Knowledge, attitude and practice of adverse drug reaction reporting among healthcare professionals of a tertiary care hospital in Gujarat

Background: The objective of the present study was to assess knowledge, attitude and practice of adverse drug reaction reporting among healthcare professionals of Parul Sevashram Hospital, Parul University, Vadodara.Methods: The study was prospective, observational and questionnaire-based involving medical doctors, nurses and pharmacists of Parul Sevashram Hospital. A total number of 210 structured questionnaires were distributed among health care professionals (100 clinicians from various specialities, 100 nurses and 10 pharmacists). Written informed consent forms were obtained from participants as their consent to participate in the study.Results: All questionnaires were filled and returned producing overall response rate of 100%. 80% of the respondents were aware of the existence of Pharmacovigilance Program of India (PvPI). 90.95% and 91.90% of respondents felt ADR reporting is necessary and it would be beneficial to the patients respectively. Only 11.43% of respondents had reported ADRs. 90.95% and 85.24% of respondents suggested training is required in reporting ADR and regular information should be provided regarding ADR by PvPI respectively.Conclusions: The health care professionals had positive knowledge and attitude towards pharmacovigilance and there is a need to create awareness for better practice of ADR reporting. It would help to improve patient care.

Comparative study between Laproscopic appendicectomy and Laproscopic assisted appendicectomy

Objectives: To evaluate the advantages of laproscopic assisted appendicectomy on laproscopicappendicectomy. Materials and methods: this was a retrospective study evaluated conducted in ACPM medical and GMC, dhule. In total 50 patients were evaluated during a time period of 1 year from June 2017 to May 2018. Results: here we compare the mean duration time and hospital stay in two different groups. Conclusion:Laparoscopically assisted appendicectomy (LAA) can be done at a shorter operating time when compared to Laparoscopic appendicectomy (LA), and with less post operative hospital admission as opposed to open appendicectomy.

Use Of Bipolar Cauterization In Circumcision

Male circumcision is done very frequently in all Pediatric surgery set up. Though several open and device based techniques of circumcision have been described in literature but no single procedure is taken as gold standard in terms of prevention of complications. In India, generally population are from tribal regions and due to non availability of resources dorsal slit technique is preferred and accepted but had complications like injury to urethra/glans, skin laceration, bleeding and infection. Bipolar cauterization holds its merits and demerits. In our experience the use of bipolar technique is safe, mostly complication free and gives good cosmetic outcome.

Counterfeit drugs in India: significance and impact on pharmacovigilance.

Counterfeit drugs have emerged as a major global problem. This issue has been brought to the centre of the Indian media due to the death of 15 women attending a sterilization camp in Chhattisgarh. India’s pharmaceutical industry exports drugs worth 15 billion dollars, which means a high prevalence of counterfeiting in India’s drug industry has global repercussions. However, accurate figures on the extent of counterfeit drugs in India are not available. The scientific literature as well as media reports often quotes figures of 10-35%, though studies done by the Indian Government dispute this. Counterfeit drug numbers have been known to be under represented by Governments due to fear of undermining their economy and health systems. On the other hand, rival companies in other countries may have an incentive to over hype India’s counterfeit problem to dent India’s growing status as the leading global supplier of generic medicines. Lack of clear definitions and differences between laws of countries further complicate reporting. A high prevalence of counterfeit drugs has a large impact on both health and economic indicators. Additionally, counterfeit drugs provide significant challenges to Pharmacovigilance programmes. Hence, here we discuss the significance of use of counterfeit drugs in India and challenges faced by Pharmacovigilance due to the extensive use of counterfeit drugs.

Adverse drug reaction monitoring on antiretroviral therapy in human immunodeficiency virus patients in a tertiary care hospital.

Background: The aim of current study was to assess the pattern of adverse drug reactions (ADRs) in patients receiving antiretroviral (ARV) therapy. Methods: A prospective, observational study was carried out for duration of 15 months. Clinical and treatment data were collected from patients, who underwent ARV therapy during the study period. CDSCO forms were used to record the ADRs. Causality, severity and preventability were assessed by suitable scales. Result: Out of 216 patients 165 (76%) patients develop ADRs. Total of 274 ADRs were noted among 165 patients (1.66 ADR/patient). Out of them 100 (60.60%) were males and 65 (39.39%) were females. The most common ADR was gastrointestinal disorders (83, 30.29%). The most numbers of ADRs were observed in ZLN (Zidovudine + Lamivudine + Nevirapine) regimen (54%) followed by SLN (Stavudine + Lamivudine + Nevirapine) regimen (26%). According to WHO causality assessment scale most ADRs were possible (236, 86.13%). Hartwig and Siegel severity scale show 243 (88.69%) ADRs were moderate. Schumock and Thornton scale show all, ADRs were “not preventable.” Conclusion: Early detection of drug toxicity helps to treat the patient and modify the drug regimen to minimize toxic effects.

Radiological evaluation of neonatal thoracic lesions in 118 neonates.

Background: within 48 – 72 hours, most common disorder that occurs in neonate is respiratory distress. Post natal respiratory distress is the most important indication for chest X- ray. Clinically it is very difficult to distinguish between pulmonary and extra pulmonary causes. Aim: To show the radiographic appearances of various causes of neonatal respiratory distress, and varied appearances of each pathology. Material and methods: This was a prospective observational study that was conducted in Dhiraj General Hospital. Antero-posterior chest radiograph in supine position of (118) neonates were taken, presented with a chief complaint of respiratory distress. Chest X-ray was taken presented with a chief complaint of respiratory distress. Chest X-ray was taken with the help of portable X-ray machine in NICU department. Chest X-ray were taken on first day of admission and then follow up chest X-rays were taken. Results: The commonest cause of respiratory distress in neonates which presented with respiratory distress was transient tachypnoea of new born, which was (32.20%), followed by hyaline membrane disease (20.33%) , neonatal congenital pneumononia (16.94%), meconium aspiration syndrome (11.86%), cardiac causes (5.08%), trachea-oesophageal fistula (4.23%), congenital diaphragmatic hernia (2.54%), aspiration pneumonia (2.54%), idiopathic persistent pulmonary hypertension (1.69%), eventration of diaphragm (1.69%) followed by pneumoperitonium (0.84%). Conclusion: Any sign of respiratory distress is an indication for roentgenogram of the chest which should be taken as early as possible.

Role of Focused Assessment with Sonography for Trauma (FAST) and CT scan in abdominal trauma: Radiologist’s perspective.

Background: Diagnosis of abdominal trauma is a real. Diagnostic tools that help the treating doctor in optimum management of abdominal trauma include; Focused Assessment with Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT Scan. Objectives: The aim of this communication was to define the recent role of FAST and CT scan of the abdomen in the diagnosis of abdominal trauma. Material and methods: This study aimed at evaluating patients who came to the Radiology Department of Dhiraj General Hospital, by using USG and CT scan. This study comprised of 50 patients. Results: Out of 50 patients of abdominal trauma, 12 patients (24%) were in age group 21-30 years with male to female ratio of approximately 5.2: 1. The commonest mode of trauma was road trafic accident according for 54% of total cases. Spleen and liver were the most common organs injured, followed by kidney. USG showed overall sensitivity 57.48%, specificity 97.77%, positive predictive value 88.9125, negative predictive value 97.185 and accuracy of 90.75%. CT scan showed highest sensitivity of 95.35%, specificity of 100%, positive predictive value of 100%, negative predictive value 77.78% and accuracy 96%. Conclusion: FAST is useful as the initial diagnostic tool for abdominal trauma to detect intra abdominal fluid. With proper training and understanding the limitations of ultrasound, the results of FAST can be optimized. DPL is indicated to diagnose suspected internal abdominal injury when ultrasound machine is not available, there is no trained person to perform FAST, or the results of FAST are equivocal or difficult to interpret in a hemodynamically unstable patient. In contrast, in hemodynamically stable patients the diagnostic modality of choice is CT with intravenous contrast. It is useful to detect free air and intra peritoneal fluid, delineate the extent of solid organ injury, detect retroperitoneal injuries, and help in the decision for conservative treatment. Helical CT is done rapidly which reduces the time the patient stays in the CT scan room. Furthermore, this improves sagittal and coronal reconstruction images which are useful for detecting ruptured diaphragm.

Post-traumatic-Zygomaticocoronoid Ankylosis: A Rare Clinical Case Report.

