Drug utilization study in the paediatric department of a tertiary care teaching hospital

Background: Rational drug use is one of the main concerns of the health care system in India. Paediatric population being more vulnerable require additional focus to achieve this goal. Objectives of the study were to evaluate the prescription patterns according to WHO guidelines and the diseases, for which they are being prescribed, to identify the common diseases and common medications used.Methods: A cross sectional study was done in the paediatrics department for a period of 2 months. All the paediatric prescriptions were evaluated using WHO core indicators like average number of medicines per encounter, percentage of medicines from the essential drug lists and also complimentary indicators like utilization of different dosage forms and diagnostic patterns. Statistical Analysis: Data was analyzed and represented as frequency (n) and percentage (%).Results: 89 out of 302 prescriptions had 2 medicines per encounter, 100% of medicines were included from the Essential Drug List (EDL), 59.4% of the medicines were in generic format of prescription.Conclusions: This study gives a positive outlook at the utilization pattern of drugs with all the indicators specifically Essential Drugs List. Regular auditing, continuous medical education and evidence-based medicine can help in improving the health care

Nicotine Replacement Therapy in Dental Settings: An Exploratory Survey in ‎Bangalore City, India

Background: Smoking and other forms of tobacco use remain the most significant worldwide public health problem. The dental practice is being identified as potential location for smoking cessation activity. Nicotine replacement therapy (NRT) promotes the chances of tobacco cessation, however, evidence related to prescription of the NRT in dental settings is lacking. This study aimed to assess and compare the attitudes, practices, beliefs, and barriers in prescribing NRT for tobacco cessation among dental interns and post-graduates (PGs). Methods: For a cross-sectional survey among 232 participants from 10 dental colleges in Bangalore, India, a 21-item questionnaire was developed: 11-item based on attitudes and practices toward tobacco cessation and 10-items regarding scope and challenges in prescribing NRT. The data were analyzed using descriptive statistics, chi-square test, and test of proportions. Findings: Majority of participants reported ongoing tobacco cessation activity in their college. Statistically significant difference was found between interns and PGs for items related to tobacco cessation practice (assisting, providing follow-up visit). Regarding NRT, significant differences were seen for items related to practice (assisting, assessing motivation for NRT), belief (not an appropriate activity for dentist, a valuable resource, increase in quit attempts) and barriers (bitter taste, cost, and fear of addiction) (P < 0.050). The majority of the PGs suggested cessation center followed by health care workers and pharmacists for the provision of subsidized nicotine gums. Conclusion: Favorable practices and beliefs are seen regarding the prescription of NRT among interns and PGs although differences exist. Time, cost, and taste emerged as major barriers

Isolation and characterization of altered root growth behavior and salinity tolerant mutants in rice

Generation, screening and isolating mutants for any developmental and adaptive traits plays a major role in plant functional genomics research. Identification and exploitation of mutants possessing contrasting root growth behavior and salinity tolerance in rice will help us to identify key genes controlling these traits and in turn will be useful for manipulating abiotic stress tolerance through tilling and genetic engineering in rice. In this study, we have screened about 1500 mutants (M2 generation) generated by treating an upland drought tolerant genotype Nagina 22 with Ethyl Methane Sulfonate (EMS), for their root growth behavior and salinity tolerance under hydroponic conditions. Six independent mutant lines possessing significantly shorter roots and three mutant lines exhibiting greater degree of salinity tolerance than the wild type plants were identified. The identified mutant lines were advanced to M5 generation to allow the mutants to reach homozygosity, and the fixed mutants were confirmed for their phenotype. One mutant namely N22-C-241-5-6 was found to possess significantly shorter roots than wild type N22, and it was also noticed that the mutant was devoid of root cap. Among the three salinity tolerant mutant lines identified, N22-C-334-3 was found to possess a greater degree of tolerance upto 250 mM Nacl stress at germination stage. These identified mutant lines can be used for further physiological, biochemical and molecular biology experiments to identify candidate gene(s) controlling root growth behavior and salinity tolerance in rice.Keywords: Rice, mutation, EMS, altered rood growth and salinity tolerant mutantAfrican Journal of Biotechnology Vol. 12(40), pp. 5852-585

The Efficacy of Plant-Based Dietary Program in Patients with Diabetes: A Pilot Study

Dietary choices play a key role in insulin sensitivity among diabetes patients. An 8-week pilot study was conducted to evaluate whether a mostly plant-based dietary program will lead to improvement in biochemical markers in adults with diabetes. The dietary program included educational presentations, weekly cooking demonstrations and small group discussions. A sample of thirty-two adults with diabetes (types 1 and 2) were recruited and seventeen (53%) completed the study. Matched-pair tests and Fishers exact tests were used to compare the changes in means and proportion of the participants’ responses. There were changes in HbA1c, lipids, CRP (mg/L), cholesterol (mg/dL), HDL (mg/dL), triglycerides (mg/dL), LDL (mg/dL), non-HDL (mg/dL), Insulin (uIU/mL), AST (U/L), ALT (U/L), weight (lbs), systolic blood pressure (mmHg), diastolic (mmHg). The mean (std) age for the matched pair participant is 60.5 (11.35). Five type 1 and twelve type 2 diabetes patients showed a significant improvement in HbA1c (p = 0.001), weight (p = 0.002), intake of vegetables per day (p-value = 0.003), intake of plant-based protein (p-value \u3c 0.001) and self-reported reduction in fatigue and improvement in energy levels. Our 8-week dietary program showed an improvement in biochemical markers and positive attitudes toward the adoption of plant-based diets

Mechanistic Studies on the Mononuclear Zn\u3csup\u3eII\u3c/sup\u3e-Containing Metallo-β-lactamase ImiS from \u3cem\u3eAeromonas sobria\u3c/em\u3e

In an effort to understand the reaction mechanism of a B2 metallo-β-lactamase, steady-state and pre-steady-state kinetic and rapid freeze quench electron paramagnetic resonance (EPR) studies were conducted on ImiS and its reaction with imipenem and meropenem. pH dependence studies revealed no inflection points in the pH range of 5.0−8.5, while proton inventories demonstrated at least 1 rate-limiting proton transfer. Site-directed mutagenesis studies revealed that Lys224 plays a catalytic role in ImiS, while the side chain of Asn233 does not play a role in binding or catalysis. Stopped-flow fluorescence studies on ImiS, which monitor changes in tryptophan fluorescence on the enzyme, and its reaction with imipenem and meropenem revealed biphasic fluorescence time courses with a rate of fluorescence loss of 160 s-1 and a slower rate of fluorescence regain of 98 s-1. Stopped-flow UV−vis studies, which monitor the concentration of substrate, revealed a rapid loss in absorbance during catalysis with a rate of 97 s-1. These results suggest that the rate-limiting step in the reaction catalyzed by ImiS is C−N bond cleavage. Rapid freeze quench EPR studies on CoII-substituted ImiS demonstrated the appearance of a rhombic signal after 10 ms that is assigned to a reaction intermediate that has a five-coordinate metal center. A distinct product (EP) complex was also observed and began to appear in 18−19 ms. When these results are taken together, they allow for a reaction mechanism to be offered for the B2 metallo-β-lactamases and demonstrate that the mono- and dinuclear ZnII-containing enzymes share a common rate-limiting step, which is C−N bond cleavage

Construction of Data Driven Decomposition Based Soft Sensors with Auto Encoder Deep Neural Network for IoT Healthcare Applications

The architecture of IoT healthcare is motivated towards the data-driven realization and patient-centric health models, whereas the personalized assistance is provided by deploying the advanced sensors. According to the procedures in surgery, in the emergency unit, the patients are monitored till they are stable physically and then shifted to ward for further recovery and evaluation. Normally evaluation done in ward doesn’t suggest continuous parameters monitoring for physiological condition and thus relapse of patients are common. In real-time healthcare applications, the vital parameters will be estimated through dedicated sensors, that are still luxurious at the present situation and highly sensitive to harsh conditions of environment. Furthermore, for real-time monitoring, delay is usually present in the sensors. Because of these issues, data-driven soft sensors are highly attractive alternatives. This research is motivated towards this fact and Auto Encoder Deep Neural Network (AutoEncDeepNN) is proposed depending on Health Framework in the internet assisting the patients with trigger-based sensor activation model to manage master and slave sensors. The advantage of the proposed method is that the hidden information are mined automatically from the sensors and high representative features are generated by multiple layer’s iteration. This goal is consistently achieved and thus the proposed model outperforms few standard approaches which are considered like Hierarchical Extreme Learning Machine (HELM), Convolutional Neural Network (CNN) and Long Short-Term Memory (LSTM). It is found that the proposed AutoEncDeepNN method achieves 94.72% of accuracy, 41.96% of RMSE, 34.16% of RAE and 48.68% of MAE in 74.64 ms

Fallopian tube as a cause of intestinal obstruction: a rare case report with review of literature

Adhesive Intestinal obstruction is the most common cause of intestinal obstruction in post-operative period. Diagnosis is based on history, clinical examination, plain X-ray abdomen. Authors here report an interesting case of intestinal obstruction after surgery for chronic calcific pancreatitis with pancreatic duct stone with intractable pain. In post-operative period patient developed features of intestinal obstruction, patient was planned for re- exploration and it was found that band was formed by left fallopian tube with transition point at terminal ileum and treated successfully with left Salpingectomy. Very few cases of fallopian tube as cause of intestinal obstruction have been reported in literature and it should be considered as one of the cause of intestinal obstruction in females presenting with acute abdomen

Snake bite mimicking brain death

A 6 year old girl woke up with pain and increasing swelling over the left hand and difficulty in breathing. On examination, she had swelling of the left forearm and hand, flaccid quadriparesis and was in respiratory failure requiring mechanical ventilation. Two clean puncture wounds were identified on the left thumb. A provisional diagnosis of snake bite with severe envenomation was made and she was given anti snake venom therapy. Over a period of about 4 hours her weakness progressed. She became areflexic, developed internal and external ophthalmoplegia and loss of other brain stem reflexes mimicking brain death. Mechanical ventilation was continued despite features suggestive of brain stem dysfunction. About 36 hours after ventilation she showed a flicker of movement of her fingers and gradually the power improved. She was weaned off the ventilator and extubated after 5 days. External ophthalmoplegia is an established association with cobra envenomation, but, this combination of internal and external ophthalmoplegia can mimic brain death and pose a dilemma to the caregivers regarding continuation of therapy

Breastfeeding practices based on the gestational age and weight at birth in the first six months of life in a population-based cohort of infants from North India

BackgroundShort and long term benefits of early Initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in the first six months of life are well established and recommended globally. However, reliable estimates of breastfeeding practices and impact of breastfeeding counselling interventions according to gestational age and weight at birth are not available in low and middle income countries.ObjectiveTo assess the impact of breastfeeding counselling on EIBF and EBF during the first 6 months of life according to gestational age and weight at birth.MethodsWe analysed the data collected from the Women and Infants Integrated Interventions for Growth Study (WINGS), an individually randomized factorial design trial. Mothers were counselled on EIBF during third trimester of pregnancy. They were supported throughout the first 6 months to continue EBF by early problem identification, frequent home visits and assistance in expressing breastmilk when direct breastfeeding was not possible. Breastfeeding practices were ascertained through 24 h recalls at infant ages 1, 3 and 5 months for both the intervention and control groups by an independent outcome ascertainment team. The World Health Organization (WHO) definitions were used for classification of infant breastfeeding practices. Generalized linear models of the Poisson family with a log-link function were used to estimate the effect of interventions on breastfeeding practices. The relative measures of effect on breastfeeding practices were estimated in term appropriate for gestational age (T-AGA), term small for gestational age (T-SGA), preterm AGA (PT-AGA), preterm SGA (PT-SGA) infants.ResultsAmongst all infants irrespective of gestational age and weight at birth, EIBF was (51.7%) higher amongst the intervention group (IRR 1.38, 95% CI 1.28–1.48) compared with the control group. The proportion of exclusively breastfed infants at ages 1 month (IRR 1.37, 95% CI 1.28–1.48), 3 months (IRR 2.13, 95% CI 1.30–1.44) and 5 months (IRR 2.78, 95% CI 2.58–3.00) were higher in intervention group than control group. We identified significant interaction (p value for interaction &lt;0.05) between intervention and infant size and gestation at birth on exclusive breastfeeding at 3 and 5 months of age. Subgroup analysis showed that the impact of the intervention was greater on exclusive breastfeeding in PT- SGA infants at 3 months (IRR 3.30, 95% CI 2.20–4.96) and 5 months of age (IRR 5.26, 95% CI 2.98–9.28).ConclusionThis is one of the first studies wherein impact of breastfeeding counselling interventions in the first 6 months of life was assessed according to infant size and gestation at birth wherein gestational age was reliably estimated. The impact of this intervention was higher in preterm and SGA babies compared to other infants. This finding is important as preterm and SGA infants have a higher burden of mortality and morbidity during early infancy. Intensive breastfeeding counselling to these vulnerable infants is likely to improve overall breastfeeding rates and reduce the adverse outcomes.Clinical Trial Registration: [http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339%26EncHid=%26userName=societyforappliedstudies], identifier [#CTRI/2017/06/008908]

Long-term outcomes of liver transplant recipients followed up in non-transplant centres: care closer to home

Introduction: Increasing rates of liver transplantation and improved outcomes have led to greater numbers of transplant recipients followed up in non-transplant centres. Our aim was to document long-term clinical outcomes of liver transplant recipients managed in this ‘hub and spoke’ healthcare model.Methods: A retrospective analysis of all adult patients who underwent liver transplantation between 1987 and 2016, with post-transplant follow-up in two non-transplant centres in the UK (Nottingham) and Canada (Ottawa) was performed.Results: The 1-, 5-, 10- and 20-year patient survival rates were 98%, 95%, 87% and 62%, and 100%, 96%, 88% and 62% in the Nottingham and Ottawa groups, respectively (p=0.87). There were no significant differences between the two centres in 1-, 5-, 10- and 20-year cumulative incidence of death-censored graft-survival (p=0.10), end-stage renal disease (p=0.29) or de novo cancer (p=0.22). Nottingham had a lower incidence of major cardiovascular events (p=0.008).Conclusion: Adopting a new model of healthcare provides a means of delivering post-transplant patient care close to home, without compromising patient survival and long-term clinical outcomes