Drug prescribing pattern in dermatology outpatient department at a tertiary care teaching hospital of North India – A cross-sectional survey-based study

Background: The pattern of drug use in a hospital setting needs to be monitored intermittently to analyze their rationality. Aim and Objective: The aim of this study was to assess the prescribing pattern as per World Health Organization core drug use indicators. Materials and Methods: This is a prospective cross-sectional, single-center, and observational study. A total of 620 prescriptions were included and analyzed in dermatology outpatient attendees at a tertiary care teaching hospital. A predesigned pro forma was used to collect and compile data. All the statistical analysis was performed with the Microsoft Excel office 2019 version. Results: The average number of drugs per encounter was 4.03. The percentage of encounters with antibiotics was 33.38%. There was no prescription having an injection. The drugs prescribed by their generic names were 16.61%. Drugs prescribed from local institutional essential drugs list were 42.11%. Conclusion: Studies based on drug prescribing patterns are a very important tool not only to guide physicians to improve their prescribing habits but also for hospital administration to recognize the lacunae in drug prescribing and formulate guidelines to facilitate rational drug use.

A Comparative Analysis Of Vitamin-C Concentration In Commercial Fruit Juices And Fresh Fruits Of Nepal With Effect Of Temperature

Objective: It was aimed to determine the best storage temperature for fruits to achieve the highest quality of vitamin-C and to compare vitamin C concentration between commercial fruits juices and fresh fruit juices in by using Spectrophotometry and Titrimetric method Methods: Titration involved the redox reaction between iodine and vitamin C. As the iodine was added during the titration, the ascorbic acid was oxidized to dehydroascorbic acid, while the iodine was reduced to iodide ions. The Spectrophotometric method involved the coupling reaction of 2,4 dinitrophenylhydrazine (DNPH) dye with Vitamin C. The samples were analyzed using UV-Vis-Spectrophotometer at 521 nm. Results: Titrimetric and spectroscopic methods were performed for fresh and marketed fruits comprising of apple, grapes, lemon, orange. The maximum amount was found in lemon and orange whereas apple and grapes contained lesser amount of Vitamin C. The stability of marketed fruit juices made up of apple, grapes, lemon, orange were analyzed by storing them on the freeze at 0 °C and 10 °C and on the hot air oven at 20 °C, 30 °C, 40 °C, 50 °C for 72 h and estimated by both Titrimetric and Spectroscopy method. UV-Spectroscopy method showed that, at freezing condition up to 10 °C temperature, degradation was too low but when the temperature reached 50 °C the extent of degradation was more, showing 24.56% apple juice, 10.89% orange juice,12.70% grapes juice and 50% orange juice were degraded in 100 ml sample. Similar results were observed by analysing the samples with titration technique. Conclusion: A new analytical method was developed to address the content of vitamin C in fruits consumed in the local market of Nepal along with the best possible storage of fruit juice to yield the maximum amount of nutrients.

Cortical Folding On Medial Surface Of Foetal Brain At Different Gestational Age

Background: Cortical folding is a hallmark of many but not all mammalian brains. The degree of folding graduallyincreases with the size of brains in mammals but at different range between the families.Gyrification is a processwhich varies widely in mammals in early foetal and prenatal life.Materials: This study was conducted on 100 dead foetuses in anatomy department, brought from the departmentof Obstetrics and gynaecology of MNR Medical College and Hospital.Results: The brain surface is smooth up to 12 weeks,Cingulate sulcus appeared by 16-18weeks.Growth of adjoininglobes of brain make surface more convoluted with well-defined sulci and gyral pattern between 30-32 weeks.Conclusion: Cortical folding is due to consequence of restricted space and rapid growth of brain with in thecranial cavity. There is no differences between male and female brains of same gestational age, with no obviousasymmetrical development of gyri on different lobes of brain

To Correlate The Age And Gender Between Living Female Children And Adult Through Measurement Of Different Segment Of Sternum Bone In North Population Of India

Introduction: The ideal rule of identification of sex and age is a sever need in medico legal cases. Sternum ismuch more appropriate for detection of sex and age of human beings separately from racial characters.Method: This study has been conducted on the total 100 subjects, 50 female (0-15 yrs) and 50 female (16-60yrs)of healthy people (living children & adults) from general population of north India as well as in and around theLucknow of Uttar Pradesh. The technique described by Ashley GT -1956b was used for measurement of sternum.Discussion: on the basis of observation and result in my present study it was fully supported and agree of theprevious researchers, who has done the work in measurement of sternum bone in cadaver and skeletal of human,because they told that the sterna has distinguish in different zone of India.Result: Comparing the mean length, Student’s t test showed significantly different and higher (8.1%) length ofmanubrium in 16-60 yrs female living adults as compared to 2-15 yrs female living children (44.47 ± 5.79 vs.48.38 ± 5.71, t=3.39, p=0.001).Conclusion: Different segment of sternum bone significantly different and higher length of manubrium, becausethe growth of sternum segment was completely develop in adult, but the development in children female iscontinuous in ratio of adults female.

Evaluation of Gender in Living Male and Female Children Through the Measurement of Sternum Bone in the Population of Uttar Pradesh

Introduction: Sex evaluation from the skeletal remains is of very much important for medicolegal aspects in the field of medical science. On the basis of previous researcher, I have been planned to verify the existrnal data and establish them in reference to population in and around Lucknow. With the help of this study we were distinguishes the male and female sternum bone in children. Subjects and Methods: The technique described by Ashley GT -1956b was used for measurement of sternum. Each linear measurement has been taken thrice on the anatomical position of the sternum using Mitutoyo-digital vernier calipers to the nearest millimeter with precision of 0.01 mm. Results: Discussion: The previous researchers told that the sternum has distinguished in different zone of India, and it is shorter than European country. Our findings of manubrium were 49.45±3.45 mm for male and 44.47± 5.79 mm for female children respectively. The study done by previous researcher was provided full support to our present finding. Conclusion: The comparison of mean length of manubrium, mesosternum and sternum between 2 to 15 yrs, female and male sternum between two groups, significantly different and higher length of manubrium, mesosternum and sternum in males as compared to females children.

HAIR-AN Syndrome: Inside Story

15-year-old adolescent girl presented with weight gain, irregular menstrual cycle, skin lesions suggestive of acanthosis nigricans and hirsutism. On evaluation, she was found to have elevated testosterone levels with normal FSH, LH and fasting blood sugar, decreased glucose insulin index suggestive of Insulin resistance. In view of above features, diagnosis of hyperandrogenism-insulin resistance-acanthosis nigricans syndrome (HAIR-AN syndrome) was made. This syndrome is considered as a sub-type of polycystic ovary syndrome (PCOS). HAIR-AN syndrome has varied presentation and is usually seen by primary care physician, gynaecologist or dermatologist. Life style modification with weight reduction and drugs such as metformin helps in alleviating the symptoms. With limited resources in our country, diagnosis is frequently delayed leading to systemic complications. Early diagnosis and appropriate treatment would help in preventing complications of obesity, insulin resistance leading to coronary artery disease, Type 2 diabetes mellitus, hyperlipidemia. Depression and suicidal behavior may be associated with it and should be aggressively addressed in young adults suffering from HAIR-AN syndrome.

High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India.

Background & objectives: It is well documented that the Northeast State of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection. Methods: Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection. Results: HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection. Interpretation & conclusions: The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.

Alveolar rhabdomyosarcoma in children with histomorphological review.

Rhabdomyosarcomas (RMS) are aggressive malignant neoplasm of mesenchymal origin, related to skeletal muscle lineage. These are the most common soft tissue tumors in children. The diagnosis is made by microscopic analysis and ancillary techniques like immunohistochemistry, electron microscopy, cytogenetics and molecular biology. We encountered a case of a 03 years old child who presented with a tender, reddish, soft swelling over cheek for three weeks. The FNAC was reported as a small round cell tumor, Probably Primitive Neuroectodermal Tumor (PNET). The biopsy of tumor revealed a small round cell tumor with an alveolar pattern. Tumor giant cells were absent and mitotic figures were infrequent. Hence, differentials of alveolar rhabdomyosarcoma and PNET were rendered. Immunohistochemistry (IHC) demonstrated desmin positivity. Thus, a final diagnosis of alveolar rhabdomyosarcoma was offered.

Tuberculous Meningitis - A Clinico- Radiological Study.

To study the CT-scan changes in brain in patients of tuberculous meningitis and their correlation with stage of disease and its outcome.A prospective, hospital - based, clinico - radiological study of one year duration including 48 pediatric and 44 adult patients. 50% of patients in the stage I had normal CT-Scan and this proportion decreased to 10.53% in stage - II and 6.67% in stage III. A normal CT-scan is associated with complete recovery in 72.22%, partial recovery in 16.67% and death in 11.11% of cases. Abnormal CTscan is associated with advancing stages of disease and a poor outcome. CT-scan is a valuable tool for diagnosis and monitoring the progress of cases of tuberculous meningitis.

Comparative studies on the effects of Bt-transgenic and non-transgenic cotton on arthropod diversity, seedcotton yield and bollworms control.

The effectiveness of commercial Bt-cotton in pest management, influence on arthropod diversity, natural enemies, and toxin flow in the insect fauna under field conditions were studied keeping in view the need to assess bioefficacy and biosafety of Bt-transgenic cotton. There were no significant differences in oviposition by Helicoverpa armigera on Bt-transgenic and non-transgenic cottons (9.2 versus 9.6 eggs plants-100), while the numbers of H. armigera larvae were significantly more on non-transgenic than on Bt-transgenic (10.4 versus 4.0 larvae plants-100) cotton. The Bt-cotton had significantly more number of mature opened bolls (9.6 versus 4.4 bolls plant-1), lower bollworm damage (12.8 versus 40.2% bolls damaged), and higher seedcotton yield (667.7 versus 231.7 kg ha-1). Population of cotton leafhopper, Amrasca biguttula biguttula was lower (582.2 versus 732.2 leafhoppers plants-100), while that of whitefly, Bemisia tabaci was higher on Bt-transgenic (65.2 versus 45.6 whiteflies plants-100) than on non-transgenic cotton. There was no significant influence of Bt-transgenic cotton on abundance of natural enemies of crop pests – chrysopids (9.6 versus 8.4 chrysopids plants-100), ladybird beetles (16.0 versus 10.8 ladybirds plants-100), and spiders (128.4 versus 142.8 spiders plants-100). There were no significant differences in H. armigera egg (19.8 versus 20.9%), larval (7.4 versus 9.6%), and larval-pupal (1.3 versus 2.9%) parasitism on Bt-transgenic and non-transgenic cottons in the farmer’s fields. The parasitism in larvae of H. armigera was far lower than that of the eggs, which might be because of early mortality of H. armigera prior to parasitoid development in the host larvae. Although, Cry1Ac Bt toxin was detected in Cheilomenes sexmaculatus, chrysopids, A. bigutulla bigutulla, Thrips tabaci, Myllocerus sp., Oxycarenus laetus, Dysdercus koenigii, spiders, bugs, and grasshoppers, no significant differences were observed in their abundance on Bt-transgenic and non-transgenic cottons, suggesting that there were no adverse effects of Bt-cotton on the arthropod diversity under field conditions.

Effect of mating and parasitism regimes on progeny production and sex-ratio of Campoletis chlorideae Uchida.

The ichneumonid parasitoid, C. chlorideae is an important natural enemy of pod borer/bollworm, Helicoverpa armigera (Hubner) in different agro-ecosystems. The sex-ratio of parasitoids has an important bearing on the population build up of the natural enemies for biological control of insect pests. Therefore, the present studies were conducted to gain an understanding of the influence of mating behaviour and abundance of the insect host on fecundity and sex-ratio of the parasitoid, C. chlorideae. There was no significant influence of number of matings and abundance of the insect host on cocoon formation, adult emergence, and larval and pupal periods of C. chlorideae. However, fecundity and female longevity were significantly influenced by mating and abundance of the insect host. There was a significant and positive correlation (r = 0.84**) between longevity and fecundity of C. chlorideae females. The unmated C. chlorideae females produced only males. Nearly 20% of the females that had mated twice were able to parasitize the H. armigera larvae successfully. The sex-ratio of the progeny from females that had mated twice was male biased. Females mated with males from the unmated females produced significantly less numbers of females than those mated with males from the fertilized females, indicating genetic regulation of sex-ratio in C. chlorideae.

Proton magnetic resonance spectroscopy of brain in obstructive sleep apnoea in north Indian Asian subjects.

Background & objectives: Repeated apnoeic/hypoapnoeic episodes during sleep may produce cerebral damage in patients with obstructive sleep apnoea (OSA). The aim of this study was to determine the absolute concentration of cerebral metabolites in apnoeic and non-apnoeic subjects from different regions of the brain to monitor the regional variation of cerebral metabolites. Methods: Absolute concentration of cerebral metabolites was determined by using early morning proton magnetic resonance spectroscopy (1H MRS) in 18 apnoeic patients with OSA (apnoeics) having apnoea/hypopnoea index (AHI) >5/h, while 32 were non-apnoeic subjects with AHI< 5/h. Results: The absolute concentration of tNAA [(N-acetylaspartate (NAA)+N-acetylaspartylglutamate (NAAG)] was observed to be statistically significantly lower (P<0.05) in apnoeics in the left temporal and left frontal gray regions compared to non-apnoeics. The Glx (glutamine, Gln + glutamate, Glu) resonance showed higher concentration (but not statistically significant) in the left temporal and left frontal regions of the brain in apnoeics compared to non-apnoeics. The absolute concentration of myo-inositol (mI) was significantly high (P<0.03) in apnoeics in the occipital region compared to non-apnoeics. Interpretation & conclusions: Reduction in the absolute concentration of tNAA in apnoeics is suggestive of neuronal damage, probably caused by repeated apnoeic episodes in these patients. NAA showed negative correlation with AHI in the left frontal region, while Cho and mI were positively correlated in the occipital region and Glx showed positive correlation in the left temporal region of the brain. Overall, our results demonstrate that the variation in metabolites concentrations is not uniform across various regions of the brain studied in patients with OSA. Further studies with a large cohort of patients to substantiate these observations are required.

Groundwater quality assessment in different land-use areas of Faridabad and Rohtak cities of Haryana using deviation index.

Physico-chemical parameters were analysed to evaluate the groundwater quality of the two important cities of Haryana, Faridabad and Rohtak, and the pollution status of groundwater was compared using deviation index (DI). Groundwater of both the cities had high alkalinity, hardness, total dissolved solids (TDS) and electrical conductivity. The groundwater of Faridabad showed low fluoride concentration whereas in 74% of groundwater samples of Rohtak the fluoride levels were high. Land use and waste disposal practices were found to have an important effect on groundwater pollution.

Water quality index and suitability assessment of urban ground water of Hisar and Panipat in Haryana.

Ground water quality in two well-developed cities of Haryana, viz. Hisar and Panipat was assessed for drinking purpose based on water quality parameters like pH, EC, turbidity, TDS, alkalinity, total hardness, calcium (Ca), magnesium (Mg), sodium (Na), potassium (K), chloride (Cl), nitrate (NO3), phosphate (PO4), sulphate (SO4) and fluoride (F) with respect to different land-use areas viz. residential, industrial, commercial and agricultural. Water quality index based on 9 parameters showed that at Panipat, underground water in all the land-use zones was fit for consumption (WQI < 50), whereas at Hisar, water in agricultural areas was good in quality, but that in other areas varied in magnitude of pollution (WQI > 50 to 100).

Host plant resistance to insects: an eco-friendly approach for pest management and environment conservation.

Host plant resistance (HPR) to insects is an effective, economical, and environment friendly method of pest control. The most attractive feature of HPR is that farmers virtually do not need any skill in application techniques, and there is no cash investment by the resource poor farmers. Considerable progress has been made in identification and development of crop cultivars with resistance to the major pests in different crops. There is a need to transfer resistance genes into high-yielding cultivars with adaptation to different agro-ecosystems. Resistance to insects should form one of the criteria to release varieties and hybrids for cultivation by the farmers. Genes from the wild relatives of crops, and novel genes, such as those from Bacillus thuringiensis can also be deployed in different crops to make HPR an effective weapon to minimize the losses due to insect pests. HPR will not only cause a major reduction in pesticide use and slowdown the rate of development of resistance to insecticides in insect populations, but also lead to increased activity of beneficial organisms and reduction in pesticide residues in food and food products.

Solid--cystic papillary tumor of pancreas.

A case of Solid and Cystic Papillary Epithelial Tumor of Pancreas displaying low grade malignancy occurring in a 38 years old female is presented. It is a rare condition and could be diagnosed histopathologically after complete excision.