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Aim: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. Methods: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. Results: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Conclusion: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.
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Background: Cervical cancer ranks fourth in global cancer incidence and mortality among women. A comparison of the global trends in cervical cancer would help us to identify high focus regions and serves an opportunity to evaluate the impact of the screening programs. Hence, the current study was done to assess the global trend in the incidence of cervical cancer from 1993 to 2012 among individuals aged between 30 and 79 years. Methods: This secondary data analysis was conducted using the World Health Organization (WHO) Cancer Incidence data of five continents plus database (America, Asia, Europe, and Oceania) on the incidence of cervical cancer. Joinpoint regression was performed to determine the average annual percent change (AAPC) in cervical cancer incidence. We performed an age-period-cohort analysis to obtain age, period, and cohort-specific deviations and rate ratio (RR). Results: Out of the four regions studied, all the regions showed a declining trend in cervical cancer incidence. The maximum decline was found in Oceania (AAPC = ?3.3%) followed by America (AAPC = ?2.0%). There was a consistent rise in cervical cancer incidence across the age groups in all the four continents with the maximum burden among the elderly. All the regions showed a steady decline in the rate of cervical cancer through the periods 1998–2002 to 2007–2012. There was also a steady decline in cervical cancer incidence across the cohorts from 1923–1927 to 1978–1982 in all the regions except America. Conclusion: To summarize, cervical cancer incidence showed a declining trend globally, with the maximum decline in the Oceania region from 1993 to 2012.
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Background@#Shone’s syndrome is a rare complex congenital cardiac condition, characterized by a supra-valvular mitral ring, parachute deformity of the mitral valve, aortic stenosis, and coarctation of the aorta.Case: A 26-year-old parturient with partial Shone’s syndrome presented to our delivery unit in pulmonary edema. She underwent a scheduled cesarean section performed under a combined spinal-epidural anesthetic at 33 weeks. She had multidisciplinary input from the cardiac, obstetric, and anesthetic teams, which led to a good outcome. A review of the five published case reports of Shone’s syndrome in pregnancy is presented along with key findings. @*Conclusions@#Our case report and the review highlight the successful use of combined spinal-epidural anesthetic and provides guidance to the multidisciplinary team on the varied presentation and the optimum management of women with Shone’s syndrome during the peripartum period.
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Background@#Shone’s syndrome is a rare complex congenital cardiac condition, characterized by a supra-valvular mitral ring, parachute deformity of the mitral valve, aortic stenosis, and coarctation of the aorta.Case: A 26-year-old parturient with partial Shone’s syndrome presented to our delivery unit in pulmonary edema. She underwent a scheduled cesarean section performed under a combined spinal-epidural anesthetic at 33 weeks. She had multidisciplinary input from the cardiac, obstetric, and anesthetic teams, which led to a good outcome. A review of the five published case reports of Shone’s syndrome in pregnancy is presented along with key findings. @*Conclusions@#Our case report and the review highlight the successful use of combined spinal-epidural anesthetic and provides guidance to the multidisciplinary team on the varied presentation and the optimum management of women with Shone’s syndrome during the peripartum period.
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Sheep and goats, being hardy and prolific in their growth, play a crucial role in cultural and socioeconomic life of rural poor under privileged people in Afro-Asian countries by providing meat, milk, wool and hide to them. Gastrointestinal helminthic infections are worldwide problem in ruminants. They results considerable loss in them causing mortality and poor production. Various helminthes types like trematodes, cestodes and nematodes are prevalent in different climates and geographical regions depending on rearing systems, intermediate host’s availability and management practices. Epidemiology of helminthic diseases, though variable at times, is determined by various factors like treatment, climate and poverty (socio-economic and traditional practices). The study oversees gastrointestinal helminthic challenges in goats and sheep faced in Afro-Asian region in last decade. Methodology involves exhaustive exercise of screening and massive literature hunt which included published research, both abstracts and full length papers on the subject in last 10 years in addition to authors own observations. The diseases like Fasciolosis, Dicrocoelosis, Amphistomosis in trematodes, Monieziosis, Avitellinosis in cestodes and Haemonchosis, Trichostronglylosis, Oesophagostomosis, Trichuriosis, Strongyloidosis in nematodes were still serious challenges in the region threatening the small ruminant production. Frequent reports on Marshallgia, Ostertagia, Nematodirus, Stilesia, Thysaniezia spp. from this region showed emerging threats. Infections like Camelostrongylus, Graphidiops, Parabronema and Skrjabinema spp. were scarcely distributed. The paper reviews scientific work and developments of last 10 years on occurrence, distribution and epidemiology of common gastrointestinal helminthic infections of sheep and goats in Afro-Asian region with future research prospective in light of newer scientific approaches
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Background: Hyperglycaemia and hyperlipidaemia seen in diabetes mellitus result in oxidative stress and pose significant risk of cognitive decline that may lead to Alzheimer’s disease. Approved anti-diabetic drugs have so far failed to demonstrate anti-oxidant and anti-hyperlipidemic activity, apart from saroglitazar. Therefore, this study was done to find a suitable anti-diabetic drug that possesses anti-hyperglycaemic, anti-oxidant and anti-hyperlipidemic activities and can reverse cognitive decline.Methods: Emblica officinalis (250 mg/kg, p.o. and 500 mg/kg, p.o.) and Murraya koenigii (250 mg/kg, p.o. and 500 mg/kg, p.o.) were chosen to study these activities in Wistar rats. Diabetes was induced by single intraperitoneal injection of streptozotocin [STZ] (50 mg/kg). Fasting blood glucose levels and lipid profile were measured on day 1 and day 30 of the experiment. Cognitive function was assessed by measuring transfer latency (TL) on elevated plus maze, step-down latency (SDL) on passive avoidance apparatus and retention latency (RL) and quadrant time (QT) in Morris water maze. Oxidative stress was assessed at end of study by measuring brain MDA and GSH levels. Cholinergic marker of cognition, AChE was measured in brain at end of study.Results: Both E. officinalis and M. koenigii showed dose dependent anti-hyperglycemic, anti-hyperlipidemic and anti-oxidant effects in diabetic rats with 500 mg/kg dose showing significantly higher effect. Both 250 mg/kg and 500 mg/kg dose of E. officinalis and M. koenigii partially reversed cognitive decline in diabetic rats by day 30.Conclusions: 500 mg/kg p.o. dose of E. officinalis or M. koenigii has potential to reverse cognitive decline in diabetic patients.
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Background: Painful diabetic neuropathy is a common complication of long standing diabetes mellitus. Amitriptyline is commonly used to treat painful diabetic neuropathy. Pregabalin has been shown to be effective in the treatment of painful diabetic neuropathy with lesser adverse effects. Sustained release (SR) of pregabalin has the advantage of once daily dosing and a better patient compliance. Hence, this study was planned to compare the efficacy and safety of pregabalin-SR with amitriptyline in painful diabetic neuropathy.Methods: It is a prospective, open labelled, randomized controlled study. A total of 80 patients diagnosed with painful diabetic neuropathy based on Diabetic neuropathy symptom score and Michigan neuropathy screening instrument, were randomized into two groups to receive amitriptyline and pregabalin SR. Amitriptyline was started at 25mg OD and pregabalin SR 75mg OD for 6 weeks with optional dose titration. Patients were assessed for pain relief by using visual analogue scale and an overall improvement in their general condition by patient’s global impression of change scale. Adverse drug reactions were recorded on each follow up.Results: All patients had significant improvement in pain relief in both the treatment groups. The median VAS (visual analogue scale) score was slightly higher in pregabalin SR group (25 vs 22) however it was not statistically significant. Intergroup comparison did not show any significant differences between the treatment groups. Good and moderate pain relief were noted in 37(92.5%) and 3(7.5%) patients on amitriptyline and 36 (90%) and 4 (10%) patients on pregabalin SR respectively. The common adverse effects reported in amitriptyline group were drowsiness (27.5%) and dry mouth (17.5%) and in pregabalin-SR group were drowsiness (15%) and dizziness (5%). No serious adverse event was reported in either of the groups.Conclusions: In patients with painful diabetic neuropathy both amitriptyline and pregabalin-SR are equally effective in alleviating pain and improving the patient’s general condition, but pregabalin-SR has the advantage of fewer adverse effects and convenient dosage timing.
