Evaluation of rationality of fixed dose combinations of antimicrobials available in Indian market

Background: The antimicrobial resistance is alarming at present. One of the important factors for resistance is use of irrational fixed dose combinations. Thus, objective was to critically analyze the rationality of FDCs of antimicrobial agents currently available in India.Methods: The FDCs of AMAs enlisted in Indian Drug Review 2019 were analyzed by 8 point criteria tool. Analysis includes number of active pharmacological ingredients, approval by central drug standard control organization, listing in world health organization model list of essential medicines (2019) or Government of India national list of essential medicines (2015). Literature search was used for assessing efficacy, safety, pharmacokinetic and pharmacodynamic interactions and advantages of each FDC. Each criterion was assigned score one, if positive and minus one, if negative leading to total score of 12. FDC with score of ≥7 was considered as rational.                                                                         Results: The FDCs of AMA available in Indian market were 116 while FDCs included in WHO model list, 2019 were 24. Majority of FDCs available were irrational that include combination of antibacterial with bromhexine, carbocisteine, ambroxol, serratiopeptidase, antiamoebic and antifungal etc. Most of the rational FDCs belong to antiretroviral, antitubercular and antimalarial drugs.                                Conclusions: Most of the FDCs of AMAs available in Indian market are irrational. These needs educating the prescribers including resident doctors. There is need to critically review such FDCs by drug regulators with strict action regarding manufacturing and marketing

Evaluation of effect of amitriptyline and pregabalin on heart rate variability in neuropathic pain in non-diabetic patients

Background: The effects of amitriptyline and pregabalin on heart rate variability (HRV) in patients with neuropathic pain in non-diabetic patients are poorly understood in India. The present study was conducted to evaluate the effect of amitriptyline and pregabalin on heart rate variability (HRV) and neuropathic pain in non-diabetic patients.Methods: Forty adult patients (aged 18-65 years) of either sex diagnosed with neuropathic pain were divided into two groups. The study was prospective open label and observational study. Amitriptyline 10 mg once a day was given to group 1 while group 2 received pregabalin 75 mg once a day and HRV and pain score were recorded; and post-treatment data at 2 and 4 weeks were compared with pre-treatment values (control). All the statistical analysis was performed by using Statistical package for social sciences (SPSS) 20.0 software.Results: Both amitriptyline and pregabalin have increased HRV and reduced neuropathic pain intensity after 2- and 4-weeks treatment. The correlation between HRV and neuropathic pain was not observed.Conclusions: To conclude both the drugs have significantly increased HRV and reduced the pain intensity; but no correlation was observed between increased HRV and reduced pain intensity

Effect of amitriptyline and pregabalin on heart rate variability and electrolytes in neurotrophic pain in diabetic patients

Background: The data regarding effects of amitriptyline and pregabalin on heart rate variability in patients with neuropathic pain in diabetic patients are poorly understood in India. The present study was conducted to evaluate the effect of amitriptyline and pregabalin on heart rate variability in diabetic patients with neuropathic pain and their effect on serum electrolyte (sodium and potassium).Methods: The patients include 60 diabetic patients of either sex aged 18-65 years diagnosed with neuropathic pain and divided into two groups. The study was prospective open label and observational study. Group 1 was treated with amitriptyline 10 mg once a day while group 2 with pregabalin 75 mg once a day and HRV, serum sodium and serum potassium levels and pain score were recorded; and data of post-treatment at 2 and 4 weeks were compared with pretreatment values (control). All the statistical analysis was performed by using SPSS 20.0 software.Results: Both the drugs have increased HRV and reduced neuropathic pain intensity after 2 and 4 weeks treatment. The sodium and potassium level were not altered by these drugs. No correlation was observed between HRV and neuropathic pain.Conclusions: In conclusion, both the amitriptyline and pregabalin have significantly increased HRV and reduced the neuropathic pain intensity; but no correlation was observed between increased HRV and reduced neuropathic pain intensity

Analysis of price variation of some commonly used antibacterial agents

Background: Antimicrobial resistance is a serious problem. Resistance may develop due to irrational use including poor patient compliance due to prescription of expensive drugs. In present study, the variation in the price of commonly used antibacterial was analysed.Methods: The price of commonly used antibacterial agents listed in recent issues of CIMS and MIMS was analysed in respect of number of brands available, price range (10 tablets or capsules) and 1 ampoule or vial (parenteral preparation) i.e. minimum, maximum and average price and price ratio (maximum/minimum). FDCs and formulation with only 1-2 brands were excluded.Results: The number of brands of oral antibacterial agents varied from 3 (faropenem 200 mg) to 90 (azithromycin 500 mg). The maximum price variation amongst different brands was 21.64 for levofloxacin 500 mg followed by 14.28 and 11.26 for linezolid 600 mg and moxifloxacin 400 mg respectively. For parenteral preparations, the number of brands varied from 2 (gentamicin 80 mg) to 57 (ceftriaxone 1 g). The maximum price variation was 5.05 for meropenem 1 g followed by 3.69 and 2.63 for meropenem 500 mg and ceftriaxone 1 g respectively.Conclusions: A very wide price variation was observed amongst different brands of both oral and parenteral formulations of antibacterial agents. Prescribing expensive brands may lead to resistance due to poor patient compliance

