Utilization pattern of drugs among patients attending geriatric outpatient department in a tertiary care hospital in Kashmir

Background: Quality and safety of prescribing in older people remains a global healthcare concern and inappropriate prescribing is a major public health issue because of its direct association with morbidity, mortality and wastage of health resources in this age group. Very limited data is available on the drug utilization pattern in geriatric population and the present study was carried out to see the prescription pattern in geriatric population in this part of the world.Methods: The present study was conducted by the department of pharmacology in outpatient department of geriatrics in a tertiary care centre to look into the prescription pattern among geriatric age group.Results: A total of 237 prescriptions were collected, out of which 108 (45.56%) were males and 129 (54.44%) were females. The majority of the patients were in the age group of 60-69 years (n=141, 59.5%). The most commonly found comorbidity was hypertension (63.29%) and antihypertensive agents (74.68%) were the most frequently prescribed class of drugs. Calcium (37.57%), budesonide (32.91%), thyroxine (27.84%) and pantoprazole (25.31%) were the most common individual drugs prescribed.Conclusions: Like other studies on geriatric population polypharmacy was also observed in the present study and periodic therapeutic audit is essential to ensure rational medicine use

Quantum Field Theory in de Sitter spacetime

In this paper we will analyse quantum field theory on de Sitter spacetime. We will analyse a general scalar and vector field theory on de Sitter spacetime. This is done by first calculating these propagators on four-Sphere and then analytically continuing it to de Sitter spacetime

Climatic Events and Natural Disasters of 21st Century: A Perspective of Pakistan

In recent years, the frequent occurrence of natural calamities in the world has gained much attention due to infrastructure and life losses. Increase in global temperature has threatened the earth’s climate, causing unpredictable and extreme weather events more often. These events were both short-term as well as long-term. In spite of insufficient monitoring coverage of inner areas and high altitudes, an intensification of average yearly temperature has been observed after the 20th century in many regions of Asia. Pakistan has faced a number of natural disasters including severe floods, devastating earthquakes, disturbing droughts, distressing smog, extreme temperature and torrential rainfall patterns. These calamities have affected people economically, socially, physically and mentally by posing a threat to earth, its species and their livelihood. This paper was aimed to document the natural calamities in Pakistan since the beginning of 21st century till date. The country is facing the problem of intense and longer summers and has witnessed two intense heat waves. Moreover, in some areas, extensive droughts are threatening crops, freshwater supply and wildlife. In recent years, the problem of smog has emerged in Pakistan, especially in Punjab. The problem is getting worse in every coming year due to overpopulation, cities expansion, increased emission of greenhouse gases, open burning of crop residues and extreme reliance on fossil fuels for energy purpose. So far in this century, Pakistan has faced 3 droughts, 2 heat waves, 10 severe floods, 27 major earthquakes, 2 consecutive sessions of severe smog and extreme high and low temperature events. Some of the deadliest events were; 2005 Kashmir earthquake claiming 87,350 human lives and 2010 flood impacting nearly 20 million people with 1,781 causalities. Change in climate is posing a severe threat to species, livelihood of the human beings and the earth. Global warming is causing warming of oceans and consequently rise in sea level. Climate change affects average as well as extreme temperatures hence increasing the probability climate-related disasters. Thus, global warming is causing a chain of catastrophic events that make the problem even more complex to understand

Efficacy of Various Treatment Modalities on Patientrelated Outcome in Hospitalized COVID-19 Patients –A Retrospective Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in China, in December 2019, and was declared a pandemic by WHO on March 11, 2020. The treatment is evolving and is mostly supportive in nature. Material and methods: This was a single-center retrospective study that included confirmed COVID-19 cases treated at our institute (a tertiary care hospital in Jammu and Kashmir, India), between March 2020 and December 2020. Patients with age more than 18 years were included in the study. Results: On evaluating the effect of various drug therapies used in management of COVID-19 patients of all severity, use of remdesivir and famotidine was associated with significantly higher odds of survival. In subgroup of patients with severe disease, use of systemic steroids was associated with significantly higher odds of survival in addition to remdesivir and famotidine. In patients with severe COVID-19 illness, likelihood of survival was significantly higher in those who received combination of systemic steroids plus remdesivir compared to steroids and remdesivir alone. Conclusion: Steroids were effective in severe COVID-19 illness and the combination of steroids and remdesivir was more effective in severe illness. There is a need to undertake more large scale prospective randomized trials to determine the most effective drug therapies to treat the sick patients and prevent worsening of mild cases

Zinc nutrition and arbuscular mycorrhizal symbiosis effects on maize (Zea mays L.) growth and productivity

Zinc (Zn) is an essential micronutrient required to enhance crop growth and yield. In the arid – semiarid region, Zn deficiency is expected due to alkaline calcareous soil. Contrarily, Zn toxicity is also becoming an environmental concern due to increasing anthropogenic activities (metal smelting, copper industry, etc.). Therefore, balanced Zn application is necessary to save resources and achieve optimum crop growth and yield. Most scientists suggest biological approaches to overcome the problem of Zn toxicity and deficiency. These biological approaches are mostly environment-friendly and cost-effective. In these biological approaches, the use of arbuscular mycorrhizae fungi (AMF) symbiosis is becoming popular. It can provide tolerance to the host plant against Zn-induced stress. Inoculation of AMF helps in balance uptake of Zn and enhances the growth and yield of crops. On the other hand, maize (Zea mays L.) is an important cereal crop due to its multifarious uses. As maize is an effective host for mycorrhizae symbiosis, that's why this review was written to elaborate on the beneficial role of arbuscular mycorrhizal fungi (AMF). The review aimed to glance at the recent advances in the use of AMF to enhance nutrient uptake, especially Zn. It was also aimed to discuss the mechanism of AMF to overcome the toxic effect of Zn. We have also discussed the detailed mechanism and physiological improvement in the maize plant. In conclusion, AMF can play an imperative role in improving maize growth, yield, and balance uptake of Zn by alleviating Zn stress and mitigating its toxicity

Synchronization of Boron application methods and rates is environmentally friendly approach to improve quality attributes of Mangifera indica L. on sustainable basis

Micronutrient deficiency in the soil is one of the major causes of mango fruit and yield's poor quality. Besides, the consumption of such a diet also causes a deficiency of micronutrients in humans. Boron deficiency adversely affects the flowering and pollen tube formation, thus decreasing mango yield and quality attributes. Soil and foliar application of B are considered a productive method to alleviate boron deficiency. A field experiment was conducted to explore the Boron most suitable method and application rate in mango under the current climatic scenario. There were nine treatments applied in three replications. The results showed that application of T8 = RD + Borax (75 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) and T9 = RD + Borax (150 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) significantly enhanced the nitrogen, potassium, proteins, ash, fats, fiber, and total soluble solids in mango as compared to the control. A significant decrease in sodium, total phenolics contents, antioxidant activity, and acidity as citric acid also validated the effective functioning of T8 = RD + Borax (75 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) and T9 = RD + Borax (150 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) as compared to control. In conclusion, T8 = RD + Borax (75 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) and T9 = RD + Borax (150 g plant -1 as a basal application) + H3 BO3 (0.8% as a foliar spray) is a potent strategy to improve the quality attributes of mango under the changing climatic situation

Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

Background: Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.Methods: From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.Results: From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46-81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4 days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.Conclusions: In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Disseminated candidiasis: A rare presentation of acute leukemia

Disseminated fungal disease most commonly found in patients with hematologic malignancies or immunecompromised state, is rarely seen. Though the reported prevalence ranges from 20% to 40%, most fungal microabscesses occur in leukemic patients and are caused by candida albicans; others include cryptococcosis, mucormycosis and histoplasmosis. Hepatosplenic candidiasis also known as chronic disseminated candidiasis has been described in patients with acute leukemia following recovering from neutropenia, pathogenesis of which is not understood, thought to be due to exacerbated inflammatory reaction resulting in an immune reconstitution inflammatory syndrome. The purpose of presenting this case is to describe variable presentation of disseminated candidiasis which can be presenting feature of acute leukemia even without neutropenia and atypical radiological pattern in hepatosplenic candidiasis

Effectiveness of sodium thiopentone, propofol, and etomidate as an ideal intravenous anesthetic agent for modified electroconvulsive therapy

Introduction: Electroconvulsive therapy (ECT) is a well-established psychiatric treatment in which seizures are electrically induced in patients for therapeutic effects. ECT can produce severe disturbances in the cardiovascular system and a marked increase in cerebral blood flow and intracranial pressure. These cardiovascular changes may be altered using various anesthetic drugs. Aim and Objectives: This study was undertaken to compare the effects of intravenous (IV) sodium thiopentone, propofol, and etomidate, used as IV anesthetic agents in modified ECT as regards, induction time and quality of anesthesia, alteration of hemodynamics, seizure duration, and recovery time. Materials and Methods: A total of 90 patients in the age group of 16–60 years of either sex, who had to undergo ECT therapy were divided randomly into three equal groups. Group A received propofol 1% - 1.5 mg/Kg, Group B received etomidate - 0.2 mg/Kg, and Group C received thiopentone 2.5% - 5 mg/Kg. All the patients were monitored for changes in heart rate, systolic blood pressure, diastolic blood pressure, and oxygen saturation at basal, after induction and 1 min, 2 min, 3 min, 5 min, 10 min, 20 min, and 30 min following ECT. Quality of anesthesia, seizure duration, and recovery times were also recorded. Conclusion: We found that propofol had the advantage of smooth induction, stable hemodynamic parameters and rapid recovery as compared to etomidate and thiopentone. Thiopentone had the advantage over propofol of having longer seizure duration at the cost of a relatively prolonged recovery period. Etomidate had a definite advantage of longer seizure duration