Pan-striatal reduction in the expression of the astrocytic dopamine transporter precedes the development of dorsolateral striatum dopamine-dependent incentive heroin seeking habits

The emergence of compulsive drug-seeking habits, a hallmark feature of substance use disorder, has been shown to be predicated on the engagement of dorsolateral striatal control over behaviour. This process involves the dopamine-dependent functional coupling of the anterior dorsolateral striatum (aDLS) with the nucleus accumbens core, but the mechanisms by which this coupling occurs have not been fully elucidated. The striatum is tiled by a syncytium of astrocytes that express the dopamine transporter (DAT), the level of which is altered in individuals with heroin use disorder. Astrocytes are therefore uniquely placed functionally to bridge dopamine-dependent mechanisms across the striatum. Here we tested the hypothesis that exposure to heroin influences the expression of DAT in striatal astrocytes across the striatum before the development of DLS-dependent incentive heroin seeking habits. Using Western-blot, qPCR, and RNAscope™, we measured DAT protein and mRNA levels in whole tissue, culture and in situ astrocytes from striatal territories of rats with a well-established cue-controlled heroin seeking habit and rats trained to respond for heroin or food under continuous reinforcement. Incentive heroin seeking habits were associated with a reduction in DAT protein levels in the anterior aDLS that was preceded by a heroin-induced reduction in DAT mRNA and protein in astrocytes across the striatum. Striatal astrocytes were also shown to be susceptible to direct dopamine- and opioid-induced downregulation of DAT expression. These results suggest that astrocytes may critically regulate the striatal dopaminergic adaptations that lead to the development of incentive heroin seeking habits.

Retrospective Comparative Analysis of Clinical and Functional Outcome After Arthroscopic Bankart Repair using All-Suture Anchor and Metal Anchor

Introduction

Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors.

Materials and methods

In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared.

Results

A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%).

Conclusion

All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.

Short term outcome of patients attending a renal-immunology clinic in central India

Background:

Glomerular diseases (GDs) and other renal immunologic diseases are an important cause of morbidity and mortality. Providing a single point of service in collaboration with various specialists at a renal immunology clinic for such patients is not novel, but outcomes have not been reported. Here, we report the short-term outcome of Indian patients attending our clinic.

Methods:

This single-center prospective cohort study enrolled biopsy-proven immunologically-mediated adults with renal diseases between April 2018 and December 2019, and followed them for six months. The primary end point for the analysis was an incidence of end-stage renal disease (ESRD) or loss of >50% estimated glomerular filtration rate (eGFR) and patient survival at six months. Secondary endpoints were the rate of complete or partial remission, and impact of demographic factors.

Results:

Ninety two patients underwent renal biopsy for suspected immunological renal diseases. Fourteen (15.2%) cases were excluded for nonimmune etiologies, whereas 78 (84.7%) confirmed cases of immune etiology were included. Most common primary GD (n = 51) (93.5%) was membranous nephropathy (n = 20) (25.6%), whereas lupus nephritis was the most common (n = 8) (29.6%) secondary GD. Overall, 10 (12.8%) patients reached renal endpoint of ESRD or >50% fall in eGFR. Focal segmental glomerulosclerosis (FSGS) (27%) patients had worst renal outcome. Patient survival was 94.8%. Thirty patients (38.4%) achieved complete, whereas 24 each (30.7%) achieved partial remission and remained resistant to disease specific therapies, respectively. Univariate analysis identified hypertension, severity of hypertension, and resistance to achieve proteinuria remission as significantly associated (P < 0.001) factors with poor renal outcome.

Conclusions:

The present study shows that short term renal outcome of Indian patients with renal immune diseases remains poor. FSGS remains the GD with the worst renal outcome. Hypertension, its severity, failure to achieve proteinuria remission were significantly associated with poor renal outcomes.

Poroid hidradenocarcinoma and atypical hidradenoma papilliferum of the vulva – Two cases

Benign and malignant tumours may arise from eccrine and apocrine sweat glands. Hidradenocarcinoma is a rare malignant eccrine sweat gland tumour representing <0.01% of all skin cancers. There are 6 case reports in the literature of hidradenocarcinoma arising on the vulva, none of which are classified as poroid hidradenocarcinoma. Hidradenocarcinoma is thought to be an aggressive tumour with poor prognosis and high levels of local recurrence and systemic metastases. Conversely, hidradenoma papilliferum is a common benign apocrine sweat gland tumour found on the vulva. The prevalence and significance of atypical changes, however, is unknown. Distinguishing between these tumour types can be difficult. The authors present two cases, a poroid hidradenocarcinoma and an atypical hidradenoma papilliferum with necrosis and increased mitotic activity, to illustrate the diagnostic challenges associated with rare tumours of the vulva in the absence of an established histopathological classification system.

An Observational Study on Drug Utilization Pattern in Anaemic Pregnant Women in the Tertiary Care Teaching Hospital

Background: Anemia is a disease that is more prevalent among pregnant women in India. Objective: To Study the Drug Utilization Pattern, compare and evaluate better drug selection in Anaemic Pregnant Women. Methodology: A total of 300 pregnant women ranging in the age group of 17 to 38 years and having 1 month to 9 months of pregnancy was included in a study. The medical records of patients were checked and information was recorded. The prescriptions were analyzed for drug utilization patterns. Statistical analysis was done. Result: Out of all 300 pregnant women 176 patients having iron deficiency Anemia, 99 patients having sickle cell Anemia, 20 patients having folate deficiency Anemia, and the rest of the patients having Vitamin B12 deficiency or hemolytic or beta-thalassemia. The average number of drugs prescribed per patient was 3-4 and the average monthly cost per patient was 920.68 Rs. The most commonly prescribed drug was Vitamin C it is of Category C drug which could be harmful to the fetus followed by MVBC (Multivitamin B complex). Conclusion: Anemia was commonly seen in 2nd trimester. Sickle cell Anemia was seen in 1/3rd of the patients. Study data highlights that Vitamin C, Calcium & Multivitamin B complex were the most prescribed drugs in anemic patients. Drugs prescribed were produced risk to the fetus according to USFDA criteria.

A Drug Use Evaluation Study on Antidepressants in Psychiatric Patients at a Tertiary Care Teaching Hospital

Background: The pattern of prescribing Antidepressants to patients has been varying worldwide. Objective: We aim to observe the prescribing pattern of antidepressants as well as assess its various outcomes in patients, the rationality of the prescriptions, and the prevalence of antidepressant usage. Methodology: A prospective observational study of a total of 56 subjects receiving antidepressants was performed at the Psychiatry. They were screened for their various outcomes on using antidepressants. The written form of the medical record sheet was used to preserve the patient's Data. Prescription pattern, treatment chart, abnormal vitals were noted. Morisky's adherence scale was used to assess the adherence of patients to prescribed drugs. Hamilton depression rating scale was used to measure the patient's depressive stage. They were screened for possible ADRs. The causality and severity assessment of the observed ADRs was done by the WHO-UMC scale and Hartwig-Seigel scale respectively. Statistical analysis was done for all relevant data. Results: In our study, the age of patients varies from 18 years to 85 years. The maximum number of patients were from the age group of 31-40 years [28.57% (N=16)]. The 50% (N=28) of patients were diagnosed with Depressive mood disorder. A total of 169 drugs were prescribed out of which 52.07% (N=88) were Antidepressant drugs. Out of 88 Antidepressant drugs, 20% (N=18) patients received Venlafaxine, followed by 17% (N=15) Escitalopram. Out of 56, 26.78% (N=15) showed low adherence, 41.07% (N=23) showed medium adherence and 32.14% (N=18) showed High adherence.41.07% (N=23) patients were identified with drug use problems. Adverse drug reactions were suspected in 25% (N=14) patients. The most common type of Adverse reaction due to the drug was Weight gain (N=6 patients). Paroxetine drug was found with the highest number of ADRs 28.57% (N=4). Conclusion: Most common antidepressant prescribed was Venlafaxine. Most Patients in the community included suffered from Depressive mood disorder with a maximum number of patients appeared from the age group of the thirties to forties. Patients due to their unstable mental status were adhering to therapy at medium levels. Drug use problem was identified commonly with patients on sedatives resulting them to either forget taking the pills or missing the dose. Patients generally had a common Adverse drug reaction of weight gain. Proper lifestyle modifications and patient counselling is required to benefit patient from treatment.

An Observational Study on Drug Utilization Pattern in Asthma and Chronic Obstructive Pulmonary Disease in Tertiary Care Teaching Hospital

Background: Obstructive airway diseases such as asthma and COPD are defined as a decreased capacity to get air through the conducting airways and out of the lungs. Objective: To study the drug utilization pattern in asthma and chronic obstructive pulmonary disease, determine irrationally (does not comply with prescription) drug usage, and whether they were prescribed following the standard treatment guidelines. Methodology: A total of 150 patients of either sex aged 18 years and above having asthma and/or COPD were included in the study. The medical records of patients were checked and information was recorded. The prescriptions were analyzed for drug utilization patterns. The newly diagnosed patients were followed up and medication adherence was determined after 1 month. Results: Out of all 150 patients there were 103 male and 47 female patients. 54 patients were having asthma, 89 patients COPD, and 7 patients asthma COPD overlap. The majority of the patient were prescribed 1 to 3 drugs per prescription. Inhaled corticosteroids were the highest prescribed drug class. The most commonly prescribed drug combination was budesonide + formoterol. The majority of the patients have poorly adhered to the treatment. Conclusion: Study data highlights that very few drug interactions were identified between prescribed medications. The drugs and their combinations were prescribed according to the standard guidelines GOLD (Global Initiative for Chronic Obstructive Lung Disease) and GINA (Global Initiative for Asthma).

Assessing of the Risk Factor & Determine Epidemiology of Acne Vulgaris in Tertiary Care Teaching Hospital

Background: Acne vulgaris remains one of the commonest diseases to afflict humanity, with over 90% of males and 80% of females affected by the age of 21 years. Objectives: The aim of this study was to assessing the specific risk factors, determine the epidemiology and etiology of Acne Vulgaris. Methodology: It is a cross-sectional observational study conducted for a period of six month in the department of dermatology, Dhiraj General Hospital, Vadodara. Patients who were diagnosed with acne vulgaris and fulfilled the inclusion criteria were enrolled in the study. Data was collected by filling the patient medical record sheet. Result: Total 300 patients were included in the study. Out of which 38.67% males and 61.33% females were found affected by Acne Vulgaris. The mean age group affected were found to be 21.77±4.06 years. When compared their social habits, patients consumed more caffeine (49.67%) than alcohol (24.67%), smoking (15.33%) and tobacco (5.67%). 32.33% patients also had history of seborrheic dermatitis. Using GAGS scale, we found 94% patients suffered from moderate Acne condition while 6% suffered from severe Acne condition. Conclusion: Acne Vulgaris was predominantly found in females in adolescence and in males in adulthood. The severity was found more in males than females. The common site for Acne Vulgaris was found to be face while comedones and papules were the common types of lesions. Stress was found to be one of the major aggravating factors for severity of Acne Vulgaris.

A Prospective Observational Study on Prescription Pattern and Its Efficacy in the Management of Osteoarthritis at Multispecialty Teaching Care Hospital

Background: osteoarthritis is a severe clinical condition in elderly patients. Almost any bone can fracture as a result of the increased bone fragility of osteoarthritis. Aim and Objective of study: The principle aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. To Study current prescription pattern and its efficacy to manage osteoarthritis. Methodology: This study was a prospective observational study and conducted over a period of six month from October 2015 to March 2016. Patients diagnosed with arthritis with or without co-morbidities were enrolled in the Study considering the inclusion and exclusion criteria. The main sources of data collection were OPD file and case sheets of patients. Results: In this study 148 patients were enrolled, 105 (70.9%) female patients and 43 (29.1%) male patients were participated. Out of 148 study participants 60 (40.54%) patients from age group 51-65 years, followed by 54 (36.48%) patients from age group 36-50 years. In the study population 94 (63.51%) patient were suffering osteoarthritis of both knee, 29 (19.59%) patients were suffering osteoarthritis of right knee and 25 (16.89%) patients were having osteoarthritis of left knee. X-ray report were representing in study population, in 44 patient reports were shows degenerative change seen in both knee, 08 patient report were shows degenerative change seen in right knee. In our study out of 148 patients, 92 (62.16%) patients prescribed NSAIDs, 25 (16.89%) patients prescribed Analgesic, 05 (03.37%) patients were prescribed Opioid analgesic, 11 (07.43%) patients were prescribed supplements and 15 (10.13%) patients received other class of drugs.  Among the study population 112 (75.67%) patients were received oral route of drugs and 36 (24.32%) Patients were prescribed topical preparation. The visual analogue scale has been categorized as follows 0-3 Mild pain, 4-7 Moderate pain and 8-10 severe pain. In visual analogue scale initially 16 patients were suffering mild pain, but after treatment it was 93 patients suffering mild pain. The facial pain scale has been categorized as follow 0 = very happy, no hurt, 2 = hurts just a little bit, 4 = hurts a little more 6 = hurts even more, 8 = hurts a whole lot, 10 = hurts as much as you can imagine.  Among 148 study participants 14 patients were having final Facial pain score 0, 67 patients were having a final Facial pain score 2 and 3 patients having Initial Facial Pain score 2, 42 patients were having a final Facial pain score 4 and 42 patients having Initial Facial pain score 4, 19 patients were having a final Facial pain score 6 and 63 patients having Initial Facial pain score 6, 06 patients were having final Facial pain score 8 and 33 patients having Initial Facial pain score 8, 07 patients having Initial Facial score 10. Conclusion: The principal aim of drug utilization research is to facilitate the rational use of drugs in an individualized patient. For the individual’s patients, the rational use of a drug implies the prescription of the well documented drug at optimal dose, together with the correct information, at an affordable price.

A Cross-sectional Observational Study on Pharmacoeconomic Burden of Asthma in a Tertiary Care Teaching Hospital

Background: Asthma remains one of the most common chronic respiratory diseases. Even with significant advancement in the diagnosis and management of asthma, its control remains suboptimal. As the overall health expenditures are escalating, the healthcare community has become more sensitive to the concept of Pharmacoeconomic. Objective: We aimed to assess the healthcare cost; economic burden associated with the management of asthma. Methodology: A Prospective Observational Study was conducted in a Hospital of Vadodara, Gujarat, India with the sample of 120 patients. Patient’s data, financial data and the healthcare cost were collected while interviewing the patient. The healthcare costs included were direct medical cost, direct non-medical cost, and indirect cost. Result: The average costs per asthmatic patient per month with severe, moderate and mild asthma were found to be USD 65.27, USD 50.89, and USD 48.85, respectively. The average overall cost with or without co-morbidity were calculated as USD 56 and USD 38, respectively. Out of USD 53.6, the average direct medical cost was USD 29.6, the average direct non-medical cost was USD 17.4, and the average total indirect cost was USD 6.6. The mean total cost for inpatient was calculated to be USD 105.12 and for outpatient it was USD 56.09. The 43% of the population had burden of illness less than 30% and 40% of the population had burden of illness between 60-80%. Only 6.6% of population had more than 80% of Pharmacoeconomic burden of asthma. Conclusion: In our study, it was concluded that the patients with severe asthma and/or co-morbidity have higher treatment cost. Out of the overall cost, the maximum cost borne by the patient was the direct medical cost. The hospitalization increased the total health care cost by about 47%. The 43% of the population has less than 30% of burden of asthma while only 6.67% of population had more than 80% of burden of asthma.

Implementation of WHO Surgical Safety Checklist and Pre-operative Anxiety Levels to Study the Effect on Post-operative Recovery among Surgery Patients

Background: World Health Organization Surgical Safety Checklist demonstrated a significant reduction in both morbidity and mortality. Objectives: This study aimed to find out the feasibility of implementation of WHO Surgical safety checklist in the routine practice, to ensure the teams follow critical safety steps, consistency in patient safety, and to maintain a culture that values achieving it, to assess the pre-operative status and post-operative quality of recovery among the patients undergoing surgery. Methodology: It is a prospective and observational study. A total of 65 patients of age group 18 and above were included in the study. The data was collected by filling the patient medical record sheet. Result: A total of 65 patients were included in the study. 64.62% were male, 35.38% were female. Out of 65 patients 61.54% experienced pre-operative anxiety; of which 20% of patients (n=9) showed very fast to fast recovery, 27.5% of patients (n=11) showed moderate recovery) and 52.5% of patients (n=21) showed slow to very slow recovery. Conclusion: Implementation of the WHO surgical safety checklist may improve miscommunications between the OR team, avoid unexpected errors ((Improving teamwork and communication). Appointing a staff or member of the OR team with the responsibility to check the checklist may improve the feasibility to implement the WHO SSC. The level of pre-operative anxiety greatly influences postoperative recovery. Thus, the Surgical and Anaesthetic team must assess the patient's pre-operative anxiety and take the necessary step before surgery.

Knock-in models related to Alzheimer's disease: synaptic transmission, plaques and the role of microglia

Background

Microglia are active modulators of Alzheimer’s disease but their role in relation to amyloid plaques and synaptic changes due to rising amyloid beta is unclear. We add novel findings concerning these relationships and investigate which of our previously reported results from transgenic mice can be validated in knock-in mice, in which overexpression and other artefacts of transgenic technology are avoided.

Methods

App^NL-F and App^NL-G-F knock-in mice expressing humanised amyloid beta with mutations in App that cause familial Alzheimer’s disease were compared to wild type mice throughout life. In vitro approaches were used to understand microglial alterations at the genetic and protein levels and synaptic function and plasticity in CA1 hippocampal neurones, each in relationship to both age and stage of amyloid beta pathology. The contribution of microglia to neuronal function was further investigated by ablating microglia with CSF1R inhibitor PLX5622.

Results

Both App knock-in lines showed increased glutamate release probability prior to detection of plaques. Consistent with results in transgenic mice, this persisted throughout life in App^NL-F mice but was not evident in App^NL-G-F with sparse plaques. Unlike transgenic mice, loss of spontaneous excitatory activity only occurred at the latest stages, while no change could be detected in spontaneous inhibitory synaptic transmission or magnitude of long-term potentiation. Also, in contrast to transgenic mice, the microglial response in both App knock-in lines was delayed until a moderate plaque load developed. Surviving PLX5266-depleted microglia tended to be CD68-positive. Partial microglial ablation led to aged but not young wild type animals mimicking the increased glutamate release probability in App knock-ins and exacerbated the App knock-in phenotype. Complete ablation was less effective in altering synaptic function, while neither treatment altered plaque load.

Conclusions

Increased glutamate release probability is similar across knock-in and transgenic mouse models of Alzheimer’s disease, likely reflecting acute physiological effects of soluble amyloid beta. Microglia respond later to increased amyloid beta levels by proliferating and upregulating Cd68 and Trem2. Partial depletion of microglia suggests that, in wild type mice, alteration of surviving phagocytic microglia, rather than microglial loss, drives age-dependent effects on glutamate release that become exacerbated in Alzheimer’s disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13024-021-00457-0.

A Case Report on Reversible Toxic Optic Neuropathy on Long Term Treatment of Linezolid in Extensively Drug-Resistant Tuberculosis Patient

We describe a case of Linezolid-induced severe toxic optic neuropathy in a patient with drug-resistant tuberculosis. Linezolid produced severe toxic optic neuropathy in some who used it for a long time. To the best of our knowledge, the optic neuropathy was completely reversed after omitting Linezolid which is one of the effective drug regimens in his prescription, with significant improvements in eye vision.

A Cross-sectional Observational Study to Find out the Pattern of Drug Utilization and Medication Adherence of Anti-Epileptic Drugs (AEDs) among Epileptic Patients at a Tertiary Care Teaching Hospital

Background: Antiepileptic drugs (AEDs) are the mainstay of the therapy for epilepsy, despite the development in recent years of new therapeutic options, such as brain stimulation or Surgery. Objective: To understand the pattern of drug utilization and medication adherence of anti-epileptic drugs (AEDs) among epileptic patients at a tertiary care teaching hospital. Methodology: A cross-sectional observational study of a total of 120 subjects receiving anti-epileptics was done. All the patients with epilepsy were prescribed with anti-epileptic drug who visited, admitted, or referred to the Department of Neurology. All inpatients and outpatients of epilepsy were screened for the study. Results: A total of 120 patients were included in our study into which (38.33%) were inpatients and (61.67%) were outpatient. The male (56%) patients were more as compared to female (44%) patients. A maximum number of patients were from the age group of 21-40 (41%) year. The majority of the patient were suffered from focal epilepsy (63%), remaining were having a generalized seizure. The highest comorbidities were found to be HTN and diabetes mellitus. Monotherapy was highly prescribed as compare to polytherapy. Among single AED, the maximum prescribed drug was Carbamazepine [30% (N=17)] followed by 25% (N=14) of phenytoin and levetiracetam 21% (N=12). In two AED Combinations, the most prescribed drugs were clobazam + Levetiracetam and Midazolam + phenytoin 12% (N=5) followed by sodium valproate + clobazam 10% (N=4). Highest combination of three AEDs that were prescribed the highest were carbamazepine + Levetiracetam + clobazam and phenytoin + phenobarbitone + sodium Valproate 20% (N=2) The highest medication adherence was found in patients who were on single AEDs and the lowest adherence was found in the patients who were on more than two AEDs. Conclusion: Antiepileptic drug monotherapy was highly prescribed as compare to polytherapy. Phenytoin was the most commonly prescribed AEDs followed by carbamazepine and highly prescribed single AEDs were found to be carbamazepine. The patients who were on single epileptic drugs showed the highest adherence as compared to the patients with more than two AEDs.

An Observational Study on Drug Utilization Pattern in Chronic Kidney Disease Patients using Anti-Hypertensive Drugs in a Tertiary Care Teaching Hospital

Background: There is a strong relationship between Hypertension and chronic kidney disease. HTN is highly prevalent in CKD patients, contributing to high cardiovascular risk. Objectives: This study aims drug utilization pattern of Antihypertensive drugs in CKD. The objective of the study to determine the occurrence of co-morbidities, the prevalence of CKD stages in chronic kidney patients and to prepare a protocol of anti-hypertensive in CKD. Methodology: This was an observational/cross-sectional study that was carried out for six months at Dhiraj General Hospital, Vadodara. CKD patients who were prescribed antihypertensive agents were included as per study criteria. Data was collected by filling the patient medical record sheet. Results: A total of 60 CKD patients with HTN were included in the study according to inclusion and exclusion criteria. Out of 60 patients, we noticed that number of inpatients was 67% while the number of OPD patients was just 33%. Comparing gender proportionality, male represents 63% and female represents 37% were found between the age group of 18-65 years. The recorded systolic BP in mild case in the overall study population was found to be 140-159 mmHg and diastolic BP was found to be 90-99 mmHg. In moderate case systolic BP was 160-179 mmHg and diastolic BP was found to be 100-109 mmHg. In severe cases systolic BP was ≥180 mmHg and diastolic BP was found to be ≥110 mmHg. Among antihypertensive Calcium channel blockers was prescribed in 34.18% of patients and mostly recommended drug for hypertensive chronic kidney patients was furosemide which was 19.34%. Most participants were treated with multi-drug therapy. Conclusion: In Hypertensive CKD patients, calcium channel blockers and furosemide were highly recommended which do not diverge from National Kidney Foundation Kidney Disease, Outcome Quality Initiative guidelines.

Assessment of Risk Factors Associated with Low-Birth-Weight Neonates in a Tertiary Care Teaching Hospital: A Case-Control Study

Background: Low birth weight (LBW) is still a significant public health problem globally and is associated with a range of both short- and long-term consequences. Overall, it is estimated that 15% to 20% of all births worldwide are low birth weight, representing more than 20 million births a year. Objective: We aimed the study to assess the risk factors associated with low-birth-weight neonates in a rural tertiary care hospital. Methodology: A prospective observational Case-Control Study was conducted in the Department of Pediatrics (Neonatal Intensive Care Unit) and Department of Obstetrics and Gynecology, Dhiraj Hospital, Vadodara with the sample of 240 women who were admitted for the delivery. The patient interview was done based on the questionnaires (Proforma). Results: Area of residence, Parent's education, Anaemia among pregnant women, Mid upper arm circumference (MUAC) less than 23 cm, Maternal age, and antenatal visits <4 were found as significant risk factors associated with low birth weight in the study. Study findings suggest that 91.3% of cases were from rural areas compared to 71% of controls from the same area. Similarly, Anaemia though prevalent in both case and control groups was seen as a significant predictor more in the case group. Other factors such as parity, spacing between babies, and consumption of drugs and alcohol by pregnant others were also recorded but were protective of LBW. Conclusions: The study concluded that delay age of first pregnancy, lacking iron/folic acid supplementation, not taking nutritional food during pregnancy, anemia and other factors were independently associated with LBW.

A Cross-Sectional Questionnaire-Based Study to Find Out the Knowledge and Awareness of Community Pharmacist and Physician about Drug Information Center (DIC) and Its Services

Background: Drug information centre (DIC) is a facility specially developed to provide relevant, accurate and unbiased drug information (DI) to consumer and health care professionals regarding the proper use of the drugs, drug safety and all the critical problems regarding the drug information of their usage and side effects. Objective: The present study was about to access the knowledge of the primary care physicians and community pharmacists about the DIC and its facilities and to spread awareness regarding the same. Methodology: A cross-sectional, questionnaire-based study was conducted among the 88 participants of Vadodara city, Halol-Kalol town for 6 months of period. 68 pharmacist and 20 physicians took part in the study from these cities. The data was further Analysed by comparing the available data and resource to find out the awareness regarding the DIC. Result: During the study duration, a total of 88 participants took part in the study from various out of them 68 (77%) were community Pharmacist, and 20 (23%) were primary care physicians. In the end of the study, 48 (70.2%) pharmacist and 10 (50%) physicians know about the following data of DI, DIC, DIQ (Drug Information Query), resources and the role of pharmacist in DIC and it was clearly evaluated that the knowledge about the DIC, DI, DIQ was not thoroughly available for the pharmacist and physicians. Conclusion: The present study concludes that the awareness about Drug Information Centre (DIC), Drug Information, and its value and importance is not as much as it should be in Vadodara city, Halol-Kalol. Several awareness programme should be carried to bring the importance and value of DIC in limelight and to make it accessible easily for all to decrease several drug related problems.

Antiplatelet Agents Utilization Pattern and Assessment of Patient Specific Drug use Problems among Cardiac Patient

Background: Antiplatelet agents reduce the occurrence of the cardiovascular issue in people with established cardiovascular disease. Objective: To understand the pattern of Antiplatelet drug utilization among cardiovascular disease patients. To evaluate the prevalence of polypharmacy and responsible factors like age, gender, co-morbid condition, and patient-related drug use problems. Methodology: A cross-sectional observational study. Patients with cardiovascular disease above 18 years of age were prescribed antiplatelet agents from the department of cardiology and ICCU were enrolled in the study. Result: A total of 150 patients were enrolled of which male 79% (N=119) and female 21% (N=31). Most patients belong to 51-60 years of age groups. The patients diagnosed with IWMI (inferior wall myocardial infarction) 43.3% (N=65) have highly prescribed antiplatelet agents. Smoking 54.7% (N=82) followed by Alcohol 26.7% (N=40) found to be the most dominant risk factors.60.7% (N=91) patients had no comorbidity followed by 31.3% (N=47) had a comorbid cardiac condition. Most prescribed antiplatelet agents were monotherapy of Aspirin 28.8% (N=43), Clopidogrel 16.7% (N=25), and combination therapy of both 51.2% (N=82). Conclusion: The study concluded that increases in the number of co-morbidities can significantly increase the Utilization of drugs which can further lead to drug use problems. The clinical pharmacist can help to alleviate the problems of polypharmacy and its consequence.

A Prospective Observational Study to Find out Prevalence of Polypharmacy, Co-Morbidities and Drug-Related Problems among Type 2 Diabetes Patients at a Tertiary Care Teaching Hospital

Background: Presently India, depicts 49% of the world’s diabetes burden, with an approximated 72 million cases in 2017. Comorbidities make type 2 Diabetes Mellitus (DM) management complicated for health care providers. Therefore, patients have been prescribed multiple drugs. As a result of polypharmacy, the chances of the occurrence of drug-related problems (DRPs) increase. Objective: The present study aimed to find out the prevalence of comorbidities, polypharmacy, and drug-related problems among type 2 DM patients. Methodology: A prospective observational study was conducted for six months among 110 patients having type 2 DM. Based on inclusion and exclusion criteria data were collected. All collected cases were analysed for the number of medications prescribed and comorbidities present. Prescriptions were further assessed to find out the drug-related problem. Results: Comparing the gender proportionality, male represents 59% (n=65) and female represents 41% (n=45) of the study population. The present study evaluated that 91% (n=100) of patients were having at least one comorbid condition or complication along with diabetes, the most common being cardiovascular disorders. The average number of drugs prescribed is 7.86±7.83 per patient. Polypharmacy was observed in 84.54% (n=93) of the patients. A total of 180 DRPs were found among 110 patients. Conclusion: The present study concluded that the increase in the number of co-morbidities significantly increases the burden of polypharmacy which can further lead to DRPs. Reducing the number of pills and the presence of a clinical pharmacist in prescription monitoring can help to alleviate the problems of polypharmacy and its consequences.

Assessment of Causality, Preventability and Severity of Cutaneous Adverse Drug Reactions: A Prospective Observational Study

Background: All drug regulatory authorities have to ensure the safety, efficacy and quality of all the marketed products. Quality and efficacy can be determined by the data from preclinical and clinical trials. In clinical trials at the pre-marketing stage, it is challenging to identify rare Adverse reactions (ADR) and delayed side effects or effects due to long-term exposure because of lack of follow-up. In this case, pharmacovigilance comes into picture where it plays a significant role in marketed drugs safety profile establishment. Aim: This study helps in safety profile establishment for drugs. Methodology: It was conducted by the Department of pharmacy practice at drug information Centre in collaboration with Department of pharmacology at private multi-specialty Hospital. ADR reporting forms of the Central Drug Standard Control Organization has been used for collecting the data, and this form includes patient demographic details like clinical history, co-morbid conditions like Diabetes mellitus, Hypertension, Asthma, history of any drug allergies etc. were collected. The chance of preventability modified Schumock and Thornton criteria was found to be very less, and it was evident that most of them were not. By using Hartwig et al., scale, the severity of ADRs were of moderate severity. The reason behind this moderate severity was a history of allergy and multiple drug therapy. Result: It was observed that preventability 86% were not preventable whereas 14% were preventable as per Schumock and Thornton scale. In these cases of definitely preventable cases were due to history of reaction upon administration of the same drug. It is advised that in such cases usage of drug alert card is preferred. Conclusion: The major risk factor for the development of ACDR includes self-medication, patients’ lack of awareness regarding the dose and frequency of administration, polypharmacy. This can be avoided by prescribing the required drugs only and by educating     the patients regarding the drugs.

An observational study to monitor and report radiation-related adverse events by a clinical pharmacist to achieve a better therapeutic outcome and suggest preventive measures in a tertiary care teaching hospital

Objectives:

This study was conducted to investigate the potential role of clinical pharmacists in monitoring and developing a reporting system of radiation-related adverse events (RRAEs) in cancer patients and provided suggestive measures to prevent RRAEs to achieve a better therapeutic outcome for improving patient health-related quality of life.

Methodology:

This study was a prospective observational study conducted for a period of 2 years at a private academic oncology teaching care hospital. Patients on radiation therapy or chemoradiation therapy were enrolled and followed by clinical pharmacists on daily basis to identify adverse event(s) if any. Upon identification, adverse events were discussed with concerned radiation oncologists for authentication and graded as defined by the radiation therapy oncology group. Enrolled patients were also followed to ensure if they were provided adequate supportive care for RRAEs.

Results:

A total of 715 patients were followed during the study period. A total of 422 RRAEs were identified in patients who were on radiation therapy or chemoradiation therapy. The most common reported events were fatigue (n = 64, 15.16%), followed by mucositis (n = 55, 13.03%), diarrhea (n = 37, 8.76%), vomiting (n = 31, 7.34%), gastritis (n = 29, 6.87%), and dryness of the mouth (n = 22, 5.21%). Among the study patients who developed RRAEs, majority (n = 253, 60%) of them received a combination of chemotherapy and radiation therapy and 169 (40%) of 442 patients received radiotherapy alone. Cisplatin weekly monotherapy or cisplatin-based chemotherapy was commonly used pharmacological treatment in patients on chemoradiation therapy. Clinical pharmacists intervened to initiate adequate supportive care for nearly 20% (n = 84) patients.

Conclusions:

Clinical pharmacists may be contributing to monitoring and development of reporting systems for radiation-related toxicities/RRAEs in cancer patients. Teamwork of clinical pharmacists with radiation oncologists can improve the safety reporting of radiation and can ensure required medical and supportive care to manage RRAEs.

Cystic fibrosis precision therapeutics: Emerging considerations

Small molecules that address fundamental defects underlying cystic fibrosis (CF), including modulators such as the approved drugs ivacaftor, lumacaftor, tezacaftor, and elexacaftor, have advanced dramatically over the past few years and are transforming care and prognosis among individuals with this disease. The new treatment strategies are predicated on established scientific insight concerning pathogenesis, and applying "personalized" or "precision" interventions for specific abnormalities of the cystic fibrosis transmembrane conductance regulator (CFTR). Even with the advent of highly effective triple drug combinations-which hold great promise for the majority of patients with CF worldwide-barriers to precision therapy remain. These include refractory CFTR variants (premature truncation codons, splice defects, large indels, severe missense mutations, and others) not addressed by available modulators, and access to leading-edge therapeutic compounds for patients with ultrarare forms of CF. In addition to describing the remarkable progress that has occurred regarding CF precision medicine, this review outlines some of the remaining challenges. The CF experience is emblematic of many conditions for which personalized interventions are actively being sought.

Atypical Location of an Atrial Myxoma: A Case Report

Here, we report a case of a right atrial myxoma attached to the lateral wall, which is seen in only 10% cases, impinging upon the tricuspid valve. A 57 year old male normotensive, non-diabetic, nonsmoker patient was presented to us on 5th of August 2018 with the complaints of cough, dyspnea and orthopnea for the last two years. This type of presentation is very rare. After excision of myxoma, there was a significant improvement in the signs and symptoms of the patient. In this report, we emphasize the rarity of myxoma in the Right Atrium, and its difficulty in diagnosis because of its uncommon location and atypical presentation, surgical management has shown to quickly alleviate the majority of symptom and expectant sequeale.

Depression and anxiety in patients with multidrug-resistant tuberculosis in Nepal: an observational study

Setting

Multidrug-resistant tuberculosis (MDR-TB) patients in the national TB treatment programme of Nepal.

Objective

To estimate the prevalence of depression and anxiety in people receiving treatment for MDR-TB, identify potential risk factors for depression and anxiety and determine temporal changes in their severity during treatment.

Design

An observational study using a screening tool, the Hopkins Symptom Checklist (HSCL-25) for depression and anxiety, administered monthly to a group of 135 patients in Nepal. Logistic and multilevel linear regression models were used to identify any patient characteristics associated with depression and anxiety.

Results

Most of the 135 patients were male (76%) and living with their families (68%). The period prevalences of depression and anxiety were respectively 22.2% and 15.6%. Patients reporting physical side effects of MDR-TB treatment had a higher depression score on HSCL by 2.63 points (95%CI 0.77-4.48) and a 1.59 point higher anxiety score (95%CI 0.45-2.73) than those who did not report any side effects. Being single was associated with having anxiety (aOR 0.2, 95%CI 0.03-1.0).

Conclusion

Given the high rates of depression observed among MDR-TB patients, national TB treatment programmes should ensure their patients are routinely screened for depression and anxiety, and effective treatment offered.

Efficacy of red contact lens in improving color vision test performance based on Ishihara, Farnsworth D15, and Martin Lantern Test

Background

The aim of this study was to evaluate the efficacy of red contact lens in improving color vision test performance based on Ishihara, Farnsworth D15, and Martin Lantern Test (MLT).

Methods

Thirty subjects with a known color vision defect were enrolled after consent. The color vision was assessed using Ishihara test, D15 test, and MLT. The error scores were recorded. The test was repeated after using a red contact lens.

Results

The mean error scores were 7.87 (±1.00), 3.33 (±3.15), and 5.67 (±2.52) on Ishihara, MLT, and D15 test, respectively. The error scores reduced to 3.93 (±3.78), 1.33 (±1.34), and 2.77 (±2.12) Ishihara, MLT, and D15 test, respectively (P value < 0.05, Wilcoxon rank test). None of the subjects were in color perception (CP) II at presentation but 47.5% became CP II with the lens on Ishihara test. Ninety percent could pass the MLT CP III standard.

Conclusion

This study shows that red lens reduced error scores and subjects could pass the color vision tests. Notwithstanding the improvement in performance on color vision tests, lens is not recommended for personnel on active combat duty. The recruiting medical officer needs to be aware of the fact that a subject with defective color vision can pass various tests with a red contact lens.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Management of chronic hepatitis B before and after liver transplantation

Chronic hepatitis B infection is a global public health problem associated with significant morbidity and mortality. Persistent infection may evolve to liver cirrhosis and hepatocellular carcinoma, and hepatitis B-related liver disease is a common indication for liver transplantation. Patients with advanced liver disease should be treated with antiviral therapy which may result in clinical improvement. The management of patients after liver transplant then focuses on preventing hepatitis B recurrence in the graft. With the introduction of prophylactic treatment, patient and graft survival has improved significantly. In this review, we will discuss the management of patients with hepatitis B-related cirrhosis, both compensated and decompensated. We also review the management of hepatitis B after liver transplantation.

Optically transparent dense colloidal gels

Traditionally it has been difficult to study the porous structure of dense colloidal gels and (macro) molecular transport through them simply because of the difference in refractive index between the colloid material and the continuous fluid phase surrounding it, rendering the samples opaque even at low colloidal volume fractions. Here, we demonstrate a novel colloidal gel that can be refractive index-matched in aqueous solutions owing to the low refractive index of fluorinated latex (FL)-particles (n = 1.37). Synthesizing them from heptafluorobutyl methacrylate using emulsion polymerization, we demonstrate that they can be functionalized with short DNA sequences via a dense brush-layer of polystyrene-b-poly(ethylene oxide) block-copolymers (PS-PEO). The block-copolymer, holding an azide group at the free PEO end, was grafted to the latex particle utilizing a swelling-deswelling method. Subsequently, DNA was covalently attached to the azide-end of the block copolymer via a strain-promoted alkyne-azide click reaction. For comparison, we present a structural study of single gels made of FL-particles only and composite gels made of a percolating FL-colloid gel coated with polystyrene (PS) colloids. Further we demonstrate that the diffusivity of tracer colloids dispersed deep inside a refractive index matched FL-colloidal gel can be measured as function of the local confinement using Dynamic Differential Microscopy (DDM).

Serum vitamin D levels in Indian patients with retinal venous occlusions

Purpose

To estimate serum vitamin D (25 OH D) level in patients of retinal vein occlusion (RVO) and compare it with age-matched controls.

Methods and material

Forty patients above 18 years of age with retinal vein occlusion and forty age-matched controls underwent serum vitamin D (Vit D) level estimation using a standard protocol. Student’s t test was used to analyse differences between the mean of two groups.

Results

The mean age in RVO and control group was 60.25 and 60.73 years respectively. The mean (±SD) level of vitamin D in RVO patients was 13.68 (±4.58) ng/mL (range 5.5–24.8), and the 95% CI of mean was 12.21–15.14 with SD 4.58 while in control group it was 23.03 (±2.89) ng/ml (range 18.4–30.1) with 95% CI of mean being 22.11–23.96 with SD 2.89 (p value of <0.005). While comparing the level of Vitamin D based on type of occlusion the mean level of Vit D in CRVO patients was 15.36 (SD 5.30) and in BRVO it was 12.77 (SD 3.96) which was statistically not significant (p = 0.08). The odds ratio calculated for RVO cases versus controls was 133.33 which was statistically significant (P < 0.05).

Conclusions

There is a paucity of published literature on level of Vit D in RVO. This study shows significantly lower levels of serum vitamin D in Indian patients with retinal vein occlusion as compared to age matched controls. Establishment of this correlation has possible implications for prophylaxis or treatment of RVOs.

Universal institutional delivery among mothers in a remote mountain district of Nepal: what are the challenges?

Setting: Eight village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators. Objectives: 1) To assess the proportion of mothers who delivered in health facilities (institutional delivery); 2) among mothers who delivered at home, to understand their reasons for doing so; and 3) among mothers who delivered in health facilities, to understand their challenges. Design: Cross-sectional study involving semi-structured interviews with mothers conducted in 2015. Results: Of 275 mothers, 97 (35%) had an institutional delivery. Multivariate logistic regression analysis showed that women who resided within 1 h distance from the birthing centre, had adequate mass media exposure or had only one child were more likely to deliver in hospital. Reasons for non-institutional delivery (n = 178) were related to geographical access (49%), personal preferences (18%) and perceived poor quality care (4%). Mothers who accessed institutional delivery (n = 97) also reported difficulties related to travel (60%), costs (28%), dysfunctional health system (18%) and unfriendly attitudes of the health-care providers (7%). Conclusion: To improve access to institutional delivery, the government should establish a 24/7 emergency ambulance network, including air ambulance. Health system issues, including unfriendly staff attitudes, urgently need to be addressed to gain the trust of the mothers.

Seasonal immunohistochemical reactivity of S-100 and α-smooth muscle actin proteins in the epididymis of dromedary camel, Camelus dromedarius

The S-100 and alpha smooth muscle actin (α-SMA) proteins have been localised in epididymal tissue of several mammalian species, but there have been no data for a seasonal work in camel. The aim of this study was to investigate the immunoreactivities of S-100 and α-SMA proteins in the epididymis of dromedary camel during breeding and nonbreeding seasons. The immunopositive signals for both proteins were observed in different regions of camel epididymis. S-100-immunopositive signals were noted in both the epididymal epithelium and the intertubular connective tissue, while α-SMA signals were confined to the intertubular connective tissue, especially in the peritubular smooth muscle coat and the blood vessels. This study showed an increase in the intensity of S-100 and α-SMA immunoreactions during the breeding season in different regions of camel epididymis than that seen in the nonbreeding season. In conclusion, epididymis might be considered as a source of S-100 and α-SMA proteins in the camel and the secretion of these proteins showed distinct seasonal variations. Further, S-100 and α-SMA may affect the structural and physiological states of the epididymal duct.

Spectrum of ocular diseases in patients attending eye camps in Andaman and Nicobar

BACKGROUND

Andaman and Nicobar Island is a group of 572 islands with a population of 3,80,500. The only service hospital as well as govt hospital is situated at its capital, Portblair. The islands are interconnected only by sea passage and to reach the capital by this route it sometimes takes two days.

METHODS

The objective of this study is to assess the spectrum of different ocular diseases in remote islands of Andaman and Nicobar. Author had conducted various camps on these remote islands as a community outreach programme over two years.

RESULTS

Top eye diseases found were refractive error (35%), cataract (22%), conjunctival infammatory disease (15%), glaucoma cases (07%), pterygium (07%), NLDO (02%) and uveitis (02%). Out of total 132 cataract patients screened, 32 patients (approximately 24%) were operated in INHS Dhanvantari at free of cost with help of NPCB (National Programme for Control of Blindness).

CONCLUSION

This was the first kind of study conducted on these remote islands to know the prevalence of different ocular diseases. The important point to be seen in this study was unawareness of glaucoma and cataract load. No optometrist was posted in the PHCs to provide primary eye care like prescribing glasses, which is also a big concern.

Designing disordered materials using DNA-coated colloids of bacteriophage fd and gold

DNA has emerged as an exciting binding agent for programmable colloidal self-assembly. Its popularity derives from its unique properties: it provides highly specific short-ranged interactions and at the same time it acts as a steric stabilizer against non-specific van der Waals and Coulomb interactions. Because complementary DNA strands are linked only via hydrogen bonds, DNA-mediated binding is thermally reversible: it provides an effective attraction that can be switched off by raising the temperature only by a few degrees. In this article we introduce a new binary system made of DNA-functionalized filamentous fd viruses of ∼880 nm length with an aspect ratio of ∼100, and 50 nm gold nanoparticles (gold NPs) coated with the complementary DNA strands. When quenching mixtures below the melt temperature Tm, at which the attraction is switched on, we observe aggregation. Conversely, above Tm the system melts into a homogenous particulate 'gas'. We present the aggregation behavior of three different gold NP to virus ratios and compare them to a gel made solely of gold NPs. In particular, we have investigated the aggregate structures as a function of cooling rate and determine how they evolve as function of time for given quench depths, employing fluorescence microscopy. Structural information was extracted in the form of an effective structure factor and chord length distributions. Rapid cooling rates lead to open aggregates, while slower controlled cooling rates closer to equilibrium DNA hybridization lead to more fine-stranded gels. Despite the different structures we find that for both cooling rates the quench into the two-phase region leads to initial spinodal decomposition, which becomes arrested. Surprisingly, although the fine-stranded gel is disordered, the overall structure and the corresponding length scale distributions in the system are remarkably reproducible. Such highly porous systems can be developed into new functional materials.

An 'omics' approach towards the characterisation of laboratory scale anaerobic digesters treating municipal sewage sludge

In this study, laboratory scale digesters were operated to simulate potential shocks to the Anaerobic Digestion (AD) process at a 350 ML/day wastewater treatment plant. The shocks included high (42 °C) and low (32 °C) temperature (either side of mesophilic 37 °C) and a 20% loading of fats, oil and grease (FOG; 20% w:v). These variables were explored at two sludge retention times (12 and 20 days) and two organic loading rates (2.0 and 2.5 kgTS/m(3)day OLR). Metagenomic and metabolomic approaches were then used to characterise the impact of operational shocks in regard to temperature and FOG addition, as determined through monitoring of biogas production, the microbial profile and their metabolism. Results showed that AD performance was not greatly affected by temperature shocks, with the biggest impact being a reduction in biogas production at 42 °C that persisted for 32 ± 1 days. The average biogas production across all digesters at the completion of the experiment was 264.1 ± 76.5 mL/day, with FOG addition observed to significantly promote biogas production (+87.8 mL/day). Metagenomic and metabolomic analyses of the digesters indicated that methanogens and methane oxidising bacteria (MOB) were low in relative abundance, and that the ratio of oxidising bacteria (methane, sulphide and sulphate) with respect to sulphate reducing bacteria (SRB) had a noticeable influence on biogas production. Furthermore, increased biogas production correlated with an increase in short chain fatty acids, a product of the addition of 20% FOG. This work demonstrates the application of metagenomics and metabolomics to characterise the microbiota and their metabolism in AD digesters, providing insight to the resilience of crucial microbial populations when exposed to operational shocks.