INFECTIOUS EXACERBATION OF BRONCHIECTASIS SUCCESSFULLY TREATED WITH CEFTRIAXONE/SULBACTAM/DISODIUM EDETATE-1034 (ELORESâ„¢)

ABSTRACTBronchiectasis is a type of chronic obstructive pulmonary disease, defined as permanent abnormal dilation of bronchi due to vicious cycle of transmuralinfection and inflammation. Bronchiectasis is generally characterized by cough, wheeze, and dyspnea. Pathogens responsible for bronchiectasisinclude pathogens Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, and nontuberculousmycobacteria. Empirical antibiotic therapy and other drugs are used empirically in the management of bronchiectasis.Here, we discuss a case ofinfectious exacerbation of bronchiectasis successfully treated with an empirical use of ceftriaxone/sulbactam/disodium edetate-1034.Keywords: Bronchiectasis, Eloresâ„¢, Ceftriaxone/sulbactam/disodium edetate-1034, Disodium edetate, Antibiotic resistance

Electrochemical Reduction Of Carbon Dioxide On Carbon Nanostructures: Defect Structures & Electrocatalytic Activity

The advantages of the electrochemical conversion of carbon dioxide to fuels using renewable energy sources are two-fold: (1) it has the potential to accomplish a carbon-neutral energy cycle and (2) it can provide an approach to tackle the environmental challenges caused by anthropogenic carbon dioxide emissions. Although thermodynamically possible, the kinetics of carbon dioxide reduction to fuels remains challenging and therefore, an efficient and robust electrocatalyst is needed to promote the reaction. The ideal catalyst for the electrochemical CO2 reduction must be capable of mediating multiple proton-coupled electron transfer reactions at low overpotentials, suppressing the concurrent hydrogen evolution reaction, converting CO2 to desired chemicals with high selectivity, and achieving long-term stability. Extensive research has been carried out on metallic electrocatalysts during the past three decades; however, none of these materials are simultaneously efficient and stable for practical purposes. This Ph.D. dissertation focuses on the investigation of the electro-reduction of CO2 on carbon nanostructures with a focus on understanding the relationship between defect structures and electrocatalytic activity. The initial focus of this work was to accomplish active performance and durability for electrosynthesis of fuels from CO2 using cost-effective catalysts. N-doped carbon nanotubes (NCNTs) were demonstrated as highly efficient, selective and more importantly, stable catalysts to achieve CO2 conversion to CO. The catalytic activity of these NCNTs was further benchmarked against other metallic catalysts reported in literature (Chapter 2). Compared to noble metals Ag & Au, these NCNTs exhibited a lower overpotential to achieve similar selectivity towards CO formation. The second part of this work was a study of the dependence of catalytic activity, i.e., the overpotential and selectivity for CO formation on the defect structures (pyridinic, graphitic, pyrrolic-N) inside NCNTs. The presence of both pyridinic and graphitic-N was found to significantly decrease the absolute overpotential and increase the selectivity towards CO formation (Chapter 3). The third part of this thesis work was to investigate CO2 reduction on N-doped graphene, in order to explore morphology effects on catalytic activity of NCNTs towards CO formation (Chapter 4). Overall, pyridinic-N defects exhibited the highest catalytic activity; thereby suggesting the directions for developing carbon nanostructures as metal-free electrocatalysts for CO2 reduction

Cost variation analysis of oral anti-diabetic drugs

Background: Diabetes Mellitus is a chronic metabolic disorder, one of the major causes of morbidity, mortality and needs lifelong treatment. There are large numbers of oral anti-diabetic drugs available for the treatment of type 2 diabetes mellitus. There are numerous brands available for each of the individual oral anti-diabetic drug. Thus, a study was planned to find out cost variation among different brands of same active oral anti-diabetic drug.Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from the price list provided by the pharmaceutical companies in Current Index of Medical Specialities (CIMS) (October 2017- January 2018). The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was analyzed.Results: Percentage cost variation of the commonly used drugs found was seen highest with Sulfonylureas (Glimepiride - 562%) followed by Metformin (492%) which was followed by Pioglitazone (488%), DPP-4 inhibitor Teneligliptin (231%), α- glucosidase inhibitors (Voglibose 284%), Meglitinides (Repaglinide 0.5mg 154%) and lowest was seen with Repaglinide 2mg (15%).Conclusions: There is very wide cost variation among different brands of the same oral anti-diabetic drugs manufactured in India. The average percentage cost variation of different brands of the same oral anti diabetic drugs manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences

Overexpression of the gene for Rpb7 subunit of yeast RNA polymerase II rescues the phenotypes associated with absence of the largest, nonessential subunit Rpb4

