Pilot Study of Quality of Diclofenac Generic Products Using Validated In-House Method: Indian Drug Regulatory Concern.

Globally, the expanding issues over the extent of substandard or spurious medicines remain a challenge. It is operated largely by encompassing wrong therapeutic doses or adulterated formulations that necessitates routine monitoring to avoid any potential public health adversity. This study was aimed to determine the diclofenac sodium content in generic products available in northern Indian market. Therefore, 32 commercially available generic products of diclofenac sodium tablet were procured from the open market and subjected to assay evaluation using in-house developed and validated high performance liquid chromatography (HPLC) method. Product identification was confirmed by thin layer chromatography (TLC) method; and the quantitative results by validated in-house HPLC method showed 34.37% (11/32) products as out of Indian Pharmacopoeia specification including 15.62% (5/32) substandard products. This makes the health situation miserable for public and their trust. On comparing the assay with price of each tablet, it was noticed that quality of products was irrespective of price. People rely completely on manufacturer quality promises and on regulatory process. However, such substandard products which still exist in the market for use by the patient; unfortunately not identified yet, poses a serious issue and require some interventions to stop them in entering into market. So there is an urgent need to carry out the quality evaluation on regular and large scale by the state and national drug authorities to ensure better quality medicines.

Determinants of variable hearing loss in patients with chronic suppurative otitis media

To determine the impact of ear discharge, duration size and site of tympanic membrane perforation on hearing loss. Cross-Sectional prospective study. Baqai Medical College and Abbasi Shaheed Hospiatl, Department of Ear Nose and Throat and Head and Neck Surgery from December 2010 to November 2011. Sixty six patients of chronic suppurative otitits media [CSOM] aged between 09 to 60 years of age were included in the study. After history and examination, pure tone audiometry was done .Statistical analysis of the collected data is done using SPSS 16 program. Patients with 107 perforated tympanic membrane, 40 males and 26 females were included in the study. Bilateral tympanic membrane perforation were seen in 41 patients, right sided perforation in 10 and left sided in 15 patients respectively. Out of total 107 perforations, 58 were large central[54.2%]and 49 were small[45.8%]. 100 perforations [93.5%] were anteriorly located and 07 [6.5%] were posterior. The size of the perforation was not a determinant of hearing loss though the site of the perforation was associated with significant degree of hearing loss. Hearing loss increased with the chronicity of the disease. The location of perforation on the tympanic membrane and the duration of ear discharge have significant effect on the magnitude of hearing loss while the size of perforation does not affect the hearing level significantly

Attitudes, perceptions, habits of smoker, non-smoker general practitioners and why they fail to motivate patients to quit smoking

To investigate attitudes, perceptions and habits of General Practitioners [GPs] who smoke and those who do not smoke cigarettes, with particular attention to smoking cessation. Two physician groups were targeted: GPs who smoke and those who do not smoke. They were screened based on the inclusion and exclusion criteria. A unique country-specific questionnaire was developed to conduct a 20-minute telephonic interview. Survey was started from December 2006 and completed in May 2007. Simple statistical calculations were used to interpret the data. GPs view smoking as the most harmful behaviour among the risk factors. 94% agreed that smoking should be classified as a medical condition and if it were so would encourage more smokers to quit smoking and they have suggested the need of prescription therapies for their patients to quit smoking. Significant discontent exists between physicians and smokers. The main cause of this discontent is physician perceived inability to provide successful solutions to quit smoking due to low awareness level and lack of training. This issue, when properly addressed, can be useful as an additional tool to aid patients in quitting

study of non spinal, extra articular, osseous tuberculosis in a tertiary care hospital of Lahore Pakistan

The incidence and prevalence of tuberculosis has increased tremendously during the present decade and is expected to rise further. A prospective study of 21 patients with osseous tuberculosis was carried out in orthopaedic department unit - I Mayo Hospital, Lahore.The diagnosis was made by physical examination, mantoux and mycodot test, haematological examination, culture [Pus, Urine, Sputum] X-rays of involved area, bone scan and MRI. The patient were discharged on chemotherapy and were advised to visit for follow up for one year on monthly basis for initial four months. Out of 21 patients 19 completed their follow up while 2 were lost during follow up. All patients completed their treatment. Young females in the age group of 10-20 years [66.6%] suffered from the disease more frequently than the other age groups and the male to female ratio was found to be 1:1.6

Role of digital rectal examination and prostate specific antigen in detecting carcinoma prostate

To investigate the ability of digital rectal examination [DRE] and prostate specific antigen [PSA] in detecting carcinoma prostrate. Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in the Department of Urology and Renal Transplantation from December 1996 to December 1999. patients and Two hundred patients entered the protocol. They presented with complaint of prostatism or retention of urine. The patients were evaluated with estimation of serum prostate specific antigen and digital rectal examination was performed. Prostatic tissue biopsy was also done. Digital rectal examination has shown sensitivity of 63% and specificity of 73.22%. The sensitivity of PSA was 87% and specificity was 70.8%. The positive predictive value for DRE and PSA was 57.5% and 78.04% respectively. Negative predictive value was 73.22% and 85.22% respectively. P value was statistically significant <0.037. In the second part of study a baseline serum PSA level in age-matched 200 patients without history of prostatism was estimated. It was concluded that PSA represent an important adjunct to DRE for detection of prostate carcinoma

use of prophylactic ureteric stenting in eswl

This prospective study was conducted at the lithotripsy centre, department of urology, Jinnah Hospital, Lahore to evaluate the role of double pigtail stents, prophylactically inserted in patients with moderate stone burden [15-30 mm] undergoing ESWL Therapy. Fifty randomly selected patients, with renal calculi, were included in the study. These patients were divided into two groups, group I [control] comprised 25 patients who underwent ESWL without a double pigtail stent insertion while the 25 patients of Group II underwent ESWL after insertion of double pigtail stents. Both group were closely followed up for 3 months. Both groups were compared regarding complications [renal pain, haematuria, fever, pyuria, bacteriuria, bladder discomfort and stienstrasse], need for a auxiliary procedure and stone clearance. Chi-square, and Fisher Exact tests were employed to establish the statistical significance of the difference between the values of different variables, between the two groups. No statistically significant difference was noted in renal pain, fever bacteriuria, stienstrasse, need for auxiliary procedure and stone clearance between the patients of both groups [p=0.05]. However, haematuria, bladder discomfort and pyuria were observed to be significantly more in a patients with stents. We conclude that a prophylactic use of double pigtial stents in patients with a moderate stone burden does not improve the treatment outcome as measured at 3 months

Cerebral malaria or meningitis?

Cerebral malaria is prevalent in Pakistan and is a major community health problem, therefore, accurate and easier methods of its diagnosis are needed at primary health care level. Over a span of 3 years [August 1993 to July 1996], nine febrile, comatosed patients with neck stiffness due to cerebral malaria, initially diagnosed as meningitis, were seen. This rare presentation of cerebral malaria was suspected, in a falciparum positive patient. CSF examination showed a neutrophil count of more than 1000/mm[3] and glucose less than 40% of the blood glucose level. Blood smears for malarial parasites are valuable in establishing the diagnosis in all clinically suspected patients of meningitis