Studying drug prescription pattern of dermatology OPD of an Indian tertiary care hospital- a prospective, observational, cross-sectional study

Background: Studying prescription patterns helps prescribers to provide rational and cost-effective medical care. Drugs prescribed for skin disorders by a specialist differ in terms of numbers and the selection of drug class, necessitating periodic prescription audits and drug utilization studies. Methods: This prospective, cross-sectional, observational study was conducted at the dermatology department OPD of Government Medical College, Aurangabad (Maharashtra, India) from January 2021 to May 2021. Digital records of prescription were collected from the hospital management information system (HMIS). Results: N=5338 prescriptions were analysed, 40.89% of patients were from the 21-35 years age group. Polytherapy was 62.96% and monotherapy 36.99%. Drugs prescribed by generic names were 18% and brand names were 82%. Topical drugs constituted 71.67% followed by systemic drugs 28.32% of total prescriptions and the average injectables prescribed per encounter was 0.33%. Antifungals were most prescribed followed by steroids. The average number of drugs prescribed was 1.85 per encounter and the percentage of antibiotic prescriptions was 17.70%. Conclusions: The current study showed that WHO DUS indicators were followed. The results reflect rational prescription of drugs within the available resources

Myanmar Undergoing an Exciting Phase: An Indian Traveller's Impression

After collecting my baggage, I joined other co-passengers to face the immigration counter at Yangon airport. Being on a research trip, I was expecting the usual grilling and curious questions from immigration officials. The grilling was particularly more intense during my previous visit to Bangladesh. For almost half an hour, the customs officials posted at the Dhaka airport had interviewed me to get a clearer understanding on the exact purpose of my visit to Bangladesh

A comparative study of effect of fluoroquinolones on blood glucose levels in rats

Background: Fluoroquinolones (FQ) are frequently prescribed because of their broad-spectrum applicability in treatment of community acquired pneumonia and urinary tract infections. Increased use has raised some concerns regarding side effects like dysglycaemia, tendon rupture and QT interval prolongation. Gatifloxacin was banned in India in 2011 for causing fatal hypoglycemia. This study compares the effect of different fluoroquinolones on blood glucose levels in rats.Methods: 24 rats were divided into four study groups. Each group was administered one fluoroquinolone namely levofloxacin 9 mg, moxifloxacin 7.2 mg, ciprofloxacin 18 mg and ofloxacin 14.4 mg respectively for five days. The changes in blood glucose levels were observed for 10 days.Results: The mean blood glucose levels in all the four groups dropped below the baseline by day five. A statistically significant reduction in mean glucose levels was found in the moxifloxacin, ciprofloxacin and levofloxacin group. Among the rats that were given ofloxacin, the reduction in the mean blood glucose levels was not statistically significant. After stopping the drugs, the blood glucose levels in all the four groups returned near to the baseline within five days.Conclusions: The use of fluoroquinolones causes hypoglycemia in rats. The blood glucose level reduction associated with moxifloxacin was maximum, whereas ofloxacin appeared to have the minimum effect on blood glucose levels. These effects do not appear to be permanent and the dysglycaemia subsided after the drugs were stopped

Plasmid profile analysis of multidrug resistant E. coli isolated from UTI patients of Nagpur City

Abstract Infections caused by Escherichia coli (E. coli) have become a significant worldwide public health problem with India being no exception. Furthermore, the situation is worsening due to advent of increased antibiotic resistance due to the evolution of multi-resistant antibiotic plasmid genes. Extended Spectrum B-lactmases (ESBLs) are plasmid mediated and these enzyme producing organisms exhibit co resistance to many other classes of antibiotics. The wide spread presence of drug resistant E. coli and other pathogens in our environment necessitates regular monitoring of antibiotics susceptibility trends in the clinical isolates obtained from different regions to provide the basis for developing National and International prescription programs that can be used for delineating guidelines to maintain the desired effectiveness of antibiotics. In the present study, out of 135 isolates, 76 isolates were of E.coli. These isolates were tested for antibiotic resistance and plasmid profiles. The results revealed that more than 50% of the isolates exhibited multi-drug resistance. Out of 76 E.coli isolates, 40(52.6%) were found to possess plasmids. Some isolates possess single sized plasmid while other had multiple plasmids with different size ranged from 2.3 kb to 26 kb, very high antibiotic resistance was detected from isolates possessing high molecular weight plasmids (23kb). The studies show good prospects for further research in the same area to explore and assign definite cause for antibiotic resistance and multi drug resistance

The 'Nightmare' of Wrong Level in Spine Surgery: Is Minimally Invasive Spine Technique More Forgiving?

Objective Operating on a wrong level is a nightmare for every surgeon, which has devastating consequences for the patient as well as the surgeon and has potential for serious medical, personal and legal repercussions. There is limited literature of Wrong Level Spine Surgery (WLSS) in Minimally Invasive Spine Surgery (MISS). The aim of the study is to evaluate the incidence of WLSS in MISS using tubular retractors. Methods The study included a retrospective review of prospectively collected data of all MIS surgeries utilizing tubular retractors during the period extending from January 2007 to December 2014. The surgeries included Micro-Endoscopic Discectomies, Micro-Endoscopic Decompression surgeries for lumbar canal stenosis and Minimal Invasive Trans-Foraminal Lumbar Interbody Fusion (MI-TLIF) surgeries. The surgeries involved docking of the tubular retractor at the level of interest under fluoroscopic guidance. Surgical charts as well as clinical and imaging follow-up data were analyzed. The incidence of WLSS was analyzed. Results There were 1,043 surgeries in all in the study period. There were 393 discectomies, 370 decompressions and 280 MI-TLIF surgeries. There were no wrong level surgeries in the entire series. There were two (0.19%) wrong side tube dockings which were subsequently rectified during surgery. No clinical complications were seen. The results were reviewed in light of a meta-analysis of current literature available on WLSS in open and MISS. The results were consistent with the present literature in demonstrating a decreased incidence of WLSS with MISS. Conclusion The docking of the tubular retractor under fluoroscopic guidance offers an advantage of preventing WLSS. This is an additional benefit of MISS using tubular retractors

Big Data Integration Solutions in Organizations: A Domain-Specific Analysis

Big Data Integration (BDI) process integrates the big data arising from many diverse data sources, data formats presents a unified, valuable, customized, holistic view of data. BDI process is essential to build confidence, facilitate high-quality insights and trends for intelligent decision making in organizations. Integration of big data is a very complex process with many challenges. The data sources for BDI are traditional data warehouses, social networks, Internet of Things (IoT) and online transactions. BDI solutions are deployed on Master Data Management (MDM) systems to support collecting, aggregating and delivering reliable information across the organization. This chapter has conducted an exhaustive review of BDI literature and classified BDI applications based on their domain. The methods, applications, advantages and disadvantage of the research in each paper are tabulated. Taxonomy of concepts, table of acronyms and the organization of the chapter are presented. The number of papers reviewed industry-wise is depicted as a pie chart. A comparative analysis of curated survey papers with specific parameters to discover the research gaps were also tabulated. The research issues, implementation challenges and future trends are highlighted. A case study of BDI solutions implemented in various organizations was also discussed. This chapter concludes with a holistic view of BDI concepts and solutions implemented in organizations

The population of merging compact binaries inferred using gravitational waves through GWTC-3

We report on the population properties of 76 compact binary mergers detected with gravitational waves below a false alarm rate of 1 per year through GWTC-3. The catalog contains three classes of binary mergers: BBH, BNS, and NSBH mergers. We infer the BNS merger rate to be between 10 $\rm{Gpc^{-3} yr^{-1}}$ and 1700 $\rm{Gpc^{-3} yr^{-1}}$ and the NSBH merger rate to be between 7.8 $\rm{Gpc^{-3}\, yr^{-1}}$ and 140 $\rm{Gpc^{-3} yr^{-1}}$ , assuming a constant rate density versus comoving volume and taking the union of 90% credible intervals for methods used in this work. Accounting for the BBH merger rate to evolve with redshift, we find the BBH merger rate to be between 17.9 $\rm{Gpc^{-3}\, yr^{-1}}$ and 44 $\rm{Gpc^{-3}\, yr^{-1}}$ at a fiducial redshift (z=0.2). We obtain a broad neutron star mass distribution extending from $1.2^{+0.1}_{-0.2} M_\odot$ to $2.0^{+0.3}_{-0.3} M_\odot$. We can confidently identify a rapid decrease in merger rate versus component mass between neutron star-like masses and black-hole-like masses, but there is no evidence that the merger rate increases again before 10 $M_\odot$. We also find the BBH mass distribution has localized over- and under-densities relative to a power law distribution. While we continue to find the mass distribution of a binary's more massive component strongly decreases as a function of primary mass, we observe no evidence of a strongly suppressed merger rate above $\sim 60 M_\odot$. The rate of BBH mergers is observed to increase with redshift at a rate proportional to $(1+z)^{\kappa}$ with $\kappa = 2.9^{+1.7}_{-1.8}$ for $z\lesssim 1$. Observed black hole spins are small, with half of spin magnitudes below $\chi_i \simeq 0.25$. We observe evidence of negative aligned spins in the population, and an increase in spin magnitude for systems with more unequal mass ratio

