Overuse Of Drugs Research Articles

Overuse of antidepressants in older outpatients with Alzheimer's disease and associated disorders: an observational study.

a single-centre, prospective, cross-sectional study carried out at the Bretonneau outpatient department between 1st December 2014 and 31st May 2015. All patients aged 70 and above, suffering from ADRD (according to DSM IV criteria) and currently being prescribed an antidepressant were eligible. "Overuse" was defined as off-label prescriptions or prescriptions that went beyond the recommended duration of treatment. This was assessed by the geriatrician in charge and validated by an expert committee, who were blind to the geriatrician's assessment. Fifty-four patients were included in the study (mean age: 82.9 years (± 5.4); 70.4% women; 60% with mild to moderate dementia). The main indication of antidepressant treatment was a major depressive episode (59.3%). The geriatrician could not reach a conclusion on overuse in 10 cases (18.5%). Inter-rater agreement between geriatricians and the expert committee was good (kappa coefficient: 0.73 [0.5-0.95]). Finally, 33 (61%) of these patients were overusing antidepressants: a third had an off-label prescription and two thirds had exceeded the recommended treatment duration. The only factor associated with this overuse was co-prescription of psychotropic drugs (p = 0.009). the overuse of antidepressants is common in older patients with dementia, particularly overuse due to exceeding the treatment duration. This is significantly associated with co-prescription with another psychotropic drug, suggesting that this represents a more global problem of the overuse of psychotropic drugs.

Effects of Chinese medical pricing reform on the structure of hospital revenue and healthcare expenditure in county hospital: an interrupted time series analysis

BackgroundChina has initiated a medical pricing reform to combat the overuse of drugs and relieve the financial burden of patients. This paper aims to analyze the effect of medical pricing reform on revenue structure and healthcare expenditure of county public hospitals in Guangdong province.MethodsBased on the monthly data from January 2013 to August 2019, we use interrupted time series design to evaluate the effects of medical pricing reform on healthcare expenditure in both outpatients and inpatients. A counterfactual is also established to examine the net effect of the policy.ResultsThe proportion of drug revenue decreased from 35 % to 2015 to 29.7 % in 2019, and the revenue from medical services and inspection increased 3.2 and 3 % respectively. Meanwhile, the increasing trend of total expenditure and its main components is slowed down, especially the drug expense and medical consumable expense for inpatients after the Zero Mark-up Drug policy (coefficient = -18.76, p < 0.01; coefficient = -13.41, p < 0.01, respectively). However, the growth of inspection expense for outpatients continues to increase, while the healthcare expenditure for inpatients experiences an instant increase after the Zero Mark-up Medical Consumables policy. In terms of the net effect, most of healthcare expenditure in both outpatient and inpatient experienced a negative net growth from 2015 to 2019.ConclusionsThe medical pricing reform is a valuable attempt in controlling the unreasonable increase of medical expenses. In the meantime, the unexpected increase in inspection expenditure and insufficient compensation from medical service adjustment should draw the attention of the policymakers.

Syndrome-Based Prescription to Optimize Psychotropics: Are CHROME Criteria a Game Changer?

A variety of medical and social factors have contributed over the last decades to the overuse of psychotropic drugs in people with dementia. One social factor is probably the frequent failure to provide adequate person-centered care, be it in the community or in institutional settings. This unfortunate reality has been reacted upon with numerous guidelines to reduce prescriptions of the most dangerous drugs (e.g., neuroleptics). Each psychotropic drug prescription can in principle be assessed around three dimensions: (a) adequate, (b) inadequate, and (c) chemical restraint. The CHemical Restraints avOidance MEthodology (CHROME) defined chemical restraint as any prescription based on organizational convenience, rather than justified with medical diagnosis. Two validation studies revealed that one of the main medical reasons of over- and miss-prescriptions was symptom-based prescription. By switching to syndrome-based prescription, a large proportion of drugs could be de-prescribed and some re-adjusted or kept. Paucity of research and weakness of data are not conclusive about the adequacy of specific drugs for the myriad of cases presented by patients with dementia and comorbid conditions. Clinical practice, however, leads us to believe that even under optimal care conditions, psychotropics might still contribute to quality of life if based on an adequate diagnosis. This article explains the rationale that underlies a syndromic approach aimed at optimizing psychotropic treatment in people with dementia whose significant suffering derives from their thought, affective, or behavioral problems. The results of previous validation studies of this new methodology will be discussed and conclusions for future results will be drawn.

Assessment of Peri-Urban and Rural Cassava Farmer`s Perception of Orthodox and Traditional Healthcare Facilities in Enugu State, Nigeria.

The study analyzed the perception of peri-urban and rural cassava farmers' perfor- mance of orthodox and traditional healthcare facilities in Enugu State, Nigeria. Multi-stage sampling technique was adopted for this research. Four LGAs out of the seventeen LGAs in Enugu State that produces cassava were purposively se- lected for this research based on their cassava output figures. LGAs were consid- ered peri-urban and rural based on their population, several government parasta- tals and business establishments were found in these LGAs. Four communities were selected using the systematic random sampling technique. In each communi- ty, (15) cassava farmers were also randomly selected, making a total of (60) re- spondents in each LGA and a total of (240) respondents. The age bracket of 41-50 years (44.58%) of the respondents dominated cassava farming in the study area. The major perception problems amongst the respondents were; Inadequate/lack of orthodox healthcare facilities, problems of adulteration of drugs, poor government funding, risk of poisoning associated with overuse of drugs, practitioners not usu- ally cordial and friendly in the handling of patients, the harmful buildup of chemi- cals in the body from drugs, lack of external supervision of healthcare facilities by health inspectors and efficacy of drugs and treatment in the rural LGAs. More so, the result compared the profitability level of the two categories of farmers in the study area. It showed that an average of ₦186,210.56k was incurred as a cost of production per hectare for cassava farms in the rural local government areas compared to ₦183,805.08k per hectare for farmers in the peri-urban local govern- ment areas. An average of ₦288,741.11k was recorded as total revenue per hec- tare for farmers in the rural LGAs compared to ₦296,517.54k recorded per hec- tare for farmers in peri-urban areas. For the peri-urban and the rural LGAs, the double log functional form was chosen as the lead equation based on some signif- icant variables, the R-square, Adjusted-R square, the F-ratio and the conformity to a priori expectations.

Tick Infestation and Piroplasm Infection in Barbarine and Queue Fine de l'Ouest Autochthonous Sheep Breeds in Tunisia, North Africa.

Simple SummaryTicks and tick-borne pathogens affect the productivity of sheep in Tunisia. Searching for genetically resistant breeds to infestation by ticks may represent an alternative to the overuse of chemical drugs. The aim of this study was to assess if there is any difference in tick infestation among the main sheep breeds in Tunisia. Four hundred and thirty-nine ear-tagged ewes from Barbarine and Queue Fine de l’Ouest (QFO) breeds were examined and sampled each trimester for two years. Ticks were identified to the species level, and piroplasms were detected using Polymerase Chain Reaction (PCR). Queue Fine de L’Ouest ewes were markedly less infested by ticks, and none was infected by piroplasms compared with Barbarine conterparts. The QFO sheep breed could be considered in concrete control strategies, including a breeding program.As ticks and tick-borne pathogens affect the productivity of livestock, searching for genetically resistant breeds to infestation by ticks may represent an alternative to the overuse of chemical drugs. The aim of this study was to assess if there is a difference in tick infestation among the main sheep breeds in Tunisia. The study was carried out between April 2018 and January 2020 in 17 small to middle-sized sheep flocks from 3 regions across Tunisia. Four hundred and thirty-nine ear-tagged ewes from Barbarine (n = 288, 65.6%) and Queue Fine de l’Ouest (QFO) (n = 151, 34.4%) breeds were examined and sampled each trimester. Ticks were identified to the species level, and piroplasms were detected using PCR that targets a common sequence ARNr18S to both Babesia and Theileria genera using catch-all primers. Totally, 707 adult ticks were collected from animals; 91.4% (646/707) of them were Rhipicephalus sanguineus s.l. Queue Fine de l’Ouest animals were markedly less infested by ticks, and no one of them was infected by piroplasms compared to the Barbarine breed. Indeed, during the first four seasons, 21 animals, all from the Barbarine breed, were detected positive for piroplasms. This is the first study in Tunisia about the low susceptibility of QFO ewes to infestation by ticks and to infection by piroplasms. The QFO sheep breed could be raised preferably at high-risk areas of tick occurrence and could be considered in concrete control strategies, including a breeding program.

New therapeutic agents marketed in 2020: Part 1

New therapeutic agents marketed in 2020: Part 1

Hypolipidemia: a study evaluating magnitude and underlying etiologies of the entity

Background: Hyperlipidemia is a common and well-known entity as it is one of the risk factors of various noncommunicable diseases. Hypolipidemia is an entity which is very less known among health care givers. Currently available data about this entity is insufficient and nonconclusive.Methods: This study was a prospective observational study. Lipid profile reports at the central lab of the institute was observed and among them hypolipidemia reports and related patients were identified. Patients were further evaluated and classified into 10 etiological categories.Results: Total 450 lipid profile reports were observed out of which 36 (8%) reports had hypolipidemia. Most patients had hypolipidemia were having chronic illness (41.7%) or critical illness (33.3%) followed by malnutrition (11.1%), idiopathic etiology (11.1%), moderate to severe anemia (8.3%), chronic liver disease (8.3%), cancer (5.5%), statin use for more than 3 months (2.8%), malabsorption (2.8%), hyperthyroidism (0%).Conclusions: Awareness about hypolipidemia among health care givers is needed to look out for underline diseases with consequences and to have active participation to unsolved the mystery of this entity. Overuse of antihyperlipidemic drugs should be avoided. This study highlighted causes and consequences of hypolipidemia.

Commentary: Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter.

“Superbugs” are the antimicrobial-resistant microorganisms. Bacteria, viruses, fungi, and parasites acquire the ability to evade the antimicrobial drug effects, not only to survive but also, in some cases, become more virulent. As such, the existing antimicrobial drugs are no longer effective and useful in treating the infections (used to be treatable). Superbug-induced infections are the major worldwide health concern with higher human mortality and an increased financial burden on society. The underlying mechanism of the evolvement of drug-sensitive to drug-resistant microorganisms is an extremely complex phenomenon. It is partly related to microorganism's unique ability to modify their genetic structures and biochemical functionality to survive and keep growing even in the presence of antimicrobial drugs. Since there are multiple factors involved in developing antimicrobial drug resistance, it cannot be reversed by adopting a single prevention strategy. Of importance, certain bacterium may not require antimicrobial drug exposure to develop resistance, as surrounding environmental exposure can facilitate the resistance. Consistent misuse and overuse of antimicrobial drugs by healthcare professionals and consumers with its extensive use in food and meat production have put human health at risk. Lack of resources for research and low interest in developing the newer generation of antimicrobial drugs are also contributing to the evolution of superbugs. Without global involvement, partnership and collaboration, superbug-induced morbidity and mortality will be unmanageable in the future. To address this impending global health crisis, in May 2015, the World Health Organization (WHO) assembly adopted a global action plan to combat the antimicrobial resistance, that include (1) to increase the awareness of antimicrobial resistance, (2) to advance research and surveillance, (3) to cut down the rate of infections through preventive measures, (4) to ensure the optimal use of antimicrobial drugs, and (5) to develop sustainable investment, taking into account the needs of the countries, to develop novel interventions. Unfortunately, implementing such WHO measures have both financial and logistic hurdles, and the rates of superbug-induced infections are alarmingly increasing. A recently published article in “Frontiers in Public Health” has highlighted the importance of microbial resistance movements to reduce the burden of superbug-induced infections (1). The authors have elaborated on the genesis of antimicrobial drugs and listed the challenges of producing the newer generation of drugs to combat existing drug-resistant pathogens (1). Although the authors briefly touched on the irrational prescription of antimicrobial drugs in the both developed and developing countries, the review article did not discuss in depth the regulatory enforcement procedures to minimize the antimicrobial resistance (1). The opportunities and challenges of global standardization of the antimicrobial prescription processes were not explained in detail in the publication (1). Another critical area that was not emphasized enough in the article was the use of the antimicrobial drugs on animals and its potential consequences in developing antimicrobial resistance. This commentary will briefly elaborate on the cross-species transmission of resistant pathogens from animal to human. Appreciating that one single review article cannot cover all the aspects of antimicrobial resistance, the authors have fittingly highlighted the scientific and economic challenges that are hindering the novel antimicrobial drug development (1). The publication has justifiably concluded that antimicrobial resistance is a multifaced issue driven by numerous interrelated factors, and therefore, the use of any single intervention would have limited success (1). Recent publications have also emphasized why implementing an antimicrobial stewardship program is necessary to prepare the future medical professionals to enhance their awareness and knowledge of antimicrobial resistance to reduce the disease burden related to superbug-mediated infections (Figure 1) (2, 3). Open in a separate window Figure 1 Schematic diagram showing the main steps needed to be implemented to minimize the antimicrobial drug resistance (2).

Местная терапия в лечении пациентов с острым риносинуситом

Acute rhinosinusitis is one of the most common diseases in the world, characterized by acute inflammatory processes in the nasal cavity and paranasal sinuses, lasting less than 4 weeks. According to statistics, in Russia, this disease is recorded in 6–15% of the population annually, in European countries in every seventh person, while there is a tendency to an increase in the incidence. Acute viral rhinosinusitis has the highest incidence among all rhinosinusitis and occurs in most patients in a mild form, however, untimely treatment of inflammation of the nasal mucosa can lead to obstruction of the natural anastomoses, impaired physiological ventilation and drainage of the paranasal sinuses, stagnation of secretions with further development acute bacterial rhinosinusitis. The overuse of local vasoconstrictor drugs (intranasal decongestants) leads to the development of drug-induced rhinitis, long-term imbalance of autonomic innervation of the nasal mucosa and edema, called "rebound syndrome". In the article we consider the issues of etiology, pathogenesis, features of the course of rhinosinusitis. The principles of differential diagnosis of viral and bacterial rhinosinusitis are stated, taking into account the latest recommendations and research in this area. The features of the use of the most frequently used topical preparations in acute rhinosinusitis in the practice of an ENT doctor have been analyzed.

Effect of topical melatonin 10% on the healing of infected wounds after surgery

Melatonin remarkably accelerates wound healing in full-thickness incisional wounds. The present study aims to examine the possible antibacterial effect of topical melatonin against wound infection after surgery. Fifty-nine patients had wound infection after surgery were included in this study. One gram of tissue culture contains more than 105 colonies/gram where investigated. The culture was done after five days of surgery. Two types of bacteria were isolated; Streptococcus and Staphylococcus species. Three groups included in this study. Conventional therapy group (Fucidin 2% ointment) was considered negative control group, local melatonin 10% group, which was regarded as a positive control group and combination group of conventional therapy and local melatonin 10% groups. Treatment duration was six days; The majority hard work has been conducted to improve the antimicrobial actions of a wide range of topically used therapeutic agents, to ensure disinfection in wound sites, also, to increase wound healing processes and tissue regeneration mechanisms. The most significant cause for the manifestation and distribution of strains of bacteria which have resistant is the overuse of antibacterial drugs which initiate look for agents that may have antibacterial actions. Combination therapy gives 100% cured cases. This may be attributed to a synergistic effect between conventional treatment and melatonin therapy; therefore, the present study is to investigate the possible antibacterial effect of topical melatonin (10%) against wound infection after surgery.

Ethnobotanical Survey on Antiurolithiatic Activity of Some Medicinal Plants

Now a day’s 80% of world population depends on herbal drugs. Apart from the synthetic drugs, Herbs has a medicinal properties as they have active constituents which are found to be more beneficial with less or no side effects. On the other hand overuse of synthetic drugs has create an interest to return to natural remedies. Prevalence of kidney stones or calculi is most common and painful disorder in population these days. Urinary stones are found in all parts of the urinary tract, the kidney, the Ureter and urinary bladder. Different causes of renal calculi are deposits of minerals, infections, hereditary factors. This may result into uremia, pyelonephritis , kidney failure etc. In the present study has been made to prominence and potential of herbal option for urinary stone or renal stone.

Advantages of Herbal Over Allopathic Medicine in the Management of Kidney and Urinary Stones Disease

Kidney and urinary stone disease (Nephrolithiasis and urolithiasis) are the condition where urinary stones or calculi are formed in the urinary tract. The problem of urinary stones is very ancient; these stones are found in all parts of the urinary tract, kidney, ureters, and the urinary bladder and may vary considerably in size. It is a common disease estimated to occur in approximately 12% of the population, with a recurrence rate of 70-81% in males and 47-60% in females. The treatment of kidney and urinary stone diseases such as a western (allopathy) medicine and surgery is now in trends. However, most people preferred plant-based (herbal) therapy because of the overuse of allopathic drugs, which results in a higher incidence rate of adverse or severe side effects. Therefore, people every year turn to herbal therapy because they believe plant-based medicine is free from undesirable side effects, although herbal medicines are generally considered to be safe and effective. In the present article, an attempt has been made to emphasize an herbal therapy is better than allopathic therapy for the management of the kidney and urinary stone disease.

Medication Overuse Withdrawal in Children and Adolescents Does Not Always Improve Headache: A Cross-Sectional Study.

Background: MOH can be diagnosed in subjects with headache occurring 15 days/month in association with a regular medication overuse, but its existence is not universally accepted. ICHD-3 redefined criteria for MOH, removing the criterion associating drug suspension with headache course. The aim of our study was to compare the rate of patients diagnosed with medication overuse headache (MOH) according to ICHD-2 and ICHD-3 criteria, to verify the degree of concordance. The secondary aim was to verify if drug withdrawal was really associated with pain relief.Methods: In this cross-sectional study, we retrospectively analyzed a sample of 400 patients followed for primary chronic headache at the Headache Center of Bambino Gesù Children's Hospital. We then selected those presenting with a history of medication overuse, and we applied both ICHD-2 and ICHD-3 criteria to verify in which patients the criteria would identify a clinical diagnosis of MOH.Results: We identified 42 subjects (10.5%) with MOH; 23 of them (55%) presented a relief of headache withdrawing drug overuse. Regarding the applicability of the ICHD-2 criteria, 43% of patients (18/42) fulfilled all criteria, while all ICHD-3 diagnostic criteria were satisfied in 76% of patients (32/42). Eighteen patients (43%) satisfied both ICHD-2 and ICHD-3 criteria, while 10 patients (24%) did not satisfy either diagnostic criterion.Conclusions: Our study suggests that in children and adolescents, withdrawing medication overuse is not always associated with a clinical benefit. Therefore, though allowing a MOH diagnosis in a higher rate of patients as compared to ICHD-2, the application of ICHD-3 criteria does not guarantee a true a causal relationship between medication overuse and headache worsening.

Gaining insight into irrational off-label use of vidarabine through analysis of a spontaneous reporting system in China.

Although superseded by other antiviral agents in many Western countries, vidarabine is still widely used in some countries, including China; hence, the extent and appropriateness of vidarabine prescriptions in children require better characterization. This study examined the rationale, extent, and health risks associated with irrational off-label vidarabine use in China. Data used in the study were extracted from a multi-provincial joint adverse drug reactions monitoring platform from 2002 to 2018. Descriptive statistics were used to analyse the characteristics of individual case safety reports (ICSRs) related to vidarabine use. Among 2772 individual ICSRs related to vidarabine, 2223 (80.19%) cases occurred in patients aged 0-9. In all patients, the median age and interquartile range were 2 (0-6). Although most adverse events were mild, five deaths were recorded, all in children below 7years of age. Paediatric use is the most prominent off-label use of vidarabine. Additionally, several other irrational off-label uses were identified, including 218 (7.86%) cases of overdosing and numerous applications beyond the approved indications, dosages, routes of administration, and solvents. Data indicate that vidarabine was mainly prescribed for suspected common viral infections in paediatric patients, demonstrating serious inappropriate off-label uses. The problem was further complicated by the lack of sufficient information regarding safety, efficacy, and dosing regimens in children, as well as by several additional risk factors such as inappropriate solvents, routes of administration, and overdose. In the case of children, the physicians' lack of understanding of antiviral activities and compassionate prescriptions were mainly responsible for drug overuse. The health risks associated with the paediatric use of vidarabine in China require greater attention and further investigation.

English

Nowadays, antibiotic resistance is a global public health threat. Bangladesh is accelerated to this owing to its sub-standards healthcare along with the self-medication and overuse of antibiotics. The study aimed to assess patterns of antibacterial resistance in the clinical samples. The study was carried out at Ibn Sina Diagnostic and Consultation Center Uttara, Dhaka, from January to December 2019. All cultures and antimicrobial susceptibility test results of patients were extracted from laboratory records, using a semi-structured checklist. Data were analyzed using Microsoft Excel and SPSS version 20.0. To ensure confidentiality coding was used instead of the patient’s identity. A total of 925 culture-positive results were analyzed, of which blood 620(65.0%) and urine 297(32.1%) samples were commonly diagnosed. The most frequently isolated bacterial were Salmonella spp. [601(65%)], Escherichia coli [244(26.4%)] and Klebsiella spp. [57(6.16%)]. The majority of the patients were females [540(58.4%)]. E. coli was found to be highly sensitive (>80%) to nitrofurantoin, meropenem, amikacin, amoxiclav, and imipenem; simultaneously, resistant (>45%) to cefixime, cephalexin, piperacillin, aztreonam, ampicillin, cefuroxime, and ciprofloxacin. S. typhi and S. paratyphi were sensitive (>80%) for cefepime, ceftriaxone, imipenem, tetracycline, cefixime, ceftazidime, cephalexin, cotrimoxazole, aztreonam, cefuroxime, and amoxiclav; concurrently, above 80% resistance for ciprofloxacin, azithromycin, gentamycin, and ampicillin. Overall, most of the isolates showed a significant rising rate of microbial resistance to ciprofloxacin, azithromycin, piperacillin, cephalexin, gentamycin, and ampicillin. The study findings revealed gradually rising rates of antibiotic resistance to commonly prescribed antibiotics. The study suggested the prescribers should be avoided overuse and irrational use of drugs to reduce antimicrobial resistance. Key words: Bacteriology, antibiotic susceptibility, clinical samples, Dhaka.

Utilization trends of drugs in patients admitted with ischemic heart disease in a tertiary care teaching hospital

Background: Coronary artery disease (CAD) takes the highest toll of lives across the world as well as India. Prompt diagnosis and effective treatment is lifesaving. Drug utilization studies scrutinize the appropriateness of treatment and provide favourable feedbacks to strengthen clinical practices. Several other studies have reported underuse of four evidence-based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD. Polypharmacy, injection overuse is some of the shortcomings. The objectives of this study was to describe treatment practices in terms of different disease spectrum and drug utilization (group-wise and individually) for inpatients with CAD using core prescription indicators by WHO.Methods: A cross-sectional study of 4-month duration was undertaken for patients with CAD admitted to cardiology indoor of a tertiary care hospital. A total no of 143 prescriptions was screened and analyzed.Results: Males (67.13%) were more in number than females (32.87%). Age group from (57-66) topped in frequency (61.05%) ahead of (67 to 76) group (38.46%). Average no of drugs per patient were 8.056±1.97 and 5.86±0.14 for cardiovascular drugs. Prescription in generics (45.49%), antibiotics (0.61%), fixed-dose combinations (FDCs) (0.52%) and injectables (28.47%) were noted. The most common categories of CAD were ST-segment elevated myocardial infarction (69.23%) followed by chronic stable angina (17.48%). Antiplatelets (100%), hypolipidemics (99.3%), antianginals (60.14%), β-blockers (37.06%) and ACE-I/ARBs (27.97%) were utilized. Drugs from the national list of essential medicines were 66.49%.Conclusions: Among four evidence-based drugs, use of β-blockers and ACE-I/ARBs were inappropriately low. Polypharmacy and overuse of Injectable drugs are noted.