Study of Covid-19 - Related Ecological Habitat of College Students: A Survey

In recent years, the interaction of people with the surrounding ecological environment has become increasingly unsafe for health, namely the person' physical and mental capabilities. This is especially true of the younger generation, like students of higher educational institutions, who have weakened immunity due to a busy study schedule, constant mental overload and stress. That is, health, as a sign of the quality of life of a student, is associated with the ecological situation and lifestyle, therefore, is one of the main concepts of human ecology. The influence of additional negative factors, such as stress and restrictions associated with the Covid-19 pandemic, greatly increases the risk of developing students' mental health problems. Unexpected isolation related to Covid-19 has caused disruption to daily routines, especially in students. The sudden change in the learning environment and limited social interactions and activities posed an unusual situation for children's developing brains. The study aim is to investigate and identify the psychological threats posed by students of different ages (under 20, between 21–25, and 26-32) in this pandemic of COVID-19. It was found that 28.0% of students were often nervous and stressed in the age group under 20, in contrast to 26.5% and 11.1% in groups 21 to 25 and over 26, respectively. In the younger group of students, 10.2% of students never felt upset, in the group of 21-25 years old - 8.3% and over 26 years old - 5.6%. It was concluded that it is mandatory to assess the student's psychological health and to plan for necessary support mechanisms, mainly during the recovery phase, because depression, stress, fear of getting infected, fear of losing a loved one, fear about getting jobs and related academic issues, disturbance in sleeping pattern, increase in duration of screen time, etc., were found to be common among students of all age groups

Finite Element Study on the Effect of Geometrical Parameters on the Mechanical Behavior of 3D Reentrant Auxetic Honeycombs.

Abstract Auxetic materials are a special case of cellular materials, which exhibit a negative Poisson’s ratio. This in fact is the reason behind their peculiar behavior i.e. lateral shrinkage under longitudinal compression and vice versa. Since these materials do not obey the laws of “normal” materials and go beyond common sense, they are still an emerging class which can be put to use for various purposes like self-locking reinforcing fibers in composites, controlled release media, self-healing films, piezoelectric sensors, and also be used in biomedical engineering. Their stress-strain behavior, Poisson’s ratio and impact energy absorption are controlled by bulk material as well as the unit cell geometry. Among many forms of auxetic structures available, we have chosen a three-dimensional reentrant auxetic honeycomb unit cell. The unit cell geometrical parameters were taken from literature. In this study, we try to understand the effects of strut angle through finite element simulations while keeping the bulk material, unit cell size, strut thickness and number of repetitions constant. A total of three different angles were tested, based on which we conclude that as angle increases, the Poisson’s ratio increases and Energy absorption is maximum at 30 deg

Bioremediation of Petroleum Contamination: A Short Review

The pros and cons of using the bioremediation method for the removal of petroleum pollutants are discussed in this review article. Other methods along with bioremediation have been used to remediate petroleum hydrocarbon contaminants in the past. Bioremediation is cheap and efficient method than any other because major constituents of the crude oils are biodegradable. Despite the fact that, as compared to physicochemical strategies, longer periods are normally required, complete pollutant degradation can be achieved, and no further containment of the contaminated matrix is required. According to hydrocarbon present in the contaminants different strategies and organism are used for the bioremediation. Common strategies include controlling environmental factors such as oxygen availability, hydrocarbon solubility, nutrient balance and managing hydrocarbon degrading bacteria by eliminating the rate limiting factors that may slow down the bioremediation rate. Microorganism dynamics during bioremediation is most important for understanding how they respond, adapt and remediate pollution. However, bioremediation can be considered one of the best technologies to deal with petroleum product contaminants

Transformation as Praxis: Responding to Climate Change Uncertainties in Marginal Environments in South Asia

This paper provides some of the conceptual and methodological underpinnings being developed in the ongoing TAPESTRY project which is part of the Transformations to Sustainability (T2S) Programme. We debate how the notion of transformation may be conceptualized from ‘below’ in marginal environments that are especially marked by high levels of climate-related uncertainties. We propose the notion of transformation as praxis — where the focus is on bottom-up change, identities, wellbeing and the recovery of agency by marginalized people and explore how ‘patches’ and the ‘marginal’ offer critical conceptual templates to examine whether and how systemic transformative changes are being assembled and effected on the ground by hybrid and transformative alliances. The article concludes by discussing potential challenges of such engagements, alongside pursuing a normative and political approach to T2S

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely