ASSESSMENT OF POTENTIAL DRUG INTERACTIONS AMONG HOSPITALIZED PATIENTS AT THE CARDIAC AND PULMONARY DEPARTMENTS IN TERTIARY CARE HOSPITALS

Objective: The aim of this study was to assess the potential drug interactions among hospitalized patients in cardiac and pulmonary wards in three tertiary care hospitals.Methods: A prospective, observational study was carried out for 12 months. A sample of 1150 patients were assessed for potential drug-drug interactions (pDDIs) using Micromedex®- 2.7 and Drugs.com.Results: A total of 1150 patients were analyzed, and it was found that 685 were cardiac and 465 were pulmonary patients. The study identified 524 (76.49%) cardiac patients and 345 (74.19%) pulmonary patients, with pDDIs higher in male cardiac (298 [56.87%]) and male pulmonary (199 [57.68%]) patients, compared to females. Incidences of pDDIs were found to be higher in the age group of 60–70 years in cardiac (193 [36.83%]) and pulmonary (146 [42.31%]) patients and incidences of interactions based on duration of 4–6 days' hospital stays in cardiac were 380 (72.53%) and 215 (62.31%) in pulmonary patients, respectively. Moreover, 51.90% of cardiac patients and 56.52% of pulmonary patients were found to be prescribed with more number of drugs (cardiac 7 drugs and pulmonary 5–6 drugs) causing higher incidences of pDDIs. Some of the most common drug interacting pair was aspirin and clopidogrel combination observed in 245 cardiac patients, whereas in the pulmonary department, it was ranitidine-theophylline combination with a frequency of 195 pDDIs. Drug-food interactions were found with atorvastatin–citrus fruits in cardiac and theophylline–caffeine in pulmonary patients. The most common drug-disease interaction was found to be isosorbide dinitrate–myocardial infarction in cardiac and diazepam–COPD in pulmonary, respectively.Conclusion: Pharmacists must take responsibility in the monitoring of drug interactions and notifying the physician and patient about potential problems. With their detailed knowledge of drugs, pharmacists have the ability to relate unexpected symptoms experienced by patients to possible adverse effects of their drug therapy

Effect of okra plant resistance on transmission rate of okra enation leaf curl virus by its vector whitefly, Bemisia tabaci

The present study aimed to investigate the effect of age of the okra plants that showed varying whitefly resistance responses on the transmission rate of okra enation leaf curl virus (OELCV) by its vector whitefly Bemisia tabaci. The OELCV infected whitefly adults were collected from whitefly colonies and were challenged on the test okra accessions (Upl mona 2, Co 1, Arka anamika and AE 64) of differential ages which were individually caged (7, 10 and 15 d after germination) with glass chimney and the number of such whiteflies used were at the rate of 2, 4, 6, 8, 10, 12, 14 and 20 adults per plant. Observations were made on the virus symptom expression 30 d after challenge. The efficiency of transmission was determined. The efficiency of transmission of OELCV was the highest (maximum T and P*, 0.80, 1.00 and 0.08, 0.10) when 7 d old seedlings were inoculated (Arka anamika and AE 64 respectively) and transmission had decreased as the age of seedlings increased. The estimated transmission rate for single whitefly (P*) increased with an increase in the number of whiteflies used per plant. Okra plant resistance to B. tabaci significantly changed the transmission rates of OELCV on okra. Understanding the resistance mechanisms of the okra accessions and interactions between plant viruses and their insect host can pave the way for novel approaches to protect plants from virus infection

Correlation of Bony Invasion With Nodal Metastasis, Pattern of Invasion and Survival in Oral Squamous Cell Carcinoma: A Retrospective Analysis of 122 Primary Cases From Oral Cancer Centre of South India

Oral squamous cell carcinoma (OSCC) is considered to be the most common epithelial malignant neoplasm of the oral cavity. Despite advancements in diagnosis and therapeutics the clinical outcome of the disease has not improved much which may be attributed to tumor biology and heterogeneity. Bone invasion by cancer cells is currently staged as a moderately advanced disease. However, many low-grade carcinomas such as verrucous carcinoma and carcinoma cuniculatum show body invasion but less nodal metastases and better overall survival. The present study was orchestrated to analyze if bone invasion in OSCC has any impact on regional nodal metastases and survival

Chronic nail biting, orthodontic treatment and Enterobacteriaceae in the oral cavity

Chronic nail biting is common in children and young adults. Auto inoculation of environmental pathogens can manifest as infection in distant organs. Multi-drug resistance gram negative bacteria are on the rise globally. Several of the foodborne bacteria fall within the Enterobacteriaceae family but very few studies have explored these microbes in the oral cavity of children with chronic nail-biting habit or orthodontic treatment. The study aims to investigate oral load of Enterobacteriaceae in children with chronic nail-biting habit and or those undergoing orthodontic treatment. 150 children (no nail-biting n=30, nail biting n=60, fixed orthodontic treatment n =30 and a combination of fixed orthodontic appliance use and nail-biting habit n =30) were assessed for culture based microbiological investigation. The concentrated oral rinse technique was used. The rinse was inoculated in MacConkey?s and Blood Agar. The gram stained culture was subjected to biochemical tests for sub-species identification using Biomerieux Vitek 2 Compact Automated Microbiological Analyzer. Fisher?s exact and Kruskal Wallis with post hoc analysis using Dunn method was performed to test association and difference between groups. Enterobacteriaceae was positive for 72% of the children. Of them, nail biting or orthodontic treatment group comprised 89%. Those with a combination of nail biting and undergoing orthodontic treatment exhibited highest CFU/ml and those without nail biting or orthodontic treatment exhibited the lowest. Three of the four organisms isolated tested positive in the orthodontic treatment group. E. coli was positive in 38% of the children while Klebsiella and E. cloacae were isolated exclusively in the orthodontic treatment group. Chronic nail biting or the use of fixed orthodontic appliances is associated with higher incidence of Enterobacteriaceae in the oral cavity. Oral health professionals play an important role in preventing multi drug resistance infectious diseases

Comparative dosimetric analysis of IMRT and VMAT (RapidArc) in brain, head and neck, breast and prostate malignancies

Purpose: Intensity modulated radiotherapy (IMRT) in the recent past has established itself as a gold standard for organs at risk (OAR) sparing, target coverage and dose conformity. With the advent of a rotational treatment technology such as volumetric modulated arc therapy (VMAT), an inter-comparison is warranted to address the advantages and disadvantages of each technique. Methods: Twenty patients were selected retrospectively from our patient database. Sites included were brain, head and neck, chest wall, and prostate, with five patients for each site. For all the selected patients, both the IMRT and VMAT treatment plans were generated. Plan comparison was done in terms of OAR dose, dose homogeneity index (HI), dose conformity index (CI), target coverage, low isodose volumes, monitor units (MUs), and treatment time.Results: The VMAT showed better sparing of “parotids minus planning target volume (PTV)”, spinal cord and head of femur as compared to the IMRT. The lung V40 for VMAT was lower, whereas the lung V10, contralateral lung mean dose, contralateral breast mean dose and mean body dose were lower with IMRT for chest wall cases. Both the VMAT and IMRT achieved comparable HI except for the brain site, where IMRT scored over VMAT. The CI achieved by the IMRT and VMAT were similar except for chest wall cases, whereas the VMAT achieved better dose conformity. The target coverage was comparable with both the plans. The VMAT clearly scored over IMRT in terms of average MUs (486 versus 812 respectively) and average treatment time (2.54 minutes versus 5.54 minutes) per treatment session. Conclusion: The VMAT (RapidArc) has a potential to generate treatment plans for various anatomical sites which are comparable with the corresponding IMRT plans in terms of OAR sparing and plan quality parameters. The VMAT significantly reduces treatment time as compared to the IMRT, thus VMAT can increase the throughput of a busy radiotherapy department

Comparative dosimetric analysis of IMRT and VMAT (RapidArc) in brain, head and neck, breast and prostate malignancies

Purpose: Intensity modulated radiotherapy (IMRT) in the recent past has established itself as a gold standard for organs at risk (OAR) sparing, target coverage and dose conformity. With the advent of a rotational treatment technology such as volumetric modulated arc therapy (VMAT), an inter-comparison is warranted to address the advantages and disadvantages of each technique. Methods: Twenty patients were selected retrospectively from our patient database. Sites included were brain, head and neck, chest wall, and prostate, with five patients for each site. For all the selected patients, both the IMRT and VMAT treatment plans were generated. Plan comparison was done in terms of OAR dose, dose homogeneity index (HI), dose conformity index (CI), target coverage, low isodose volumes, monitor units (MUs), and treatment time.Results: The VMAT showed better sparing of “parotids minus planning target volume (PTV)”, spinal cord and head of femur as compared to the IMRT. The lung V40 for VMAT was lower, whereas the lung V10, contralateral lung mean dose, contralateral breast mean dose and mean body dose were lower with IMRT for chest wall cases. Both the VMAT and IMRT achieved comparable HI except for the brain site, where IMRT scored over VMAT. The CI achieved by the IMRT and VMAT were similar except for chest wall cases, whereas the VMAT achieved better dose conformity. The target coverage was comparable with both the plans. The VMAT clearly scored over IMRT in terms of average MUs (486 versus 812 respectively) and average treatment time (2.54 minutes versus 5.54 minutes) per treatment session. Conclusion: The VMAT (RapidArc) has a potential to generate treatment plans for various anatomical sites which are comparable with the corresponding IMRT plans in terms of OAR sparing and plan quality parameters. The VMAT significantly reduces treatment time as compared to the IMRT, thus VMAT can increase the throughput of a busy radiotherapy department.</p

GBS-based SNP map pinpoints the QTL associated with sorghum downy mildew resistance in maize (Zea mays L.)

Sorghum downy mildew (SDM), caused by the biotrophic fungi Peronosclerospora sorghi, threatens maize production worldwide, including India. To identify quantitative trait loci (QTL) associated with resistance to SDM, we used a recombinant inbred line (RIL) population derived from a cross between resistant inbred line UMI936 (w) and susceptible inbred line UMI79. The RIL population was phenotyped for SDM resistance in three environments [E1-field (Coimbatore), E2-greenhouse (Coimbatore), and E3-field (Mandya)] and also utilized to construct the genetic linkage map by genotyping by sequencing (GBS) approach. The map comprises 1516 SNP markers in 10 linkage groups (LGs) with a total length of 6924.7 cM and an average marker distance of 4.57 cM. The QTL analysis with the phenotype and marker data detected nine QTL on chromosome 1, 2, 3, 5, 6, and 7 across three environments. Of these, QTL namely qDMR1.2, qDMR3.1, qDMR5.1, and qDMR6.1 were notable due to their high phenotypic variance. qDMR3.1 from chromosome 3 was detected in more than one environment (E1 and E2), explaining the 10.3% and 13.1% phenotypic variance. Three QTL, qDMR1.2, qDMR5.1, and qDMR6.1 from chromosomes 1, 5, and 6 were identified in either E1 or E3, explaining 15.2%–18% phenotypic variance. Moreover, genome mining on three QTL (qDMR3.1, qDMR5.1, and qDMR6.1) reveals the putative candidate genes related to SDM resistance. The information generated in this study will be helpful for map-based cloning and marker-assisted selection in maize breeding programs

Glandular Odontogenic Cyst: Report of Two Cases and Review of Literature

Glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin described in 1987 by Gardner et al. It is a cyst having an unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency to recur with only 111 cases having been reported thus far. The first case occurred in a 42-year-old female and presented as a localized swelling extending from 19 to 29 regions. There was a history of traumatic injury at the site. There was evidence of bicortical expansion and radiographs revealed a multilocular radiolucency. The second case occurred in a 21-year-old male, as a large swelling in the mandible and radiograph revealed radiolucency in the region. On histopathological examination, these lesions were diagnosed as GOC. It was concluded that, two cases submitted by us correlate with the existing literature that GOC’s affect more commonly in the middle age group, having predilection for mandible and that trauma could be a precipitating factor for its occurrence. The increased recurrence rates can be due to its intrinsic biological behavior, multilocularity of the cyst, and incomplete removal of the lining following conservative treatment

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases