Prescribing Pattern of Antimicrobials in Patients during Post-Operative Period – An Observational Study.

Background: Understanding prescribing pattern of antimicrobials in postoperative period will provide data pertaining to efficacy of prophylaxis during post surgical period and economic burden faced by patients. This data will help local authorities formulate practical guidelines to ensure their rational prescription. Our aim was to evaluate the type and dosage schedule of antimicrobials used in post-operative patients and to estimate the cost of antimicrobials in these patients. Materials and Methods: This is a prospective observational study conducted by the Department of Pharmacology at R.L. Jalappa Hospital and Research Centre attached to Sri Devaraj Urs Medical College between April and September 2013. All patients above the age of 18 years undergoing surgical procedures in the departments of Orthopedics, Surgery and ENT and hospitalised were included. Results: There were 500 patients, 351 males and 149 females. The mean age and duration of stay was 43.15±16.8 years and 6.7±3.1 days respectively. Types of surgeries were, fracture fixation (31.8%), head and neck (18.2%), soft tissue - extremities (18.0%), abdominal (9.4%) and others (22.6%). All patients received antimicrobials prophylactically. 72% of the patients received antimicrobials for more than 24 hours. Commonly prescribed antimicrobials were cephalosporins (54.6%) and aminoglycosides (22.3%). The daily defined dose (DDD) /1000 patient days) was highest for aminoglycoside - amikacin (296.96±63.5). Conclusion: All patients received prophylactic antimicrobials and more than seventy percent were continued with the antimicrobials in the post operative period to prevent surgical site infection. However use of third generation cephalosporins was extensive, which may result in the development of resistance to these agents in the near future.

Initiating Case Based Learning (CBL) for large group in Pharmacology.

Objectives: Undergraduate medical education (MBBS) still involves large classes and most of the curriculum is delivered through traditional lectures. Some students lack opportunities for active and self-directed learning. Hence, it is necessary to initiate Case-Based Learning (CBL) for large group teaching, gather perception of students and compare the effectiveness of the CBL with regular lectures. Methods: Tuberculosis and malaria were chosen for CBL. We formulated 15 case scenarios in tuberculosis and 12 in malaria. CBL was facilitated in a large group of 112 students using buzz groups of about 10 students each. Structured feedback questionnaire was prepared to assess the perception of students about these modules using a five point Likert scale. After one month a test was administered which included questions from CBL and lecture topics. Results: Most students (93% to 96%) either strongly agreed or agreed that the module improved their comprehension, stimulated interest in the subject, improved their ability to correlate pharmacology with medicine, increased understanding of bedside clinics of tuberculosis and malaria, rational drug therapy and adverse drug reactions. The marks scored in CBL topics was significantly high 4.85 ± 1.3 compared to lecture 3.98 ± 1.4 (p<0.0001). There was significant difference (p<0.001) in the marks between high and low achievers in the CBL topics, but performance of high and intermediate achievers was insignificant. Conclusions: The majority of students perceived that CBL improved their ability to integrate the knowledge gained in pharmacology to bedside clinics. CBL significantly improved the performance of students. CBL was more effective than lecture for intermediate achievers.

Effect of sulphur on quality of sugarcane juice and jaggery.

Results of the experiment conducted in sandy loam soils during 2006-07 and 2007-08 revealed that quality parameters of cane juice and jaggery were positively and significantly influenced by the application of sulphur irrespective of sources of sulphur. Application of sulphur at 100kg/ha had significantly influenced the quality of juice but it was comparable with the application of sulphur at 80kg/ha which was reflected in quality of jaggery. There is an increase of 1.27 units in juice sucrose was observed with the application of sulphur at 80kg/ha. But sources did not differ markedly on juice quality and jaggery quality parameters. As Gypsum is cheapest source compared to Elemental sulphur, it can be concluded that maximum returns can be obtained at 80 kg S/ha through Gypsum application.