Fusion of the zygomatic bone to the coronoid process of the mandible is a rare phenomenon reported in the literature and commonly called as zygomaticocoronoid ankylosis. It can be sequel of trauma or infection in the midfacial region, mimicking a wide range of problems including the common temporomandibular joint ankylosis and dysfunction. Maxillofacial trauma involving the displaced fracture of zygoma can obstruct the movement of coronoid and if not treated can cause ankylosis between both bones. It is very diffi cult to identify zygomaticocoronoid ankylosis on conventional radiographs and requires the through clinical and advanced radiological evaluation like cone-beam computed tomographic (CBCT) to diagnose it. CBCT can be a great help to identify the size and extension of ankylotic mass and decide the approach to remove it. Zygomaticocoronoid ankylosis can be approached intraorally by Keen’s incision, and extraorally through a hemicoronal approach we have approached intraorally. Here, we present surgical management of post-traumatic zygomaticocoronoid ankylosis in 42-year-old male patient who had trismus for 18 years.

Role of arthroscopy in osteoarthritis of the knee joint.

Background: Degenerative changes in the knee occur with increasing frequency after the third decade of life. In early osteoarthritis with no mal-alignment of the knee, arthroscopic surgery is an attractive alternative for many elderly patients as it reduces the degree of surgical insult and postoperative rehabilitation with hope of restoration of painless mobility. To study the role of arthroscopic debridement in alleviation of pain in cases of osteoarthritis knee and to evaluate the effectiveness of arthroscopy in diagnosis of osteoarthritis knee and its co-relation with radiological diagnosis. Methods: The present study is cross-sectional study of consecutive cohort of 53 patients. Body mass index was calculated based on height and weight of the patients and from their assessment of X - Rays patients were graded from 0 to 4 based on Kellegren–Lawrence radiological grading method. Selected patient were then assessed by pain domain of the knee society scoring system, which is joint specific score ranging from 0 to 50. These patients were then subjected to arthroscopic examination and debridement. Results: Overall 17 (32.08%) out of total 53 cases studied showed improvement after one year. Majority of patients improved were grade 2 (57.89%) but none of the grade 4 patients showed improvement at 1 year. Conclusions: Arthroscopic debridement does not influence the ongoing pathological process; it is only useful for symptomatic relief in cases of low grade osteoarthritis where it provides pain relief. Conversely, in patient with sever osteoarthritis there is very limited role of arthroscopy.

Prospective study of treatment of extraarticular fractures of distal end radius by cross K wire fixation and cast immobilisation and its comparison with Kapandji’s method of intrafocal pinning anatomically and functionally.

Background: Distal radius fractures account for 17% of all fractures in adults. The fracture of the lower end of radius crushes the mechanical foundation of man’s most elegant tool, the hand. No other fracture has a greater potential to devastate hand function. Extra-articular fractures (type A in the AO classification) require avoidance of malunion with angulation and shortening. Malalignment results in limitation of movement, changes in load distribution, midcarpal instability and an increased risk of osteoarthritis of the radiocarpal joint. Aims and objectives: Treatment of extraarticular fractures of distal end radius by cross K wire fixation and cast immobilisation and its comparison with Kapandji’s method of intrafocal pinning anatomically and functionally. Methods: Total 50 cases were included in the study. First 25 cases were treated by Kapandji’s method and next 25 cases were treated by cross K wire fixation and all cases were given below elbow cast after internal fixation. Patients were followed up at regular intervals and Anatomical and functional outcomes were evaluated in all the patients. Results: In our study anatomical end results were satisfactory in 96% and unsatisfactory in 4% of the subjects treated with cross K wire fixation and 72% and 28% in cases treated by Kapandji’s method whereas Functional end results were excellent in 28% cases, good in 68% cases, fair in 4% case and poor in 0% cases treated with cross k wire fixation and 12%, 60%, 24% and 4% in cases treated by Kapandji’s method. Conclusion: Cross K wire method proved to be better than Kapandji’s method of intrafocal K wire fixation both functionally and anatomically.

Drug utilization pattern of analgesics in various departments of a tertiary care teaching rural dental hospital.

Background: The aim was to study drug utilization pattern of analgesics in various departments of a tertiary care teaching rural dental hospital. Methods: A prospective and observational study was undertaken in 150 patients from January 2014 to February 2014. Relevant information was obtained from the interview as well the hospital case record. Structured and pre-tested format were used for compiling the data. Results: The majority of the patients (46%) were in the age group 41-60 years. Common indications for analgesic use included endodontic diseases (61.3%), surgical procedures (41.33%), and periodontal diseases (27.33%). Three analgesic formulations were used leading to a total of 150 drug uses. Fixed-dose drug combination (FDC) of diclofenac sodium plus paracetamol (78.66%) was the most commonly prescribed analgesic formulation, followed by aceclofenac plus paracetamol (15.33%) and ibuprofen (6%). The average number of analgesics prescribed per patient was 1.94. Analgesics were prescribed for 3 days. Except ibuprofen, FDC of diclofenac sodium + paracetamol and aceclofenac + paracetamol have been included in the WHO model list of essential medicines. All analgesic drug formulations were prescribed by their brand names. Conclusions: Drug utilization data can help to formulate appropriate clinical guidelines for drug use and facilitate rational use of medicines in population.

Drug utilization pattern of antimicrobial agents in dental outpatients of a tertiary care teaching rural hospital.

Aim: To study drug utilization pattern of antimicrobial agents in various outpatient departments of a tertiary care teaching rural dental hospital. Methods: A prospective-observational study was carried out in 200 patients from January 2014 to March 2014. Relevant information was obtained from the interview as well the hospital case record. Structured and pre-tested format was used for compiling the data. Results: The majority of the patients (51.5%) were in age group 41 to 60 years. Common conditions for antibiotic use included periodontal diseases (46.5%), endodontic diseases (38.5%) and dental caries (21.5%).Five antimicrobial drug formulations were used leading to a total of their 253 drug uses. Amoxicillin alone (64%) was the most commonly prescribed antimicrobial formulation followed by amoxicillin plus clavulanic acid (31.5%), metronidazole (26.5%), ofloxacin plus ornidazole (3%) and doxycycline (1.5%). The average number of antimicrobials prescribed per patient was 1.61. The average duration of antimicrobial was found to be minimum 3 days to maximum 5 days. Except ofloxacin plus ornidazole, all of the prescribed antimicrobials have been included in the WHO Model List of Essential medicines. 50.59% and 49.40% of total antimicrobial drug formulations were prescribed by generic and brand names respectively. Conclusions: Drug utilization data can help to formulate appropriate clinical guidelines for drug use and facilitate rational use of medicines in population.

Levofloxacin induced hypoglycemia in a non-diabetic patient.

Fluoroquinolones are generally regarded as safe antimicrobial agents with relatively few adverse effects or drug interactions. Because of their recognized safety profile and potent in vitro activity, fluoroquinolones have been widely used for the treatment of community- and hospital-acquired infections. Although uncommon, both hypoglycaemia and hyperglycaemia (dysglycaemia) appear to occur with all the fluoroquinolones. It is usually reported in conjunction with impaired creatinine clearance and elderly diabetics receiving concomitant treatment with antidiabetic agents (especially sulfonylureas) or insulin. The exact mechanism of this effect is unknown but is postulated to be a result of blockage of adenosine 5'-triphosphate-sensitive potassium channels in pancreatic cell membranes. Here we report a case of hypoglycaemia in a hospitalized non-diabetic elderly patient in whom this life-threatening adverse effect was related in a temporal fashion to the administration of intravenous levofloxacin meant to cover pulmonary infection in a setting of subacute small bowel obstruction and septicaemia. This case emphasizes the occurrence of profound and prolonged hypoglycaemia consequent upon levofloxacin use, an adverse reaction that has been described with almost all members of the quinolone family of antibiotics. Taking into consideration the frequency of fluoroquinolones use in the hospital and ambulatory setting, clinicians should be cognizant of this potential adverse effect in non-diabetic patients treated with levofloxacin, and they should look out for symptoms of hypoglycaemia and monitor blood glucose levels more frequently, especially early in the course of therapy.

An elucidatory review of the association between thyroid disorders and diabetes.

Thyroid disease and Diabetes (type 1 and type 2) are known to be pathophysiologically associated. The implications of the associations have clinically relevant implications for insulin sensitivity and adequate management requirements. Interconnectedness of common signalling pathways forms the pathophysiological basis of this association. In the case of type 1 diabetes and autoimmune thyroid disease, linked genetic susceptibilities may be involved. Interactions between thyroid hormone and the basal mechanisms controlling appetite, energy expenditure and insulin sensitivity regulation / secretion governance are also significant to understand. A clearer understanding of the interactions between diabetes mellitus and thyroid hormones has the potential to assist in optimization of treatment in a select group of diabetic patients.