratio were significantly high in PCOS group. Hirsute patients had raised LDL levels as compared to non-hirsute. LDL showed positive significant correlation with insulin, HOMA, testosterone in PCOS group. TC was significantly positively correlated with insulin and HOMA in PCOS group. In both normal weight and overweight / obese PCOS subgroups, LDL had positive and significant correlation with testosterone. TC showed positive and significant correlation with HOMA in overweight/obese subgroup. HDL showed positive and highly significant correlation with FSH in normal weight PCOS.Conclusions: Hyperandrogenism in PCOS may be additionally marked by raised LDL. Overweight/obese PCOS subgroup may be prone to dyslipidemia as well as deranged glucose homeostasis, thereby making it an important therapeutic target

Current pattern of adverse drug reactions to anti-retroviral therapy in an antiretroviral therapy centre attached to a government medical college of Maharashtra, India: a retrospective study

Background: Antiretroviral drug therapy (ART) has brought a ray of hope to people living with HIV/AIDS. Adverse drug reactions (ADRs) can often cause significant morbidity among individuals on ART, occasionally leading to mortality. The present study was conducted to assess the nature, causality, severity of ADRs to ART, and to identify risk factors for ADRs in HIV-positive patients receiving ART in India.Methods: A total of 109 patients reported with ADRs to ART during July 2015-December 2015 were randomly included in a retrospective observational study conducted at an ART center attached to a government medical college of Maharashtra. Causality and severity assessment of ADRs was done by using Naranjo’s ADR Causality scale and Modified Hartwig and Siegel scale respectively. The data was computed using MS Excel and descriptive results were expressed as counts and percentages. The study was approved by Institutional Ethics Committee.Results: Among 109 patients, females (60.55%) had higher prevalence of ADRs than males (39.45%). A total of 132 ADRs were reported. Anemia (76.52%) was the commonest ADR reported followed by skin rash (11.36%) and raised renal function tests (6.06%). Zidovudine + Lamivudine + Nevirapine (ZLN) were the commonest ART regimen causing anemia as ADR.Conclusions: Reporting of ADRs is a very inefficient system in detecting drug-related conditions, leading to underestimation of the burden due to ADRs in India. A well-structured, efficient pharmacovigilance systems, which assesses and monitor safety profile and impact of antiretroviral medicines is very much needed at present in India

High sensitivity C - reactive protein (hs-CRP) and clinical characteristics, endocrine, metabolic profile in Indian women with PCOS: a correlation

Background: Role of hs-CRP was studied in PCOS women.Methods: Correlation between serum hs-CRP and endocrine, metabolic profile was studied in 30 healthy women and 88 PCOS women. In PCOS women correlation between hs-CRP and clinical characteristics viz obesity, infertility, acne, hirsutism, acanthosis nigricans (AN) was also studied. Serum levels of hs-CRP, Luteinizing hormone (LH), Follicle stimulating hormone (FSH), LH:FSH ratio, Testosterone (Testo), fasting insulin, fasting blood glucose (FBG), total cholesterol (TC), triglyceride (Tg), low density lipoprotein (LDL), high density lipoprotein (HDL) and Homeostasis Model Assessment (HOMA) were estimated.Results: Mean serum hs-CRP in PCOS women was higher than that in control women (6.9 ± SE 0.84 v/s 2.0 ± SE 0.19mg/L, P=0.005).  In PCOS group overweight/obese had higher hs-CRP as compared to normal weight women (P=0.0051). In control group hs-CRP was positively correlated with age (r=0.385 p=0.035) and LDL (r=0.38 P=0.036). PCOS women showed positive correlation between hs-CRP and cholesterol, LDL, fasting insulin, HOMA. PCOS women showed a significant negative correlation between hs-CRP and LH. AN positive PCOS women showed higher serum hs-CRP levels as compared to AN negative PCOS women (11 ± SE 0.7 v/s 5.5 ± SE 2.3, P=0.0439).Conclusions: Serum hs-CRP is raised in Indian PCOS women reflecting association of low grade chronic inflammation. A positive correlation is present between hs-CRP and AN, insulin in PCOS women and obesity may aggravate this association. A positive correlation between hs-CRP and TC, LDL in the background of normal lipid profile is suggestive of precedence of chronic inflammation over dyslipidemia in PCOS