The easily dissociable subcomplex of Rpb4 and Rpb7 subunits of yeast RNA polymerase II has been considered, for long, to play a role in stabilizing Pol II under stress. On the basis of previous genetic and biochemical observations, it was proposed that within the subcomplex one of the functions of Rpb4p is to stabilize the interaction between Rpb7p and the rest of Pol II. We took a direct approach to test the latter possibility by overexpression and mutagenesis of RPB7 in absence of Rpb4p. We report here the results, which support the latter hypothesis. While it has been previously reported that absence of Rpb4p results in reduction in overall transcription by Pol II, our comparative analysis of RNAs from RPB4 and rpb4d cells suggests that there are indeed several genes differentially expressed between the two cells. We propose that the qualitative differences in overall transcription in presence and absence of Rpb4p imply a more active role for Rpb4p in transcription of at least a subset of genes

Cost variation study of antidepressant drugs

Background: Depression and anxiety disorders are the most common mental illnesses, each affecting in excess of 10-15% of the population at some time in their lives. Approximately 10-15% of those with severe depression attempt suicide at some point of time. Thus, it is important that symptoms of depression be recognized and treated appropriately.Methods: The prices of 15 antidepressant drugs, available in 43 different formulations were analyzed. Costs of different brands of a particular generic antidepressant drug being manufactured by different companies, in the same strength and dosage forms were used to calculate cost ratio and percentage cost variation.Results: This study shows that there is a wide variation in the prices of different brands of same antidepressant drug in Indian market. The highest cost ratio and percent cost variation was found for amitriptyline 50 mg, followed by bupropion 25 mg, amitriptyline 75 mg and dosulepin 50 mg. Highest number of brands of antidepressant drugs available in Indian market are for escitalopram 10 mg followed by escitalopram 5 mg and 20 mg.Conclusions: There is wide price variation of different brands of the same generic antidepressant drug in Indian market. Cost of a drug plays an important role in treatment of depression as it follows a long course and adherence to the treatment is related with drug cost. To decrease the wide cost variation among different brands of antidepressant drugs; it is high time to generate physician awareness about impact of cost effectiveness of drug regimen and for regulation of drug prices by the concerned agencies

Cost variation analysis of antidyslipidemic drugs

Background: Dyslipidemia is the most common cause of premature coronary atherosclerosis manifesting as ischemic heart disease. Hyperlipidemia has a major role in the causation of atherosclerosis and atherosclerosis-induced conditions, such as ischemic cerebrovascular disease, coronary heart disease (CHD) and peripheral vascular disease.Methods: The prices of 07 antidyslipidemic drugs, available in 19 different formulations marketed in 260 brands and 03 fixed dose combinations available in 11 different formulations marketed in 75 brands were analyzed. Costs of different brands of a particular generic antidyslipidemic drug being manufactured by different companies, in the same strength and dosage forms were used to calculate cost ratio and percentage cost variation.Results: In this study, it was found that there exists a wide cost variation among the different brands of same antidyslipidemic drugs in Indian market. Among individual antidyslipidemic drugs, highest cost ratio and percent cost variation was found for atorvastatin 20 mg, followed by atorvastatin 10 mg and atorvastatin 5 mg. Among fixed dose combinations for antidyslipidemic drugs, highest cost ratio and percent cost variation was found for atorvastatin 20 mg+fenofibrate 160 mg, followed by atorvastatin 10 mg+ezetimibe 10 mg and atorvastatin 20 mg+ezetimibe 10 mg. Highest number of brands of antidyslipidemic drugs available in Indian market are for atorvastatin 10 mg followed by atorvastatin 20 mg and rosuvastatin 10 mg. Highest number of brands of fixed dose combinations of antidyslipidemic drugs available in Indian market are for atorvastatin 10 mg+ezetimibe 10 mg and atorvastatin 10 mg+fenofibrate 160 mg.Conclusions: In Indian market, there is very wide price variation of different brands of the same generic antidyslipidemic drug. Treatment of dyslipidemia has long course of treatment. For long term adherence to the treatment, cost of a drug plays an important role for successful drug treatment. Various steps are needed to reduce this wide price variation of different brands of the same generic antidyslipidemic drug

Understanding of effects of potassium on cardiac tissue by medical students: a critical appraisal

