Assessment of drug related problems and clinical pharmacist interventions in paediatric department of a tertiary care teaching hospital

Background: Drug-related problems (DRPs) are frequent in hospitalization in pediatrics. The main aim of present investigation is to assess drug related problems and clinical pharmacist interventions in pediatric department of tertiary care hospital.Methods: It was a prospective, observational and interventional study carried over a period of 6 months.Results: A total of 66 patients were identified with drug related problems. Among them 31 (42%) were in between 1month–2 years followed by 25 (34%) were in between 2-11 years, 10(24%) were in between 11-18 years of age. 30(45.3%) patients were prescribed with 0-3 drugs followed by 21 (31.3%) were prescribed with 3-5 drugs, 15(23.3%) were prescribed with 6-10 drugs. Most of the DRP’s observed in the study were drug interactions 52(78.78%) [major-19 (36.53%), moderate-27 (5192%) and minor-6(11.53%)] followed by adverse drug reactions 12 (18.18%), and duplication errors were 2 (3.03%). Majority of the clinical pharmacist recommendations were duration change 52 (34.66%), drug change 10(6.66%), dose reduction 2 (1.35%) followed by drug termination 2 (1.33%). Major significance of DRPs were noted high 31(57.96%), whereas 25 (39.8%) were moderate and 8 (12.12%) were minor. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high in 57 (86.66%) cases while in 9 (13.33%) cases suggestions were accepted but therapy was not changed. There were no cases with neither suggestion were accepted nor therapy changed.Conclusions: Clinical pharmacist involvement in inpatient pediatric care can significantly help to identify, resolve and prevent the drug related problems. The study concluded that the clinical pharmacist has a significant role in patients care at hospital

EARTHLY AND PRACTICAL TRANSMITTING FOR SUBMERGED REMOTE SYSTEM

Submerged remote sensor systems (UWSNs) have been appeared as an encouraging innovation to screen and investigate the seas in lieu of customary undersea wireline instruments. In any case, the information get-together of UWSNs is still seriously restricted on the grounds that of the acoustic channel correspondence qualities. One approach to enhance the information gathering in UWSNs is through the plan of steering conventions thinking about the special attributes of the submerged acoustic correspondence and the profoundly unique system topology. In this paper, we propose the GEDAR directing convention for UWSNs. GEDAR is an anycast, geographic and entrepreneurial directing convention that courses information bundles from sensor hubs to different sonobuoys (sinks) at the ocean's surface. At the point when the hub is in a correspondence void locale, GEDAR changes to the recuperation mode strategy which depends on topology control through the profundity alteration of the void hubs, rather than the conventional methodologies utilizing control messages to find and keep up steering ways along void districts. Recreation comes about demonstrate that GEDAR fundamentally enhances the system execution when contrasted and the gauge arrangements, even in hard and troublesome versatile situations of extremely meager and exceptionally thick systems and for high system movement loads

Integrated Approach for Stabilisation of Varunavat Parvat Landslide – A Case Study

Uttarkashi Township, located on the toe of the Varunavat Parvat, in the State of Uttarakhand in North India is known for having a history of a number of natural disasters. One of such disaster was a major landslide on the slopes of the Varunavat Parvat, in the year 2003. There had been huge loss of property of residential complexes, office buildings, hotels and many other business apartments. The risk of further such slides continuously hovered over the town which was the serious concern of District and State Authorities. An integrated approach of long term stabilization measures with flattening of slopes with suitable berms, effective drainage arrangement (surface & sub-surface), suitable erosion control measures , multistage protection measures by providing catch pits, wide platforms, retaining walls and construction of tunnel on the national highway for mitigating the rock fall hazards are being adopted, to minimize the impact of disaster in future so that people of Uttarkashi Town can live safely without fear. The paper highlights the description of the problem, probable causes of the Landslide, Geology of the area, stability analysis, measures adopted for averting future landslide and subsequent rock fall hazard

Initial Filling of Tehri Reservoir — Analysis of Seepage Data

Initial Filling of reservoirs in dams, particularly the embankment type, is a very important phase as unusual behaviour / accidents of many dams have been reported during this period. A regular observation / analysis of quantum of seepage vis-à-vis the reservoir level is a significant activity so that any serious development inside the body of dam and foundation / abutments rocks are revealed in advance and remedial measures are taken up timely to prevent catastrophic failures. At Tehri, a 260.5m high earth & rockfill dam has been constructed across river Bhagirathi, a tributary of mighty river Ganga in India. Seepage discharge data of first two years of Initial Filling of Tehri reservoir has been analysed, which has led to a few important conclusions. The Analysis of Seepage data for the Initial Filling of Tehri reservoir is presented in the paper

