Recent Update on Serum Alkaline and Acid Phosphatases in Pre- and Postoperative Breast Cancer Patients

Background: Breast carcinoma in females is an ever-growing malaise with significant mortality and morbidity. In resource-poor settings, the need for a cost-effective and reliable diagnostic tool is of utmost importance.Methods: In the present study, 54 histopathologically proven breast cancer patients were investigated for their pre- and postoperative serum ALP and ACP levels.Results: A total of 34 cases (belonging to the age interval of 40–60 years) exhibited a significant drop in serum ALP level after surgery (P = 0.002). Although the serum ACP also showed a postoperative decline, it was not as significant as that of serum ALP.Conclusion: The role of serum ALP and ACP in the diagnosis, prognosis, and monitoring/surveillance of breast carcinoma cannot be underestimated particularly in third-world countries lacking in medical infrastructure or resource-poor settings. Keywords: alkaline phosphatase, acid phosphatase, breast cancer, malignanc

A case report on usage of rituximab on complicated steroid-dependent nephrotic syndrome

Nephrotic syndrome (NS) is one of the common yet challenging childhood disease. Treating NS with immunosuppressants like corticosteroids is typically effective. However, there are significant evidences which displayed resistance patterns to the former drugs. Here in this case, a male patient came to the nephrology department with the history of steroid dependant nephrotic syndrome with complaint of its infrequent relapse. The condition was complicated since, the patient was on multiple steroids even after which there were recurrent episodes of syndrome. Considering the status, Mycophenolate mofetil was added as a supportive treatment for the management of the disease along with steroids, still the outcome was unremarkable. Hence, rituximab was ordered (four cycles). The outcome this time was appreciable, rituximab administration produced a positive result. No events were recorded during the treatment duration.

A case report on Kawasaki disease

Kawasaki disease (KD) is an acute vasculitis of children that leads to coronary artery aneurysms in ≈ 25 of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disorder in children in developed countries. The diagnosis of KD is made on basis on the clinical findings. Atypical KD includes patients who don't meet all the criteria for opinion. The main complication of Kawasaki complaint is coronary aneurysm, and the treatment is intravenous immunoglobulin and aspirin. Another dose of immunoglobulin is given if the patient doesn't ameliorate, and several other treatment options have been proposed over the last many years as alternate and third line options. The AHA criteria, which incorporate suggestions for laboratory tests and early echocardiography, are helpful for diagnosing incomplete KD. Diagnosis is based on the presence of fever lasting longer than 5 days and four of five specific clinical criteria. In Japan, at least five of six criteria (fever and five other clinical criteria) should be fulfilled for the determination of KD. From the Japanese circulation society joint working groups criteria (JCS 2008, Guidelines for diagnosis and management of cardiovascular sequela in KD), KD can be diagnosed indeed when fever lasts lesser than 5 days. Though, according to the American heart association (AHA) criteria, fever lasting more than 5 days is essential for KD diagnosis. The use of intravenous immunoglobulin is well established in KD. Aspirin has been used in KD for anti-inflammatory effect, and low-dose aspirin is recommended to reduce the risk of thrombosis

A study of drug utilization pattern using WHO prescribing indicators in pediatric patients

Background: The study aimed to get drug utilization pattern using WHO prescribing indicators in pediatric patients. Methods: It was an observational prospective study carried out in pediatric in-patients with a sample size of 280 patients based on inclusion, and exclusion criteria for a period of 6 months. The study data were collected using patient case record and analysis was done. Results: Out of 280 patients data collected, majority of patients were in the gender male category 168 (60%) and many were from the age group of early childhood (1-5 years) 126 (45%). Respiratory tract infections were the major diagnosis made among the sample size. The drug class commonly prescribed were oral antibiotics 261 (28.38%). The average number of drugs per prescription were 3.28%. Among the total number of prescription percentage of drugs prescribed by generic name and antibiotics were 2.7%, 76.07%. Percentage of patients prescribed with injection were 79.28%. Conclusions: This study highlights WHO prescribing core indicators in evaluating the usage of rational prescription. It helps in reinforcing rational prescribing practices and increases awareness among physicians and medical students. Irrational prescriptions may result in harmful events. A rational prescription should follow the standard treatment guidelines of WHO. The assessment of these indicators can also help us to decrease the cost burden on the patient. Continuous education with focus on rational drug usage and evidence-based medicine can further increase the understanding and improves health care policies

Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians

Aim: To evaluate the clinical and biochemical profile of patients with non alcoholic fatty liver disease (NAFLD) and to assess their histological severity at presentation. Methods: Consecutive patients presenting to the liver clinic of All India Institute of Medical Sciences (AIIMS) with raised transaminases to at least 1.5 times upper limit of normal, and histologically confi rmed non-alcoholic fatty liver disease were included. Patients who had significant alcohol intake or positive markers of other liver diseases or who were taking drugs known to produce fatty liver were excluded. The clinical, biochemical and histological profi le of this group was studied. Results: Fifty-one patients with NAFLD formed the study population. Their median age and BMI were 34(17-58) years and 26.7(21.3-32.5) kg/m2 respectively and 46 (90.1%) were males. The majority of the patients had mild inflammation, either grade 1 [32 (63%)] or grade 2 [16 (31%)] and only 3 (6%) patients had severe (grade 3) infl ammation. Twenty-three (45%), 19 (37%), 8(16%) and 1(2%) patient had stage 0, 1, 2 and 3 fi brosis respectively on index biopsy and none had cirrhosis. On univariate analysis, triglyceride levels more than 150 mg % (OR = 7.1; 95% CI: 1.6-31.5, P = 0.002) and AST/ALT ratio > 1 (OR = 14.3; 95% CI: 1.4-678.5, P = 0.008) were associated with high grades of inflammation and none was associated with advanced fibrosis. On multivariate logistic regression analysis, hypertriglyceridemia >150 mg% was the only factor independently associated with presence of high grade of infl ammation (OR = 1.6; 95% CI: 1.3-22.7, P = 0.02), while none was associated with advanced fi brosis. Triglyceride levels correlated positively with infl ammatory grade (r = 0.412; P = 0.003). Conclusion: NAFLD in North Indian patients is a disease of young over-weight males, most of whom are insulin resistant and they tend to have a mild histological disease at presentation

A Holistic Approach for Achieving Impact through CSR

Food and nuuitional security of projected population of 9.7 billion globally and 1.7 billion in India by 2050 is the major challenge of the 21st century. Alongside the challenge is to improve farmers' income and upgrade agriculture is a business to make It attractive to the youth and generate livelihood options through value chain, as 55% of the youth population in India is dependent on agriculture and allied sectors..

An approach of clinical pharmacist pertaining to solve drug related problems in pediatric patients

Background: The objectives of the study were to assess the outcomes of clinical pharmacist intervention in solving drug related problems in pediatric patients and to identify the drug related problems in accordance with the causes observed.Methods: It was a prospective observational study done over a period of six months (October 2019 to March 2020) at Apollo children’s hospital in Chennai.Results: Total of 480 subjects were enrolled into the study, out of which 248 were male children and 232 were female children. The patients were divided into 4 age groups. In this study 60.41% pediatric patients were prescribed with less than 5 drugs 290 (60.41%). Drug related problems which were identified during the study was classified according to Pharmaceutical Care Network Europe (PCNE) and drug-related problem (DRP) classification (v9.00). The most frequent DRP was drug choice problem 37 (33.33%). The total number of caused drug related problems was 73 and same number of interventions was given by clinical pharmacist. The most frequent cause of drug related problems was identified as dose selection 31 (42.46%). Outcomes of interventions revealed that 70 (95.89%) problems were solved overall.Conclusions: In this study, clinical pharmacist’s level of involvement has shown interesting results. Moreover, they play an essential role in improving patient safety and outcome, reducing cost and providing quality of care for ill patients

Enhancing Resource Use Efficiency Through Soil Management for Improving Livelihoods

