Drug utilization study in postoperative patients in obstetrics and gynaecology ward of tertiary care hospital

Background: A growing number of pharmaceutical products are available in the world market and there has been an increase both in the consumption of the drugs and in expenditure on them. The aim of the study was to analyse drug usage in post-operative patients in obstetrics and gynaecological ward and to assess the prescribing indicators (WHO: Core Drug Use Indicators).Methods: A prospective observational study was conducted over a period of six months, after getting approval from Institutional Ethics committee. A specially designed proforma was used to collect the data of post-operative patients in Obstetrics and Gynaecological ward of a tertiary care hospital. The data was analysed using descriptive analysis with the help of SPSS software.Results: A total of 582 cases were analysed during the study. Out of 582 patients, 559 (96%) were prescribed with parenteral cefotaxime and metronidazole. Post-operative pain was managed with tramadol (96%). All patients were prescribed with an antibacterial agent and analgesic (100%). The percentage of encounters with an injection prescribed was 100% in our study. Out of 19 different drugs prescribed, 16 (84.21%) were from the Essential Medicines WHO Model List (2015) and 10 (52.63%) were prescribed by their generic name.Conclusions: The present study provides valuable insight about the overall pattern of drug used in postoperative patients. The study is useful in decreasing the irrational prescription, which helps to decrease the morbidity and health care burden in the society

A clinical study of maternal outcome among pregnant mothers suffering from preeclampsia with thrombocytopenia

Background: The thrombocytopenia in preeclampsia is mild to moderate, but severe thrombocytopenia can occur. Patients with eclampsia were at even greater risk for developing severe thrombocytopenia. And more likely to have HELLP syndrome, which is a subset of preeclampsia. Thrombocytopenia is a key and necessary component of this syndrome. The objective of the present study was to observe a clinical study of maternal outcome among pregnant mothers suffering from preeclampsia with thrombocytopenia.Methods: A Hospital based Study was conducted at Mysore Medical College from January 2018 to December 20180 in the department of Obstetrics and gynecology. A total of 100 cases of Pregnancy from the records / case sheets of pregnant women with pregnancy induced hypertension admitted in the labor ward of the department of obstetrics and gynecology, Mysore Medical College, Mysore, Karnataka, India.Results: Majority of the study subjects in present study were aged between 21-25 years (42%) followed by <20 years (26%). Nearly 55% of the study group were prim parous. In the above table out of 100 cases included in the study, 28 and 40 cases presented with mild and severe pregnancy induced hypertension, 8 cases were diagnosed as eclampsia and 24 cases presented with HELLP syndrome. The association between the mode of delivery and the variants of PIH was found to be statistically not significant. The Association between Mode of delivery and gestation weeks among the eclampsia cases was found to be not significant.Conclusions: Thrombocytopenia in pregnancy induced hypertension carries a risk for both the mother and her fetus. The associated causes like abruption, retain dead fetus, septicemia and disseminated intravascular coagulation aggravates the complication for thrombocytopenia

A study on pregnancy outcome in patients with first trimester vaginal bleeding

Background: Vaginal bleeding is a common obstetric problem and a cause of anxiety and worry both to patients and the Obstetrician. The common cause of bleeding in 1st trimester include various types of abortion, ectopic pregnancy and molar pregnancy. This study was conducted to assess the maternal and perinatal outcome in pregnant women who present with first trimester vaginal bleeding.Methods: A Prospective study (Longitudinal study) among pregnant women presenting with First trimester bleeding was conducted for a period from November 2017 to Jan 2019 at Mysore Medical College and Hospital 200 subjects were included into the study by Multiphasic sampling method using a structured questionnaire to collect the data.Results: The study observed that among 200 subjects who were included in the study 123 (61.5%) were non-viable pregnancy and 67 (38.5%) were viable pregnancy. Among 67 viable pregnancy only 30 (47%) had no obstetrical complications, 11 (17.1%) aborted and others had problems of PROM, Preterm labour, Placenta previa, IUGR and IUD.Conclusions: It can be concluded that first trimester bleeding is a predicting factor for obstetric and perinatal complications during pregnancy. Hence it is necessary to increase the knowledge of pregnant women in this regard for closer care. It is also important factor for clinician to be attentive towards first trimester bleeding in providing clinical interventions for the continuation of pregnancy and also reducing the fetal complications in these high-risk pregnancies

A comparative study of different route of administration of misoprostol in the management of third stage of labour

