Knowledge of guidelines of drug use in geriatric patients can avoid high misuse of antibiotics in these patients

Objective: To determine the knowledge of drug prescribers, it's impact on their prescription and the basis of their decisions in geriatric patients

Study design, settings and duration: Prospective cross sectional study in medical units of three tertiary care government hospitals of Karachi, Pakistan from 1[st] June till 31[st] August, 2014

Subjects and Methods: Two hundred seven [207]house officers, Postgraduates, Residents and Medical officers who completed their undergraduate degree programs in five different medical universities and working in three tertiary care government hospitals, were asked to complete a questionnaire to check their knowledge about the selection of medications in the geriatric patients. The questions were aimed to check the awareness of prescribers regarding different facts which should be considered before prescribing drugs in geriatric patients and to explore the choice of drugs in these patients as per standard criteria. Detail of medications which were purchased from different medical stores outside the hospital and were used in geriatric patients was collected to link the knowledge of prescriber and its impact on prescription. Same physicians filled another questionnaire to justify their prescriptions when their knowledge of the use of drugs in geriatric patients was found to be poor

Results: Assessment of knowledge of 124 prescribers [59.9% of 207 who responded the questionnaire] showed that only 32.2% knew the lower age limits of geriatric patients, 29.8% knew guidelines for drug use in elderly, 18.5% were aware of the factors effecting drug selection, 12.0% knew the factors causing over-prescription and 46.7% knew the factors influencing dose selection. Antimicrobial drugs were the most inappropriately prescribed drugs and 78.3% are prescribed irrationally. Cephalosporin was the most prescribed group and given to 71.2% of the patients. Within this group Ceftrioxone, a [3rd generation Cephalosporin] was mostly prescribed in 43.1% of the total patients. Fear was the most prevailing factor [41.1%] in prescribing an antibiotic in geriatric patients

Conclusion: Results show that poor knowledge of prescribers for appropriate use of drugs in geriatric patients results in excessive use of broad spectrum antibiotics and the decision is mostly based on illogical basis

Augmentation of oral submucous fibrosis by NSAIDs in the presence of risk factors

Various Risk factors initiate Submucous fibrosis which may be augmented by NSAIDs. A number of animal studies on their mechanism indirectly support it especially regarding alterations in prostaglandin synthesis. This study has been designed to find association of these drugs with Oral Submucous fibrosis in the presence of risk factors. Newly diagnosed patients of Oral Sub mucous fibrosis were recruited for this study who attended Dental Department of Karachi Medical and Dental College from July 1 till Dec 31,2013. A structured interview and medical record of each patient was used to determine the demographic profile, any addiction, previous and present illnesses and drug [s] used. Through examination of Oral cavity was carried out to access the severity of disease as per modified Khanna and Andrade Classification [1995]. Statistical Analysis was done by SPSS 15. Total 102 patients were recruited from dental OPD as per criteria of inclusion. Among these patients 36 [49.31%] were using NSAIDs in which Acetaminophen [30.55%], Acetylsalicylic acid [25.00%] and Diclophenac [19.44%] were 1[st], 2[nd] and 3[rd] most common drugs. Data shows that 14 patients [28.88%] had mild and 22[61.11%] had sever fibrosis which was significantly high [P<0.05]. Mild fibrosis was seen in 05 [45.46%] and Sever fibrosis in 06 [54.54%] out of total 11 patients who were using NSAIDSs since less than or equal to 6 months. Similarly mild fibrosis was seen in 09 [36.00%] and Sever fibrosis in 16 [64.00%] out of total 25 patients who were on NSAIDs since more than 6 months. No statistical significant difference [P>0.05] in severity of fibrosis is seen in patients who were using NSAIDs since less than or equal to 6 months but statistical significant difference [P<0.05] in severity of fibrosis is seen in patients who on these drugs since more than 6 months. Addiction burden was calculated by Average Duration x Average Frequency, which was 92.72 for Pan, 88.88 for Supari and 61.30 for Miscellaneous. No statistically significant difference [P>0.05] was seen in addiction burden of various substances in these patients. An association of NSAIDs with Oral Sub mucous fibrosis exists. The pathology is augmented if these drugs are used in the presence of risk factors. Therefore these drugs should not be prescribed to these patients until a clear benefit is not targeted

Thrombo-embolic risk in high estrogenic phase of normal menstrual cycle in healthy women

Objective: this study is conducted to compare the risk of thrombo-embolism during different phases of menstrual cycles