Potassium (K+) is one of the most important ion present in the human body and involved in numerous physiological activities. It mainly affects heart and skeletal muscle but the effects are not confined to theses organs only. The article precisely focuses on the explaining the physiological as well as pathological aspects of potassium on cardiac tissue. This article tends to explain: The cause of difference in extra cellular and Intra cellular concentration of potassium when potassium channels are open in resting conditions, why are Purkinje fibers and ectopic tissue are more sensitive to effect of potassium, mechanisms responsible for increased action potential duration by hypokalemia and decreased action potential duration by hyperkalemia. Hypokalemia generates ectopic activities and hyperkalemia inhibits them, therapeutic effects of potassium administration without causing hyperkalemia. These issues will be discussed and try to be explained with the help of Ohm’s law , Nernst equation and Nernst potential to sort out the complicated actions of potassium on cardiac tissue in a simplified manner. The primary aim of article is to improve understanding of potassium physiology by medical graduates, secondarily, convey message regarding improvement in teaching methodology in Pharmacology for the benefit of new generations

TEICOPLANIN RESISTANCE IN GRAM-POSITIVE BACTERIAL ISOLATE: AN EMERGING THREAT

Objectives: Development of antimicrobial resistance in microorganism isolated from blood stream infection constitutes a major concern about their treatment. Teicoplanin is a glycopeptide antibiotic used in the treatment of infection caused by Gram-positive bacteria. This study was planned to determine Teicoplanin resistance in the Central India and recommend policy changes for prevention of the future resistance to the higher antibiotics. Methods: A total of 1855 septicemia suspected blood samples were studied. The blood culture samples were processed and identified in the microbiology laboratory according to the Clinical and Laboratory Standards Institute guidelines. Antibiotic susceptibility test was done using Kirby B disk diffusion method. Results: About 39.5% of blood culture samples showed positive growth for organism. We observed high teicoplanin resistance (29.5%) among Gram-positive isolates, predominantly (53%) in the Enterococcus species. Conclusion: Teicoplanin resistance has emerged tremendously in the present study. Hence, attention is required about this serious issue otherwise very limited choice of antibiotics will be available for treating infections in the future

Utilization pattern of oral hypoglycemic agents for diabetes mellitus type 2 patients attending out-patient department at tertiary care centre in Bhopal, Madhya Pradesh, India

Background: Diabetes mellitus type 2 is a chronic disease that may be due to insulin deficiency and insulin resistance or both. The resultant hyperglycemia leading to micro and macro vascular complications.The objective was to evaluate drug utilization pattern of oral hypoglycemic agents in type-2 diabetic attending OPD.Methods: A prospective study was carried out in 200 out patients for a period of 3 months in a tertiary care hospital. Patients treated with oral hypoglycemic agents were taken for the study.Results: In the present study 102(51%) were male. Majority (40%) of patient were in the age group 50-60 years. Metformin was the most commonly prescribed drug (38.3%), followed by sulfonylurea class of drugs (35.6%). Majority of the patients n=143(71.5%) were on combination therapy in comparision to monotherapy (28.5%). Fixed dose combinations more preferred more. Brand name was prefered (98.1%) on generic drugs. Comorbid condition was found in 117 patients (58.5%).  And hypertension (34%) was the the most common comorbid condition. The average number of antidiabetic drugs per prescription was 2.2.Conclusions: Metformin was the most commonly used drug .The prescribing trend also appears to be more towards combination therapy. It was seen that particularly two drug were used

A descriptive analysis of patients admitted in short stay ward at psychiatric centre, Jaipur, Rajasthan, India

Background: The average length of stay (LOS) at psychiatric centre and the factors determining longer LOS in Psychiatry disorders remains largely unexplored. Longer LOS is associated with social isolation and maladaptive behaviours in patients thus warrants a shorter stay. The observed LOS and predicted LOS among different psychiatry hospitals in future may serve as an index of quality care and efficient management of meagre but available resources in our country. The aim was (1) To study the socio demographic and clinical factors of patients admitted at our hospital and (2) To ascertain the relationship between the socio demographic, clinical factors and LOS.Methods: A retrospective analysis of psychiatry inpatients admitted at Psychiatric Centre, Jaipur during July 2014 and June 2015. The data was analysed studying the 489 case records. The socio demographic characteristics and clinical factors were correlated with LOS in hospital.Results: Our study has shown the correlation of socio-demographic factors and clinical factors with LOS. Rural population, marital status, employment status, number of episodes and diagnosis itself has positive correlation with longer LOS.Conclusions: From present study it was shown the correlation of socio-demographic factors and clinical profile with LOS. Rural population, marital status, premorbid employment status, number of episodes and diagnosis itself has positive correlation with longer LOS. However, gender and substance abuse had no correlation with LOS. Short term and planned admissions along with individualized treatment plans fitting patient’s social background may be more beneficial as compared to long term admissions