Comparison of cardiovascular safety of escitalopram and sertraline based on electrocardiographic alterations: a pharmacovigilance study

Background: Escitalopram and sertraline are the most commonly prescribed antidepressant drugs, belongs to SSRI class. Both the drugs are long been considered as free from cardiovascular adverse effects. Recently number of studies reported potential association between these drugs and pronounced cardiovascular adverse effects. ECG changes like prolongation of QT interval are frequently used as markers for the increased risk of a fatal cardiac arrhythmia. The potential cardiovascular adverse reaction profile of both these drugs is little studied in Indian rural population.Methods: This was a 6 weeks prospective open label observational study carried out in a drug naive 209 patients receiving either escitalopram (n=106) or sertraline (n=103). ECG parameters like heart rate, RR interval, PQ/PR interval, QRS duration and QTc interval, were obtained directly from the digital machine recordings, additionally the QT interval was measured manually with the help of caliper. Statistical analysis was done by using Statistical software SPSS 17.0.Results: Out of 209 drugs naive patients, 12 from escitalopram group and 10 patients from Sertraline were lost to follow-up. Hence ECG recordings of the remaining 94 patients under escitalopram group, 93 patients under sertraline group were used for study analysis. The ECG alterations caused by the escitalopram were compared with that caused by sertraline. It was observed that the differences between the ECG alterations caused by either of escitalopram or sertraline were statistically non-significant.Conclusions: It was concluded, at therapeutic doses neither of the drugs have the potential risk of drug induced arrhythmias, throughout the study. 

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

JBiopest 7(2):144-150(2014) Management of Meloidogyne incognita JBiopest 5(1): 1-6 © 453 Management of Meloidogyne incognita infecting carrot by using bioagents

ABSTRACT Root-knot nematode (Meloidogyne incognita) is a serious pest of vegetables and major limiting factor in the commercial production of carrot in many parts of the world, including India. To avoid excess use of chemicals, an attempt was made to manage M. incognita infecting carrot by using bioagents viz., Trichoderma harzianum (indigenous and commercial) and Pseudomonas fluorescens (commercial) under field conditions. Among biocontrol agents, the lowest nematode population in soil (222.66/200 g) was recorded in isolated T. harzianum @ 25g/m 2 (2 × 10 6 Cfu/g) treated plot than by commercial T. harzianum @ 20g/m 2 . Maximum reduction of galls/rhizome (11.00), galls/5 g of root (36.00) and egg masses (11.33) per 5 gram of root was recorded in isolated T. harzianum @ 25g/m 2 treatment compared to other treatments. Maximum shoot height (49.66 cm), shoot weight (26.00 g/rhizome) and rhizome yield (8.20 q/ha) were also recorded in isolated T. harzianum @ 25g/m 2 followed by isolated T. harzianum and commercial T. harzianum @ 20g/m 2

Measurement of t(t)over-bar normalised multi-differential cross sections in pp collisions at root s=13 TeV, and simultaneous determination of the strong coupling strength, top quark pole mass, and parton distribution functions

Peer reviewe

An embedding technique to determine ττ backgrounds in proton-proton collision data

An embedding technique is presented to estimate standard model tau tau backgrounds from data with minimal simulation input. In the data, the muons are removed from reconstructed mu mu events and replaced with simulated tau leptons with the same kinematic properties. In this way, a set of hybrid events is obtained that does not rely on simulation except for the decay of the tau leptons. The challenges in describing the underlying event or the production of associated jets in the simulation are avoided. The technique described in this paper was developed for CMS. Its validation and the inherent uncertainties are also discussed. The demonstration of the performance of the technique is based on a sample of proton-proton collisions collected by CMS in 2017 at root s = 13 TeV corresponding to an integrated luminosity of 41.5 fb(-1).Peer reviewe