SELF MEDICATION PRACTICE AMONG MEDICAL, PHARMACY AND NURSING STUDENTS

Objective: The main objective of this study was to identify the commonly used drugs, indications, reasons, factors and to assess the attitude of medical, pharmacy and nursing students towards self-medication.Methods: A prospective cross-sectional study was carried out in students of Medical, Pharmacy and Nursing college of Adichunchanagiri Institutions B. G Nagara from October 2014 to March 2015. Relevant information was obtained by using the questionnaire after taking the consent from students. The obtained data were analyzed by SPSS version 17.0.Results: 736 students were enrolled in the study, with the age group of 17-26 y. In that 516 (70.1%) were females, 220 (29.9%) were male students. Females were self-medicating more (96.5%) than males (89.54%). The most common drugs used as self-medication are antipyretics (83.15%), antihistamines (26%), analgesics (25%). Fever and headache are the most common illness for self-medication reported. Among the reasons for self-medication, 86.54% students were reported that they used self-medication due to lack of time to consult the physician, 54.89% and 54.07% were reported that they felt their health problem is not serious and for their quick relief respectively.Conclusion: Study concluded that the prevalence of self-medication practice is more among the medical and paramedical students because they are having easy access to knowledge related to the diseases and drugs. Among the three groups of students the prevalence of self-medication is more among nursing students.Keywords: Self-medication, Over the counter drug, NSAID

Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19

INTRODUCTION: Inappropriate antibiotic use in COVID-19 is often due to treatment of presumed bacterial coinfection. Predictive factors to distinguish COVID-19 from COVID-19 with bacterial coinfection or bloodstream infection are limited. METHODS: We conducted a retrospective cohort study of 595 COVID-19 patients admitted between March 8, 2020, and April 4, 2020, to describe factors associated with a bacterial bloodstream coinfection (BSI). The primary outcome was any characteristic associated with BSI in COVID-19, with secondary outcomes including 30-day mortality and days of antibiotic therapy (DOT) by antibiotic consumption (DOT/1000 patient-days). Variables of interest were compared between true BSI (n = 25) and all other COVID-19 cases (n = 570). A secondary comparison was performed between positive blood cultures with true BSI (n = 25) and contaminants (n = 33) on antibiotic use. RESULTS: Fever (\u3e 38 °C) (as a COVID-19 symptom) was not different between true BSI (n = 25) and all other COVID-19 patients (n = 570) (p = 0.93), although it was different as a reason for emergency department (ED) admission (p = 0.01). Neurological symptoms (ED reason or COVID-19 symptom) were significantly higher in the true BSI group (p \u3c 0.01, p \u3c 0.01) and were independently associated with true BSI (ED reason: OR = 3.27, p \u3c 0.01; COVID-19 symptom: OR = 2.69, p = 0.03) on multivariate logistic regression. High (15-19.9 × 10(9)/L) white blood cell (WBC) count at admission was also higher in the true BSI group (p \u3c 0.01) and was independently associated with true BSI (OR = 2.56, p = 0.06) though was not statistically significant. Thirty-day mortality was higher among true BSI (p \u3c 0.01). Antibiotic consumption (DOT/1000 patient-days) between true BSI and contaminants was not different (p = 0.34). True bloodstream coinfection was 4.2% (25/595) over the 28-day period. CONCLUSION: True BSI in COVID-19 was associated with neurological symptoms and nonsignificant higher WBC, and led to overall higher 30-day mortality and worse patient outcomes

CLOSTRIDIUM DIFFICILE INFECTION IN LONG TERM CARE FACILITIES

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Platelets and renal failure in the SARS-CoV-2 syndrome

The coronavirus disease 19 (COVID-19) is a highly transmittable viral infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS‐CoV‐2 utilizes metallocarboxyl peptidase angiotensin receptor (ACE) 2 to gain entry into human cells. Activation of several proteases facilitates the interaction of viral spike proteins (S1) and ACE2 receptor. This leads to cleavage of host ACE2 receptors. ACE2 activity counterbalances the angiotensin II effect, its loss may lead to elevated angiotensin II levels with modulation of platelet function, size and activity. COVID-19 disease encompasses a spectrum of systemic involvement far beyond respiratory failure alone. Several features of this disease, including the etiology of acute kidney injury (AKI) and the hypercoagulable state, remain poorly understood. Here, we show that there is a high incidence of AKI (81%) in the critically ill adults with COVID-19 in the setting of elevated D-dimer, elevated ferritin, C reactive protein (CRP) and lactate dehydrogenase (LDH) levels. Strikingly, there were unique features of platelets in these patients, including larger, more granular platelets and a higher mean platelet volume (MPV). There was a significant correlation between measured D-dimer levels and MVP; but a negative correlation between MPV and glomerular filtration rates (GFR) in critically ill cohort. Our data suggest that activated platelets may play a role in renal failure and possibly hypercoagulability status in COVID19 patients

Evaluation of the potential impact of a carbapenem de-escalation program in an academic healthcare system

Summary: The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the impact that a formalized de-escalation protocol to ertapenem could potentially have on group 2 carbapenem usage in the hope of alleviating the selective pressure on Acinetobacter and Pseudomonas. This analysis was conducted in three hospitals within the Detroit Medical Center in 2009. Patients were considered candidates for de-escalation of carbapenem therapy when a group 2 carbapenem was utilized to treat Enterobacteriaceae, such as extended spectrum β-lactamase (ESBL)-producing organisms, or if cultures were negative in non-intensive care unit (ICU) patients. In total, 179 patients (28%) and 1074 patient-days (29%) were deemed eligible for de-escalation according to our pre-defined criteria. We concluded that preferential utilization of ertapenem in appropriate patients warranting carbapenem therapy has the potential to significantly decrease group 2 carbapenem usage at our institution. Keywords: Ertapenem, De-escalation, Streamlining, Antimicrobial stewardship, Carbapene