Sustainable intensification and improvement in farm-based livelihoods particularly in dryland tropics are the biggest challenges of the century. Widespread soil degradation, growing water scarcity, and looming threat of climate change further compound the problem of achieving food and nutritional security along with improved livelihoods. Large yield gaps in drylands provide a huge opportunity to increase the food production for future food security and mainstreaming of drylands. Soil management for correcting micro and secondary nutrient deficiencies has shown to increase crop productivity by 20–66% in Karnataka, India. During 2009–2013 in this state, more than 5 million farmers benefitted and net economic benefits through increased production were estimated to the tune of US$353 million (Rs. 1963 crores). Balanced nutrition led to increased nitrogen uptake efficiency, utilization efficiency, and use efficiency for grain yield and harvest index. Best practices like soil test-based fertilization including micronutrients and improved cultivars also contribute to increasing rainwater use efficiency in crops by channelizing unproductive evaporation loss into productive transpiration. In current rainy fallow regions, the landform management like broadbed and furrow along with balanced nutrition has shown that fallow lands in black soil regions in Madhya Pradesh can be successfully cultivated to grow soybean crop. Similarly soil fertility management along with other best practices provides opportunities for intensification through cultivating 11.4 million ha rice fallow in India by growing of early maturing chickpea. Thus, efficient rainy and post-rice fallow management is a way forward to enhance land use efficiency for higher productivity and incomes. Along with productivity and economic benefits, improved soil-nutrient-crop-water management is found to contribute to organic C building, enhancing microbial activity and resilience building of production systems. Efficient soil management thus serves as a foundation to enhance livelihoods through resource-efficient production and providing opportunities for scaling up

Determination of insecticide resistance in cotton whitefly in north India

The whitefly, Bemisia tabaci (Gennadius) considered as most destructive pest, poses a significant threat to various crop species globally has developed resistance due to the indiscriminate use of synthetic chemicals. A study was carried out in 2018 at ICAR-Indian Agricultural Research Institute, New Delhi to determine insecticide resistance, in five Asia II 1 populations of B. tabaci from different cotton (Gossypium hirsutum L.) growing regions of north India. The susceptibility of the populations to different insecticide classes, viz. synthetic pyrethroid (cypermethrin); neonicotinoids (imidacloprid and thiamethoxam); thiourea (diafenthiuron) and diamide (cyantraniliprole) were assessed. Results revealed substantial heterogeneity in the responses of these populations to the insecticides. Sriganganagar and Bathinda populations exhibited moderate resistance to cypermethrin, imidacloprid, and thiamethoxam. Low level of resistance was observed in Bathinda and Sriganganagar populations against diafenthiuron. All populations were highly susceptible to cyantraniliprole. No cross-resistance was observed between cyantraniliprole and other insecticides, suggesting its potential as an alternative for managing insecticide resistance. High levels of detoxification enzymes (esterase, cytochrome P450 monooxygenase, and glutathione-S-transferase) in Sriganganagar and Bathinda populations indicated a positive correlation between insecticide resistance and detoxifying enzymes. These findings offer valuable insight for implementing insecticide rotation strategies to combat B. tabaci resistance in India

Improving water use in tropical rain-fed systems: the situation in India Crops Research Institute for the Semi-Arid Tropics (ICRISAT), India

Providing global food security for an ever-growing population, predicted to reach nine billion by 2050, and reducing poverty are challenging tasks. Growing per capita income in the emerging giant economies such as Brazil, Russia, India, China and South Africa (BRICS) means increased pressure on global food production due to changing food habits. This increased food production has to be met using finite water and land resources. The quantity of available water and land has not increased since 1950, but the availability of water and land per capita has declined significantly due to an increased global human population. For example, in India, per capita water availability has decreased from 5177 m3 in 1951 to 1625 m3 in 2011 due to the population increasing from 361 million in 1951 to 1.15 billion in 2011, which is expected to rise to 1.39 billion by 2025 and 1.64 billion by 2050, with an associated decrease in per capita water availability of 1345 m3 in 2025 and 1140 m3 by 2050 (Wani et al., 2012). The distribution of water and land resources varies in different countries and regions of the world, and the current population is expected to increase rapidly. In this chapter, we analyse the current status of agricultural water use in tropical rain-fed areas, assess the potential and propose a new paradigm to manage agricultural water efficiently by adopting various land, water, nutrient and crop management technologies