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Background: Adverse drug reactions (ADRs) have become frequent cause for hospitalization and are coming up as an economic burden on health systems. Identification of ADRs and their reporting pattern can provide useful information for their management. Hence, this study was planned to evaluate causality and pattern of ADRs in a tertiary care hospital.Methods: The present study was undertaken in a tertiary care teaching hospital. A total of 200 ADRs reports collected in the ADR monitoring centre were analysed. The WHO definition of an ADR was adopted as well as WHO scale for causality assessment was used. Evaluation of the data was done for various parameters which included drug groups causing ADRs, body systems affected in ADRs, reporters and seriousness of reactions.Results: Overall occurrence of ADRs was slightly more in males (58%). Skin (72%) was the most commonly affected organ system. Antimicrobials (47%) were the drug group most commonly involved in ADRs. The causative drug was withdrawn for the management of the ADR in the majority (86%) of the patients. Upon causality assessment, majority of the ADRs were rated as probable (83.5%). Almost all of the reports were contributed by clinicians (99%).Conclusions: The causality assessment and pattern of ADRs reported in our hospital is comparable with the results of studies conducted in hospital set up elsewhere, although there are few differences. The study results revealed opportunities for interventions in ADR management especially for the preventable ADRs to ensure safer drug use.
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The present study was conducted to evaluate the spontaneous ADR monitoring in a tertiary care hospital. A total of 150 ADRs reports were collected. The WHO definition of an ADR was adopted. Evaluation of the data was done for various parameters which included types, severity and seriousness of reactions. Naranjo score was used for causality assessment. Overall occurrence of ADRs was more in males. Type A reactions (77%) accounted for majority of the reports. Gastrointestinal system (33%) was the most commonly affected organ system. Antibiotics (32%) were the drug class most commonly involved in ADRs. The suspected drug was withdrawn for the management of the ADR in the majority (82%) of the reports. Upon causality assessment, majority of the ADRs were rated as possible (64%). Mild and moderate reactions accounted for 23 and 65% of ADRs, respectively. The pattern of ADRs reported in our hospital is comparable with the results of studies conducted in hospital set up elsewhere, although there are few differences. Our evaluations revealed opportunities for interventions especially for the preventable ADRs to ensure safer drug use.
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A number of medical schools throughout the world have tried to downsize the basic sciences, but studies have shown that teaching of basic sciences is of importance for the clinical years that lie ahead. While some students endorse this finding, others want instruction in these sciences to be limited in terms of content and time. With the increasing cost of medical education and healthcare, medical schools the world over are trying to contain expenditure on the teaching of the basic sciences. In India, too, instruction in these sciences has been curtailed. This trend may need to be reviewed and the new challenges in this area must be addressed. Natl Med J India 2015;28:137–40
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Background: Patients with prehypertension have an increased risk of cardiovascular disease. The coexistence of prehypertension with risk factors increases cardiovascular morbidity and mortality. That’s why it is important to treat pre-hypertensive patients having risk factors. The objective was to evaluate the effect of atenolol and nebivolol in pre-hypertensive patients. Methods: Pre-hypertensive patients having risk factors were selected, and non-pharmacological therapy was advised to all patients. Those patients who were not able to follow strictly non-pharmacological guidelines and remained pre-hypertensive were included in this study. Pre-hypertensive patients were divided into three groups. One group received atenolol 50 mg orally, once daily. Second group received nebivolol 5 mg orally, once daily. Third group received placebo orally, once daily. All groups received treatment for 1 month. Results: In the nebivolol group after 1 month of study, the mean reduction in systolic blood pressure (SBP) was 134.2±3.07-118.26±4.66 and mean reduction in diastolic BP (DBP) was 87.13±1.87-80.73±1.99. Reduction in SBP and DBP in the nebivolol group was significant (p≤0.0001). In the placebo, and atenolol group results were not significant. Conclusion: Nebivolol produces a significant reduction in SBP and DBP in pre-hypertensive patients. Atenolol and placebo did not show beneficial results.
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Background: Urinary tract infection (UTI) is one of the most common bacterial infections encountered and treated worldwide. The objective was to determine the incidence, culture-sensitivity status, prescription pattern of antibiotics and response to various antibiotics and other therapeutic considerations in patients of complicated UTI (cUTI). Methods: The observational prospective analytical study conducted in Department of Nephrology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai. Results: A total percentage of patients having UTI was 13.08%. Of these 200 patients, 119 patients were female (60%) and 81 patients were male (41 %). Among male, the prevalence was seen more in geriatric age group and among female in adult group. Symptomatologically, fever was the most common symptom. Among male, diabetes mellitus was most commonly associated with cUTI whereas recurrent UTI were more common among female. Of the 200 patients, culture sensitivity was done in 133 patients. Escherichia coli was found to be the most common organism. Quinolones were the most commonly prescribed first line drug followed by beta-lactamase inhibitors. Combinations such as cefoperazone + linezolid were the most commonly prescribed second-line drug, followed by combination of ceftriaxone or cefoperazone with metronidazole. Paracetamol was the most common non antibiotic support given. Conclusions: The results of this study may not be representative of the general population; but UTIs are often treated empirically, and susceptibility tests are often carried out only when the patient has failed one or more courses of antibiotics.
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Drug-induced nephrotoxicity is an extremely common condition and is responsible for a variety of pathological effects on the kidneys. Drug-induced acute renal failure (ARF) accounted for 20% of all ARF cases. Drugs showed to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Although it is impossible to present all the drugs causing the nephrotoxicity, this article will summarize the mechanism of injury associated with particular common medications, discuss clinical presentations, renal markers, and evaluate strategies that prevent or minimize renal injury. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. General preventive measures include using alternative nonnephrotoxic drugs whenever possible; correcting risk factors, if possible; assessing baseline renal function before initiation of therapy, followed by adjusting the dosage; monitoring renal function and vital signs during therapy, and avoiding nephrotoxic drug combinations. Surprisingly, little information is available to guide us with respect to avoiding complications in critical illness; therefore, it is necessary to follow the guidelines.
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The reported rates of Barrett's esophagus [BE] ranged from 2.6% to 23% in Indian patients with gastro-esophageal reflux disease [GERD] symptoms. The role of methylene blue chromoendoscopy during endoscopy, either for the diagnosis of Barrett's esophagus or for the detection of dysplasia and early cancer, remains controversial. Our study was designed to find out the endoscopic as well as histological prevalence of BE in India in a specified patient population affected by GERD, and whether methylene blue chromoendoscopy improves detection of specialized intestinal metaplasia in endoscopically suspected Barrett's esophagus in GERD patients. Three hundred and seventy eight patients with characteristic symptoms of GERD from Northern India were subjected to upper endoscopy. On endoscopic suspicion of columnar lined epithelium [CLE] either 4-quadrant conventional biopsies at 2 cm interval or Methylene Blue [MB] directed biopsies were obtained randomly. The two groups were compared for the detection of Specialized Intestinal Metaplasia [SIM], which was diagnosed if the intestinal goblet cells were present. Out of 378 patients with GERD, 56 [14.81%] were suspected of CLE on endoscopy. After taking biopsy samples from the 56 patients, only 9 [2.38%] had specialized intestinal metaplasia on histopathological examination. Five [15.15%] patients in the conventional group and four [17.39%] patients in the chromoendoscopy group [P=0.55] were diagnosed as having BE. On univariate analysis the predictors of SIM were symptoms of reflux and length of CLE. The prevalence of biopsy proven BE and CLE in Northern India was 2.38% and 14.81%, respectively in patients with symptoms of GERD. The results of MB directed biopsies were similar to conventional biopsies in detecting SIM
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Humans , Male , Female , Prevalence , Risk Factors , Gastroesophageal Reflux , Methylene Blue , BiopsyABSTRACT
Background & objectives: Pipistrellus ceylonicus bat species is widely distributed in South Asia, with additional populations recorded in China and Southeast Asia. Bats are the natural reservoir hosts for a number of emerging zoonotic diseases. Attempts to isolate bat-borne viruses in various terrestrial mammalian cell lines have sometimes been unsuccessful. The bat cell lines are useful in isolation and propagation of many of the viruses harboured by bats. New stable bat cell lines are needed to help such investigations and to assist in the study of bat immunology and virus-host interactions. In this study we made an attempt to develop a cell line from P. ceylonicus bats. Methods: An effort was made to establish cell line from embryo of P. ceylonicus species of bat after seeding to Dulbecco’s modified eagle medium (DMEM) supplemented with 10 per cent foetal bovine serum; a primary cell line was established and designated as NIV-BtEPC. Mitochondrial DNA profile analysis was done using cyt-b and ND-1 gene sequences from the cell line. Phylogenetic tree was constructed using neighbour-joining algorithm for cyt-b and ND-1 genes with 1000-bootstrap replicates. Results: NIV-BtEPC cell line was susceptible to Chandipura (CHPV) and novel adenovirus (BtAdv-RLM) isolated from Rousettus leschenaulti from India but did not support multiplication of a number of Bunyaviruses, Alphaviruses and Flavivirus. This might be useful for isolation of a range of viruses and investigation of unknown aetiological agents. Interpretation & conclusions: In this study, a new bat cell line was developed from P. ceylonicus. This cell line was successfully tested for the susceptibility to Chandipura and BtAdv-RLM virus isolated from bats. The approach developed and optimised in this study may be applicable to the other species of bats and this established cell line can be used to facilitate virus isolation and basic research into virus-host interaction.
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SUMMARY The molluscicidal activity of the leaf powder of Moringa oleifera and lyophilized fruit powder of Momordica charantia against the snail Lymnaea acuminata was time and concentration dependent. M. oleifera leaf powder (96 h LC50: 197.59 ppm) was more toxic than M. charantia lyophilized fruit powder (96 h LC50: 318.29 ppm). The ethanolic extracts of M. oleifera leaf powder and Momordica charantia lyophilized fruit powder were more toxic than other organic solvent extracts. The 96 h LC50 of the column purified fraction of M. oleifera leaf powder was 22.52 ppm, while that of M. charantia lyophilized fruit powder was 6.21 ppm. Column, thin layer and high performance liquid chromatography analysis show that the active molluscicidal components in M. oleifera leaf powder and lyophilized fruit of M. charantia are benzylamine (96 h LC50: 2.3 ppm) and momordicine (96 h LC50: 1.2 ppm), respectively. Benzylamine and momordicine significantly inhibited, in vivo and in vitro, the acetylcholinesterase (AChE), acid and alkaline phosphatase (ACP/ALP) activities in the nervous tissues of L. acuminata. Inhibition of AChE, ACP and ALP activity in the nervous tissues of L. acuminata by benzylamine and momordicine may be responsible for the molluscicidal activity of M. oleifera and M. charantia fruits, respectively. .
RESUMO A atividade moluscicida do pó das folhas de Moringa oleifera e do pó liofilizado das frutas da Momordica charantia contra o caramujo Lymnaea acuminata é dependente do tempo e da sua concentração. O pó da folha da M. oleifera (96 h LC50: 197.59 ppm) foi mais tóxico do que o pó liofilizado da fruta da M. charantia (96 h LC50: 318.29 ppm). Os extratos etanólicos do pó de folha da M. oleifera e do pó liofilizado da fruta da M. charantia foram mais tóxicos do que outros extratos orgânicos solventes. O 96 h LC50 da fração purificada por coluna do pó das folhas da M. oleifera foi 22.52 ppm enquanto que o pó liofilizado do fruto da M. charantia foi 6.21 ppm. Coluna, camada fina e a alta performance da análise da cromatografia líquida mostram que os componentes ativos moluscicidas do pó da folha da M. oleifera e do liofiliizado da fruta da M. charantia são a benzilamina (96 h LC50: 22.3 ppm) e a momordicina (96 h LC50: 1.2 ppm), respectivamente. A benzilamina e a momordicina inibiram de maneira significante in vivo e in vitro a acetilcolinesterase (AChE), as atividades das fosfatases alcalina e ácida (ACP/ALP) nos tecidos nervosos da L. acuminata. A inibição da atividade da AChE, ACP e ALP nos tecidos nervosos da L. acuminata pela benzilamina e momordicina podem ser responsáveis pela atividade moluscicida da M. oleifera e dos frutos da M. charantia, respectivamente. .
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The Government of India initiated a cash incentive scheme—Janani Suraksha Yojana (JSY)—to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.