An Analysis of the Cost Variation Among Different Antimicrobial Agents: The Indian Scenario.

Background and objective Infectious diseases pose a substantial global health challenge, especially in developing countries where healthcare accessibility is limited. Pharmaceutical expenses constitute a significant share of out-of-pocket expenditure (60-90%). Hence, the affordability of medications becomes a critical determinant for patient compliance. This study focuses on the economic dynamics of antimicrobial agents. Methodology After collecting data from the Current Index of Medical Specialties (CIMS), different antimicrobial agents (AMAs) were assessed based on their cost per 10 tablets/10 capsules/one vial of injection. A comprehensive analysis was performed to assess the minimum and maximum costs for each medication across diverse pharmaceutical companies. Cost variation was assessed through both the cost ratio and percentage cost variation. The data were analyzed and represented using descriptive statistics Results Our findings indicate significant cost variations, with nitrofurantoin 100 mg tablet showcasing a staggering 1498.5% variation, followed by meropenem 500 mg vial at 473.91%. Conversely, the cotrimoxazole (sulfamethoxazole 800 mg + trimethoprim 160 mg) tablet exhibits a minimal 6.05% variation, underscoring the diversity in pricing strategies. The number of brands ranged from two to 62. Conclusions This study underscores the importance of considering cost variations in antimicrobial agents while prescribing the same. Doing so will not only address the economic challenges faced by patients but also help in improving compliance and reducing the risk of antimicrobial drug resistance. This approach advocates for a more economically sustainable and patient-centric healthcare ecosystem in India.

Ethambutol-Induced Optic Neuritis and Vision Loss: A Case Report.

Ethambutol is a first-line chemotherapeutic agent, which is commonly used in combination with other drugs for the treatment of tuberculosis. Ethambutol-induced optic neuritis is a serious and rare side effect that is either dose or duration-related and causes progressive painless vision loss, and cecocentral scotomas in the visual field. A rare case of ethambutol-induced optic neuritis was reported in a 52-year-old female who was taking anti-tubercular treatment for pulmonary tuberculosis for five months. She presented with painless diminished vision in both eyes. The patient was diagnosed with a rare case of optic neuritis through various examination methods. Ethambutol was stopped and therapy was continued with oral prednisone, zinc, and vitamin B complex being started along with anti-TB treatment. She showed no marked improvement in visual parameters until the last follow-up. The patient died due to cardiopulmonary arrest as a consequence of pulmonary tuberculosis.

Knowledge, Attitude, and Practice of Materiovigilance Among Healthcare Professionals at a Tertiary Care Teaching Hospital.

Objective This study aimed to assess the knowledge, attitudes, and practices (KAP) of materiovigilance among healthcare professionals (HCPs) at a tertiary care teaching hospital in South Gujarat, India. Specifically, it sought to identify gaps in current understanding and reporting practices related to adverse events associated with medical devices. Introduction Materiovigilance, the systematic monitoring and assessment of adverse events related to medical devices, is crucial for ensuring patient safety and enhancing device performance. In India, the Materiovigilance Programme of India (MvPI) under the Ministry of Health and Family Welfare oversees the safe use of medical devices, integrating them with the pharmacovigilance framework. Despite these efforts, challenges persist in awareness, reporting practices, and the integration of materiovigilance among healthcare professionals. The knowledge, attitude, and practice (KAP) of these professionals are pivotal for effective adverse event reporting, but underreporting due to a lack of awareness, inadequate training, and perceived administrative burden remains a significant barrier. The study underscores the importance of training programs, improving reporting infrastructure, and fostering a safety culture within healthcare institutions to enhance the effectiveness of materiovigilance in India. Methodology An observational, cross-sectional study was conducted using a questionnaire-based approach. A total of 215 HCPs, including consultant doctors, resident doctors, and nursing staff, participated in the study. The questionnaire covered aspects of knowledge regarding the Materiovigilance Programme of India (MvPI), classification of medical devices, attitudes towards adverse event reporting, and actual reporting practices. Data collection was carried out electronically over the course of one month using Google Forms (Google LLC, Mountain View, California, United States). Results Among the participants, 135 (62.79%) correctly identified MvPI as the program for monitoring adverse events caused by medical devices. A majority of 188 (87.44%) understood that medical devices in India are classified based on a risk-based approach. Positive attitudes towards reporting adverse events were prevalent, with 202 (93.95%) acknowledging the potential for adverse events from medical devices and agreeing on the importance of reporting. However, a significant gap was noted between noticing adverse events (138 participants, 64.19%) and actual reporting (60 participants, 27.91%), indicating a need for improved reporting practices. Only 104 participants (48.37%) had participated in workshops or continuing medical education (CME) sessions on medical device safety. Conclusion The study reveals a strong foundation of knowledge and positive attitudes towards the materiovigilance among HCPs in South Gujarat. However, there is a notable discrepancy between awareness and actual reporting practices. To enhance the effectiveness of materiovigilance, interventions such as targeted educational programs and simplification of reporting procedures are recommended. These efforts are essential to ensure timely detection, reporting, and management of adverse events related to medical devices, thereby enhancing patient safety and overall healthcare quality.

Causality Assessment of Adverse Drug Reaction Toxic Epidermal Necrolysis With the Aid of ChatGPT: A Case Report.

Toxic epidermal necrolysis (TEN) is a severe and potentially fatal adverse drug reaction. This case report presents a 19-year-old male with pulmonary tuberculosis undergoing anti-tubercular therapy who developed TEN. The patient had multiple comorbidities including type 1 diabetes mellitus and multisystem atrophy. ChatGPT was utilized alongside conventional methods to assess causality. While conventional scoring systems estimated mortality at 58.3% (SCORTEN) and 12.3% (ABCD-10), ChatGPT yielded divergent scores. Causality assessment using WHO-Uppsala Monitoring Centre (UMC) and Naranjo's scale indicated rifampicin and isoniazid as probable causative agents. However, ChatGPT provided ambiguous results. The study underscores the potential of AI in pharmacovigilance but emphasizes caution due to discrepancies observed. Collaborative utilization of artificial intelligence (AI) with clinical judgment is advocated to enhance diagnostic accuracy and treatment decisions in adverse drug reactions. This case highlights the importance of integrating AI into drug safety systems while acknowledging its limitations to ensure optimal patient care.

Piperacillin-Tazobactam-Induced Urticaria and Angioedema: A Case Report With Literature Review.

Drug-induced urticaria and angioedema cases are typically reversible upon discontinuation and can be triggered by antibiotics, angiotensin-converting enzyme inhibitors, or nonsteroidal anti-inflammatory drugs. Piperacillin-tazobactam, a common broad-spectrum antimicrobial, has been linked to severe adverse reactions, such as thrombocytopenia, hemolytic anemia, and Steven Johnson syndrome in some cases. A 35-year-old male presented to the emergency department with fever, cough, and acute breathlessness, complicating his ongoing treatment for pulmonary tuberculosis with bedaquiline and delamanid. He was admitted and received supportive care. On the third day of intravenous piperacillin-tazobactam, he developed drug-induced urticaria and angioedema, which resolved upon discontinuing the drug. Piperacillin/tazobactam-induced hypersensitivity reaction is an immunologic and IgE-mediated immediate reaction. IgE-mediated immediate reactions to three major phenotypes of allergic patients with confirmed to piperacillin/tazobactam are either (1) sensitized to the ß-lactam ring or (2) sensitized to the lateral chain of aminopenicillins or (3) selective to piperacillin/tazobactam alone. A skin patch test is advised, or prescribed to avoid hypersensitivity reactions due to piperacillin/tazobactam. This case underscores the challenges of non-adherence to anti-tubercular therapy, leading to drug resistance and prolonged, costly, and sometimes intolerable treatments. Regular patient follow-up, counseling, monitoring, and healthcare provider involvement are essential to enhance treatment adherence. Adverse drug reactions must be promptly reported and managed, and patient-centric approaches are crucial. Digital patient records and standardized data collection are recommended for program evaluation and global policy development. Causality assessment for piperacillin-tazobactam was diagnosed as the probable cause of drug-induced urticaria and angioedema. This case highlights the importance of adherence to tuberculosis treatment to prevent drug resistance. Overall, patient-centered care, monitoring adverse events of drug added, and better data collection are crucial for successful tuberculosis management.

Association between negative parent-related family interactions and child social anxiety: A cross-cultural systematic review and meta-analysis.

This meta-analysis systematically evaluates the strength and direction of the association between negative parent-related family interactions and child social anxiety, and identifies several influencing moderators. Two investigators independently searched international (PsycINFO, PubMed, and Web of Science) and Chinese (CNKI, WanFang, and VIP) databases from their inception dates until March 5, 2023, for suitable articles. Of the 5771 identified records, 85 studies were selected based on inclusion of at least one of the following three dimensions of negative family interactions: insecure attachment (n = 27), parent-related family conflicts (n = 19), or negative parenting styles (n = 46). Meta-analyses showed that all three dimensions were significantly associated with child social anxiety (insecure attachment: r = 0.271, p < 0.0001; parent-related family conflicts: r = 0.226, p < 0.0001; negative parenting styles: r = 0.186, p < 0.0001). For all three dimensions, this association was stronger in children from East Asian culture than in those from European or American culture. In addition, age group, information source, and publication year also significantly moderated this association. Our findings will help guide further research and provide recommendations for the development of effective interventions for reducing social anxiety.

The Evaluation of Orthotics in Reducing Hallux Valgus Angle in Patients with Hallux Valgus over a Twelve-Month Treatment.

BACKGROUND: Hallux valgus (HV) is one of the most common forefoot deformities among females, and its prevalence increases with age. This study aims to evaluate the effectiveness of three different types of orthotics on the reduction in hallux valgus angle (HVA) for patients with mild and moderate hallux valgus deformities. METHODS: Twenty-six patients (42 feet) with mild or moderate HV participated in the treatment with three types of orthotics in the current study. Patients were divided into three groups depending on their HV severities and the consideration of different function of the orthotics. Orthotic Type 1 is a biomechanical style orthotic applied to moderated HV in Group 1. Orthotic Type 2 is a wrap style orthotic used on mild and moderate HV with two sub-groups: mild HV in Group 2A and moderate HV in Group 2B. Orthotic Type 3 is a gel style orthotic for mild HV. Patients were required to wear the orthotics for between 6 and 8 h per night over a period of 12 months. The HVA was measured every 3 weeks using a newly designed Measuring Block. A paired t-test was used to compare the differences between initial and final HVA at different stages of HVA treatment with orthotics. RESULTS: After the 12-month treatment, for moderate HV patients treated with the Orthotic Type 1, their HVA reduced by 5.05° (95% CI 1.37, 8.73), (p < 0.05). For moderate HV patients treated with the Orthotic Type 2, their HVA reduced by 1.2° (95% CI -0.71, 3.11) (p > 0.05). For mild HV patients treated with the Orthotic Type 2, their HVA reduced by 2.44° (95% CI 1.39, 3.49) (p < 0.05). For mild HV patients treated with the Orthotic Type 3, their HVA reduced by 3.08° (95% CI -0.68, 6.83) (p > 0.05). CONCLUSIONS: Orthotic Type 1 showed a consistent significance in reduction in the HVA during the 12-month treatment, so it could be recommended for treating moderate HV. Orthotic Type 2 reduced the HVA, but it did not show a consistent significance in reduction in the HVA for mild and moderate HV. Orthotic Type 3 reduced the HVA, but it showed a volatile trend during 12 months without significant differences.

Development of a Manual Measurement Device for Measuring Hallux Valgus Angle in Patients with Hallux Valgus.

BACKGROUND: Hallux valgus (HV) is one of the most common forefoot deformities, and its prevalence increases with age. HV has been associated with poor foot function, difficulty in fitting footwear and poor health-related quality of life. The aims of this study were to design and develop an easy-to-use measurement device for measuring hallux valgus angle (HVA) in patients with HV and to assess the measurement reliability of the newly designed measurement device. METHODS: A manual measurement device for measuring HVA was designed and developed to test on patients with HV. Two measuring methods, i.e., test-retest and intra-observer measurements, were used to evaluate the repeatability and reliability of the newly designed measurement device. In the test-retest measurements, a total of 42 feet from 26 patients with HV were repeatedly measured by the same researcher using the manual measurement device every 3 weeks over a period of 12 months. The measurement reliability of the newly designed measurement device was analysed based on the collected HVA data. In the intra-observer measurements, a total of 22 feet from the same group of HV patients were measured by the same researcher using the manual measurement device and by a consultant using X-ray measurement for comparison. The intraclass correlation coefficient (ICC) was used to determine the correlation of measurements between the manual measurement device and X-ray measurement. RESULTS: The mean of the difference between the two repeat measurements of HVA using the newly designed manual device was 0.62°, and the average of ICC was 0.995, which indicates excellent reliability. The ICC between X-ray and the average of twice-repeated manual measurements was 0.868, with 95% CI (0.649, 0.947) (p = 0.000). When the relationship in HVA between X-ray measurement and manual measurement using the new device was regressed as a linear relationship, the regression equation was y = 1.13x - 4.76 (R2 = 0.70). CONCLUSIONS: The newly designed measurement device is easy to use, with low-cost and excellent reliability for HVA measurement, with the potential for use in clinical practice.

Structure, electronic, optical and thermodynamic behavior on the polymerization of PMMA: A DFT investigation.

A density functional theory based scrutiny is implemented on the structure, electronic, optical and thermodynamic properties of the Poly (Methyl MethAcrylate) polymers (PMMA or nMMA; n = 1-5). The quantum chemical descriptors, e.g. HOMO-LUMO gap, ionization potential, chemical hardness, binding energies etc. of the PMMA polymers provides the measure for the structural and electronic properties. The parameters polarizability (α) and hyperpolarizability (ß) provides information for the non-linear optical (NLO) properties of the polymers. The absorption range of the PMMA polymer in the electromagnetic radiation spectrum during its growth is assessed by the UltraViolet-Visible (UV-vis) optical absorption spectra. To gain further insight on the origin of stability during the polymerization process, we have simulated frontier molecular orbitals (FMOs) and various thermodynamic properties, viz., entropy (S), enthalpy (H) and Gibbs free energy (G).