Methodology: 105 healthy premenopausal unmarried females of 18 -21 years with a history of previous three normal menstrual cycles and 32 age matched male volunteers were recruited in the study. The phase of menstrual cycle of female volunteers was established by taking menstrual history. Bleeding time was determined by Duke's method

Results: bleeding time in 105 females was 73.03 +/- 1.89 Seconds and in 32 males was 69.33 +/- 4.94 Seconds which were not significantly different statistically [p=0.063]. Among females, 69 volunteers were in follicular phase of their hormonal cycle. Bleeding time in 29 females in early follicular phase was 70.86 +/- 3.38 Seconds and 40 females in late follicular phase was 68.25 +/- 4.03 Seconds. Statistically significant difference was not seen [p=0.095] when the two phases were compared. Bleeding time is not found to be reduced in late follicular phase as compared to early follicular phase, even high concentration of estrogen is present in the body in this phase as per normal menstrual physiology

Conclusion: high Estrogen in normal menstrual cycle does not increase thrombo-embolic risk in healthy women

Risk factors of oral cancer in Lahore, Pakistan: a case control design

Increase in incidence of oral cancers associated with tobacco and smokeless tobacco products in South Asian countries, especially in Pakistan, is creating an alarming situation

Objectives: Study investigated the association of tobacco, smokeless tobacco and alcohol with oral cancer

Methods: A case control design was used. 118 cases of oral cancer were selected from hospital, matched with 354 controls during April to June 2015. Case to control ratio was 1:3

Results: Mean age of cases was 48.9I +/- 13.24 years, 77.1% being males and 22.9% females. Most of the participants belonged to low socioeconomic status. The association of pan with oral cancer was very significant [p<0.05, OR= 9.755, 95% CI 5.7-16.5]. However, 62/118 cases were non-chewers and developed oral cancer. Pan chewing showed the strongest risk for oral cancer. We also found an increased risk for oral cancer in the consumption of Niswar [p<0.05, OR- 3.941, 95% CI 1.6-9.8], gutka [p<0.05, OR- 4.133, 95% CI 3.5-4.9], supari/chalia [p<0.05, OR-3.291, 95% CI 1.6-6.7] and alcohol [p<0.05, OR-4.789, 95%C1: 1.7-13.6]. Cigarette Smoking habit was present in both case and controls [p>0.05, OR- 1.291, 95% CI 0.8-1.9] indicating the cultural habit prevalent in Pakistan

Conclusion: Our study thus proved strong association between these predisposing factors and the development of oral cancer and the strength of association found to be stronger than in other studies

Hand sanitation practices within clinical settings: its knowledge and practice among students of Peshawar Medical College [PMC]

Introduction: Healthcare-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as the most effective method of prevention but is poorly performed by health workers. Maintaining adequate hand hygiene remains amongst the three requisites of good health. This study was conducted to assess the knowledge regarding different hand sanitation techniques and various factors responsible for non-compliance among students of Peshawar Medical College

Material and Methods: It was a cross-sectional survey based on self-administered questionnaire carried out at Peshawar Medical College. Self-designed questionnaire was distributed and responses obtained from students after their informed consents. SPSS 15 was used for analyzing data

Results: Response rate of the students was 51.6%. In total 87[56.1%] students were male and 68[43.9%] were female. Prevention in transmission of resistant microbes among patients in clinical settings was reported negative by the students [65.8%], the seven standardized steps were known by 42.6% of the students whereas 39.6% students applied it in clinical settings

Conclusion: Awareness about standardized steps of hand sanitation was not adequate among these medical students in the clinical settings; using soap and water for hand sanitation was found to be an effective tool for reducing surface tension between dirt and skin. Non-availability of hand sanitizers and careless attitude to medical students was considered as one of poor compliances. Findings may be considered important in controlling various factors responsible for poor adherence to different hand hygiene practices among medical students in clinical settings

Concomitant use of lisinopril reduces the effect of aspirin on bleeding

To determine the Lisinopril and Aspirin interaction through their concurrent effect on bleeding in adult male rabbits. Twenty four healthy adult male rabbits were used. Bleeding time of each animal was determined by Duke's Method. They were divided randomly in three groups containing equal number of animals into Control, Aspirin, Lisinopril and Combination groups. After oral administration of the drug[s], the bleeding time of the animals was again determined by same method. Prolongation of bleeding time was significant [p<0.05] in Aspirin and combination groups but insignificant [p>0.05] in Lisinopril group after 1 hour. It was significant [p<0.05] in Aspirin and Lisinopril groups but insignificant [p>0.05] in Combination group after 24 hours. This change was observed after 48 hours too. Concurrent use of Lisinopril reduces the effect of Aspirin on Bleeding after a certain time period