Background: Post partum haemorrhage is the most common cause of maternal morbidity and mortality.  Misoprostol is a prostaglandin analogue, used for management of post partum haemorrhage. It can be used by various routes with minimal side effects. This study is done to compare the different routes of administration of Misoprostol for the third stage management and their side effects. Objectives of present study were to estimate the amount of blood loss, to assess the maternal side effects of drug, to know the haemoglobin deficit, to know the duration of third stage of labour.Methods: This was a prospective hospital base study of 150 women delivery at obstetrics and gynaecology department at ESICMC Model Hospital, Rajajinagar. They were randomized into 3 groups of 50 patients each. They received 400 µg of misoprostol either orally or rectally or sublingually immediately after delivery of the fetus. The primary outcomes analysed were amount of blood loss duration of third stage of labour haemoglobin deficit and their side effectsResults: The amount of blood loss and haemoglobin deficit was least in sublingual group which was statistically significant. Need of additional oxytocics was less in sublingual and oral group, though it was not statistically significant.Conclusions: In the present study, sublingual Misoprostol was found to be more effective in reducing blood loss during third stage of labour

Analysis of medication errors in medicine ward of medical college teaching hospital, Mandya

Background: Medication errors are one of the most common types of medical error that is seen in hospitalised patients. Since medication error is one of the growing concerns of healthcare issue and have implications on patient safety, the purpose of this study was to identify medication error and in turn would help to create awareness among healthcare professionals and provide safety to the patients.Methods: Study was initiated after obtaining approval from the Institutional Ethics Committee. The study was done for a period of 1 year between June 2016 and May 2017. Clinical data and data regarding the medication that was prescribed, transcribed, dispensed, administered was collected and was analysed for various types of medication errors during the different stages of medication use process.Results: A total of 351 subjects were recruited in the study for assessing medication error. About 2,283 drugs were prescribed among 351 patients. Maximum number of drugs was administered through parenteral route (50.3%). Medication error was most common during the prescribing stage (51.4%) followed by transcribing stage (39.1%), administration stage (6.9%), and dispensing stage (2.6%). On an average 6 drugs were prescribed per patient. Total of about 5411 errors have occurred out of which 98.8% of errors were preventable, 1.2% of errors were non-preventable. Cardiovascular system (21.9%) and endocrine and renal system (21.9%) was commonly affected due to the medication errors.Conclusions: Medication errors are one of the commonest problems of the healthcare system should be identified and documented and their causes should be studied in order to develop systems that minimize the recurrence

Friendbook: An Advanced Friend Recommendation System For Social Networking sites

A couple of years ago, people had a limited social circle. In this century of evolving technology, it has become easier for people to socialize on a large scale via social media. There are several methods in the existing social networking sites where friend recommendation is based on pre-existing relationships like mutual friends, geographical distances, etc. This is not best way to suggest friends based on recent social findings. Hence we have developed a friend recommendation system that recommends friends to the user based on the lifestyle vector. Inspired by Data Mining, this method uses Apriori algorithm to match the websites visited by the users, which is the similarity metric used in this method

Preconception Maternal and Paternal Exposure to Persistent Organic Pollutants and Birth Size: The LIFE Study

Background: Persistent organic pollutants (POPs) are developmental toxicants, but the impact of both maternal and paternal exposures on offspring birth size is largely unexplored. Objective: We examined associations between maternal and paternal serum concentrations of 63 POPs, comprising five major classes of pollutants, with birth size measures. Methods: Parental serum concentrations of 9 organochlorine pesticides, 1 polybrominated biphenyl (PBB), 7 perfluoroalkyl chemicals (PFCs), 10 polybrominated diphenyl ethers (PBDEs), and 36 polychlorinated biphenyls (PCBs) were measured before conception for 234 couples. Differences in birth weight, length, head circumference, and ponderal index were estimated using multiple linear regression per 1-SD increase in natural log-transformed (ln-transformed) chemicals. Models were estimated separately for each parent and adjusted for maternal age, maternal prepregnancy body mass index (kilograms per meter squared) and other confounders, and all models included an interaction term between infant sex and each chemical. Results: Among girls (n = 117), birth weight was significantly lower (range, 84–195 g) in association with a 1-SD increase in ln-transformed maternal serum concentrations of DDT, PBDE congeners 28 and 183, and paternal serum concentrations of PBDE-183 and PCB-167. Among boys (n = 113), maternal (PCBs 138, 153, 167, 170, 195, and 209 and perfluorooctane sulfonamide) and paternal (PCBs 172 and 195) serum concentrations of several POPs were statistically associated with lower birth weight (range, 98–170 g), whereas paternal concentrations of PBDEs (66, 99) were associated with higher birth weight. Differences in offspring head circumference, length, and ponderal index were also associated with parental exposures. Conclusions: Preconceptional maternal and paternal concentrations of several POPs were associated with statistically significant differences in birth size among offsprin

3′-UTR SNP rs2229611 in G6PC1 affects mRNA stability, expression and Glycogen Storage Disease type-Ia risk

