A prospective observational study of drug usage in the management of snake bite patients and their outcome in a tertiary care teaching hospital

Background: The objectives of the study were to assess the pattern of management of snakebite especially with respect to use of anti- snake venom and other supportive treatment given and to assess the effect of anti-snake venom on different types of snakebite and to assess their outcome.Methods: A prospective observational study was conducted over a period of 6 months, after getting approval from Institutional Ethics committee. Total of 144 snake bite patients were analysed for six months duration for use of anti-snake venom and other supportive treatment in their management and were assessed for their outcome like recovery, morbidity and mortality.Results: Out of 144 snake bite patients analysed, 71.5% had poisonous type and 28.4% had non- poisonous type of snake bite. Among the total number of snakebites, 47.2% were unknown type and among the known type 25% were viper, 13.2% cobra, 7.6% krait, 6.3% sea snake and 0.7% green snake. Anti-snake venom (ASV) was given to 62 patients depending on severity, of which, 22 patients developed reaction to ASV. Patient with reaction to ASV were treated with corticosteroid and antihistamine injection. Morbidity was seen in 29.1% of patients who developed either cellulitis or gangrene of bitten area, which was more commonly seen among viper bite patients (54.7%).Conclusions: Snakebite is one of the commonest tropical diseases leading to envenomation and poisoning especially in rural areas of tropical countries which has to be treated as early as possible to prevent complications. Majority of the cases in our study were of viper bite and most of them have recovered after treatment

Gynecological problems of adolescent girls attending to rural tertiary care centre

Background: Adolescence is a transient and dynamic period between childhood and adulthood, characterised by several changes in the body and the child’s mind. The World Health Organization defines adolescents as young people aged 10-19 years, but changes may begin before and continue after this age group. Adolescents constitute over 21.4% of population in India. Adolescence is a period of enormous physical and psychological change for young girls. Hormonal events play a key role in this transition. One of the major physiological changes that take place in adolescent girls is the onset of menarche, which is often associated with problems of irregular menstruation, excessive bleeding and dysmenorrhea. The aim of this study was to determine the proportion of various gynecological problems among adolescent girls seeking care at a tertiary care centre, Kolar, Karnataka, India.Methods: A cross sectional study was conducted during March 2016 to March 2018 among all adolescent girls (10-19 years) with gynecological problems attending inpatient and outpatient Department of Obstetrics and Gynecology. A pre-tested semi-structured questionnaire was used to collect information regarding their socio-demographic characteristics, gynecological history, family history, obstetric history, documentation of general physical examination and other investigations. Data entered using Microsoft Excel and analysed using SPSS v20.Results: A total of 720 adolescent girls sought care for gynecological problems in the study period with more than 80% of the cases belonging to the age group between 15 and 19 years. Of the 720, 362 (49.8%) had some type of menstrual disorders. Of these 362 cases about 41 of them were a case of puberty menorrhagia (11.32%) and 89 cases were of dysmenorrhea (22.37%). Among 720 cases, 290 (40.2%) of them were diagnosed of teenage pregnancy; among which 34 of them were unwanted pregnancy. Other presentations include vaginal discharge, urinary tract infection, mass per abdomen, trauma to genital tract and turners syndrome (two cases).Conclusions: The study shows around half of the adolescent girls are having menstrual disorders. One third were teenage pregnancies with most of them been ‘wanted’. This alarming finding calls for strengthening of adolescent programme with targeted health education and behavioural change. Setting up a separate adolescent clinics is necessary for efficient management of menstrual disorders in adolescents

