Prescribing pattern in outpatient department of neurosurgery in a tertiary care hospital of North India

Background: The neurosurgical disorders are amongst the leading cause of global mortality and morbidity. Though surgical intervention is thought to be the main management protocol in the neurosurgical setup but drugs are being equally used especially in the outpatient setting. The present study was carried out in view of the sparse data available on prescribing pattern in neurosurgery.Methods: The present study was conducted by the department of pharmacology in outpatient department of neurosurgery in a tertiary care centre to look into the prescription pattern among these patients.Results: In 268 patients analyzed, mean age was 43.02±15.93 years and 52.23% were females. Majority of our participants (44%) were found to be of young to middle age group (21-40 years). The diagnosis among the study population was spread over large number of diseases. Lumbar Disc Prolapse (LDP) was found to be the leading cause of neurosurgical morbidity, amounting to 32%. As far as the prescription of various drugs in the outpatient of neurosurgery is concerned, Analgesics were the most common drugs prescribed constituting about 48% of the total drugs prescribed followed by GABA analogues and multivitamins which equally formed 41% of the total prescribed drugs.Conclusions: Although the prescription pattern studies among the outpatient neurosurgery patients are very scant, the analysis of prescription studies will be helpful to encourage the rational drug prescribing pattern

Drug Storage and Self-medication Practices in Kashmir, India: A Cross-sectional Study

Introduction: Among the various potential health risks, self-medication and inappropriate storage of medicines at home are found to be very important. Inappropriate storage conditions and irrational use of medication without medical consultation may result in serious health problems. Worldwide there has been an increase in the self-medication rate, which can lead to waste of resources and serious adverse reactions. Aim: To assess the practice of self-medication and household storage of medicines amongst the study population. Materials and Methods: This was a cross-sectional and questionnaire based study conducted in the southern district of Kashmir, India from 1st September 2021 to 28th February 2022. A total of 471 households were included and interviewed to determine the practice of home storage of medicines and self-medication pattern. Quantitative data was presented as means and standard deviation (mean±SD) and qualitative data as frequency and 95% Confidence Interval (CI). Results: Almost three quarters of the households were having monthly income of less than 20,000 INR whereas 219 (46.50%) of them were illiterate. Proton pump inhibitors, minerals and vitamins, antibiotics and analgesics were the most common medicines stored at home. Drawer was the most common place used for storage of medicines whereas the refrigerator was used in less than 1% of cases for the same. Solid dosage forms were mostly used by the householders and the injectables were least used for household storage purposes. Conclusion: The study revealed that the studied householders stored large amount of medicines in homes, often under inappropriate storage conditions. There is a need for better public knowledge and information about the risks of reuse of prescribed medications

EVALUATION OF PHARMACOECONOMICS AWARENESS AND ITS APPLICATION AMONG POSTGRADUATES OF A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Objectives: Pharmacoeconomics (PE) is a branch of health economics which focuses particularly on the cost and benefit of drug therapy. Postgraduatestudents form the first line of the health care delivery system, especially in government run hospitals; therefore, it is essential that they need to beaware of the concept of PE. The main objective of the study was to assess the extent of knowledge and awareness of PE and its methods of applicationamong medical professionals who are doing postgraduation in various departments.Methods: This study was conducted at Sheri Maharaja Hari Singh (SMHS) Hospital, a tertiary care hospital associated with Government MedicalCollege, Srinagar. Self-administered questionnaire was distributed among 100 students, out of which 78 completely filled questionnaires were finallyused for statistical analysis. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 19, Chicago, IL, USA).Results: It was observed that most of the participants were willing to participate in the study, and a good proportion of them (45%) were awareabout the concept of PE. However, the majority of the respondents had little knowledge about the principles of PE and only 16% of them respondedpositively. When it comes to the application of PE, it was found that only 9% are applying these principles in their day to day clinical practice.Conclusion: There is need to sensitize the health care providers to the concept of PE at undergraduate level so that they will be able to utilize theirknowledge of PE, in their clinical practice in the future.Keywords: Pharmacoeconomics, Postgraduate students, Level of knowledge, Methods of application

A descriptive study on drug prescribing pattern in hypertensive patients in a tertiary care teaching hospital

Background: Hypertension is highly prevalent and the goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Not many studies are conducted in this part of world regarding drug utilization of antihypertensive drugs and hence this study was planned.Methods: A descriptive cross-sectional study was conducted for a period 6 month in outpatient department of a tertiary care centre of Government Medical College, Srinagar, Jammu and Kashmir. The prescriptions containing antihypertensive drugs were collected from the patients attending the outpatient department.Results: During the study period a total of 230 prescriptions were collected, out of which 196 were included for the final analysis. Mean age was found to be 62.42±7.77 years. In majority of cases (44.89%), a combination of two drugs was prescribed and among the two-drug combination, Angiotensin Receptor Blockers (ARBs) and Calcium Channel Blockers (CCBs) were used most commonly (40.90%). Angiotension receptor blockers were used as single drug in most number of patients (41.66%). Proton pump inhibitors were the most common (35.71%) co-prescribed drug, followed by Anti platelet drugs (27.55%), Anti diabetics (16.32%) and Statins (16.32).Conclusions: Present study represents the current prescribing trend for antihypertensive agents. It implies that ARBs are the leading group of antihypertensive agents both when used singly and in combination. Further studies focused on the rationale for choice of drugs based on demographic data, economic status, associated comorbid conditions and complications would give additional insights into prescribing patterns in hypertension in India

