ABSTRACT
Magnesium sulfate (MgSO4) is the agent most commonly used for treatment of eclampsia and prevention of eclampsia in patients with severe pre-eclampsia. Another commonly practiced offlabel use of this drug is in preventing preterm labor in pregnant women where the duration of the treatment might be more than one week. It is usually given either by intramuscular or intravenous route. After administration, about 40% of plasma magnesium is bound with protein. The unbound magnesium ion diffuses into the extravascular extracellular space and then diffuses into bone. It also crosses the placenta and fetal membranes and then diffuses into the fetus and amniotic fluid. Magnesium is almost exclusively excreted in the urine; 90% of the dose is excreted during the first 24 hours after an intravenous infusion of MgSO4. The clinical effect and toxicity of MgSO4 can be linked to its concentration in plasma. A concentration of 1.8–3.0 mmol/L has been suggested for treatment of eclampsia. The actual magnesium dose and concentration needed for prophylaxis have never been estimated. Maternal toxicity is rare when MgSO4 is carefully administered and monitored. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most common variables for monitoring the toxic effect. Currently the United States (US) Food and Drug Administration (FDA) is advising health care professionals against using MgSO4 injection for more than 5–7 days to stop preterm labor in pregnant women (off-label use). Administration of MgSO4 injection to pregnant women for more than 5–7 days may lead to low calcium levels and bone problems in the fetus, including osteopenia and fractures. The harmful effect in the fetus with the shortest duration is not established. In light of this new safety information, the drug label for MgSO4 injection, USP 50% has also been changed, including changing the pregnancy category to D from A and denoting the effect as “New teratogenic effects”. Similarly, the manufacturers of other MgSO4 injection products have made similar changes to their drug labels. In this review, the currently available knowledge of the pharmacokinetics of MgSO4 and its clinical usage for women with pre-eclampsia and eclampsia, its off-label use and safety concern regarding the warning announced by the FDA will be outlined.
ABSTRACT
Every profession has its particular social responsibilities. Thus, professionalism is the foundation of medicine’s indenture with humanity. The schooling and refinement of professionalism has long been part of medical education. Recently professionalism is recognized as a fundamental qualification in both developed and developing countries. The objective of this study was to scrutinize and compare the professionalism of medical students of Malaysia and Bangladesh. This was Cross-sectional study conducted on 1208 Year-I to Year-V MBBS students of session 2011-2012 and 2012-2013, from Malaysia and Bangladesh. Data was collected using a validated instrument. Only 42% respondents were male and the rest 58% were female. Total mean professionalism scores for male was 177.57 and female was 175.82. Again total score of professionalism of Malaysia and Bangladesh were 175.50 and 177.14 respectively. Significant differences observed between gender (p=0.026) and country (p=0.044) in total scores of elements of professionalism. The present study found there has almost equal level of understanding on principal humanistic concerns of professionalism. Between gender and country there are significant differences. Professionalism should be incorporate in undergraduate and postgraduate medical course curriculum. Henceforth, communities will have rational prescriber for the common marginalized people.
ABSTRACT
Every medical graduate must have the intention to prescribe rationally. It is pharmacology which teaches rational of prescribing correct drug in undergraduate medical course. Therefore many eminent medical educationists believe that pharmacology is the most essential part of the medical curriculum. Medical graduates join as interns in their respective teaching hospital immediately after graduation. Although interns work is usually under the supervision of a senior consultant but there are occasions, when they need to make their own decision. Again drug market in Bangladesh, like many other countries, is rapidly expanding. Henceforth, interns’ are sometime confused to choose a drug from therapeutic choices. This study was conducted with the intention to provide some light about the knowledge of pharmacology among the Bangladeshi interns. This was a cross-sectional study conducted on Interns (n=191) of six medical schools of Bangladesh. Validated instrument was used to uptake the data. These medical schools are both government and private but Bangladesh has unique curriculum for all medical schools. Out of these 191 participants 81 (42%) rated pharmacology knowledge is good, while another 77 (40%) had average understanding. As high as 80% (152) intern population feel that undergraduate training has prepared them to prescribe safely. One hundred seventeen (61%) interns have already observed cases of adverse drug reactions in their short active clinical life. Although it is a cross sectional study with its limitations, has identified that pharmacology and therapeutics course curriculum is not enough to produce safe prescribers.
ABSTRACT
Elucidation of obesity susceptibility genes through genome wide approaches as well as candidate gene approaches provides great promise in ultimately determining the genetic underpinnings of obesity. The complex nature of human obesity stems from the multiple interaction of several genes that control the physiology of food intake, energy expenditure, development of the body, and behavioural patterns towards food intake, and the environment. According to twin, adoptees and family studies, genetic factors account for 40-70% of the variability observed in human adiposity. Twin studies supported that the heritability of adiposity is higher than other quantitative traits. The heritability of obesity traits has been further evidenced by identification of quantitative trait loci (QTL) and genes through methods such as genome-wide scans (studies conducted on unrelated obese individuals), linkage analyses (conducted in families), and association studies (investigating the correlation between obesity and polymorphisms). The number of contributing genes, however, is still unknown. Although research on the genetic basis of obesity has advanced, the mechanisms underlying the condition are still complex due to its heterogeneity even within families.