Clinical profile of celphos poisoning in central India.

Celphos poisoning (trade name of aluminium phosphide) is a large, though under-reported, problem in the Indian subcontinent. Methods: The study was conducted at the Intensive Care Unit (ICU) of a tertiary care teaching hospital of central India. Data were collected by a retrospective chart review of all patients admitted from February 2010 to February 2014 with a diagnosis of celphos poisoning. Results: Fifty patients (32 females, 18 males) were registered from the 967 patients of poisoning admitted to the ICU during the same period, of whom 44 (88%) had died (non-survivors) and the remaining 6 (12%) had survived. Forty five cases were of suicidal poisoning, and 5 were of accidental poisoning. Majority [42/50 (84%)] were from rural background. The ingested dose was 7.23 ± 1.28 gram among non-survivors and 3.3 ± 1.9 gram among survivors. Conclusion: Strict implementation of nationwide pesticide regulation, including restricting the availability of poison, being aware of its toxicity and providing improved medical management in consultation with regional or national poison control centers could further reduce the mortality due to ALP toxicity as there is no antidote available presently.

Comparison of Insulin Glargine with Human Premix Insulin in Patients with Type 2 Diabetes Inadequately Controlled on Oral Hypoglycemic Drugs in a 24-week Randomized Study among Central Indian Population.

Objective: To compare the safety and efficacy of the long-acting analog insulin glargine and human premix insulin in patients with type 2 diabetes who were previously treated with oral hypoglycemic drugs alone but inadequately controlled. Research design and methods: A total of 750 subjects with type 2 diabetes who were receiving oral hypoglycemic drugs for diabetes control were randomized to receive insulin glargine once-daily (n = 370) or human premix insulin twice-daily (n = 380) for 24 weeks in an open-label, tertiary center study. Doses were adjusted systematically to obtain target fasting glucose <100 mg/dl. Outcomes included fasting blood sugar, glycosyloted hemoglobin (HbA1C) levels, change in weight and insulin dose from study start to end. Results: At the start of study, age range was 30-70 years, BMI was 26.48 ± 6.3 kg/m2 and HbA1C was 11.9 ± 3.1% (mean ± SD) for both groups. The mean change (means ± SD) in HbA1C from baseline to endpoint was similar in the insulin glargine group (−3.0 ± 1.68%) and the human premix insulin group (−2.89 ± 1.79%) (p = 0.3861). The symptomatic hypoglycemic episodes were greater with human premix insulin than with glargine (significance level 0.00002). Subjects in the insulin glargine group experienced less weight gain than those in the premix human insulin group (0.4 vs 1.4 kg, p < 0.0001). Conclusions: In patients with type 2 diabetes, once-daily bedtime insulin glargine is as effective as twice-daily human premix insulin in improving and maintaining glycemia control. In addition, insulin glargine demonstrates a lower risk of symptomatic hypoglycemia and less weight gain compared with human premix insulin. The treatments were associated with similar reductions in fasting glucose levels and HbA1C levels.

Benefits of Telemedicine and Barriers to its Effective Implementation in Rural India: A Multicentric E- Survey.

Introduction: Telemedicine has become an accepted concept in health care worldwide. The practice of health care using interactive audio, visual and data communications is the need of the hour. This includes health care delivery, diagnosis, consultation and treatment, as well as education and transfer of medical data. Objectives: 1) To estimate the benefits of telemedicine in health care system in rural Maharashtra. 2) To identify the barriers in effective implementation of telemedicine in rural Maharashtra. Materials and Methods: Study Type: E-survey using a validated structured questionnaire. Locus of Study: Department of Pharmacology, Jawaharlal Nehru Medical College, Wardha. Duration of Study: 3 months. Study Design:The questionnaire was sent to doctors of all specialities through email. A total of 300 completed questionnaires were evaluated and statistically analyzed using SPSS software. Results: The results showed a significant association (p < 0.001) of high acceptance of telemedicine in doctors of teaching hospitals as compared to doctors from non-teaching hospitals and private practitioners. Preoperative services, discharge, referral, follow-up and obtaining second opinions are other facilities that can be offered through telemedicine to patients in rural areas. The benefits of telemedicine acknowledged by doctors through this survey include obtaining laboratory results; making appointments; transmission of ECG, X rays and still images; telephonic consultation for patients, health education, monitoring patients at home (follow up), preoperative services, obtaining second opinions and referral of patients for tertiary care. The important barriers to the effective implementation of telemedicine in rural areas, indentified through this study include heavy investments in equipments, technical difficulties, lack of staff educated in information technology and concern about legal responsibility. 48% doctors strongly agreed that telemedicine should be implemented in all hospitals with internet facility. 31% of the doctors strongly disagreed that telemedicine will increase the access of health care services for rural patients. 42% of the doctors strongly agreed that telemedicine will help to save the time and money of patients. 30% of the patients strongly agreed that drug information centers should be run through telemedicine. Conclusions: Web enabled telemedicine system can help in easy flow and better delivery of health care consultation to patients in remote areas who do not get access to a super specialized health care delivery system. However, good access to poor patients in remote areas has to be ensured.

Need of medicines information OPD in tertiary health care settings: A cross sectional study .

Background: Population burden, illiteracy, availability of few doctors for larger group of population all these leads to many unanswered questions left in a patient’s mind. Incomplete information results into noncompliance, therapeutic failure, and adverse drug reactions (ADR). It is very important to establish a system which will provide noncommercial, independent, unbiased source of medicine information. Medicines Info OPD is a concept and step towards safe and appropriate use of medicines. Objective: (1) To assess the present status of knowledge about the medicines in the patients and its correlation with education. (2) To assess the medicine information dispensing modalities, their use and sufficiency from the patients view point. (3) To assess the overall need for Medicines Information OPD in present scenario. Materials and Methods: A pre-validated questionnaire based study was conducted amongst 500 patients of tertiary health care hospital. The questionnaire consisted of specific questions regarding understanding of prescription, knowledge about adverse drug reaction, view about self-medication and opinion regarding the need of Medicines Info OPD. Results: Significantly large proportion of patients opined that doctors do not have sufficient time in current Indian healthcare to explain the prescription and they are not aware of adverse drug reactions, expiry date or use the package inserts etc. Conclusion: Clinically relevant, up to date, user specific, independent, objective and unbiased Medicines Info OPD is essential for appropriate drug use and can help in a big way to common public to address many problems faced by them.