Effect of Hyperglycemia on the Duration of Hospital Stay and Rate of Mortality in Patients of Chronic Obstructive Pulmonary Disease in Acute Exacerbation: A 1-year Hospital-based Observational Study

Background: Chronic obstructive pulmonary disease (COPD) is not only a respiratory disease but is also a systemic disease associated with comorbidities such as diabetes mellitus (DM), hypertension, osteoporosis, etc. Diabetes being one of the comorbidities, COPD is thought to be a causative factor for developing insulin resistance. Similarly, poor glycemic control is associated with worsened COPD outcomes. Thus, this study has been taken up to analyze the effect of hyperglycemia on the duration of hospital stay and rate of mortality, and other outcomes in patients with COPD with exacerbation. Methods: It was an observational study conducted for 1 year in KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, Karnataka, India. A total of 84 patients were enrolled and divided into two groups based on the mean random blood sugar (RBS) levels. Group I had 40 patients with mean RBS <250 mg/dL and group II had 44 patients with mean RBS ?250 mg/dL. Outcomes and variables of the patients with COPD were compared between both groups. Results: Patients in group II had poor outcomes compared to group I. The mean duration of hospital stays in groups I and group II were 5.43 and 7.34, respectively, with a significant p < 0.0001. The mean duration of intensive care unit (ICU) stay was 3.33 and 4.47 in groups I and II, respectively, which was statistically significant. The rate of mortality in groups I and II was 5.00 and 11.36%, respectively. Conclusion: Patients with hyperglycemia had an increased duration of hospital stay and rate of mortality. Optimal glycemic control plays a significant role in patients with COPD in reducing the severity of exacerbation and mortality.

An observational study of adverse drug reactions reported in a rural tertiary care hospital

Background: Adverse drug reactions (ADRs) are noxious and unintended effects of a drug that occurs at doses normally used in humans. ADRs may also result in diminished quality of life, increased physician visits, hospitalizations, and even death. The objectives of this study are to analyze and assess the causality and severity of reported ADRs.Methods: A cross sectional study of ADRs reported to Pharmacovigilance cell of MNR Medical College and Hospital Sangareddy in a year. The details of the various ADRs were statistically analyzed to find out pattern of ADRs. The WHO-UMC causality category and Hartwig-Seigel Scale were used to assess causality and severity of ADRs respectively.Results: The study shows, out of 60 suspected ADRs, the majority of ADRs were adults (68.3%) and out of whom 56% were females. According to the WHO-UMC Causality categories, 43.3% of the ADRs were categorized under Probable/likely, followed by possible (35%). The Hartwig-Siegel severity assessment scale shows that the majority (90%) of suspected ADRs were of mild category.Conclusions: The pattern of ADRs reported in our study is comparable to other studies. The commonest organ system affected was gastrointestinal tract, nervous and cutaneous system. Antimicrobial agents were causing maximum ADRs and medicine and allied departments have more number of ADRs. This study provides a valuable database for ADRs due to all commonly used drugs at hospitals and also helps in creating awareness regarding safe & judicious use of drugs to prevent ADRs.

Gene set enrichment analysis of alpha-glucosidase inhibitors from Ficus benghalensis

Objective: To identify alpha-glucosidase inhibitors from Ficus benghalensis and analyze gene set enrichment of regulated protein molecules. Methods: The phytoconstituents of Ficus benghalensis were queried for inhibitors of alpha-glucosidase, also identified as aldose reductase inhibitors. Druglikeness score, absorption, distribution, metabolism, excretion and toxicity profile, biological spectrum, and gene expression were predicated for each compound. Docking study was performed to predict the binding affinity with alpha-glucosidase and aldose reductase and compared with clinically proven molecules. Kyoto Encyclopedia of Genes and Genomes pathway analysis was performed for the regulated genes to identify the modulated pathways. Results: Apigenin, 3,4',5,7-tetrahydroxy-3'-methoxyflavone, and kaempferol were identified as inhibitors of alpha-glucosidase and aldose reductase. Kaempferol was predicted to possess the highest binding affinity with both targets. The p53 signaling pathway was predicted to modulate the majority of protein molecules in diabetes mellitus. All the alpha-glucosidase inhibitors were also predicted as membrane integrity agonist and anti-mutagenic compounds. Conclusions: The current study indicates alpha-glucosidase inhibitors from Ficus benghalensis can act as aldose reductase inhibitors after absorption from the intestinal tract. Furthermore, these phytoconstituents are involved in the regulation of numerous protein molecules and pathways. Hence, the anti-diabetic efficacies of these compounds are due to their action on multiple protein molecules and synergistic effects which should be confirmed by future investigations.

Utility of MOC-31 monoclonal antibody in differentiating metastatic adenocarcinoma cells and reactive mesothelial cells in effusion cytology

In effusion cytology, a clear distinction between reactive mesothelial cells and metastatic adenocarcinoma cells is sometimes challenging mainly due to similarities in the cytomorphological features. In such cases for definitive diagnosis, paraffin-embedded cell block examination and immunohistochemistry are helpful in making this distinction. MOC-31 is one of the proposed immunomarker for adenocarcinoma cells. We undertook to evaluate the role of MOC-31 as a marker for identifying adenocarcinoma cells in effusion specimen. A total of 185 paraffin-embedded cell blocks of effusion samples were identified, of these 111 cases were of metastatic adenocarcinoma. MOC-31 was positive in 101 of the 111 cases of metastatic adenocarcinoma. Minimal focal cytoplasmic staining was also seen in 7 of the 74 cases of reactive mesothelial cells, but these were taken negative as they did not show membrane positivity. The sensitivity and specificity of MOC-31 for metastatic adenocarcinoma cells were 92.5%, and 100% respectively, positive and negative predictive value (NPV) was 100% and 91.14%, respectively. MOC-31 can be used as a reliable marker in effusions for distinguishing metastatic adenocarcinoma from reactive mesothelial cases.

Knowledge, attitude, perceptions and assessment of effectiveness of educational intervention on Pharmacovigilance among undergraduate medical students at Gulbarga Institute of Medical Sciences, Kalaburagi, India

Background: The Study was designed to assess the awareness of Pharmacovigilance and to evaluate the impact of an educational intervention.Methods: This was a questionnaire-based pre- and post-test educational interventional study. Students were given handouts containing information about pharmacovigilance one month before the educational intervention. A pre-validated 20-point questionnaire on (KAP) Knowledge, attitude, perception about Pharmacovigilance was distributed to second year medical students (n=115). An interactive educational intervention (Power point presentation) was designed. The chi-square test and unpaired paired t-test was used for statistical calculation.Results: The overall response rates were expressed as percentages, Mean±SD. The knowledge, attitude and perceptions of pharmacovigilance when compared before (pre-KAP) and after (post-KAP) the educational intervention, the correct response rates were found to be statistically significant (P<0.001). The feedback from the students was encouraging, handouts before the lecture classes helped them to easily grasp the pharmacovigilance concepts better during lectures.Conclusions: The study concluded that imparting the knowledge about pharmacovigilance and ADR reporting promotes drug safety and rational use of medicines in future.

Perceptions and practices of self-medication among undergraduate medical students at Gulbarga Institute of Medical Sciences, Kalaburagi, India

Background: Self-medication practice is widespread in many countries and the irrational use of drugs is a cause of concern. It assumes a special significance among medical students as they are exposed to knowledge about diseases and drugs. To assess practice and perception of self-medication among undergraduate medical students.Methods: It is a descriptive study in which study population was comprised of 2nd year undergraduate medical students of Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India. Total 134 students were included in the study. Written informed consent was obtained from each volunteer prior to the study. Students were given a questionnaire that included both open and close ended questions about self-medication practice. Data was analysed and presented as counts and percentages.Results: It was found that 72 (54%) students practiced self-medication. The principal morbidity for seeking self-medication was cold and cough as reported by 70 (53%) students. Antibiotics were most commonly self-medicated as reported by 55 (36%) students. Only 34 (25%) students opined that self-medication is part of self-care.Conclusions: Self-medication is widely practiced among under­ graduate medical students. In this situation, we should educate the students about advantages and disadvantages of self-medication.

Preparation and therapeutic evaluation of rutin-phospholipid complex for antidiabetic activity.

The objective of the present work to prepare Rutin-phospholipid complex (RPC), a phytoformulation and characterization, evaluation for its antidiabetic activity in streptozotocin induced diabetic model. Prepared RPC was characterized and screened for antidiabetic activity by OGTT in normoglycemic and diabetic rats for RT and RPC at different time intervals. Effect of RT and RPC (50 and 100 mg/kg b.w. p.o. respectively) in STZ induced diabetic rats for one day and fifteen days was studied. This is followed by estimation of Estimation of SG, and lipid parameters. Histopathology studies of pancreatic tissue and bioavailability studies of RT & RPC were also carried out. SEM data showed that RPC has irregular size vesicles consisting of phosphatidylcholine. RPC showed a single endothermal peak at 147.68°C in DSC studies. OH group has shifted to lower frequency in phytosome compared to rutin phospholipid in FTIR spectra. Treatment with RPC (50 and 100 mg/kg b.w. p.o.) significantly reduced the blood glucose levels and restored the altered lipid parameters as compared to RT. Histopathological studies revealed that RPC also restored back the size of pancreatic islets and maintained the normal β-cells. A higher serum concentration of RT (13.20 μg/mL) in RPC treated group was observed in bioavailability studies as compared to RT. RPC maintained effective concentration of rutin for a longer period in rat serum.

Estimation of Body Fat Mass from Bioelectrical Impedance Analysis in Indian Adults Aged 23 to 81 Years: A Comparison with Dual Energy Xray Absorptiometry.

The purpose of this study was to validate a bioelectrical impedance analysis (BIA) equation for prediction of body fat mass (FM) against dual energy Xray absorptiometry (DXA) in healthy Indian adults with large variations in body mass index and age. Healthy subjects (28 males and 85 females) were investigated by two methods: FM was measured by a dual energy Xray absorptiometry and segmental bioelectrical parameters at various frequencies were measured by a commercial segmental multifrequency BIA instrument. Total body parameters were derived from segmental bioelectrical parameters. As correlation was high and prediction error was low, a single equation was developed for FM as follows: FM = 15.45 + [0.0074 × (Rbody250)] - (3.89 × sex); men = 1, women = 0) + (0.844 × w) - [6938 × (h2/Zbody50)] - (22.22 × h) + [3 × (Xbody250 - Xbody5)/age)] + [1.53 × (Φbody5)] - [0.126 × (Xbody50/h)]. Fat mass predicted with dual energy Xray absorptiometry was 28.11 ± 9.30 kg. BIApredicted FM was 28.12 ± 9.11 kg (R = 0.9794, adjusted R2 = 0.9561, standard error of estimate = 1.95 kg, total error = 1.87 kg). In conclusion, the new developed BIA equation was valid for prediction of FM in healthy subjects aged 23 to 81 years with body mass indices between 15.62 and 39.98 kg.m-2. Inclusion of reactance in the kg.m-2 single prediction equation appeared to be essential for use of BIA equation in adults with large variations in body mass and age.

A Clinical Case Report of Hashimoto's Thyroiditis And Impact On Treatment of Chronic Periodontitis.

Periodontitis is a multifactorial disease with microbial dental plaque as the initiator of periodontal disease. However the manifestation and progression of the disease is influenced by a wide variety of determinants and factors. The strongest type of causal relationship is the association of systemic and periodontal disease. Hashimoto’s thyroiditis has also been considered as one of the causes of periodontal disease. This clinical case report highlights the impact of Hashimoto’s thyroiditis on the outcome of periodontal therapy.

Detection and antifungal susceptibility testing of oral Candida dubliniensis from human immunodeficiency virus-infected patients.

Context: Candida dubliniensis, an opportunistic yeast that has been implicated in oropharyngeal candidiasis (OPC) in patients infected with Human Immunodeficiency Virus (HIV) may be under-reported due to its similarity with Candida albicans. Resistance to Fluconazole is often seen in C. dubliniensis isolates from clinical specimens. Aims: To know the prevalence of C. dubliniensis in OPC in patients infected with HIV and their antifungal susceptibility pattern. Settings and Design: One hundred and thirty-two HIV seropositive individuals and 50 healthy controls were included in the study. Materials and Methods: Two oral swabs were collected from the site of the lesion from 132 HIV-infected patients. Oral rinse was obtained from 50 healthy controls. Samples were inoculated on Sabouraud's dextrose agar (SDA) medium and on HiCrome Candida Differential Agar (CHROM agar) medium. Isolates were speciated by standard tests. Dark green-colored, germ tube positive isolates, which failed to grow at 420C and negative for xylose assimilation were identified as C. dubliniensis. Antifungal susceptibility test was performed by Macro broth dilution technique (National Committee for Clinical Laboratory Standards guidelines). Results and Conclusions: From 132 patients, 22 (16.3%) C. dubliniensis were isolated; samples from healthy controls did not reveal their presence. Antifungal susceptibility test showed higher resistance among C. dubliniensis isolates to azoles compared to C. albicans. Five (22.7%) isolates of C. dubliniensis were resistant to Fluconazole followed by four (18.2%) to Ketoconazole. This study emphasizes the importance of identification and antifungal susceptibility testing of C. dubliniensis in HIV-infected patients.

Significance of isolation and drug susceptibility testing of non-Candida albicans species causing oropharyngeal candidiasis in HIV patients.

Oropharyngeal candidiasis (OPC) continues to be a common opportunistic infection in patients infected with Human Immunodeficiency Virus (HIV) and is predictive of increasing immunosuppression. Though Candida albicans remains the predominant isolate, a rise in the frequency of isolation of non-albicans Candida (NAC) species is being observed. The levels of virulence and the sensitivities to available antifungal drugs vary among these species. Of 340 HIV seropositive patients in this study, 132 (38.8%) had oral lesions suggestive of candidiasis. Samples were collected from the lesion using sterile cotton swabs. Isolation and speciation were done by standard techniques. Antifungal drug susceptibility testing was done by macro broth dilution. The total number of Candida isolates was 135, of which, 45 (33.3%) were NAC species and 90 were C.albicans (66.6%). Of the NAC species, C. dubliniensis was the predominant pathogen (22,48.9%). Antifungal susceptibility testing showed that 14 (31.1%) of the NAC species and 11 (12.2%) of C. albicans were resistant to fluconazole (MIC > 8 microg/ml). A very high MIC of > 32 microg/ml was noted among the NAC species resistant to fluconazole.

First care givers of mentally ill patients: a multicenter study.

Pathways to psychiatric care were evaluated among three hundred and eighty four first-contact psychiatric patients from five socio-culturally different regions of India by a modified version of World Health Organization encounter form for 'pathways in psychiatric care'. Concerning first caregivers, out of 384 respondents 34.1% had chosen the psychiatrists, 29.4% the general practitioners and 26% had chosen faith healers and exorcists. Choice for the first caregiver was not influenced by gender differences, literacy status and family type. Mostly the subjects hailing from rural areas and those presenting with somatic symptoms chose psychiatrist as their first caregivers.

Urolithiasis: a tribal scenario.

Urolithiasis is quite prevalent in Satpura belt of Central India. Forty five children with urolithiasis were studied in Jawahar Medical Foundations Hospital, Dhule, Maharashtra over a period of three years. The mean age was 7.1 +/- 3.2 (range 18 months-15 years). The chief presenting complaints were dysuria and lower abdominal pain. The physical, laboratory and radiographic findings were evaluated. Calculi were located in the bladder (80%), urethra (9%), kidney (6.6%) and ureter (4.4%). Calculi were mainly composed of calcium oxalate (65.7%) and calcium phosphate (34.3%). The predominant urinary tract stones in the tribal Satpura belt are bladder stones and may be related to poor nutrition, low socioeconomic status and consumption of bajra (millet) as staple food as found in this region (93.5%).

Synthesis and antibacterial activity of some Schiff bases and 4-thiazolidinones.

Some new schiff bases (1a-d) 4-thiazolidinones (2a-d) have been synthesised and tested for their antibacterial activity. The structures of these compounds have been established on the basis of elemental analysis and spectral data (IR and H1 NMR).

Molecular cloning and restriction enzyme analysis of a long repetitive DNA sequence in rice.

Rice long repetitive DNA (9-20 kbp) reassociating at Cot 50 M.s was cloned in pBR325. Out of several recombinants (Camr Ampr Tets), only a few were selected randomly for further characterization. The insert size in all these clones was 3-4 kbp. Restriction enzyme analysis showed the absence of EcoRI and BclI sites, presence of a single PstI and PvuII site and multiple sites for AluI in 3 clones namely pRLl, pRL7 and pRL10. The BamHI-PstI fragment of about 0·4 kbp in the pRL7 insert DNA (pRL7-0·4 kbp) was subcloned in M13mpl8 and partially sequenced using Sanger’s dideoxynucleotide chain termination method. Dot matrix comparison of this sequence with rice rDNA sequences revealed low homology with the 25S rDNA sequence of rice, however, hybridisation did not indicate any homology.