EVALUATION OF INAPPROPRIATE PRESCRIPTIONS IN THE GERIATRIC POPULATION OF AN URBAN SLUM IN BANGALORE

Although the over 60 years age population constitutes approximately 8% of the total population, 30% of total medication is prescribed for this age group. Chronic diseases and polypharmacy in the elderly population increase the risk of inappropriate drug use. Some physicians prescribe medications without reviewing other supplements and medications used by the elder patient. This polypharmacy results in many adverse drug interactions and reactions. The purpose of this study was to identify older patients who were prescribed inappropriate drugs, according to START/STOPP criteria. To estimate the prevalence of inappropriate prescriptions amongst the elderly residing in an urban slum under the field practice area of Urban Health and Training Center (UHTC) of a tertiary medical college; to assess polypharmacy and morbidity pattern in these elderly. A cross-sectional study was conducted among the elderly, aged 65 years and above, residing in an urban slum under the field practice area of a tertiary medical college. A total of 215 elderly were chosen from the study area by simple random sampling. Data regarding socio-demographic profile and medication usage was collected using a pre-tested semistructured questionnaire through individual interview. START/STOPP criteria were used to identify potentially inappropriate prescriptions. The prevalence of PIPs was 43.3% and of PIOs was 20.9%. Polypharmacy was found in 36.7% of elderly population. Mean number of medications used by the study population was 6.19±2.43 (range was 1-10). The most common morbidity present in the study population was Arthritis in 34.9% followed by hypertension in 13% (28) of elderly. The faulty prescription commissions and omissions have created a significant issue of polypharmacy. This study only provides a baseline data about inappropriate prescriptions and polypharmacy. A multi-pronged approach, involving healthcare workers and policy makers is required to address this issue to optimize the elderly pharmacotherapy and thus health care.

Remembering the forest while viewing the trees: evolutionary thinking in the teaching of molecular biology

Given the centrality of evolutionary theory to the study of biology, we present a strategy for reinforcing its importance by appropriately recontextualizing classic and well-known experiments that are not explicitly linked with evolution in conventional texts. This exercise gives students an appreciation of the applicability of the theory of evolution in diverse contexts, including those where it is not explicitly mentioned.

Proteomic identification of galectin-3 binding ligands and characterization of galectin-3 proteolytic cleavage in human prostasomes

Galectin-3 is a multifunctional carbohydrate-binding protein that was previously characterized as a proteolytic substrate for prostate-specific antigen (PSA) and was shown to be associated with prostasomes in human semen. Prostasomes are exosome-like vesicles that are secreted by the prostatic epithelium and have multiple proposed functions in normal reproduction and prostate cancer. In the current study, galectin-3 binding ligands in human prostasomes were identified and characterized with the goal to investigate galectin-3 function in prostasomes. Galectin-3 binding proteins were isolated by affinity column chromatography. Candidate ligands identified by MS/MS were PSA, prostatic acid phosphatase (PAP), zinc alpha-2-glycoprotein (ZAG), dipeptidyl peptidase-4 (CD26), aminopeptidase N (CD13), neprilysin, clusterin, antibacterial protein (FALL-39) and alpha-1-acid glycoprotein (ORM1). Biochemical methods were used to characterize the ability of galectin-3 to bind to selected ligands, and galectin-3 cleavage assays were utilized to investigate the protease(s) in prostasomes that cleaves galectin-3. CD26, CD13, PSA, PAP and ZAG immunoreactivity were detected in extracts of purified prostasomes. One-dimensional electroblot analysis of prostasomes demonstrated that CD26, PAP and CD13 immunoreactivity co-migrated with galectin-3-reactive protein bands. PSA and ZAG were found to be associated with the surface of prostasomes. Both intact and cleaved galectin-3 were detected in prostate and prostasome extracts. Cleavage and inhibition assays indicated that PSA in prostasomes proteolytically cleaves galectin-3. The identification of these glycoproteins as galectin-3 ligands lays the groundwork for future studies of galectin-3 and prostasome function in reproduction and prostate cancer.

Development and evaluation of a latex agglutination test for rabies antibodies

BACKGROUND

The presently recommended tests for estimation of rabies neutralising antibodies like Rapid Fluorescent Focus Inhibition test (RFFIT) and Mouse Neutralisation test (MNT) are laborious, time consuming and not cost-effective for routine use. Simple, rapid and economical tests need to be developed for routine use.

OBJECTIVES

The main objective of the present study was to develop and evaluate a rapid Latex Agglutination Test (LAT) to detect rabies specific antibodies.

METHODS

Latex beads were coated with purified rabies glycoprotein at a concentration of 1 mg/ml followed by coating with 0.3% bovine serum albumin (BSA). These sensitised beads were used to detect antiglycoprotein antibodies in sera of 152 people who had taken a course of post exposure rabies vaccination with different cell culture vaccines and whose antibody titers were pre determined by MNT. Sera from 52 normal healthy people without any detectable levels of rabies antibodies were included as controls. The test was carried out on glass slides by mixing 20 micro l of sensitised beads and 20 micro l serum.

RESULTS

Preliminary evaluation with rabbit serum of known potency indicated that for clear agglutination of sensitised beads, a minimum of 2 IU/ml of rabies antibody should be present in the serum samples. Visible agglutination was noticed in positive sera with a titer > or =2 IU/ml within 3-5 min after mixing. Seven Sera whose MNT titers were less than 2 IU/ml did not show agglutinati or n. None of the negative control sera showed agglutination. Thus the specificity of the test was 100% and sensitivity was 95.4%.

CONCLUSIONS

The LAT described here detects rabies specific antibodies > or =2 IU/ml and can be used to screen large number of sera from vaccinated people to know the protective status after vaccination. This simple and rapid test may be used routinely in antirabies treatment centres to monitor sero conversion in vaccinated people.

A passive haemagglutination test for rabies antibodies using rabies glycoprotein coupled erythrocytes

The presently recommended tests for assaying rabies antibodies like mouse neutralization test (MINT) and rapid fluorescent focus inhibition test (RFFIT) are either time consuming or expensive and are generally performed in reference laboratories. There is a need to develop a specific and rapid method for detection of rabies antibodies that can be used to monitor sero-conversion after pre-or post-exposure vaccination. In this study, we have developed a passive haemagglutination (PHA) using purified rabies virus glycoprotein coupled to sheep erythrocytes using chromium chloride (0.04%) as a coupling agent. Two hundred and fifty five serum samples from people vaccinated with different rabies vaccines, 16 paired serum and CSF samples from autopsy confirmed cases of paralytic rabies, and serum samples from 65 normal healthy controls were tested and evaluated in comparison to standard MNT. Among the vaccinees, 250 samples were positive both by MNT and PHA but 5 samples were negative by PHA and positive by MNT. The titres obtained by PHA were lower compared to MNT, but there was significant correlation between the two (r=0.885). The specificity of the test was 99.7% and sensitivity was 100% as compared to MNT. Thus this PHA test promises to be a rapid and specific test for assaying rabies antibodies and may be useful in screening large number of serum samples for sero conversion after vaccination. It may also assist in rapid laboratory confirmation of paralytic rabies cases, based on detection of antibodies in CSF and serum.

Comparative evaluation of a simple indirect immunofluorescence test and mouse neutralization test for assaying rabies antibodies

In this study, we have developed and evaluated a simple indirect immunofluorescence test (IIFT) to detect rabies antibodies in a two-step immunofluorescence assay. One hundred and eighty five serum samples from people who had taken different rabies vaccines and 8 pairs of serum and CSF samples from confirmed paralytic rabies cases were tested by IIFT and results evaluated in comparison to standard mouse neutralization test (MNT). Though the titres of rabies antibodies obtained with IIFT were 2-4 times lesser in comparison to MNT, a significant correlation was seen between the two tests (R = 0.883). The specificity of this IIFT was found to be 97.9% and the sensitivity was 97.2%. These results indicate that this simple and rapid IIFT can be used to screen large number of serum samples to monitor sero-conversion after pre or post exposure vaccination and may also assist in rapid ante-mortem diagnosis of atypical human rabies.