Prescription audit in outpatient department of a teaching hospital of North East India

Background: Quality of the prescriptions generated from OPD of Agartala Government Medical College and Govinda Ballabh Pant Hospital is never assessed. The study objectives were to find out the quality in terms of legibility, completeness and adherence to WHO core prescribing indicators of the prescriptions generated from OPD of this hospital.Methods: This hospital based cross-sectional study was conducted during 11th to 16th December 2017 among 442 prescriptions picked up from 12 OPDs by multi stage sampling technique and examined using a checklist designed to assess adherence to WHO core prescribing indicators, legibility and completeness. Data entry and analysis were performed with computer using SPSS 15.0. Descriptive statistics and Chi-square test were used to present data.Results: Total 1169 items were prescribed in 442 prescriptions. Only 50.90% prescriptions were legible. Average number of drugs prescribed per encounter was 2.64, 223 (19.07%) were generic drugs, 14 (1.19%) were injections, 176 (15.05%) were antibiotics and 618 (52.86%) items were from the national essential drug list. History was written in 62.70%, findings were written in 52.70%, diagnosis was written in 40.00%, 87.80% prescriptions contained no review instructions, 84.60% contained complete directions to the pharmacist, 87.10% did not contain complete direction to the patients and signature section was incomplete in 99.80% of the prescriptions. Significantly higher proportions of the high ranked prescribers wrote generic items, review instructions and complete directions to the patients in their prescriptions (p < 0.05).Conclusions: Most of the prescriptions generated from OPD of Agartala Government Medical College and Govinda Ballabh Pant Hospital were found to be incomplete, about half of them were illegible and sizeable proportions did not adhere to the WHO core prescribing indicators

Sero-prevalence of SARS CoV-2 specific antibody among general population of Tripura, India: A baseline observation

Background: Spectrum of COVID-19 disease ranges from asymptomatic or mild symptomatic to life threatening cases. Population based sero-epidemiological studies are useful for assessing the magnitude of COVID-19 infection in a geographic area and it is helpful for planning control measures. Objectives: To estimate the sero-prevalence of SARS CoV-2 antibody in the general population of Tripura and to study the factors associated with it. Methodology: This community based cross-sectional study was conducted from 15th October to 14th November 2020 among 4800 subjects selected from the whole state of Tripura, India by probability proportionate to size sampling technique using 30 clusters. Electrochemiluminescence (eCLIA) based assay was used to test the serum samples for SARS-CoV-2 specific antibody. Data entry and analysis was performed using SPSS-25 for windows and sero-prevalence was expressed in percentages. Binary logistic regression model was used for predicting sero-positivity by including the significant factors associated with SARS-CoV-2 infection as found out by univariate analysis. Result: Sero-prevalence of SARS-CoV-2 antibody was found to be 34% among the general population of Tripura and it varied from 42.4% to 19.7% across different districts. Logistic regression model has identified, urban residency (OR: 1.21, 95% CI: 1.03-1.42), ethnic community (OR: 0.55, 95% CI: 0.48-0.64) and literacy (OR: 1.41, 95% CI: 1.13-1.77) as the independent risk factors for SARS-CoV-2 sero-positivity (p&lt;0.05). Conclusion: Approximately one out of three residents of Tripura has already acquired the novel SARS CoV-2 infection. As the threshold required for achieving herd immunity against COVID-19 is not yet known, control measures need to be continued for preventing further spread of disease in the community

Prevalence of Pre-diabetes and its associated risk factors: A cross-sectional study in West Tripura district of India

Background: Early detection of Pre-diabetes and controlling the risk factors may delay the development of Diabetes and related complications. Objectives: To estimate the prevalence of Pre-diabetes in West Tripura district of India and to study it’s associations with selected risk factors. Methods: This community based cross-sectional study was conducted in West Tripura district of India, during 1st January 2018 to 31st December 2019 among 320 individuals selected by multistage sampling. Fasting blood sugar was tested for diagnosing Pre-diabetes. Data entry and analysis were performed using SPSS-24. Result: Prevalence of Pre-diabetes in West Tripura district was 19.4%, 28.1% were hypertensive and 32.5% had high BMI. Multivariable logistic regression has identified age ≥40 yr (OR: 20.62, 95% CI: 4.97 – 85.49) higher socioeconomic status (OR: 4.99, 95% CI: 1.95 – 12.72), family history of diabetes (OR: 9.72, 95% CI: 2.51 – 37.61), higher BMI (OR: 2.79, 95% CI: 1.32 – 5.89) and physical inactivity (OR: 3.52, 95% CI: 1.66 – 7.46) as the predictors of Pre-diabetes. Conclusion: West Tripura district of India has higher prevalence of pre-diabetes than the national average. Age ≥40 yr, higher socioeconomic status, family history of diabetes, higher BMI and physical inactivity were identified as significant predictors of Pre-diabetes in this region