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

Comparative Biochemical Evaluation of Schizothorax niger and Cyprinus carpio from River Jhelum of Kashmir Valley

ABSTRACT The present study was conducted to evaluate the comparative biochemical profile of Schizothorax niger (endemic fish) and Cyprinus carpio (exotic fish) from the River Jhelum seasonally for a period of two years. .98 mg/dl). In both the fish hosts the higher biochemical values were recorded in the summer season and the lower values in the winter season during the study period. The seasonal differences in the biochemical parameters of the fish can be attributed to the water pollution of River Jhelum by various contaminants including metals and the comparative higher values in Schizothorax niger can be speculated to be due to the higher sensitivity of the host. From the present study it may be inferred that the change in biochemical parameters of the native fish would be one of the reasons for its decline from fresh water resources of the Kashmir Valley

Generation of remosomes by the SWI/SNF chromatin remodeler family

International audienceChromatin remodelers are complexes able to both alter histone-DNA interactions and to mobilize nucleosomes. The mechanism of their action and the conformation of remodeled nucleosomes remain a matter of debates. In this work we compared the type and structure of the products of nucleosome remodeling by SWI/SNF and ACF complexes using high-resolution microscopy combined with novel biochemical approaches. We find that SWI/SNF generates a multitude of nucleosome-like metastable particles termed "remosomes". Restriction enzyme accessibility assay, DNase I footprinting and AFM experiments reveal perturbed histone-DNA interactions within these particles. Electron cryo-microscopy shows that remosomes adopt a variety of different structures with variable irregular DNA path, similar to those described upon RSC remodeling. Remosome DNA accessibility to restriction enzymes is also markedly increased. We suggest that the generation of remosomes is a common feature of the SWI/SNF family remodelers. In contrast, the ACF remodeler, belonging to ISWI family, only produces repositioned nucleosomes and no evidence for particles associated with extra DNA, or perturbed DNA paths was found. The remosome generation by the SWI/SNF type of remodelers may represent a novel mechanism involved in processes where nucleosomal DNA accessibility is required, such as DNA repair or transcription regulation

The docking domain of histone H2A is required for H1 binding and RSC-mediated nucleosome remodeling

Histone variants within the H2A family show high divergences in their C-terminal regions. In this work, we have studied how these divergences and in particular, how a part of the H2A COOH-terminus, the docking domain, is implicated in both structural and functional properties of the nucleosome. Using biochemical methods in combination with Atomic Force Microscopy and Electron Cryo-Microscopy, we show that the H2A-docking domain is a key structural feature within the nucleosome. Deletion of this domain or replacement with the incomplete docking domain from the variant H2A.Bbd results in significant structural alterations in the nucleosome, including an increase in overall accessibility to nucleases, un-wrapping of ∼10 bp of DNA from each end of the nucleosome and associated changes in the entry/exit angle of DNA ends. These structural alterations are associated with a reduced ability of the chromatin remodeler RSC to both remodel and mobilize the nucleosomes. Linker histone H1 binding is also abrogated in nucleosomes containing the incomplete docking domain of H2A.Bbd. Our data illustrate the unique role of the H2A-docking domain in coordinating the structural-functional aspects of the nucleosome properties. Moreover, our data suggest that incorporation of a ‘defective’ docking domain may be a primary structural role of H2A.Bbd in chromatin

The incorporation of the novel histone variant H2AL2 confers unusual structural and functional properties of the nucleosome

In this work we have studied the properties of the novel mouse histone variant H2AL2. H2AL2 was used to reconstitute nucleosomes and the structural and functional properties of these particles were studied by a combination of biochemical approaches, atomic force microscopy (AFM) and electron cryo-microscopy. DNase I and hydroxyl radical footprinting as well as micrococcal and exonuclease III digestion demonstrated an altered structure of the H2AL2 nucleosomes all over the nucleosomal DNA length. Restriction nuclease accessibility experiments revealed that the interactions of the H2AL2 histone octamer with the ends of the nucleosomal DNA are highly perturbed. AFM imaging showed that the H2AL2 histone octamer was complexed with only ∼130 bp of DNA. H2AL2 reconstituted trinucleosomes exhibited a type of a ‘beads on a string’ structure, which was quite different from the equilateral triangle 3D organization of conventional H2A trinucleosomes. The presence of H2AL2 affected both the RSC and SWI/SNF remodeling and mobilization of the variant particles. These unusual properties of the H2AL2 nucleosomes suggest a specific role of H2AL2 during mouse spermiogenesis

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed