Prescription-based cost analysis of medicines for cardiovascular risk factors at Indian Council of Medical Research-Rational Use of Medicine Centre Hospitals of India.

OBJECTIVES: India has taken several initiatives to provide health care to its population while keeping the related expenditure minimum. Since cardiovascular diseases are the most prevalent chronic conditions, in the present study, we aimed to analyze the difference in prices of medicines prescribed for three cardiovascular risk factors, based on (a) listed and not listed in the National List of Essential Medicines (NLEM) and (b) generic and branded drugs. MATERIALS AND METHODS: Outpatient prescriptions for diabetes mellitus, hypertension, and dyslipidemia were retrospectively analyzed from 12 tertiary centers. The prices of medicines prescribed were compared based on presence or absence in NLEM India-2015 and prescribing by generic versus brand name. The price was standardized and presented as average price per medicine per year for a given medicine. The results are presented in Indian rupee (INR) and as median (range). RESULTS: Of the 4,736 prescriptions collected, 843 contained oral antidiabetic, antihypertensive, and/or hypolipidemic medicines. The price per medicine per year for NLEM oral antidiabetics was INR 2849 (2593-3104) and for non-NLEM was INR 5343 (2964-14364). It was INR 806 (243-2132) for generic and INR 3809 (1968-14364) for branded antidiabetics. Antihypertensives and hypolipidemics followed the trend. The price of branded non-NLEM medicines was 5-22 times higher compared to generic NLEM which, for a population of 1.37 billion, would translate to a potential saving of 346.8 billion INR for statins. The variability was significant for sulfonylureas, angiotensin receptor blockers, beta-blockers, diuretics, and statins (P < 0.0001). CONCLUSION: The study highlights an urgent need for intervention to actualize the maximum benefit of government policies and minimize the out-of-pocket expenditure on medicines.

Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences.

BACKGROUND OBJECTIVES: Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians. METHODS: It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as 'prescriptions having deviations'. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an 'unacceptable deviation'. RESULTS: Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108). INTERPRETATION CONCLUSIONS: The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.

Soft microfiber-based hollow microneedle array for stretchable microfluidic biosensing patch with negative pressure-driven sampling.

Wearable point-of-care testing devices are essential for personalized and decentralized healthcare. They can collect biofluid samples from the human body and use an analyzer to detect biomolecules. However, creating an integrated system is challenging due to the difficulty of achieving conformality to the human body, regulating the collection and transport of biofluids, developing a biosensor patch capable of precise biomolecule detection, and establishing a simple operation protocol that requires minimal wearer attention. In this study, we propose using a hollow microneedle (HMN) based on soft hollow microfibers and a microneedle-integrated microfluidic biosensor patch (MIMBP) capable of integrated blood sampling and electrochemical biosensing of biomolecules. The soft MIMBP includes a stretchable microfluidic device, a flexible electrochemical biosensor, and a HMN array made from flexible hollow microfibers. The HMNs are fabricated by electroplating flexible and mechanically durable hollow microfibers made from a nanocomposite matrix of polyimide, a poly (vinylidene fluoride-co-trifluoroethylene) copolymer, and single-walled carbon nanotubes. The MIMBP uses the negative pressure generated by a single button push to collect blood and deliver it to a flexible electrochemical biosensor modified with a gold nanostructure and Pt nanoparticles. We have demonstrated that glucose can be accurately measured up to the molar range in whole human blood collected through the microneedle. The MIMBP platform with HMNs has great potential as a foundation for the future development of simple, wearable, self-testing systems for minimally invasive biomolecule detection. This platform capable of sequential blood collection and high sensitivity glucose detection, which are ideal for personalized and decentralized healthcare.

Usage Pattern of Fixed-dose Combinations at ICMR Network of Rational Use of Medicine Centres across India: Recommendations for Policymakers and Prescribers.

AIM: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. METHODS: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. RESULTS: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. CONCLUSION: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.

Sunlight-driven photocatalytic degradation of ciprofloxacin and organic dyes by biosynthesized rGO-ZrO2 nanocomposites.

Aquatic ecology has been greatly threatened by the discharge of effluents of textile and antibiotic industries into natural waters. Herein, an efficient and easily recycled reduced graphene oxide/zirconium oxide nanocomposite has been synthesized using banana peel extract (abbreviated as rGO-ZrO2 in this work). The X-ray diffraction (XRD), field emission scanning electronic microscopy (FESEM), high-resolution transmission electron microscopy (HRTEM), Brunauer-Emmett-Teller (BET), UV-visible diffuse reflectance spectroscopy (DRS), X-ray photoelectron spectroscopy (XPS), and Fourier transform infrared (FTIR) spectroscopy were used to analyze the synthesized material. The as-prepared rGO-ZrO2 nanocomposite was employed as a photocatalyst for the decomposition of rhodamine blue (RhB) and crystal violet (CV) dyes, and ciprofloxacin (CIP) antibiotic by illumination with direct sunlight. The RhB and CV were degraded to maximum extent of around 86 and 90%, respectively, over the rGO-ZrO2 nanocomposite after exposure to direct sunlight for 120 min. On the other hand, the degradation of CIP was approximately 93.1% over the rGO-ZrO2 nanocomposite in 240 min under same experimental conditions. Further studies were performed regarding the role of parameters like pH, catalyst dose, and scavengers, in order to understand the superiority of rGO-ZrO2 nanocomposite in degrading organic pollutants. Moreover, the intermediate products and plausible CIP degradation mechanisms were examined using liquid chromatography-mass spectrometry (LC-MS). Moreover, the catalyst was easily separated from the solution and demonstrated good stability and reusability. The RhB, CV, and CIP removal efficiency were 80%, 83%, and 88%, respectively, after five cycles.

Photocatalytic degradation of tetracycline antibiotic and organic dyes using biogenic synthesized CuO/Fe2O3 nanocomposite: pathways and mechanism insights.

Tetracycline (TC) is a frequently administered antibiotic in many countries, due to its low price and excellent potency. However, certain antibiotics can be hazardous to living creatures due to their accumulation by complexation with metal ions which can contribute to teratogenicity and carcinogenicity. In this investigation, copper oxide-ferric oxide nanocomposite (CuO/Fe2O3 nanocomposite) was synthesized employing Psidium guajava (P. guajava) leaf extract as a reductant as well as a capping agent in an environment friendly and economical green synthesis method. The as-synthesized CuO/Fe2O3 nanocomposite was comprehensively characterized using various sophisticated techniques and its efficiency as a photocatalyst for degradation of tetracycline (TC) antibiotic and toxic dyes, i.e., rhodamine B (RhB) and methylene blue (MB) were investigated. The CuO/Fe2O3 nanocomposite exhibited exceptional efficiency for degradation of TC antibiotic (88% removal in 80 min), RhB (96% removal in 40 min), and MB (93% elimination in 40 min) with apparent rate constant of 0.048, 0.068, and 0.032 min-1, respectively. In the degradation experiments, photocatalytic activity of CuO/Fe2O3 nanocomposite was studied by varying different factors such as time of contact, catalyst dose, and solution pH. The role of reactive species in antibiotics and dye degradation was validated by radical scavenging studies which indicated that.OH radical played a critical role in photocatalytic decomposition. Furthermore, liquid chromatography-mass spectrometry (LC-MS) investigations were employed to anticipate a plausible mechanism for TC degradation.

Highly customized porous TiO2-PANI nanoparticles with excellent photocatalytic efficiency for dye degradation.

The present work encompasses a simple strategy to synthesize highly porous TiO2 by incorporating PANI polymer into the sol-gel chemistry of Titanium dioxide/Titanium (IV)-iso-propoxide (TiO2/TTIP). A series of TiO2 samples by varying wt.% of PANI, have been synthesized. A probable growth mechanism has been presented for the formation of a porous ginger-like nanostructure of TiO2-PANI (TP). HRTEM images reveal that the particle size range is 6-16 nm for pristine TiO2 and 5-13 nm for TP samples. XPS analysis confirms the presence of the hydrogen bonds in-between surface hydroxyl groups (Ti-OH) of TiO2 and the protonated nitrogen of PANI. UV-visible absorption study reveals a small shift towards longer wavelength for TP8 sample than that of pristine TiO2 (λmax = 314 nm) as well as reduction in Eg value from 3.02 eV to 2.89 eV. FTIR results confirm the successful interaction of PANI and TiO2. BJH and BET analysis confirms an increase of porosity in TP8 sample with an average pore volume of 0.36 cm3 g-1. High photocatalytic activity (98.77%) towards Methylene blue dye degradation is observed for TP8 sample having 8 wt% of PANI and it is explained through the combined effect of structural porosity of TiO2 and synergic effect of PANI. The Kappa value at pH 11 (0.01372 min-1) is found to be 7.84-folds higher than that of the photocatalytic reaction at pH 3 (Kappa = 0.00175 min-1). While pristine TiO2 exhibits the minimum removal efficiency (89.57%) with Kappa of 0.00756 min-1. Kappa value of catalysis reaction for TP8 is found to be almost 2-fold higher than pristine TiO2. Quantum Yield value for TP8 is found to be 3.59 × 10-4 molecules photon-1. This high Quantum Yield value of present photocatalytic system explicates the low energy consumption for the treatment of textile dye pollutant. Additionally, STY value (1.79 × 10-5 molecules photon-1 mg-1) confirms the outstanding mineralization strength of TP8 by a unit mass for high amounts of MB dye per unit time. Thus, the present study offers an excellent photocatalyst i.e., TP8 having 8 wt% of PANI for the degradation of MB dye.

Culture-Free Quantification of Bacteria Using Digital Fluorescence Imaging in a Tunable Magnetic Capturing Cartridge for Onsite Food Testing.

Accurate, onsite detection of pathogenic bacteria from food matrices is required to rapidly respond to pathogen outbreaks. However, accurately detecting whole-cell bacteria in large sample volumes without an enrichment step remains a challenge. Therefore, bacterial samples must be concentrated, identified, and quantified. We developed a tunable magnetic capturing cartridge (TMCC) and combined it with a portable digital fluorescence reader for quick, onsite, quantitative detection of Staphylococcus aureus. The TMCC platform integrates an absorption pad impregnated with water-soluble polyvinyl alcohol (PVA) with an injection-molded polycarbonate (PC) plate that has a hard magnet on its back and an acrylonitrile-butadiene-styrene case. An S. aureus-specific antibody conjugated with magnetic nanoparticles was used to concentrate bacteria from a large-volume sample and capture bacteria within the TMCC. The retention time for capturing bacteria on the TMCC was adjusted by controlling the concentration and volume of the PVA solution. Concentrated bacterial samples bound to target-specific aptamer probes conjugated with quantum dots were loaded into the TMCC for a controlled time, followed by attachment of the bacteria to the PC plate and removal of unbound aptamer probes with wash buffer. The captured bacteria were quantified using a digital fluorescence reader equipped with an embedded program that automatically counts fluorescently tagged bacteria. The bacterial count made using the TMCC was comparable to a standard plate count (R2 = 0.9898), with assay sensitivity and specificity of 94.3 and 100%, respectively.

Maintaining infliximab induced clinical remission with azathioprine and 5-aminosalicylates in acute severe steroid-refractory ulcerative colitis has lower cost and high efficacy (MIRACLE): a multicenter study.

BACKGROUND/AIMS: Infliximab (IFX) has been used to induce and maintain remission in patients with severe steroid-refractory ulcerative colitis (UC). Long-term use of biologics in developing countries is limited by high cost and frequent side effects. An optimal maintenance strategy in these patients needs to be established. METHODS: A retrospective analysis of maintenance of clinical remission with combination of azathioprine (AZA) and 5-aminosalicylates (5-ASA) in patients with severe steroidrefractory UC where IFX (5 mg/kg intravenously at weeks 0, 2, 6) had been used only as an induction therapy was done at 2 centers in India. Primary outcome was the proportion of patients maintaining corticosteroid-free sustained clinical remission (SCR) at the end of study period. Rates of relapse and cost of therapy were also analyzed. RESULTS: Of the 137 patients who received rescue IFX induction therapy, 77 (56.2%) achieved clinical remission (mean age 34.81 ± 13.32 years, 68.83% males, median follow-up 4 years, range 3 months to 6 years) and were included. Cumulative corticosteroid-free SCR was maintained in 68%, 59%, 42%, and 35% patients at 1, 2, 4, and 6 years respectively. Sixty-seven relapses were observed in 33 patients. Majority of the relapses (45/67, 67.16%) occurred within first 2 years of follow-up. Two relapses were managed with re-induction with IFX, one required colectomy, whereas all other responded to repeat course(s) of corticosteroids. Annual per capita maintenance therapy with 5-ASA and AZA was cheaper by US$ 4,526 compared to maintaining remission with IFX. CONCLUSIONS: Clinical remission achieved with IFX induction therapy in severe steroid-refractory UC can be sustained over long time with a combination of AZA and 5-ASA.

Use of drugs not listed in the National List of Essential Medicines: Findings from a prescription analysis by the Indian Council of Medical Research-Rational Use of Medicines Centres Network in tertiary care hospitals across India.

BACKGROUND: The concept of listing essential medicines can lead to improved supply and access, more rational prescribing, and lower costs of drugs. However, these benefits hinge on the prescription of drugs from an Essential Medicines List (EML). Several studies have highlighted the problem of underutilization of EMLs by prescribers. Therefore, as part of prescription research by the Indian Council of Medical Research-Rational Use of Medicines Centres Network, we evaluated the extent of prescription of drugs not listed in the National List of Essential Medicines (NLEM). MATERIALS AND METHODS: Prescriptions of outpatients from participating centers were included after obtaining verbal/written informed consent as approved by the Ethics Committee, and evaluated for prescription of drugs from the NLEM 2015. RESULTS: Analysis of 4838 prescriptions from 13 tertiary health-care institutes revealed that 2677 (55.33%) prescriptions had at least one non-NLEM drug prescribed. In all, 5215 (31.12%) of the total 16,758 drugs prescribed were not in NLEM. Of these, 2722 (16.24%) were single drugs and 2493 (14.88%) were fixed-dose combinations (FDCs). These comprised 700 different drug products - 346 single drugs and 354 FDCs. The average number of non-NLEM drugs prescribed per prescription was 1.08, while the average number of all drugs prescribed was 3.35 per prescription. It was also found that some of the non-NLEM drugs prescribed had the potential to result in increased cost (for example, levocetirizine), increased adverse effects (dextromethorphan), and less effectiveness (losartan) when compared to their NLEM counterparts. Nonavailability of an essential drug (oral hydroxocobalamin) was another important finding of our study. CONCLUSION: This study highlights the extent and pattern of drugs prescribed from outside the NLEM at the tertiary health-care level and the need for training and enhanced awareness among prescribers for greater utilization of the NLEM.

Selective N-Alkylation of Amines with DMC over Biogenic Cu-Zr Bimetallic Nanoparticles.

Herein, we report the green synthesis of copper-zirconium bimetallic nanoparticles (Cu-Zr BNPs) from aqueous solutions using Azadirachta indica leaf extract as a reducing and stabilizing agent. The CuO, ZrO2 NP, and Cu-Zr BNP samples were characterized by X-ray diffraction and Fourier transform infrared (FTIR) spectroscopy, and the morphologies of the samples were analyzed by high-resolution transmission electron microscopy (HR-TEM) with selected area electron diffraction analysis (SAED). The synthesized Cu-Zr BNPs have been employed as efficient catalysts for the selective N-methylation of aromatic and aliphatic amines with dimethyl carbonate. The effect of process conditions on the percentage conversion of benzylamine with dimethyl carbonate as a model reaction has been investigated. The Cu-Zr bimetallic nanoparticle catalytic system in a 1:2 molar ratio was able to convert amines into the corresponding N-methylated amines with a selectivity up to 91% at 180 °C in 4 h. The analysis of catalytic reusability confirmed that the reported heterogeneous catalyst can be used for five consecutive cycles without much loss in activity. Thus, the current protocol can be considered as a simpler, reproducible, and environmentally benign approach for N-methylation of amines.

Safety of hydroxychloroquine in healthcare workers for COVID-19 prophylaxis.

BACKGROUND & OBJECTIVES: Hydroxychloroquine (HCQ), reported to inhibit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in in vitro studies, has been recommended for prophylaxis of COVID-19 in healthcare workers (HCWs). The objective of this study was to assess short-term adverse events (AEs) of HCQ in HCWs. METHODS: This cross-sectional study among consenting HCWs taking prophylaxis and working in hospitals with COVID-19 patients used online forms to collect details of HCWs, comorbidities, prophylactic drugs used and AEs after the first dose of HCQ. Verification of dose and AEs was done by personal contact. Multivariate logistic regression analysis was done to determine the effect of age, gender and dose of HCQ on AE. RESULTS: Of the 1303 HCWs included, 98.4 per cent (n=1282) took HCQ and 66 per cent (n=861) took 800 mg as first day's dose. Among the 19.9 per cent (n=259) reporting AEs, 1.5 per cent (n=20) took treatment for AE, none were hospitalized and three discontinued HCQ. Gastrointestinal AEs were the most common (172, 13.2%), with less in older [odds ratio (OR) 0.56, 95% confidence interval (CI) 0.35-0.89], with more in females (OR 2.46, 95% CI 1.78-3.38) and in those taking a total dose of 800 mg on day one compared to a lower dose. Hypoglycaemia (1.1%, n=14), cardiovascular events (0.7%, n=9) and other AEs were minimal. INTERPRETATION & CONCLUSIONS: HCQ prophylaxis first dose was well tolerated among HCWs as evidenced by a low discontinuation. For adverse effects, a small number required treatment, and none required hospitalization. The study had limitations of convenience sampling and lack of laboratory and electrocardiography confirmation of AEs.

CaFu MOF as an efficient adsorbent for simultaneous removal of imidacloprid pesticide and cadmium ions from wastewater.

Heavy metal ions and pesticides are the noteworthy toxic substances which must be removed from contaminated water for safeguarding public health. The higher levels of these substances in natural water may adversely affect the human health, climate and the eco-framework. The adsorptive removal of hazardous constituents employing metal organic frameworks has drawn considerable attention of researchers during the last decade. From this point of view, single crystal of calcium fumarate [Ca(C4H4O4)1.5 (H2O)(CH3OH)2] has been developed and analyzed by single crystal X-ray crystallography which confirmed the formation of 3-D metal organic frameworks (MOFs). The synthesized MOFs was employed for simultaneous adsorptive removal of imidacloprid, a high consumption pesticide, and highly toxic Cd (II) from aqua ecosystem. The effect of variation in experimental conditions such as solution pH, adsorbent dosage, contact time, initial concentration and temperature on adsorption was systematically evaluated. Both the imidacloprid and Cd(II) exhibited maximum adsorption at pH 6.5 and 7.8, respectively. The equilibrium empirical data was fitted into Langmuir, Freundlich and Temkin isotherms. The adsorption capacity of CaFu MOFs was observed to be 467.23 and 781.2 mg g-1 for imidacloprid and cadmium ions, respectively. The adsorbed pollutants were desorbed from the adsorbent using dilute HCl, and the material was reused for five adsorption-desorption cycles without any appreciable loss of adsorption capacity. Therefore, the 3-D CaFu MOFs could be utilized as a novel material for adsorptive removal of imidacloprid pesticide as well as Cd (II) from wastewater.

Cancer Cell Detection on the Surface of Top-Gated Monolayer Graphene via Raman Spectroscopy.

A label-free biosensor is described based on the Raman spectroscopic signatures of monolayer graphene, which are modified in the compartment of cancer cells because of electron-phonon coupling in monolayer graphene. Specifically, the Raman spectra of electrostatically gated monolayer graphene on SiO2/Si substrates, in the voltage range from 0 to 5 V, were studied in the absence and the presence of cancer cells. Density functional theory simulations afforded a correlation between cancer cells and the observed Raman spectra, through the regulation of the intensities of the G and 2D Raman vibrational modes with applied voltage. The C-H and N-H bonds of phenylalanine enabled the detection of this biosensing activity. Significantly, this detection can be carried out even in the absence of cancer cell-culturing steps.

Sunlight driven photocatalytic degradation of organic pollutants using a MnV2O6/BiVO4 heterojunction: mechanistic perception and degradation pathways.

In the field of photocatalysis, fabrication of a heterojunction structure with effective charge separation at the interface and charge shift to enhance the photocatalytic activity has acquired extensive consideration. In the present investigation, MnV2O6/BiVO4 heterojunction samples with excellent photocatalytic performance under sunlight irradiation were conveniently synthesized by a hydrothermal technique, and characterized by UV-Vis, FTIR, XRD, FESEM, HRTEM, PL, BET and XPS techniques. The prepared samples were investigated as photocatalysts for degrading MB and RhB dyes under sunlight. Among various samples of MnV2O6/BiVO4, the S-V hetero-junction sample exhibited maximum photocatalytic activity with 98% and 96% degradation of MB and RhB dyes, respectively, in 6 and 35 min. The high photocatalytic activity of MnV2O6/BiVO4 may be due to the successful generation and shift of charges in the presence of visible light. The average reduction of chemical oxygen demand (COD) was found to be 75% after irradiation with direct sunlight. In the degradation process of dyes, superoxide anion radicals were the main responsive species, as revealed by trapping experiments. The degradation efficiency of MnV2O6/BiVO4 heterojunction did not diminish even after four cycles. In addition, the catalytic performance of the fabricated heterojunction was also explored for reducing 4-nitrophenols (4-NP) by using NaBH4. Absolute conversion of 4-NP to 4-aminophenol (4-AP) occurred without the production of intermediate byproducts.

Simultaneous Use of Two Different Tools to Assess Compliance with Antiepileptic Drugs: Experience in A Community-Based Study.

Objective Antiepileptic drug (AED) therapy remains the primary form of treatment for epilepsy, noncompliance to which can result in breakthrough seizure, emergency department visits, fractures, head injuries, and increased mortality. Various tools like self-report measures, pill-counts, medication refills, and frequency of seizures can assess compliance with varying extent. Thus, assessment of compliance with AEDs is crucial to be studied. Materials and Methods Compliance was assessed using pill-count and Morisky medication adherence scale (MMAS) during home visits. A pill-count (pills dispensed-pills remaining)/(pills to be consumed between two visits) value of 0.85 to ≤1.15 was recorded as appropriate compliance. Underdose (<0.85) and overdose (>1.15) was labeled as noncompliance. Score of 1 was given to each positive answer in MMAS. Score of ≥1 was labeled as noncompliance. Statistical analysis: Relationship of demographic factors between compliant and noncompliant patients was analyzed using Chi-square test (SPSS version 21.0, IBM). Rest of the data was analyzed with the help of descriptive statistics using Microsoft Excel. p < 0.05 was considered statistically significant. Results Out of 105 patients, 54 patients were noncompliant with both pill-count and MMAS. 10 patients were noncompliant with pill-count only, while 10 were noncompliant with MMAS. Conclusion Both tools complement each other when used in combination, as use of a single tool was not able to completely detect compliance.

Therapeutic status of hydroxychloroquine in COVID-19: A review.

Hydroxychloroquine (HCQ), a 4-aminoquinoline, is used worldwide mainly for its role in management of malaria and rheumatoid arthritis. In the present pandemic of coronavirus disease (COVID)-2019, the drug is being repurposed, based on its in vitro evidence of efficacy against coronavirus. There has been a lot of information, for and against the drug, and this review is an effort to bring forth the evidence and current understanding regarding role of HCQ in COVID-19. Clinical studies, case reports, and in vitro studies have generated conflicting results. There are concerns for use of HCQ because of the variable results and the known adverse effects like QT prolongation and hypoglycemia. In the current scenario, recommendations from Indian Council of Medical Research for use of HCQ in the prophylaxis of COVID-19 are being followed.

Spontaneous Adverse Drug Reaction Monitoring in a Tertiary Care Centre.

BACKGROUND AND OBJECTIVE: Adverse drug reactions (ADRs) are associated with increased economic burden on the society. Monitoring of ADRs can help in decreasing the incidence of preventable adverse reactions. METHODS: Under Pharmacovigilance Program of India, collection and reporting of ADRs has been going on at Dayanand Medical College and Hospital since January 2011. Here, we have analyzed the individual case safety reports (ICSRs) reported and uploaded between January 2017 and June 2019 from our centre. The ADR form provided by PvPI was used for collecting information, and the causality assessment was done according to the WHO-UMC scale. RESULTS: A total of 498 ICSRs were uploaded through Vigiflow software during this period. Highest number of ADRs were recorded in the age group of 31-45 years (29.01%) and the least number of ADRs were recorded in the children less than 15 years of age (6.76%). General Medicine ward reported the highest number of ADRs and the antibiotics were most commonly associated with ADRs (26.21%), followed by antipsychotics (13.83%) and NSAIDs (12.14%). More than 90% of ADRs were non-serious (93.17%) and most of the ADRs were skin and soft tissue related (49.20%). CONCLUSION: Spontaneous reporting among indoor patients shows highest number of ADRs with use of antibiotics and almost all of the ADRs were non-serious in nature. Almost half of the total ADRs were skin and subcutaneous tissue related. Continuous efforts are required for further strengthening of the pharmacovigilance program of India.

Effects of Aspect Ratio Heterogeneity of an Assembly of Gold Nanorod on Localized Surface Plasmon Resonance.

We examine the effects of aspect ratio (AR) heterogeneity of an assembly of gold nanorods (GNRs) in a colloid on the total cross-section for its light scattering via localized surface plasmons at visible wavelengths. We observe the extraordinary broadening of the extinction spectrum of light through an assembly of GNRs, a colloidal mixture of those having two different ARs. The interparticle distance estimated as ∼1.2-1.3 µm, being greater than the incident wavelength, allows the radiative dipolar coupling to govern the long-range interaction between GNRs. We find that the coupling enhanced local fields can activate the nonresonant polarization of GNRs to turn into a quasi-resonant one. These higher-order effects for GNR polarization can produce the deviation of total cross-section of GNRs assembly beyond the simple sum of an individual cross-section of GNRs that are assumed to have no such long-range coupling. The extraordinary properties of the extinction spectrum need to be taken into account for modulating the spectral distribution of electromagnetic field in photonic devices where an assembly of GNRs is utilized for field enhancement such as those for surface-enhanced spectroscopy, highly efficient photovoltaics, photothermal nanotherapy, and ultrathin absorption filters.

Heteroatom-doped graphene as sensing materials: a mini review.

Graphene is one of the astounding recent advancements in current science and one of the most encouraging materials for application in cutting-edge electronic gadgets. Graphene and its derivatives like graphene oxide and reduced graphene oxide have emerged as significant nanomaterials in the area of sensors. Furthermore, doping of graphene and its derivatives with heteroatoms (B, N, P, S, I, Br, Cl and F) alters their electronic and chemical properties which are best suited for the construction of economical sensors of practical utility. This review recapitulates the developments in graphene materials as emerging electrochemical, ultrasensitive explosive, gas, glucose and biological sensors for various molecules with greater sensitivity, selectivity and a low limit of detection. Apart from the most important turn of events, the properties and incipient utilization of the ever evolving family of heteroatom-doped graphene are also discussed. This review article encompasses a wide range of heteroatom-doped graphene materials as sensors for the detection of NH3, NO2, H2O2, heavy metal ions, dopamine, bleomycinsulphate, acetaminophen, caffeic acid, chloramphenicol and trinitrotoluene. In addition, heteroatom-doped graphene materials were also explored for sensitivity and selectivity with respect to interfering analytes present in the system. Finally, the review article concludes with future perspectives for the advancement of heteroatom-doped graphene materials.