Constraints on the cosmic expansion history from GWTC-3

We use 47 gravitational-wave sources from the Third LIGO-Virgo-KAGRA Gravitational-Wave Transient Catalog (GWTC-3) to estimate the Hubble parameter $H(z)$, including its current value, the Hubble constant $H_0$. Each gravitational-wave (GW) signal provides the luminosity distance to the source and we estimate the corresponding redshift using two methods: the redshifted masses and a galaxy catalog. Using the binary black hole (BBH) redshifted masses, we simultaneously infer the source mass distribution and $H(z)$. The source mass distribution displays a peak around $34\, {\rm M_\odot}$, followed by a drop-off. Assuming this mass scale does not evolve with redshift results in a $H(z)$ measurement, yielding $H_0=68^{+12}_{-7} {\rm km\,s^{-1}\,Mpc^{-1}}$ ($68\%$ credible interval) when combined with the $H_0$ measurement from GW170817 and its electromagnetic counterpart. This represents an improvement of 17% with respect to the $H_0$ estimate from GWTC-1. The second method associates each GW event with its probable host galaxy in the catalog GLADE+, statistically marginalizing over the redshifts of each event's potential hosts. Assuming a fixed BBH population, we estimate a value of $H_0=68^{+8}_{-6} {\rm km\,s^{-1}\,Mpc^{-1}}$ with the galaxy catalog method, an improvement of 42% with respect to our GWTC-1 result and 20% with respect to recent $H_0$ studies using GWTC-2 events. However, we show that this result is strongly impacted by assumptions about the BBH source mass distribution; the only event which is not strongly impacted by such assumptions (and is thus informative about $H_0$) is the well-localized event GW190814

Search for continuous gravitational wave emission from the Milky Way center in O3 LIGO--Virgo data

We present a directed search for continuous gravitational wave (CW) signals emitted by spinning neutron stars located in the inner parsecs of the Galactic Center (GC). Compelling evidence for the presence of a numerous population of neutron stars has been reported in the literature, turning this region into a very interesting place to look for CWs. In this search, data from the full O3 LIGO--Virgo run in the detector frequency band $[10,2000]\rm~Hz$ have been used. No significant detection was found and 95$\%$ confidence level upper limits on the signal strain amplitude were computed, over the full search band, with the deepest limit of about $7.6\times 10^{-26}$ at $\simeq 142\rm~Hz$. These results are significantly more constraining than those reported in previous searches. We use these limits to put constraints on the fiducial neutron star ellipticity and r-mode amplitude. These limits can be also translated into constraints in the black hole mass -- boson mass plane for a hypothetical population of boson clouds around spinning black holes located in the GC.Comment: 25 pages, 5 figure

GWTC-3: Compact Binary Coalescences Observed by LIGO and Virgo During the Second Part of the Third Observing Run

The third Gravitational-wave Transient Catalog (GWTC-3) describes signals detected with Advanced LIGO and Advanced Virgo up to the end of their third observing run. Updating the previous GWTC-2.1, we present candidate gravitational waves from compact binary coalescences during the second half of the third observing run (O3b) between 1 November 2019, 15:00 UTC and 27 March 2020, 17:00 UTC. There are 35 compact binary coalescence candidates identified by at least one of our search algorithms with a probability of astrophysical origin $p_\mathrm{astro} > 0.5$. Of these, 18 were previously reported as low-latency public alerts, and 17 are reported here for the first time. Based upon estimates for the component masses, our O3b candidates with $p_\mathrm{astro} > 0.5$ are consistent with gravitational-wave signals from binary black holes or neutron star-black hole binaries, and we identify none from binary neutron stars. However, from the gravitational-wave data alone, we are not able to measure matter effects that distinguish whether the binary components are neutron stars or black holes. The range of inferred component masses is similar to that found with previous catalogs, but the O3b candidates include the first confident observations of neutron star-black hole binaries. Including the 35 candidates from O3b in addition to those from GWTC-2.1, GWTC-3 contains 90 candidates found by our analysis with $p_\mathrm{astro} > 0.5$ across the first three observing runs. These observations of compact binary coalescences present an unprecedented view of the properties of black holes and neutron stars