The frequency of rs2229611, previously reported in Chinese, Caucasians, Japanese and Hispanics, was investigated for the first time in Indian ethnicity. We analyzed its role in the progression of Glycogen Storage Disease type-Ia (GSD-Ia) and breast cancer. Genotype data on rs2229611 revealed that the risk of GSD-Ia was higher (P = 0.0195) with CC compared to TT/TC genotypes, whereas no such correlation was observed with breast cancer cases. We observed a strong linkage disequilibrium (LD) among rs2229611 and other disease causing G6PC1 variants (| D′| = 1, r2 = 1). Functional validation performed in HepG2 cells using luciferase constructs showed significant (P < 0.05) decrease in expression than wild-type 3′-UTR due to curtailed mRNA stability. Furthermore, AU-rich elements (AREs) mediated regulation of G6PC1 expression characterized using 3′-UTR deletion constructs showed a prominent decrease in mRNA stability. We then examined whether miRNAs are involved in controlling G6PC1 expression using pmirGLO-UTR constructs, with evidence of more distinct inhibition in the reporter function with rs2229611. These data suggests that rs2229611 is a crucial regulatory SNP which in homozygous state leads to a more aggressive disease phenotype in GSD-Ia patients. The implication of this result is significant in predicting disease onset, progression and response to disease modifying treatments in patients with GSD-Ia

Examining the Prevalence Rates of Preexisting Maternal Medical Conditions and Pregnancy Complications by Source: Evidence to Inform Maternal and Child Research

Objectives—We sought to examine whether there are systematic differences in ascertainment of preexisting maternal medical conditions and pregnancy complications from three common data sources used in epidemiologic research Methods—Diabetes mellitus, chronic hypertension, gestational diabetes mellitus (GDM), gestational hypertensive disorders (GHD), placental abruption and premature rupture of membranes (PROM) among 4821 pregnancies were identified via birth certificates, maternal self-report at approximately 4 months postpartum and by discharge codes from the Statewide Planning and Research Cooperative System (SPARCS), a mandatory New York State hospital reporting system. The kappa statistic (k) was estimated to ascertain beyond chance agreement of outcomes between birth certificates with either maternal self-report or SPARCS Results—GHD was under-ascertained on birth certificates (5.7 %) and more frequently indicated by maternal report (11 %) and discharge data (8.2 %). PROM was indicated more on birth certificates (7.4 %) than maternal report (4.5 %) or discharge data (5.7 %). Confirmation across data sources for some outcomes varied by maternal age, race/ethnicity, prenatal care utilization, preterm delivery, parity, mode of delivery, infant sex, use of infertility treatment and for multiple births. Agreement between maternal report and discharge data with birth certificates was generally poor (kappa \u3c 0.4) to moderate (0.4 ≤ kappa \u3c 0.75) but was excellent between discharge data and birth certificates for GDM among women who underwent infertility treatment (kappa = 0.79, 95 % CI 0.74, 0.85). Conclusions for Practice—Prevalence and agreement of conditions varied across sources. Condition-specific variations in reporting should be considered when designing studies that investigate associations between preexisting maternal medical and pregnancy-related conditions with health outcomes over the life-course

Preconception and early pregnancy air pollution exposures and risk of gestational diabetes Mellitus

Background: Air pollution has been linked to gestational diabetes mellitus (GDM) but no studies have evaluated impact of preconception and early pregnancy air pollution exposures on GDM risk. Methods: Electronic medical records provided data on 219,952 singleton deliveries to mothers with (n=11,334) and without GDM (n=208,618). Average maternal exposures to particulate matter (PM) ≤ 2.5μm (PM2.5) and PM2.5 constituents, PM ≤ 10μm (PM10), nitrogen oxides (NOx), carbon monoxide, sulfur dioxide (SO2) and ozone (O3) were estimated for the 3-month preconception window, first trimester, and gestational weeks 1-24 based on modified Community Multiscale Air Quality models for delivery hospital referral regions. Binary regression models with robust standard errors estimated relative risks (RR) for GDM per interquartile range (IQR) increase in pollutant concentrations adjusted for study site, maternal age and race/ethnicity. Results: Preconception maternal exposure to NOX (RR=1.09, 95% CI: 1.04, 1.13) and SO2 (RR=1.05, 1.01, 1.09) were associated with increased risk of subsequent GDM and risk estimates remained elevated for first trimester exposure. Preconception O3 was associated with lower risk of subsequent GDM (RR=0.93, 0.90, 0.96) but risks increased later in pregnancy. Conclusion: Maternal exposures to NOx and SO2 preconception and during the first few weeks of pregnancy were associated with increased GDM risk. O3 appeared to increase GDM risk in association with mid-pregnancy exposure but not in earlier time windows. These common exposures merit further investigation