Prescription audit in outpatient department of a teaching hospital of North East, India

Background: Quality of the prescriptions generated from OPD of Agartala Government Medical College and Govinda Ballabh Pant Hospital is never assessed. The study objectives were to find out the quality in terms of legibility, completeness and adherence to WHO core prescribing indicators of the prescriptions generated from OPD of this hospital.Methods: This hospital based cross-sectional study was conducted during 11th to 16th December 2017 among 442 prescriptions picked up from 12 OPDs by multi stage sampling technique and examined using a checklist designed to assess adherence to WHO core prescribing indicators, legibility and completeness. Data entry and analysis were performed with computer using SPSS 15.0. Descriptive statistics and Chi-square test were used to present data.Results: Total 1169 items were prescribed in 442 prescriptions. Only 50.90% prescriptions were legible. Average number of drugs prescribed per encounter was 2.64, 223 (19.07%) were generic drugs, 14 (1.19%) were injections, 176 (15.05%) were antibiotics and 618 (52.86%) items were from the national essential drug list. History was written in 62.70%, findings were written in 52.70%, diagnosis was written in 40.00%, 87.80% prescriptions contained no review instructions, 84.60% contained complete directions to the pharmacist, 87.10% did not contain complete direction to the patients and signature section was incomplete in 99.80% of the prescriptions. Significantly higher proportions of the high ranked prescribers wrote generic items, review instructions and complete directions to the patients in their prescriptions (p &lt; 0.05).Conclusions: Most of the prescriptions generated from OPD of Agartala Government Medical College and Govinda Ballabh Pant Hospital were found to be incomplete, about half of them were illegible and sizeable proportions did not adhere to the WHO core prescribing indicators

Nature of the Amyloid-β Monomer and the Monomer-Oligomer Equilibrium

The monomer to oligomer transition initiates the aggregation and pathogenic transformation of Alzheimer amyloid-β (Aβ) peptide. However, the monomeric state of this aggregation-prone peptide has remained beyond the reach of most experimental techniques, and a quantitative understanding of this transition is yet to emerge. Here, we employ single-molecule level fluorescence tools to characterize the monomeric state and the monomer-oligomer transition at physiological concentrations in buffers mimicking the cerebrospinal fluid (CSF). Our measurements show that the monomer has a hydrodynamic radius of 0.9 ± 0.1 nm, which confirms the prediction made by some of the in silico studies. Surprisingly, at equilibrium, both Aβ40 and Aβ42 remain predominantly monomeric up to 3 μm, above which it forms large aggregates. This concentration is much higher than the estimated concentrations in the CSF of either normal or diseased brains. If Aβ oligomers are present in the CSF and are the key agents in Alzheimer pathology, as is generally believed, then these must be released in the CSF as preformed entities. Although the oligomers are thermodynamically unstable, we find that a large kinetic barrier, which is mostly entropic in origin, strongly impedes their dissociation. Thermodynamic principles therefore allow the development of a pharmacological agent that can catalytically convert metastable oligomers into nontoxic monomers

Two Distinct Amyloid β-Protein (Aβ) Assembly Pathways Leading to Oligomers and Fibrils Identified by Combined Fluorescence Correlation Spectroscopy, Morphology, and Toxicity Analyses*

Nonfibrillar assemblies of amyloid β-protein (Aβ) are considered to play primary roles in Alzheimer disease (AD). Elucidating the assembly pathways of these specific aggregates is essential for understanding disease pathogenesis and developing knowledge-based therapies. However, these assemblies cannot be monitored in vivo, and there has been no reliable in vitro monitoring method at low protein concentration. We have developed a highly sensitive in vitro monitoring method using fluorescence correlation spectroscopy (FCS) combined with transmission electron microscopy (TEM) and toxicity assays. Using Aβ labeled at the N terminus or Lys16, we uncovered two distinct assembly pathways. One leads to highly toxic 10–15-nm spherical Aβ assemblies, termed amylospheroids (ASPDs). The other leads to fibrils. The first step in ASPD formation is trimerization. ASPDs of ∼330 kDa in mass form from these trimers after 5 h of slow rotation. Up to at least 24 h, ASPDs remain the dominant structures in assembly reactions. Neurotoxicity studies reveal that the most toxic ASPDs are ∼128 kDa (∼32-mers). In contrast, fibrillogenesis begins with dimer formation and then proceeds to formation of 15–40-nm spherical intermediates, from which fibrils originate after 15 h. Unlike ASPD formation, the Lys16-labeled peptide disturbed fibril formation because the Aβ16–20 region is critical for this final step. These differences in the assembly pathways clearly indicated that ASPDs are not fibril precursors. The method we have developed should facilitate identifying Aβ assembly steps at which inhibition may be beneficial