A Prospective Observational Study on Rational Use of Antibiotics for Paediatric Patients with Respiratory Tract Infections in a Tertiary Care Hospital

Background: Antibiotic drug overuse and inappropriate antibiotic drug selection are associated with increased drug resistance among respiratory pathogens (most notably, Streptococcus pneumoniae), possible progression to chronic disease, and increased treatment costs.[1] The selection of an antibiotic for prophylaxis should be based on known or likely target pathogens, for a short duration of time.&#x0D; Objective: To evaluate Rational use of antibiotics in Paediatric patients suffering from Respiratory tract infections.&#x0D; Method: It was Prospective, observational study conducted by random selection of patients. Based on diagnosis, the study population was categorized into 2 groups: Upper respiratory tract infections and Lower respiratory tract infections. The study population was interviewed after obtaining written informed consent for information like demographics, diagnosis, treatment and antibiotics prescribed.&#x0D; Results and Discussion: In our study population, it was observed that male patient (74%) were higher than female patients (26%). Total number of antibiotics prescribed during the study period is 83. Most commonly prescribed antibiotic was Augmentin (Amoxicillin +Clavulanic acid) of dose (450mg IV BD) which is the combination drug, i.e, more effective than individual antibiotic drugs.&#x0D; Conclusion: In the present study it is observed that 4-different classes of antibiotics-Pencillins,Cephalosporins,Macrolides and Aminoglycosides were prescribed and used for different Respiratory diseases.The percentage of average antibiotic utilization is highest in Lower Respiratory Tract Infection with (55.22%).Mostly used Antibiotic in males for both LRTI and URTI is Augmentin with the percentage of (52%) and (80%) respectively.Where as in females it is observed that in both LRTI and URTI mostly used Antibiotic is Augmentin with percentage of (38.8%) and( 80%) respectively.Overall Second mostly used antibiotic is Ceftriaxone.&#x0D; Keywords: pediatrics, lower and upper respiratory tract infections, antibiotics.

A protocol for a systematic review and meta-analysis of the diagnostic accuracy of mid-regional pro-adrenomedullin in predicting invasive bacterial infection in children

BackgroundThe early recognition of invasive bacterial infections (IBI) in children can be difficult. Clinically it is often challenging to differentiate between the early stages of an IBI and a benign self-limiting viral infection. These challenges mandate a cautious approach resulting in the overuse of antimicrobial drugs with resultant antimicrobial resistance. Due to these challenges, there is growing research into the role of biomarkers for the early identification of children with IBI. Earlier and more accurate diagnoses may lead to improved clinical outcomes for children and reduced antimicrobial resistance. Mid-regional pro-adrenomedullin (MR-proADM) is a biomarker that has been shown to be elevated in patients with IBI. The aim of this systematic review is to determine the diagnostic accuracy of MR-proADM at identifying children with IBI.MethodsTo identify relevant studies we will search MEDLINE, Embase, Web of Science and Scopus from 1980 to the present day for all human clinical trials involving children that report the test accuracy of MR-proADM. We will include case-control studies, cohort studies and randomised control trials reported in any language. In addition, we will hand-search reference lists and grey literature including conference abstracts and web searches. Two reviewers will independently screen study titles and abstracts for eligibility followed by full-text assessment and data extraction including population, setting, timing and use of index test and reference standard used. Methodological quality will be assessed, by two authors, according to the revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2), any discrepancies will be resolved by a third author. The following test characteristics will be extracted into 2 × 2 tables for all included studies: true positives, false positives, true negatives and false negatives. Study-specific estimates of sensitivity and specificity with 95% confidence intervals will be displayed in forest plots.DiscussionThis review will report the normal ranges for MR-proADM in health and the diagnostic accuracy of MR-proADM at identifying children with IBI. The review will help to define where in the diagnostic pathway MR-proADM could be useful including potential as a point-of-care test for children at first presentation with IBI.Systematic review registrationPROSPERO CRD42018096295

“Meditate, Don’t Medicate!” an Analysis of Addict Rap, Black Men’s Social Issues, and J. Cole’s K.O.D. Album

Historically, drugs authenticated and created hip-hop, as the overuse of drugs was used to validate a drug consumption subculture known as “addict rap.” As a rap subgenre, addict rap illustrates deeper issues of drug overconsumption, hip-hop authenticity, and Black hypermasculinity, while claiming the lives of some of its most noteworthy rappers. In response to this rap trend, American rapper J. Cole released his fifth studio album, K.O.D. to present politicized counternarratives to addict rap’s discourses of drug use, hypersexuality, and materialism. Conducting a textual analysis of rap lyrics, this research examined how Cole used the K.O.D. album to: 1) discuss issues of drug addiction and drug use in the Hip-Hop community and 2) address additional social issues facing Black American men. The analysis advanced three dominant themes, which were: 1) addict rappers use drugs to cope with their inner demons and depression, 2) hip-hop drug use is linked to the systemic oppressions facing Black Americans, and 3) healing should come from self-reflection and redemption from God, not from drug use. Ultimately, K.O.D. deconstructed the drug-laden, machismo-infused, images of addict rappers and revealed the harsh realities of being Black, male, drug addicted, and depressed by fame.

In the Back Drop of Overuse of Synthetic Drugs, can Botanicals be One of the Answers: A Pilot Study on the Medicinal Use of Chlorophytum and Curcuma by Tribals of Central India

Background: In several recent surveys, it has been found that more people suffer because of over and indiscriminate use of synthetic drugs, chemicals and antibiotics, particularly with regard to issues like drug sensitivity, resistance, immune disturbances, and economic burdens, ultimately leading to a weak prognosis of a large number of diseases, eventually defeating the purpose of medicinal efficacy. We propose the old age use of scientifically validated natural compounds of plants and their products for a strong immune system along with a successful treatment regimen which can be effective as well as safe without side effects. Objective: The aim of the present work is to evaluate the various medicinal uses and applicability of Chlorophytum borivilianum, Chlorophytum tuberosum and Curcuma longa as natural plant-based ingredients by tribal communities. Methods: A survey was carried on the rural folks who used natural botanicals for alleviating their several common disorders successfully. Chlorophytum species of Liliaceae and Curcuma of Zingiberaceae are traditional rare Indian medicinal herbs widely used in the indigenous system of medicine since ancient time. A total number of 196 individuals were interviewed which included both men and women, in which the main objective was to explore the different forms of these medicinal plant species used with water or with milk by tribal folk for their wide range of common ailments such as pain in joints, loss of appetite, cold, sore throat, fever and general weakness. Results: The tribal people were found to use these plants for many of their problems such as physical weakness, natal and postnatal problems, lactation problems, cold and fever, sore throat, inflammation, joint pain, etc. Many of them (60-80%) were able to overcome their varied health problems to a great extent such as inflammation (69.4%), joint pain and arthritis (66.6%), sore throat and cold (87.5%), physical weakness (66%), natal and postnatal problems (75%). Conclusion: The findings strongly support the use of natural compounds for a safe and effective means of treating loss of appetite, general weakness, pain of the joints, inflammation and other related ailments by the people of tribal areas of Border States of MP and Maharashtra, having little access to modern health care facilities.