Initial Filling of Tehri Reservoir — Analysis of Seepage Data

Initial Filling of reservoirs in dams, particularly the embankment type, is a very important phase as unusual behaviour / accidents of many dams have been reported during this period. A regular observation / analysis of quantum of seepage vis-à-vis the reservoir level is a significant activity so that any serious development inside the body of dam and foundation / abutments rocks are revealed in advance and remedial measures are taken up timely to prevent catastrophic failures. At Tehri, a 260.5m high earth & rockfill dam has been constructed across river Bhagirathi, a tributary of mighty river Ganga in India. Seepage discharge data of first two years of Initial Filling of Tehri reservoir has been analysed, which has led to a few important conclusions. The Analysis of Seepage data for the Initial Filling of Tehri reservoir is presented in the paper

Alzheimer Disease Detection using AI with Deep Learning based Features with Development and Validation based on Data Science

Alzheimer's disease (AD), a neurological condition that worsens over time, affects millions of individuals worldwide. Because of this, effective intervention and therapy depend on early and precise detection. In recent years, encouraging findings have been obtained using data science and artificial intelligence (AI) techniques in the field of medical diagnostics, particularly AD diagnosis. This work seeks to develop an accurate algorithm for diagnosing AD by identifying AI-based traits from neuroimaging and clinical data.The three key steps of the proposed methodology are data preprocessing, feature extraction, and model development and validation. To offer neuroimaging data, such as MRI and PET scans, as well as essential clinical information, a cohort of persons made up of AD patients and healthy controls is obtained. Throughout the preparation stage, the data are normalised, standardised, and quality-checked to ensure accuracy and consistency.The critical role of feature extraction in locating critical patterns and features potentially indicative of AD is critical. Advanced AI techniques like Convolutional Neural Networks and Recurrent Neural Networks are utilised to extract discriminative features from neuroimaging data after subjecting it to feature engineering methods.The retrieved features are then utilised to build a prediction model using state-of-the-art machine learning techniques such as Support Vector Machines (SVM), Random Forests, or Deep Learning architectures. Strict validation methods, such cross-validation and test datasets, are used to evaluate the model's performance in order to ensure generalizability and minimise overfitting.The project's objective is to identify AD with high specificity, sensitivity, and accuracy to support early diagnosis and tailored treatment planning. The results of this research contribute to the body of knowledge on AI-based diagnostics for neurodegenerative diseases and have the potential to significantly impact clinical practises by facilitating early interventions and improving patient outcomes. It is important to take into account the size and heterogeneity of the dataset as well as any prospective improvements and future expansions to the usage of AI in AD detection

Study of various congenital anomalies in fetal and neonatal autopsy

Background: The study of dead is to save the livings. The growing awareness that still births and infant mortalities are unable to reduction has led to a wide spread desire for more information regarding the cause of these deaths. Congenital malformations have become important cause of fetal and neonatal (perinatal) mortality in developed countries and would very soon be increasingly important determinants of fetal and neonatal mortality in developing countries like India. In spite of antenatal diagnostic modality still the fetal autopsy plays the vital role in the conformation as well as identification of congenital anomalies and also for the counseling of the parents, to prevent the fetal congenital anomalies in further pregnancies. This study was undertaken with the purpose of finding out cause of death during the perinatal period at government maternity hospital and pediatric department S.V.R.R.G.G.H. & S.V. medical college Tirupati, and to study the clinical and pathological findings (Gross & microscopic) in fetal and neonatal death.Methods: The present study of congenital anomalies in fetal and neonatal deaths was done at S.V. medical college, Tirupati, over a time period of 2 years from September 2008 to 2010 August. Consent for autopsy in requested compassionately, respectfully and fully informed. The present study included dead fetus and neonates with gestational age above 20 weeks of intra uterine life and within 7 days of post natal life. All fetuses of gestational age <20 weeks and all neonates above 7 days of age were excluded from the study. The study also obtained clearance from the ethical committee of the institution. Autopsy was performed by standard technique adopted by Edith L. Potter. External and internal findings followed by histopathological examination, and autopsy findings were compared with available ultrasound findings.Results: A total of 46 Autopsies performed, 40 (87%) were fetal deaths, 6 (13%) were early neonatal deaths. In a total of 46 fetuses, there were 13 male and 33 female babies. On external examination of 46 fetal and Neonatal (perinatal) deaths, 8 (17.39%) babies showed congenital malformation. On internal examination of the 46 fetal and Neonatal (perinatal) deaths, 4 babies showed internal congenital anomalies. A total of 46 anatomical and histopathologic examinations were done among fetal and neonatal (perinatal) deaths. Out of 13 autopsies on male babies, 2 had congenital malformation and 33 autopsies on female babies, 7 had congenital malformations. Congenital anomalies were commonest in the birth weight group of 1000-1500 grams accounting for 9 cases. Malformations of central nervous system (33.33%) were most common followed by musculoskeletal system (16.66%), genitourinary and respiratory system (8.33%) respectively.Conclusion: Most number of perinatal deaths occurred in low birth weight and preterm babies. Study of malformations greatly helpful in genetic counseling and prenatal diagnosis in successive pregnancies

