Assessment of medication adherence using medication adherence rating scale-5 in patients with major non-communicable diseases at tertiary care hospital

Background: To assess the medication adherence using medication adherence rating scale (MARS-5) for achieving good clinical outcomes in patients with major non-communicable chronic diseases who are undergoing long-term therapy and to compare the adherence between adult and geriatric patients based on patient counselling.Methods: A Prospective observational study was conducted in the Department of Medicine, Raja Muthiah Medical College Hospital (RMMCH), Chidambaram, India over a period of 6 months. Patient details were collected using self-designed patient proforma. Patients’ medication adherence was assessed using MARS-5 and patients were counselled regarding drug use with the help of pictograms and daily monitoring sheet.Results: A total of 150 patients were enrolled in the study out of which 77 were adults and 73 were from the geriatric population. 65.33% were affected with comorbid conditions. Non-compliance was mainly due to forgetfulness, lack of assistance in the elderly population, polypharmacy and also due to failing to refill prescriptions. Nearly half of the population about 40% showed poor adherence before patient counselling and was reduced to 13.33% after proper patient counselling. And the medication adherence was found to be more among the adults 90.90% when compared to the geriatric population 82.19%.Conclusions: A new approach through pharmaceutical care was implemented; it mainly aims in delivering information regarding the importance of therapy in non-communicable chronic illness and also on the non-therapeutic considerations. It also focuses in conveying the importance of their lives to their families and to the society, thereby improving the adherence to medicine

Histopathological Analysis of Lung Infections during Pre and Post COVID-19 Eras: Insights from a Four-Year Autopsy Study at a Tertiary Care Hospital in Tirunelveli, Tamil Nadu, India

Introduction: Autopsies are routinely useful in establishing the cause and time of death. The Coronavirus Disease-2019 (COVID-19), a pandemic viral infectious disease, has affected many countries worldwide. In developing countries like India, infectious lung pathology has been a significant cause of death even before the COVID-19 era. However, the emergence of COVID-19, there has been an increase in lung infections due to factors such as prolonged hospital stays, assisted ventilation, lung damage, and immune suppression, affecting both morbid patients and survivors. Aim: To describe the histopathological spectrum of infective lesions of lung in autopsy during Pre COVID-19 and COVID-19 era in a tertiary care hospital of Tirunelveli, Tamil Nadu, India. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, between January 2018 and December 2021. Data including age, sex, COVID-19 status, clinical history, histomorphological patterns, and identification of infectious agents, were collected from clinico-pathological and autopsy documents. A total of 627 lung specimens were available, with 41 specimens being autolyzed, leaving 586 specimens for inclusion in the study. Gross morphology and microscopic features were documented, and diagnoses were made based on these findings. Results: The study included a total of 586 specimens, of which 76 (12.9%) were reported as infective pathology. Among these cases, 29 (38.1%) cases were reported in the pre COVID19 period, and 47 (61.9%) were reported during the COVID19 period. Of the 76 cases, 41 (53.95%) were male, and 35 (46.05%) were female. The number of cases reported during the post COVID-19 period (47 cases, 61.84%) was higher than the number reported during the pre COVID-19 period (29 cases, 38.16%). In both periods, the majority of cases (10 cases, 13.1% in the pre COVID-19 period; 13 cases, (17.1%) in the post COVID-19 period) were observed in individuals aged 60 years and above, followed by those in the age group of 50 to 59 years (7 cases, 9.2%). Similarly, in the pre COVID-19 period; 10 cases, 13.2% in the post COVID-19 period). Among the 76 cases, interstitial pneumonia (9 cases, 11.8%) was the most common finding in the pre COVID-19 period, followed by bronchopneumonia (seven cases, 9.2%). In the COVID-19 period, Tuberculosis (TB) was the most common finding (17 cases, 22.4%), followed by pneumonia with consolidation (10 cases, 13.2%). Additionally, the number of cases diagnosed with pulmonary TB during the COVID-19 period (17 cases, 22.4%) was higher than that during the pre COVID-19 period (6 cases, 7.9%). During the post COVID-19 period, there has been a drastic increase in the number of pneumonia cases compared to the pre COVID-19 era, and this increase is statistically significant with a p-value of 0.04. Conclusion: Pneumonia (lobar pneumonia, interstitial pneumonia, and bronchopneumonia) is the most common histopathological lung lesion in the present study. Compare to pre COVID-19 era, there is increased number of infective lesions during COVID-19 era. There was a drastic increase in pathological findings of Kochs lesion during COVID-19 era

Concentrated Growth Factors as an Ingenious Biomaterial in Regeneration of Bony Defects after Periapical Surgery: A Report of Two Cases

The overall success of a periapical surgery is assessed in terms of regeneration of functional periradicular tissues. The regenerative potential of platelets has been well documented. This article describes the use of concentrated growth factors (CGF), a new family of autologous platelet concentrates, as a sole material for bone regeneration after periapical surgery. 32- and 35-year-old female patients diagnosed with Ellis Class IV, an open apex in 11 with apical periodontitis in 11 and 12 and previously root canal-treated 31 and 41 with a chronic apical abscess, respectively, were managed with endodontic surgery. Subsequent to apicectomy and retrograde filling, the CGF fibrin block and membrane were used before suturing. There was uneventful healing during the immediate post-op and the subsequent follow-up periods. CGF is produced by a differential centrifugation process that results in the formation of a denser fibrin matrix richer in growth factors than those observed in PRF. Reasonable osseous healing was seen as early as 6-month follow-up, thereby recommending the use of CGF as an alternative to bone grafts and membranes in extensive periapical lesions to enhance bone regeneration and to decrease the healing time

Histomorphology and Chemical Constituents of Interdigital Gland of Vembur Sheep, <em>Ovis aries</em>

The interdigital gland is a specialized skin gland located between the digits of Artiodactyla (i.e., even-toed ungulates). Its secretion participates in semiochemical communication, and protects from ultraviolet radiation as well as fungal and bacterial infections of the feet. The present study aimed at finding if there are male-female differences in the anatomy, morphology, and volatile compounds of the interdigital gland of the South Indian breed of Vembur sheep. A total of 24 sheep (12 each of male and female) were spotted at the slaughterhouse and the interdigital gland was removed for examination. The anatomical examination revealed it to resemble a tobacco pipe and to consist of a body, flexure, and excretory duct with an external orifice located at the cleft of the digits. Morphometrically, the interdigital glands differed between males and females. The gland possesses a distinct fibrous capsule, epidermis, and dermis. The fibrous capsule contains several parallel bundles of collagen fibers, nerve fibers, and blood vessels, etc. The epidermis consists of keratinized squamous epithelium formed of stratum basale, stratum granulosum and stratum spinosum. The dermis consists of hair follicles, nerve plexuses, arrector pili muscles, and apocrine and sebaceous glandular lobules. The latter, lined by a simple cuboidal epithelium, are arranged in clusters of acini in the upper portion of the dermis. The apocrine secretory lobules, made up of parenchymal cells, are found in the lower portion of the dermis. The density and diameter of the apocrine and sebaceous secretory lobules were significantly higher in the males than females. Scanning electron microscopic (SEM) analysis confirmed the apocrine and sebaceous secretory components. Twenty-three major compounds were identified in the interdigital gland postings of male and female sheep, among which butanoic acid, 2-methylpropanoic acid, 1-heptanol and octadecanoic acid were present only in the male glandular post, whereas octane, 7-hexyl-tridecane, tetradecane, heptadecane and decanoic acid were present only in the female glandular post. Tetradecanol, tetradecanoic acid and hexadecanol peaks, reportedly antibacterial compounds in pronghorn antelopes, were highly prominent in both male and female sheep. Thus, the interdigital gland of Vembur sheep has two major secretory lobules, namely, sebaceous and apocrine, larger in males than females, which secrete a variety chemical compounds that may serve as chemical communication systems and protect the sheep from foot-borne diseases