Determination and Correlation of Anticardiolipin Antibody with High Sensitivity C- reactive Proteins and its Role in Predicting Short Term Outcome in Patients with Acute Coronary Syndrome

Anticardiolipin antibody (aCL) is considered to be an independent risk factor while high sensitivity C reactive protein (hsCRP) is an established marker for coronary artery disease. This study was conducted to determine levels of aCL antibodies and hsCRP, their correlation and role in predicting recurrence of events in patients presenting with Acute Coronary Syndrome (ACS). Sixty patients admitted with Acute Coronary Syndrome were followed up for 7 days or until discharge. Patients were classified into two groups as those having experienced an ischemic event needing intervention within 7 days (Group I) and other having an event free recovery (Group II). aCL antibody and hsCRP levels were estimated and compared in these two groups. Twenty age and sex matched disease free persons served as controls. The levels of aCL were significantly higher in patients with ACS as compared to the controls (p=0.020). However the levels of aCL in Group I (13.39±9.46 GPL-U/ml) and Group II (13.51±9.93 GPL-U/ml) were not significantly different (p =0.838). The mean hsCRP levels were higher in cases with an event (23.30±10.68 mg/dl) than in cases without an event (20.60±11.45mg/dl) though it was not significant statistically (p=0.389). aCL and CRP were not found to be significantly correlated in causing the recurrence of events(p=0.178). Therefore anticardiolipin antibody is an independent risk factor which could be implicated in the pathogenesis of ACS. However it is not significantly associated with recurrence of short-term events in patients with ACS. Also, aCL antibody does not have significant correlation with hSCRP in causing recurrence of events in the patients of acute coronary syndrome

Analysis of bioactive phytochemicals and evaluation of antioxidant activity of a medicinal plant, Boerhaavia diffusa L.

Boerhaavia diffusa L. (Family: Nyctaginaceae) commonly known as Punarnava is an herbaceous, spreading vine widely distributed in the tropical and subtropical regions in the world. The plants are a rich source of vitamins, minerals, protein and carbohydrate. The present study was carried out to determine the concentration of some bioactive phytochemicals (ascorbic acid,carotenoids, total phenolics, protein and carbohydrate) and their antioxidant activity in punarnava. Results showed the values for ascorbic acid (16.75±1.72 and 18.86±1.12 mg/100g of Fresh Weight), carotenoids (1.36±0.10 and 1.98±0.11 ìg/g of Fresh Weight), protein (122.975±6.27 and 134.45±6.23 mg/g of dry weight) and carbohydrate (56.67±5.77 and 60.11±5.23 mg/g of dry weight) for aqueous and methanolic of root extracts of B.diffusa respectively. Methanolic root extracts showed greater antioxidant activity than the aqueous extracts using DPPH method

Levels of protein C and soluble thrombomodulin in critically ill patients with acute kidney injury: a multicenter prospective observational study.

Endothelial dysfunction contributes to the development of acute kidney injury (AKI) in animal models of ischemia reperfusion injury and sepsis. There are limited data on markers of endothelial dysfunction in human AKI. We hypothesized that Protein C (PC) and soluble thrombomodulin (sTM) levels could predict AKI. We conducted a multicenter prospective study in 80 patients to assess the relationship of PC and sTM levels to AKI, defined by the AKIN creatinine (AKI Scr) and urine output criteria (AKI UO). We measured marker levels for up to 10 days from intensive care unit admission. We used area under the curve (AUC) and time-dependent multivariable Cox proportional hazard model to predict AKI and logistic regression to predict mortality/non-renal recovery. Protein C and sTM were not different in patients with AKI UO only versus no AKI. On intensive care unit admission, as PC levels are usually lower with AKI Scr, the AUC to predict the absence of AKI was 0.63 (95%CI 0.44-0.78). The AUC using log10 sTM levels to predict AKI was 0.77 (95%CI 0.62-0.89), which predicted AKI Scr better than serum and urine neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, urine kidney injury molecule-1 and liver-fatty acid-binding protein. In multivariable models, PC and urine NGAL levels independently predicted AKI (p=0.04 and 0.02) and PC levels independently predicted mortality/non-renal recovery (p=0.04). In our study, PC and sTM levels can predict AKI Scr but are not modified during AKI UO alone. PC levels could independently predict mortality/non-renal recovery. Additional larger studies are needed to define the relationship between markers of endothelial dysfunction and AKI

Effect of Intravenous Phenobarbital on Left Ventricular Myocardial Contractility Determined by Echocardiography in Children

Introduction. Animal studies and rare human studies have suggesteda negative effect of barbiturates on cardiac function. Althoughintravenous (IV) phenobarbital is used routinely in children in theclinical setting, studies in children are lacking. We performed a studyto evaluate effect of IV phenobarbital loading on myocardial systolicfunction of children.Methods.xIn a prospective pilot study in children without congenitalheart defects, the effect of IV phenobarbital was evaluated on theleft ventricular systolic function measured by ejection fraction (EF)by Simpson’s method via an echocardiogram. Any child less than 18years of age who received IV loading dose of at least 20 mg/kg ofphenobarbital given as an infusion over 20 - 30 minutes for variousmedical indications was eligible to take part in the study. Three measurementsof EF by an echocardiogram were made: before loadingdose, 30 minutes after completion of the loading dose, and prior tothe first maintenance dose. Relevant clinical data were recorded,including vital signs, immediately prior to each echocardiogram.Change of function as measured by EF over time was analyzed usinglinear mixed modeling methods. For this study, significant change inblood pressure was defined as a drop of at least 20 mmHg in systolicblood pressure.Results. Ten children (70% female, age range two days to 8.2 years)were enrolled. Three had hypotension with a drop of systolic bloodpressure greater than 20 mmHg from baseline. On examining thetrajectory of EF on each individual graphically, the left ventricularEF tended to fall immediately following phenobarbital therapy andreturn to baseline on re-evaluation. These trajectories were statisticallysignificant for EF.Conclusions. Phenobarbital had a direct and transient depressanteffect on systolic function of the myocardium in one third of the cases.The depression in EF appeared to be transient with return to baseline in less than 24 hours. We recommend close monitoring with anticipationof decreased function in children when using IV phenobarbital.Kans J Med 2019;12(2):40-44

A study on awareness about package inserts among postgraduate medical students: an observational questionnaire based study

Background: A package insert is a document approved by the administering licensing authority, which is provided with the package of a drug. A good package insert can prove to be of immense help to doctors as they are evidence based and are updated from time to time. The objective to study the awareness about package inserts among postgraduate medical students.Methods: The present study was a cross-sectional observational study carried out on 68 postgraduate medical students of Acharaya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu (J & K) in the month of February 2017 after taking approval from the institutional ethical committee. Pre-validated self-administered questionnaire was used to elicit responses from the students. The questionnaire consisted of specified questions regarding knowledge and opinion about package inserts.Results: In the present study, 86.7% of the students understand the relevance of Package inserts (PIs). About 72% of the students think that PIs are a necessary add-on to drug information and 70.6% of the students think that information given on package inserts is necessary for the patients. However, only 2.9% of the students had the knowledge of Drug Acts governing the information to be provided on PIs in India. About 86.8% of the students think that PIs should also be in regional language apart from in English language.Conclusions: It was found from the present study that the majority of the postgraduate students were aware about the package inserts available with the medicines but the information provided on package inserts was not optimally used by them. To achieve the target of optimally utilization of information provided in the package inserts, the PIs should be designed by considering the needs and information of two differently educated target groups i.e; patients and doctors

A study on assessment of awareness on generic drugs among doctors in a tertiary care teaching hospital in north India

Background: The assessment of doctors’ perceptions and understanding about generic medicines may help in recognizing the key areas which may act as hurdle to mass scale use of generics. The primary objective of this study was to explore the knowledge, attitude, and practice (KAP) of doctors toward generic medicines.Methods: A cross-sectional study was carried out using a pretested questionnaire in a tertiary care teaching hospital of Jammu (J and K). The questionnaire was designed to assess the KAP about generic medicines. The doctors working in this institute during the study period were included. Data was compiled and analysed using online website, http://www.graphpad.com. P-values of < 0.05 were considered to indicate statistical significance.Results: A 62.9% doctors agreed to the fact that generic medicines were intended to be interchangeable with a branded drug (p=0.0139). Among the doctors, 77.5% were aware that generic drug manufacturers need to conduct studies to show bioequivalence between the generic medicine and their branded counterparts (p =0.0001). 88.8% of the doctors agreed that importance of generic medicines should be taught in early part of internship. 80.9% doctors did not think that switching a patient from a brand-name to generic drug may change the outcome of the therapy (p <0.0001).Conclusion: The present study showed that a good percentage of doctors were well aware of generic medicines’ usage. However due to concerns expressed by a certain fraction of participants, further work is needed on how interventions for medical professionals and for the public can lead to increase in the awareness and acceptability of generic medicines

Systematic decay studies of even-even 132−138132-138^Nd, 144−158144-158^Gd, 176−196176-196^Hg and 192−198192-198^Pb isotopes

The alpha and cluster decay properties of the $132-138$^Nd, $144-158$^Gd, $176-196$^Hg and $192-198$^Pb even-even isotopes in the two mass regions A = 130-158 and A = 180-198 are analysed using the Coulomb and Proximity Potential Model. On examining the clusters at corresponding points in the cold valleys (points with same A_2) of the various isotopes of a particular nucleus we find that at certain mass numbers of the parent nuclei, the clusters emitted are getting shifted to the next lower atomic number. It is interesting to see that the change in clusters appears at those isotopes where a change in shape is occurring correspondingly. Such a change of clusters with shape change is studied for the first time in cluster decay. The alpha decay half lives of these nuclei are computed and these are compared with the available experimental alpha decay data. It is seen that the two are in good agreement. On making a comparison of the alpha half lives of the normal deformed and super deformed nuclei, it can be seen that the normal deformed $132$^Nd, $176-188$^Hg and $192$^Pb nuclei are found to be better alpha emitters than the super deformed (in excited state) $134,136$^Nd, $190-196$^Hg and $194$^Pb nuclei. The cluster decay studies reveal that as the atomic number of the parent nuclei increases the N \neq Z cluster emissions become equally or more probable than the N=Z emissions. On the whole the alpha and cluster emissions are more probable from the parents in the heavier mass region (A=180-198) than from the parents in the lighter mass region (A= 130-158). The effect of quadrupole ({\beta}_2) and hexadecapole ({\beta}_4) deformations of parent and fragments on half life times are also studied.Comment: 42 pages,19 figure

A study on determinants of underreporting of adverse drug reactions among resident doctors

Background: Adverse Drug Reactions (ADRs) are global problem with significant morbidity and mortality. Health care providers/professionals (HCPs) play a critical role in ADR surveillance. However, only 6% of all ADRs are reported and under-reporting acts as great impedance in exchange of drug information. Thus, spontaneous reporting of suspected adverse drug reactions requires greater commitment from healthcare professionals. The aim was to determine the reasons of underreporting of ADRs among resident doctors.Methods: This was a cross-sectional observational study with self-administered questionnaire assessing the reasons for underreporting of ADRs among resident doctors.Results: Very low level of awareness about ADR reporting was found among doctors. Eighty eight percent of doctors did not know the authority and the procedure for ADR reporting. About 32.8% were not sure with the reaction and the drug, while 46.3% doctors felt that there is no need of reporting the recognized reactions again. Other factors responsible for under reporting were lack of time in 73% and cumbersome procedure in 45% of the participants.Conclusions: A poor level of awareness of pharmacovigilance was seen among doctors. Measure to improve awareness, accessible systems for reporting and effective National Programme are required to improve reportin