An observational study on dapagliflozin as an add-on therapy in type-2 diabetes mellitus patients in a tertiary care teaching hospital

Background: Diabetes mellitus is one of the prevalent morbid conditions all over the world and no exception for India. Day by day, increase in its prevalence is attributed to lifestyle derangements. To treat this condition many drugs and treatment modalities are developed. Dapagliflozin is an oral antidiabetic drug which acts by sodium-glucose cotransport-2 (SGLT-2) inhibition. Its effectiveness seen in type-2 diabetes mellitus makes it an option for Add-On therapy. Methods: This study is a retrospective observational study conducted at tertiary care hospital, GGH, Kurnool. The study proposal has been reviewed and approved by institutional ethics committee. All adult diabetic patients who were prescribed Dapagliflozin during the period of January 2021 to February 2022, total 45 were included in the study. FBG, HbA1c collected through hospital records from General Medicine and Endocrinology. Patients who stopped drug before 3 months period were excluded. Results: Administration of dapagliflozin as an add-on therapy was found 26.63% decrease in base line mean FBG 184 mg/dl to 135 mg/dl after 3mnoths which is significant (p=0.001). Mean HbA1c significantly reduced by 0.96 percentage point after 3 months (p=0.001). Dapagliflozin effectively reduced the FBG and HbA1c when used in combination with other OHAs or insulin within 3 months. Conclusions: Dapagliflozin as an add-on therapy significantly reduced the HbA1c level and fasting blood glucose of Type-2DM patients, in a 3-month treatment period. Due to the frequency of Genitourinary tract infections, caution is indicated while treating the patients

Taxanes induced hypersensitivity reactions in cancer chemotherapy patients reported at adverse drug reaction monitoring centre at a tertiary care hospital

Background: Cancer chemotherapy involves highly complex regimens using antineoplastic agents like taxanes (paclitaxel, docetaxel) etc. Taxanes cause hypersensitivity reactions (HSRs) like redness, rashes, dyspnoea, severe anaphylaxis and death. In this study, adverse drug reactions (ADRs) associated with taxanes are described & analysed on their severity and preventability. The present study aims to analyse and determine the prevalence of ADRs, especially HSRs in patients treated with taxanes.Methods: After getting IEC approval, the present study is done retrospectively by assessing the HSRs in suspected ADR reporting forms from December 2019 to February 2022 in ADR monitoring centre (AMC) in the Department of Pharmacology at Kurnool Medical College, Kurnool. Descriptive statistics used to analyse patient demography, frequency, various carcinomas under treatment & organ involved, causality assessment using WHO-UMC Scale and Naranjo's Algorithm, severity assessment using modified Hartwig & Siegel’s scale and preventability by modified Schumock & Thornton scale.Results: A total of 258 ADRs were recorded, of which 30 cases reported HSRs with taxanes-paclitaxel (22) and docetaxel (8). The most commonly occurred HSR is shortness of breath. Naranjo’s algorithm showed 52.5% possible (score 1-4) HSRs. WHO-UMC causality assessment scale showed 56.4% as probable HSRs. Modified Hartwig & Siegel severity scale showed 46.6% moderate (level 3). Modified Schumock and Thornton scale showed 76.9% as not preventable.Conclusions: Chemotherapy-related ADRs among cancer patients urges the oncologists to be actively involved in ADR reporting, in the need of the hour in order to mitigate, avoid their occurrence and reducing morbidity and mortality, when practiced with diligence

Evaluation of knowledge, attitude and practice towards drug-drug interactions among postgraduates in tertiary care hospital, Kurnool

Background: Drug-drug interactions (DDIs) are changes in a drug’s effects due to concurrent use of another drug. Clinically significant interactions lead to undesired adverse effects, therapeutic failure, toxicity or may even cause death of the patients. The Aim is to evaluate the Knowledge, Attitude and Practice of Postgraduates regarding DDIs and implementation of educational program may enhance patient’s safety.Methods: A cross-sectional study was conducted among postgraduates in all clinical departments of Government general hospital, Kurnool in the month of October 2021. Pre-validated questionnaire was used to assess the KAP. It contains demographic data, knowledge and practice questions related to DDIs and attitude towards the preferable sources of drug interaction information. Data analysis was done by using SPSS version 26.Results: Out of 220 questionnaires distributed, 126 postgraduates submitted with complete answers(n=126). Overall response rate is 57%. By using the Bloom’s cut-off points, most of the respondents (43.5%) had low level of knowledge towards DDIs. Even respondents with high knowledge level (19%) are not practicing the drug interaction screening during the admission of patients. Majority of PGs with low level knowledge agreed to ask doctors than pharmacist about DDIs and prefer to search for DDIs using reference book than online mode as the source of drug information.Conclusions: In my study, most of the respondents had insufficient knowledge to prevent life threatening DDI’s. So, there is a need to increase medical educational program regarding the importance of screening and assessing of DDI’s before prescribing medicines

A questionnaire-based exploratory study on self medication among second year MBBS students

Background: The practice of self-medication is expected to be higher in health science students due to their exposure to knowledge about different diseases and drugs. This study was done to assess the knowledge, attitude and practice of self-medication and to compare the impact of knowledge of Pharmacology on it, among second-year MBBS students.Methods: A semi-structured questionnaire consisting of both open-ended and close-ended questions was prepared and given to second-year medical students of Kurnool medical college, Kurnool. Data was analysed and entered in Microsoft Excel (version 2019), and associations were tested using the Chi-square test. The results are expressed as counts and percentages. Statistical significance was p<0.05.Results: Among the respondents, 37.33% are practising self- medication, 54.66% think knowledge of Pharmacology aids students to practice without any dire consequences. Most of the students take for fever (95.33%), (97.33%) for cough, cold, sore throat.84% were aware that it’s not safe to take drugs pertaining to alternate systems of medicine like Ayurveda, homoeopathy. A statistically significant association between knowledge, attitude, practice and gender and residence has been observed.Conclusions: The study shows that students are aware that self-medication is dangerous when followed by lay people. On the other hand, health professionals with knowledge about medications can take self-medication for common conditions without any dire consequences. They are also aware that it’s not safe to take medications that come under alternate systems of medicines, and WhatsApp consultation is not to be encouraged

Hybrid chaotic map with L-shaped fractal Tromino for image encryption and decryption

Insecure communication in digital image security and image storing are considered as important challenges. Moreover, the existing approaches face problems related to improper security at the time of image encryption and decryption. In this research work, a wavelet environment is obtained by transforming the cover image utilizing integer wavelet transform (IWT) and hybrid discrete cosine transform (DCT) to completely prevent false errors. Then the proposed hybrid chaotic map with L-shaped fractal Tromino offers better security to maintain image secrecy by means of encryption and decryption. The proposed work uses fractal encryption with the combination of L-shaped Tromino theorem for enhancement of information hiding. The regions of L-shaped fractal Tromino are sensitive to variations, thus are embedded in the watermark based on a visual watermarking technique known as reversible watermarking. The experimental results showed that the proposed method obtained peak signal-to-noise ratio (PSNR) value of 56.82dB which is comparatively higher than the existing methods that are, Beddington, free, and Lawton (BFL) map with PSNR value of 8.10 dB, permutation substitution, and Boolean operation with PSNR value of 21.19 dB and deoxyribonucleic acid (DNA) level permutation-based logistic map with PSNR value of 21.27 dB

A bright, spatially extended lensed galaxy at z = 1.7 behind the cluster RCS2 032727-132623

We present the discovery of an extremely bright and extended lensed source from the second Red Sequence Cluster Survey (RCS2). RCSGA 032727-132609 is spectroscopically confirmed as a giant arc and counter-image of a background galaxy at $z=1.701$, strongly-lensed by the foreground galaxy cluster RCS2 032727-132623 at $z=0.564$. The giant arc extends over $\sim 38$\,\arcsec and has an integrated $g$-band magnitude of 19.15, making it $\sim 20$ times larger and $\sim 4$ times brighter than the prototypical lensed galaxy MS1512-cB58. This is the brightest distant lensed galaxy in the Universe known to date. Its location in the `redshift desert' provides unique opportunities to connect between the large samples of galaxies known at $z\sim3$ and $z\sim1$. We have collected photometry in 9 bands, ranging from $u$ to $K_s$, which densely sample the rest-frame UV and optical light, including the age-sensitive 4000\AA\ break. A lens model is constructed for the system, and results in a robust total magnification of $2.04 \pm 0.16$ for the counter-image; we estimate an average magnification of $17.2 \pm 1.4$ for the giant arc based on the relative physical scales of the arc and counter-image. Fits of single-component spectral energy distribution (SED) models to the photometry result in a moderately young age, $t = 115 \pm 65$\,Myr, small amounts of dust, $E(B-V) \le 0.035$, and an exponentially declining star formation history with \textit{e}-folding time $\tau = 10-100$\,Myr. After correcting for the lensing magnification, we find a stellar mass of $\log(\mathrm{M}/\mathrm{M}_\odot)=10.0 \pm 0.1$. Allowing for episodic star formation, an underlying old burst could contain up to twice the mass inferred from single-component modeling. This stellar mass estimate is consistent with the average stellar mass of a sample of `BM' galaxies ($1.4 < z < 2.0$) studied by Reddy et al. (2006).Comment: 13 pages, 8 figures, abstract abridge

GR-397 Conceptualizing a TOC-Enhanced Chatbot: Pattern Recognition and Interaction

A chatbot is a software which is capable of communicating with human by using natural language processing. In our project, we plan to develop a Python-based chatbot that integrates theory of computation (TOC) concepts, including finite automata and regular expressions. The chatbot will interact with users, recognizing patterns and keywords in their inputs. We’ll begin by defining initial regular expressions for basic user interactions including greetings and inquiries.Future developments may enhance regular expressions and broaden the chatbot’s TOC-related capabilities, creating a versatile educational tool with practical TOC applications

Comparative evaluation of H1 receptor blocking activity and safety of newer H1antagonist mizolastine with loratadine and placebo: a randomized double blind three way crossover study

Background: Histamine is a naturally occurring body constituent synthesized from L-histidine by histidine decarboxylase enzyme that is expressed throughout the body including central nervous system neurons, gastric mucosa, mast cells and basophils. The objective of this study was to compare the pharmacological activity and safety of 10 mg mizolastine, 10 mg loratadine and placebo in healthy human volunteers.Methods: After randomly allocating the 3 drugs, a battery of psychometric tests was done. Histamine prick test for wheal and flare reaction, VAS for sedation and itch followed by salivary flow test were done. Vitals were recorded. The subjects were randomized to receive either of the treatment in a cross-over manner with washout period of 7 days. The wheal and flare areas were recorded before and after 1,2,4,8, and 24 hours.Results: Mean inhibition on histamine induced wheal and flare response with mizolastine was highly significant as compared to placebo from 1 hour onwards (p<0.001) with maximum inhibition of 98.1±1.8% at 4 hours and of 85.1±24.8percent at 8 hours, for wheal and flare, respectively. The mean inhibition on histamine induced response with loratadine was significant from 2 hours (p<0.05) for wheal area and 1 hour onwards up to 24 hours (P<0.01) for flare area with the maximum inhibition of 56.2±31.6 percent and 60.1±14.2percent at 8hours, respectively. Mean inhibition on histamine induced itch with mizolastine was also significant from 4 hours onwards and persisted up to 24 hours (p<0.05) with maximum inhibition of 58.6±54.2% at 8 hours for the itch response, unlike loratidine. There was no significant change in mean effect on sedation assessed on a VAS of 0-100 mm. There was no significant change in psychomotor functions, salivary flow or vital parameters. All were well tolerated.Conclusions: Mizolastine has good antihistaminic activity than loratadine. Neither drug causes any psychomotor impairment or has anti-cholinergic action

A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease

A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease.BackgroundWe prospectively evaluated 3 treatment regimens of argatroban, a direct thrombin inhibitor, for providing adequate, safe anticoagulation in patients with end-stage renal disease (ESRD) during hemodialysis.MethodsIn this randomized, 3-way crossover study, ESRD patients underwent hemodialysis sessions of 3- or 4-hour duration using high-flux membranes and each of 3 argatroban treatment regimens (A: 250-μg/kg bolus, with an additional 250-μg/kg bolus allowed; B: 250-μg/kg bolus followed by 2-μg/kg/min infusion; C: steady-state, 2-μg/kg/min infusion initiated 4 hours before dialysis). Pharmacodynamic effects including activated clotting times (ACTs); hemodialysis efficacy including single-pool Kt/V, urea reduction ratio (URR), and circuit flow; and safety through a 3-day follow-up were monitored. Argatroban pharmacokinetic parameters including dialytic clearance were evaluated during regimen C.ResultsThirteen patients completed 38 hemodialysis sessions (1 patient withdrew consent after 2 sessions). Mean ± SD ACTs increased from 131 ± 14 seconds at baseline to 153 ± 24, 200 ± 30, and 197 ± 33 seconds, respectively, after 60 minutes of hemodialysis using regimens A, B, and C. Across regimens, mean Kt/Vs (1.5–1.6) and URRs (70%-73%) were comparable. No dialyzer was changed; 1 session was shortened 15 minutes because of circuit clot formation. Systemic argatroban clearance increased ∼20% during hemodialysis, without clinically significantly affecting ACTs. Upon argatroban discontinuation, ACTs and plasma argatroban decreased concurrently (elimination half-life, 35 ± 6 min). No thrombosis, bleeding, serious adverse events, or clinically significant changes in vital signs or routine laboratory measures occurred.ConclusionArgatroban, administered by each treatment regimen, provides safe, adequate anticoagulation to enable successful hemodialysis in ESRD patients. Argatroban dialytic clearance by high-flux membranes is clinically insignificant