Center to limb observations and modeling of the Ca I 4227 A line

The observed center-to-limb variation (CLV) of the scattering polarization in different lines of the Second Solar Spectrum can be used to constrain the height variation of various atmospheric parameters, in particular the magnetic fields via the Hanle effect. Here we attempt to model non-magnetic CLV observations of the $Q/I$ profiles of the Ca I 4227 A line recorded with the ZIMPOL-3 at IRSOL. For modeling, we use the polarized radiative transfer with partial frequency redistribution with a number of realistic 1-D model atmospheres. We find that all the standard FAL model atmospheres, used by us, fail to simultaneously fit the observed ($I$, $Q/I$) at all the limb distances ($\mu$). However, an attempt is made to find a single model which can provide a fit at least to the CLV of the observed $Q/I$ instead of a simultaneous fit to the ($I$, $Q/I$) at all $\mu$. To this end we construct a new 1-D model by combining two of the standard models after modifying their temperature structures in the appropriate height ranges. This new combined model closely reproduces the observed $Q/I$ at all the $\mu$, but fails to reproduce the observed rest intensity at different $\mu$. Hence we find that no single 1-D model atmosphere succeeds in providing a good representation of the real Sun. This failure of 1-D models does not however cause an impediment to the magnetic field diagnostic potential of the Ca I 4227 A line. To demonstrate this we deduce the field strength at various $\mu$ positions without invoking the use of radiative transfer.Comment: 20 pages, 10 figures, Accepted for publication in Ap

Analysis of medication errors in medicine ward of medical college teaching hospital, Mandya

Background: Medication errors are one of the most common types of medical error that is seen in hospitalised patients. Since medication error is one of the growing concerns of healthcare issue and have implications on patient safety, the purpose of this study was to identify medication error and in turn would help to create awareness among healthcare professionals and provide safety to the patients.Methods: Study was initiated after obtaining approval from the Institutional Ethics Committee. The study was done for a period of 1 year between June 2016 and May 2017. Clinical data and data regarding the medication that was prescribed, transcribed, dispensed, administered was collected and was analysed for various types of medication errors during the different stages of medication use process.Results: A total of 351 subjects were recruited in the study for assessing medication error. About 2,283 drugs were prescribed among 351 patients. Maximum number of drugs was administered through parenteral route (50.3%). Medication error was most common during the prescribing stage (51.4%) followed by transcribing stage (39.1%), administration stage (6.9%), and dispensing stage (2.6%). On an average 6 drugs were prescribed per patient. Total of about 5411 errors have occurred out of which 98.8% of errors were preventable, 1.2% of errors were non-preventable. Cardiovascular system (21.9%) and endocrine and renal system (21.9%) was commonly affected due to the medication errors.Conclusions: Medication errors are one of the commonest problems of the healthcare system should be identified and documented and their causes should be studied in order to develop systems that minimize the recurrence

Koebner’s phenomena observed in patient receiving adalimumab in psoriasis

Koebner’s phenomena, first described in 1877 as the appearance of psoriatic lesions in the uninvolved skin of psoriatic patients as a consequence of trauma. Koebner phenomena has been associated with the use of biological response modifiers. The development of the anti-TNF therapies is a milestone in the therapy of rheumatic diseases. As in all new treatment opportunities it is of concern whether all potential undesired side effects have been evaluated. We report a case involving a 31-year-old young male patient diagnosed with psoriasis and psoriatic arthritis (PsA) since a year, who received Adalimumab as part of his treatment and developed Koebner’s phenomena.

Nonequilibrium Phase Transitions in Models of Aggregation, Adsorption, and Dissociation

We study nonequilibrium phase transitions in a mass-aggregation model which allows for diffusion, aggregation on contact, dissociation, adsorption and desorption of unit masses. We analyse two limits explicitly. In the first case mass is locally conserved whereas in the second case local conservation is violated. In both cases the system undergoes a dynamical phase transition in all dimensions. In the first case, the steady state mass distribution decays exponentially for large mass in one phase, and develops an infinite aggregate in addition to a power-law mass decay in the other phase. In the second case, the transition is similar except that the infinite aggregate is missing.Comment: Major revision of tex

A prospective observational study of prescription appropriateness of elderly hypertensive patients using Beers criteria in a tertiary care teaching hospital

