Effects of gamma irradiation on the physico-chemical and biological properties of levofloxacin

The aim of the present study was to examine the effect of gamma radiation on levofloxacin. Powder form of levofloxacin was subjected to different radiation doses [25, 50, 75, 100 and 125kGy] of Cobalt-60 source in a Gammacell-220 at a rate of 8.5 Gray/hr. The effect of radiation has been investigated with the aid of different spectroscopic techniques [UV-Vis, FT-IR], scanning electron microscopy [SEM], X-ray diffraction [XRD], and by antibacterial activities. UV data did not reveal significant changes in the structure of levofloxacin which is supported by scanning electron microscopy. However, X-rays diffraction shows a change in crystallinity of levofloxacin to an amorphous structure and this has been reflected on the morphology of this compound as indicated by SEM images. The antibacterial activities, on the other hand, reveal resistance of irradiated levofloxacin against bacteria, where some bacteria were highly affected by the irradiated drug. Similarly, FT-IR data show some changes in the functional groups principal absorption bands, in the IR spectrum, at frequencies 3286, 2846, 1716 and 1620 cm-1 for the O-H stretching band of quinolone, C-H stretching band, and C=O stretching band of carboxylic and pyridine. In addition, new peaks appeared which were not seen in the non-irradiated spectrum. In conclusion, some changes occurred in levofloxacin drug with the passage of radiation but the drug was chemically stable

Practices of proton pump inhibitors use in medical wards

Objective: To determine the pattern of proton pump inhibitors [PPIs] use in medical wards

Study Design: Prospective observational study

Place and Duration of Study: Department of medical post graduate medical institute, study for 24 weeks, from 01 Nov 2014

Material and Methods: One thousand eight hundred consecutive patients admitted in medical wards and emergency department were enrolled and followed during hospital stay and their discharge slips were analyzed without intervention in the management protocol of different primary consultants

Results: Results were analyzed on SPSS version 20. Out of 1800 patients, 53.3% [n=960] were males and 46.7% [n=840] females, 72.6% [n=1306] had been prescribed PPIs. Major indications for the use of PPI were stress ulcer prophylaxis [32.5%], upper G.I bleeding [20.0%], acid peptic disease [12.5%], patients of GERD [8.1%] and NSAID use [7.5%]. In 19.3% patients, indication of PPI use was not mentioned. Out of the admitted patients 57.7% patients were prescribed inject-able and 42.3% were given oral PPIs. There were 77.9% [n=1018] patients prescribed PPIs on discharge slips while duration of treatment and indication for their use were not mentioned on discharge slips for 66.3% [n=866] and 72.3% [n=944] patients, respectively

Conclusion: PPIs are over used without clear indications in hospitalized and discharged patients

Evaluation of modified Alvarado score for frequency of negative appendicectomies

Appendicitis being the commonest surgical emergency is primarily diagnosed clinically but posses diagnostic difficulty usually, especially to junior surgeons, demanding the need for tool/scoring system that can be easily applicable, accurate and reproducible in the diagnosis of appendicitis, with low negative Appendicectomy rate. This study is designed to assess one such scoring system, i.e., Modified Alvarado Score. A total of 100 consecutive male and female patients with age 10 year and above presenting with symptoms suggestive of acute appendicitis were included in study, assessed according to eight variables of Modified Alvarado scoring system and were accordingly placed into 3 groups. Group-I patients having score 1-4 were discharged, Group-II patients having score 5-7 were observed while Group-III patients having score 8-10 were operated. Status of appendix of operated patients was assessed histo-pathologically. Out of 100 patients included in study, 58 patients were operated on the basis of said scoring system. Of the operated patients 52 [89.65%] had acute appendicitis, thus yielding a positive predictive value of 89.66% while negative appendectomy rate of 10.34%. Frequency of negative appendicectomy was 7.69% [3/39] amongst males and 15.79% [3/19] in females. Post-operative complication rate including wound infection, pelvic abscess, chest and urinary tract infection was 22.41% [13/58]. Frequency of the negative appendicectomies can be reduced through standardization of the diagnostic procedure, by applying Modified Alvarado score in the diagnosis of suspected appendicitis cases as compared to simple clinical assessment