Assessment of Prescribing Practices in Overactive Bladder Pharmacotherapy across Different Specialties of India : A Prescription Trend Analysis

Purpose : To assess the temporal prescription patterns of overactive bladder (OAB) pharmacotherapy based on the prescription trend analysis amongst Indian clinicians. Methods : IQVIA (Quintiles and IMS Health) secondary sales audit (SSA) and prescription audit for antimuscarinics and beta-3 adrenoceptor agonist (mirabegron) from 2014 to 2022, were analyzed. Prescribers overlap analysis for solifenacin and mirabegron among Indian urologists was also analyzed. Results : Urologists’ prescription rates of OAB drugs were 65% in 2016 and 52% in 2022. The rate of OAB medication prescription by non-urologists was highest among surgeons (17%), followed by consultant physicians (9%) and gynecologists (8%) in 2022. In addition, among OAB medication prescription rates for antimuscarinics were 100% in 2016 and 56% in 2022 whereas for mirabegron, it was 0% in 2016 and 44% in 2022. The proportion of prescribers of OAB medication among urologists was 38% in 2016 and 33% in 2022. Exclusive prescribers of solifenacin were 748 in 2018 and 715 in 2022 at the urologist, whereas for mirabegron, it was 961 in 2018 and 1475 in 2022. Conclusions : Urologists remained a top prescribing specialty for OAB drugs, although prescription share increased among surgeons and consultant physicians. OAB medicines prescriptions by urologists are shifting from solifenacin to mirabegron. The results of this study could further help clinicians, to design the optimum treatment approach in OAB patients according to their need, which can help to lower antimuscarinic side effects, improves treatment adherence, and improves patient’s QoL.

Unusual presentation of scrub typhus in pregnancy with postpartum dilated cardiomyopathy: a case report

Though scrub typhus is one of the uncommon causes of fever in peripartum period it must be kept in differential diagnosis of any febrile illness particularly when the signs and symptoms points towards rickettsial etiology. Weil-Felix test can be used for diagnosis. Uncommon complications such as cardiomyopathy must be suspected in cases who present with undue dyspnea and signs of congestive heart failure. Patients with cardiomyopathy needs appropriate management in intensive care units. ECG and 2D echocardiography (2D echo) needs to be done in these patients which may show arrhythmias and ventricular hypokinesia and decreased ejection fraction respectively. A 21 years aged first gravida female at 34 weeks of gestational age was admitted with complaints of high-grade fever since 4-5 days with no previous antenatal visits. A diagnosis of rickettsial fever was suspected on the basis of presenting complaints and clinical examination. Weil-Felix test turned out to be positive with OX19 titre of 1:160. She underwent LSCS in view of fetal distress and delivered a healthy male child. In immediate postpartum period she developed respiratory distress. Her 2D echo showed features suggestive of dilated cardiomyopathy. She was managed in medical intensive care unit and was eventually discharged. Though uncommon rickettsial diseases should be kept in the differential diagnosis of any febrile illness particularly when presenting with characteristic rash. Serious complications such as cardiomyopathy must be diagnosed early and treated appropriately in these patients to prevent mortality.

Optimization of Melt in Mouth Tablets of Palonosetron HCl using 32 Full Factorial Design.

Palonosetron HCl is a 5HT3 antagonist licensed for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) associated with highly emetogenic chemotherapy agents (HEC) and the prevention of CINV associated with moderately emetogenic cancer chemotherapy (MEC). It has a substantially longer half-life (Approximately 40 h). So, it was plan to prepare melt in mouth tablet which could rapidly dissolved and absorbed which may produce rapid onset of action. Melt in mouth tablets were prepared by direct compression method using various superdisintegrants like Kyron T314 and Vivasol, and evaluated for pre compression and post compression parameters. A 32 full factorial design was applied systematically to optimize responses. The concentration of Kyron T314 (X1) and concentration of Vivasol (X2) were selected as independent variables and disintegration time (Y1) and wetting time (Y2) as dependent variables. The prepared tablets were evaluated for hardness, friability, disintegration time, wetting time, drug content and in vitro drug release. The results indicated that concentration of X1 and X2 significantly affected Y1 and Y2. Regression analysis and numerical optimization were performed to identify the best formulation. Similarity (f2) and dissimilarity (f1) study for optimized batch was also carried out. Batch P9 was found to be best batch with 10.43 s. disintegration time, 19.53 s. wetting time and 99.02% drug release in 30 min. There was no drastic change in the result of tablets of optimized batch at end of six month accelerated stability study.

Mass propagation of Cymbidium giganteum Wall. ex Lindl. using in vitro seedlings.

In vitro seedlings were used as explants for protocorm like bodies (PLBs) production which in turn were used for regeneration purpose. PLBs were induced from the base of seedlings (1.0-1.5 cm in size) in MS + BAP (8.88 µM). After 90 days of inoculation, PLBs production rate started declining and most of the PLBs turned into plantlets. Preculture of seedlings in 1.0 µM thidiazuron (TDZ) for 7 days and transfer to BAP supplemented medium resulted in production of 16 PLBs per seedling within 90 days of culture. Increase of TDZ concentration to 2.5 µM and preculture time 15 days, resulted in induction of highest number of PLBs (19 PLBs per seedling) in the basal medium. The results emphasized the importance of thidiazuron (TDZ) concentration and preculture time for PLBs proliferation from the base of seedlings. The PLBs thus produced were used for regeneration studies. Irrespective of single, segmented or clumps of PLBs, the regeneration response was 100% in 2,4-D (4.52 µM) and KN (4.64 µM) but when KN was replaced by BAP (8.88 µM), response was observed only in clumps of PLBs, whereas in single and segmented ones it was 99 and 97%, respectively. Regenerants developed stout root system in half strength M medium supplemented with 2.84 µM of IAA and transferred to greenhouse with 90% survival. The present study holds tremendous potential as the mother plant is not destroyed and PLBs are produced as a continuous system.

In vitro flowering – A system for tracking floral organ development in Dendrocalamus hamiltonii Nees et Arn. ex Munro.

Dendrocalamus hamiltonii plants are slender and tall (15-25 m) thereby, rendering tagging, sampling and tracking the development of flowers difficult. Therefore, a reproducible system of in vitro flowering was established for tracking the stages of flower development. MS medium supplemented with 2.22 µM 6-benzylaminopurine, 1.23 µM indole-3-butyric acid and 2% sucrose was optimized as the flower induction medium (FIM) wherein 28 and 42 days were required for the development of gynoecium and androecium, respectively. Six distinct stages of in vitro flower development were identified, and the flowers were comparable with that of in planta sporadic flowers. Pollen viability of the in vitro flowers was higher than those of in planta ones. The in vitro system developed in the present study facilitates easy tracking of different stages of flower development under controlled environmental conditions. It can also be used for medium- or long-term storage of pollens and manipulation of in vitro fertilization.

A simple technique for tracking individual spore and gametophyte development in Adiantum lunulatum Burm. f. using modified extra thin alginate film technique.

A new technique was developed for accurate calculation of percent germination and tracking of individual spores from germination to gametophyte development in Adiantum lunulatum. High percentage of ETAF immobilized spore germination (72.4%) was followed by development of gametophytic clumps. The ETAF immobilized clumps were cut into pieces and multiplied en masse. Apomictic sporophytes developed from the gametophytes. This indicated the potential of ETAF for mass propagation of A. lunulatum without the need to start from spores. Since individual spores can be tracked from germination to gametophyte development, the ETAF technique has the potential to be used for (i) harvesting uniformly developed plants of similar age for extensive experimentations and commercial utilization and (ii) detailed study on developmental and reproductive biology of different ferns and fern allies.

Study of virulence factors of uropathogenic Escherichia coli and its antibiotic susceptibility pattern.

Context: Urinary tract infection (UTI) is one of the most common nosocomial infections, caused by Escherichia coli. This study determined the presence of virulence factors in the organism and correlates it with the multi-drug resistance (MDR). Aims: The aim of the following study is to assess the virulence factors of uropathogenic E. coli and antibiotic susceptibility pattern. Settings and Design: This was a prospective study conducted in the Department of Microbiology in PT. B. D. Sharma, PGIMS, Rohtak. Subjects and Methods: The study was conducted over a period of 1 year. Urine samples received were processed as per standard microbiological procedures. Virulence factors such as hemolysin, hemagglutination, cell surface hydrophobicity, serum resistance, gelatinase and siderophore production were studied. The antimicrobial susceptibility was done as per Clinical and Laboratory Standard Institute Guidelines. Statistical Analysis Used: The data was analyzed by using SPSS(Statistical Package for the social sciences) IBM Corporation version 17.0. A two sided P ≤ 0.05 was considered to be signifi cant. Results: Hemolysin production was seen in 47.4%, hemagglutination in 74.8%, cell surface hydrophobicity in 61%, serum resistance in 59%, gelatinase in 67.5% and siderophore production in 88% isolates. Nitrofurantoin was found to be most effective followed by, gatifl oxacin and gentamicin. Twenty nine percent (29.62%) isolates were MDR. Conclusions: Therefore, the knowledge of virulence factors of E. coli and their antibiotic susceptibility pattern will help in better understanding of the organism and in the treatment of UTI.

Resistance Pattern of Escherichia coli Isolates from Surgical Wound Infections.

Background: Surgical wound infections, are common post-operative complications, that cause significant postoperative morbidity and mortality. Aim of the study: To isolate, identify and study the antimicrobial sensitivity of E. coli isolates from surgical wounds. Methodology: A total of 1088 pus samples were received over a period of one year from post-operative wounds. 313 isolates of E. coli were recovered and identified and antimicrobial sensitivity testing (AST) including extended spectrum beta lactamases (ESBL) detection was performed according to Clinical Laboratory Standard Institute (CLSI) guidelines. Results: E. coli accounted for 37.5% . ESBL production was detected in 22.0% of E. coli isolates. Conclusion: Our study shows that there is increased isolation rate of E. coli from post-operative wound infections. Hospital disinfection and treatment protocols should be practiced thoroughly and regularly monitored to control the incidence of wound infections.

C-reactive proteins as an indicator of sub-clinical infection in cases of premature rupture of membranes.

The present study was conducted on 25 cases of preterm, premature rupture of membranes and 25 patients preterm with intact membranes, between 28-36 weeks of gestation, admitted in the maternity ward of Obstetrics and Gynecology, PGIMS, Rohtak. The sensitivity and specificity of CRP determination was found to be 80% each as an early predictor of subclinical chorioamnionitis. TLC had a low sensitivity of 20% and specificity of 60% in detecting histopathological chorioamnionitis. So CRP estimation is a reliable marker for detection of early choriamnionitis, at the same time, it is quite affordable and reasonably simple.

Bacteraemia in children.

OBJECTIVES: (i)To know the etiology of bacteraemia in children, (ii) To learn the antibiotic sensitivity pattern of the isolates. METHOD: Over the period of thirteen months 4,368 blood samples (for blood culture) were collected from children in the age group of 0 day-14 years, suspected of having fever and sepsis. Blood samples were collected for blood culture from each case. Organisms were isolated and identified by conventional methods. Antibiotic susceptibility for each isolate was determined by using modified Stokes method. RESULT: 1,001 cases (22.9%) were culture positive. Incidence of bacteraemia in neonates was 521(33.94%). Gram negative organisms were the most predominant isolates (88.8%). Commonest was Klebsiella 471 (47.1%) followed by Salmonella sp. 162 (16.2%) and Pseudomonas 80 (8%) whereas in gram positive, Staphylococcus aureus 76 (7.6%) was the most common. Maximum sensitivity was seen by sulbactum/cefaperazone combination-969 (98.2%) by all isolates. Linezolid 97 (99.0%) was the most sensitive drug for gram positive isolates. CONCLUSION: Gram negative multidrug resistant organisms were the main cause of septicemia in all the age groups. Therefore great caution is required in selection of antibiotic therapy.