Perforated Meckel diverticulum

Perforation of a Meckel diverticulum (MD) is a rare complication that can often mimic appendicitis. This case report identifies a child who presented to our Emergency Department (ED) with right lower quadrant abdominal pain, free fluid and air in the abdomen and pelvis, and inflammatory changes visualized on Ultrasonography (US) and computer tomography (CT) scan. In our patient, ruptured appendicitis was suspected, and the diagnosis of ruptured MD was ultimately made by laparoscopy. This case demonstrates that a healthy degree of suspicion for complicated MD should be present when dealing with a questionable diagnosis of appendicitis, particularly in the pediatric population

Facts and Treatment of Bullous Pemphigoid: A Review

Bullous pemphigoid (a type of pemphigoid) is an autoimmune pruritic skin disease that typically occurs in people aged over 60, that may involve the formation of blisters (bullae) in the space between the epidermal and dermal skin layers. It is classified as a type II hypersensitivity reaction, which involves formation of anti-hemidesmosome antibodies, causing a loss of keratinocytes to basement membrane adhesion. Pemphigus and bullous pemphigoid are autoantibody-mediated blistering skin diseases. In pemphigus, keratinocytes in epidermis and mucous membranes lose cell-cell adhesion, and in pemphigoid, the basal keratinocytes lose adhesion to the basement membrane. Pemphigus lesions are mediated directly by the autoantibodies, whereas the autoantibodies in pemphigoid fix complement and mediate inflammation. In both diseases, the autoantigens have been cloned and characterized; pemphigus antigens are desmogleins (cell adhesion molecules in desmosomes), and pemphigoid antigens are found in hemidesmosomes (which mediate adhesion to the basement membrane). This knowledge has enabled diagnostic testing for these diseases by enzyme-linked immunosorbent assays and dissection of various pathophysiological mechanisms, including direct inhibition of cell adhesion, antibody-induced internalization of antigen, and cell signaling. Understanding these mechanisms of disease has led to rational targeted therapeutic strategies

Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian children in the second year of life

Rotavirus gastroenteritis is one of the leading causes of diarrhea in Indian children less than 2 years of age. The 116E rotavirus strain was developed as part of the Indo-US Vaccine Action Program and has undergone efficacy trials. This paper reports the efficacy and additional safety data in children up to 2 years of age. In a double-blind placebo controlled multicenter trial, 6799 infants aged 6-7 weeks were randomized to receive three doses of an oral human-bovine natural reassortant vaccine (116E) or placebo at ages 6, 10, and 14 weeks. The primary outcome was severe (≥11 on the Vesikari scale) rotavirus gastroenteritis. Efficacy outcomes and adverse events were ascertained through active surveillance. We randomly assigned 4532 and 2267 subjects to receive vaccine and placebo, respectively, with over 96% subjects receiving all three doses of the vaccine or placebo. The per protocol analyses included 4354 subjects in the vaccine and 2187 subjects in the placebo group. The overall incidence of severe RVGE per 100 person years was 1.3 in the vaccine group and 2.9 in the placebo recipients. Vaccine efficacy against severe rotavirus gastroenteritis in children up to 2 years of age was 55.1% (95% CI 39.9 to 66.4; p&#60;0.0001); vaccine efficacy in the second year of life of 48.9% (95% CI 17.4 to 68.4; p=0.0056) was only marginally less than in the first year of life [56.3% (95% CI 36.7 to 69.9; p&#60;0.0001)]. The number of infants needed to be immunized to prevent one episode of severe RVGE in the first 2 years of life was 40 (95% CI 28.0 to 63.0) and for RVGE of any severity, it was 21 (95% CI 16.0 to 32.0). Serious adverse events were observed at the same rates in the two groups. None of the eight intussusception events occurred within 30 days of a vaccine dose and all were reported only after the third dose. The sustained efficacy of the 116E in the second year of life is reassuring