Antibiotic prescribing pattern among paediatric patients attending tertiary care hospital in South India

Background: The usage of antibiotics among paediatric age group in India is on the higher side, that more than 60% of children in the age group 0 to 4 years received antibiotics. The higher use of antibiotics results in antibiotic resistance, increased health care costs, adverse drug reaction and may complicate the treatment of infections in future. There is a continuous need to monitor the prescription of antibiotics at all health care levels to prevent antibiotic resistance.Methods: A prospective and descriptive study was conducted in one of the pharmacies which dispenses the paediatric prescriptions in a tertiary hospital. The prescriptions used to treat infection were collected and analysed. A total of 500 prescriptions were collected and analysed.Results: The prescriptions were analysed for the WHO prescribing indicators. The average number of drugs per prescription is 1.84 with 21% of the prescriptions containing antibiotics. The most commonly prescribed antibiotics were penicillin like amoxycillin, phenoxymethyl penicillin followed by cotrimoxazole and cephalosporin group of antibiotics. The antibiotics prescribed belonged to the access group of antibiotics. The percentage of the prescriptions with drugs form essential drugs list and prescribed with generic name is 65.8% and 67% respectively. There were no injections prescribed.Conclusions: The antibiotic prescribing pattern and the average drugs per prescription falls with the WHO range indicating reduced use of antibiotics and absence of polypharmacy. However, the prescription of generic drugs and the drugs from the essential drug list is less

Therapeutic drug targets for COVID-19

Covid 19, caused by Corona virus started in Wuhan, China on December 2019 and the disease has spread rapidly among 210 countries. Corona virus disease, a RNA virus infection affected millions of people and caused death in many patients. The symptoms include fever, sneezing, coughing and other respiratory symptoms. The disease can highly affect the elderly, immunocompromised and the fatality rate is increased among these people. There is no definitive treatment till now and patients are treated symptomatically. The steps involved in the pathogenesis including attachment of the virus to the host cell, replication, protease action, assembly of nucleocapsid, release by exocytosis and they are the potential targets for the drugs. There are various trials ongoing to evaluate the efficacy of antiviral drugs, chloroquine, hydroxychloroquine, convalescent plasma and monoclonal antibodies. This review gives a summary of the most important drugs and drug targets used in the management of Covid 19

A study on awareness of pharmacovigilance and determinants of underreporting of adverse drug reactions by health care professionals and general practitioners

Background: Health care providers/professionals (HCPs) play a critical role in ADR surveillance. Only 6% of all ADRs are reported and under-reporting acts as great impedance in exchange of drug information.Methods: This was a prospective questionnaire-based study. Structured questionnaire was issued to HCPs before and after the conduct of Pharmacovigilance awareness program and scores given to each question was analyzed statistically.Results: Of the 69 participants, 46.4% were nurses, 40.6% were residents of a tertiary health care facility and 13% were general practitioners in Pondicherry. The response rate was found to be 62.7% and 100% both before and after the awareness program respectively. Creation of awareness amongst HCPs is the most important factor (77%) influencing spontaneous reporting.Conclusions: Our study suggests that HCPs were aware of the concept of ADR but the majority did not know how and where to report. Thus, creation of awareness amongst HCPs is the most important determinant influencing spontaneous reporting of ADRs

Performance Evaluation of Audio Coding by Amalgam AAC and FLAC Audio codec using MDCT and INTMDCT Algorithm

The MDCT and IntMDCT Algorithm is widely utilized is Audio coding.By lifting scheme or rounding operation IntegerMDCT is evolved from Modified Discrete Cosine Transform.This method acquire the properties of  MDCT and  contribute excelling invertiblity and good spectral mean.In this paper we discuss about the audio codec like AAC and FLAC using MDCT and Integer MDCT algorithm and to find which algorithm shows better Compression Ratio(CR).The confines of this task is to hybriding lossy and lossless audio codec with  diminished bit rate but with finer sound quality. Certainly the quality of the audio is figure out by Subjective and Objective testing which is in terms of MOS (Mean opinion square) , ABx and some of the hearing aid testing methodology like PEAQ(Perceptual  Evaluation Audio Quality)  and ODG(Objective Difference Grade)is followed. Execution measure, that is Compression Ratio(CR) and Sound Pressure Level (SPL) is approximated

Ayurvedic herbal medicine and lead poisoning

Although the majority of published cases of lead poisoning come from occupational exposures, some traditional remedies may also contain toxic amounts of lead. Ayurveda is a system of traditional medicine that is native to India and is used in many parts of world as an alternative to standard treatment regimens. Here, we report the case of a 58-year-old woman who presented with abdominal pain, anemia, liver function abnormalities, and an elevated blood lead level. The patient was found to have been taking the Ayurvedic medicine Jambrulin prior to presentation. Chemical analysis of the medication showed high levels of lead. Following treatment with an oral chelating agent, the patient's symptoms resolved and laboratory abnormalities normalized. This case highlights the need for increased awareness that some Ayurvedic medicines may contain potentially harmful levels of heavy metals and people who use them are at risk of developing associated toxicities

A STUDY ON PREVALENCE OF PULMONARY CANDIDIASIS AMONG TUBERCULOSIS PATIENTS AND USE OF CHROMAGAR IN IDENTIFICATION OF CANDIDA SPECIES

Introduction: In recent years, fungal infections are on the rise due to various predisposing factors such as long term administration of antibiotics, use of steroids, pulmonary tuberculosis, immunosuppressive drugs and HIV infection. When host resistance is lowered, these opportunistic fungi may become fatal. Candida albicans was the most important pathogen causing pulmonary candidiasis. In recent times, there is increase in incidence of non-albicans Candida. Identification to the species level becomes mandatory in the selection of appropriate antifungal agents. Aim: To find out the prevalence of Candida co-infection among pulmonary tuberculosis patients and to identify the species of Candida using CHROMagar. Materials & Methods: A total of 107 smear positive pulmonary tuberculosis patients were included in this study. Two consecutive sputum samples were collected and subjected to gram staining. Only those samples which showed pus cells with budding yeast cells and pseudohyphae in direct gram stain were cultured on Sabouraud’s dextrose agar (SDA) with gentamycin. The Candida grown was identified and speciated based on the color produced on CHROMagar Candida. Results: Out of 21 Candida isolates, 14 were C. albicans (66.7%), 2 were C. tropicalis (9.5%), 2 were C.krusei (9.5%), 2 were C. parapsilosis (9.5%) and one was C. glabrata (4.8%). Conclusion: The secondary fungal infections are associated with persistence of lung symptoms inspite of successful completion of antituberculous therapy. Hence adequate measures need to be taken for the early identification and treatment of these opportunistic infections. Keywords: Pulmonary tuberculosis, Candida albicans, non-albicans Candida, antifungal agent

Integrating depth of invasion in T classification improves the prognostic performance of the American Joint Committee on Cancer primary tumor staging system for cutaneous squamous cell carcinoma of the head and neck

BACKGROUND: The last revision of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual included a specific system for cutaneous squamous cell carcinoma (CSCC) of the head and neck. Here, we assessed the prognostic performance of six candidate modified T-classification models in head and neck CSCC patients. METHODS: Analysis of 916 patients with head and neck CSCC given treatment with curative intent at The University of Texas MD Anderson Cancer Center between 1995 and 2019 was performed. The main outcome was disease-specific survival (DSS), and the impact of depth of invasion (DOI) was analyzed using multivariable regression models. Candidate models were developed using the optimal DOI cut points for each AJCC T classification based on goodness of fit of the model and the simplicity of the model. Staging systems were compared using Harrell\u27s concordance index. RESULTS: Median age was 70 years (range, 19-97years) and median follow-up time of 22 months (range, 1-250months). The median DOI was 6.0 mm (range, 0.1-70.0 mm). The five-year DSS rate was 80.7% (95%CI, 77.4-83.7%). We found significant association between DOI (hazard ratio, 1.21 [95%CI: 1.01-1.43]) and DSS on multivariable analysis. Based on a low Akaike information criterion score, improvement in the concordance index, and Kaplan-Meier curves, model 6 surpassed the AJCC staging system. CONCLUSIONS: Incorporation of DOI in the current AJCC staging system improves discrimination of T classifications in head and neck CSCC patients. LAY SUMMARY: The current staging system for head and neck cutaneous squamous cell carcinoma demonstrates wide prognostic variability and provides suboptimal risk stratification. Incorporation of depth of invasion in the T-classification system improves risk prediction and patient counseling. PRECIS: We propose improved head and neck cutaneous squamous cell carcinoma T staging that will include depth of invasion and should be considered in future versions of the American Joint Committee on Cancer after external validation

Ets1 Induces Dysplastic Changes When Expressed in Terminally-Differentiating Squamous Epidermal Cells

BACKGROUND: Ets1 is an oncogene that functions as a transcription factor and regulates the activity of many genes potentially important for tumor initiation and progression. Interestingly, the Ets1 oncogene is over-expressed in many human squamous cell cancers and over-expression is highly correlated with invasion and metastasis. Thus, Ets1 is believed to mainly play a role in later stages of the oncogenic process, but not early events. METHODOLOGY/PRINCIPAL FINDINGS: To better define the role of Ets1 in squamous cell carcinogenesis, we generated a transgenic mouse model in which expression of the Ets1 oncogene could be temporally and spatially regulated. Upon Ets1 induction in differentiating cells of stratified squamous epithelium, these mice exhibited dramatic changes in epithelial organization including increased proliferation and blocked terminal differentiation. The phenotype was completely reversed when Ets1 expression was suppressed. In mice where Ets1 expression was re-induced at a later age, the phenotype was more localized and the lesions that developed were more invasive. Many potential Ets1 targets were upregulated in the skin of these mice with the most dramatic being the metalloprotease MMP13, which we demonstrate to be a direct transcriptional target of Ets1. CONCLUSIONS/SIGNIFICANCE: Collectively, our data reveal that upregulation of Ets1 can be an early event that promotes pre-neoplastic changes in epidermal tissues via its regulation of key genes driving growth and invasion. Thus, the Ets1 oncogene may be important for oncogenic processes in both early and late stages of tumor development

25th Annual Computational Neuroscience Meeting: CNS-2016

Abstracts of the 25th Annual Computational Neuroscience Meeting: CNS-2016 Seogwipo City, Jeju-do, South Korea. 2–7 July 201