Background: The prevalence of hypertension has been increased among the urban population especially among the elderly. Use of inappropriate medication is one of the major problems seen among elderly age group above 60 years who take more medication when compared to that of younger population. Inappropriate prescriptions can be avoided by identifying safer pharmacological alternatives and also utilizing non-pharmacological therapy. Quality and safety of prescribing in elderly patients is one of the global healthcare concern and efforts should be made to improve appropriateness of medication among this group of population. This study was done to assess the relationship between inappropriate medication use and its health outcomes in elderly hypertensive population.Methods: A prospective observational study was conducted over a period of 3 months, after getting approval from Institutional Ethics Committee. Total of 117 elderly hypertensive patients aged >60 years were analysed for three months duration for the rationality of medication prescribed using Beer’s criteria and the health outcome due to inappropriate medication use.Results: Out of 117 elderly hypertensive patients analysed, 49 (41.9%) were males and 68 (58.1%) were females. Most of the patients had associated co morbid illness like diabetes mellitus (48.7%), respiratory diseases (24.8%), cerebrovascular accident (30.8%), cardiovascular diseases (19.7%), fever (13.7%), anaemia (9.4%), etc. Out of 117 patients 10 drugs were used in 3.4% of cases. Antihypertensive drugs that were commonly used in our study was calcium channel blocker (52.1%), diuretics (42.7%), Angiotensin converting enzyme inhibitors (36.8%), β-blockers (17.1%) and Angiotensin receptor blockers (11.1%). Adverse health effects like drug induced gastritis, electrolyte imbalance, metabolic dysfunction and renal impairment was seen in few patients because of inappropriate medication.Conclusions: Use of inappropriate medication is one of the major problems seen among elderly, because of the co morbid illness associated with the primary disease which leads to polypharmacy. Prescription inappropriateness was seen among 86.3% of elderly hypertensive patients as per Beers criteria which may be because of comorbid illness that was seen among these patients. It is necessary to implement certain policies in geriatric healthcare to prevent the poor outcome due to drug therapy.

Effect of spatial bias on the nonequilibrium phase transition in a system of coagulating and fragmenting particles

We examine the effect of spatial bias on a nonequilibrium system in which masses on a lattice evolve through the elementary moves of diffusion, coagulation and fragmentation. When there is no preferred directionality in the motion of the masses, the model is known to exhibit a nonequilibrium phase transition between two different types of steady states, in all dimensions. We show analytically that introducing a preferred direction in the motion of the masses inhibits the occurrence of the phase transition in one dimension, in the thermodynamic limit. A finite size system, however, continues to show a signature of the original transition, and we characterize the finite size scaling implications of this. Our analysis is supported by numerical simulations. In two dimensions, bias is shown to be irrelevant.Comment: 7 pages, 7 figures, revte

Implementation of an Intelligent Target Classifier with Bicoherence Feature Set

ABSTRACT: This paper examines the feasibility of bispectral analysing of acoustic signals emanated from underwater targets, for the purpose of classification. Higher order analysis, especially bispectral analysis has been widely used to analyse signals when non-Gaussianity and non-linearity are involved. Bicoherence, which is a normalized form of bispectrum, has been used to extract source specific features, which is finally fed to a neural network classifier. Vector quantization has been used to reduce the dimensionality of the feature set, thereby reducing computational costs. Simulations were carried out with linear, tan and log-sigmoid transfer functions and also with different code book sizes. It is found that the bicoherence feature set can provide acceptable levels of classification accuracy with a properly trained neural network classifier

Investigation of the crystal structures of n-(4-fluorobenzoyl) benzenesulfonamide and n-(4-fluoro-benzoyl)-4-methylbenzenesulfonamide

The title compound, C26H26N2O7, is a thia­midine derivative. Geometric parameters are in the usual ranges. The crystal packing is stabilized by a classical N—H⋯O hydrogen bond, several weak C—H⋯O hydrogen bonds and a π–π stacking inter­action