ABSTRACT
Background: Pain is a very well-known symptom of many diseases and analgesics are used to relieve pain. The main problem with these drugs remains that of side effects. Herbal medicines are better in view of their cultural acceptability, better compatibility with human body systems and lesser incidence of side effects. Extract of Tinospora cordifolia (Guduchi) plant have been traditionally used to treat pain in traditional medicine.Methods: Commercially available preparation of T. cordifolia plant has been used as test drug (aqueous extract). Healthy albino rats of either sex, weighing between 140-200 g were selected for the study, divided into 4 groups of 6 each (control, standard, 100 mg/kg, 300 mg/kg). Central analgesic activity was assessed by tail flick model (morphine as standard drug I.P). Acetic acid 1% 10 ml/kg aqueous solution I.P. was used for abdominal writhing model. Diclofenac 150 mg/kg oral as standard drug for assessment of peripheral analgesic activity. Results were analysed using SPSS version 16 and Microsoft office excel 2007.Results: T. cordifolia extract significantly increased the tail flick latency time (sec) (mean tail flick latency control, T100, T300 6.833±0.25 sec, 8.65±017 sec, 10.01±0.14 respectively) (p value control vs T100, T300 at 90 min, 120 min, 0.0573, 0.0198, 0.0198 in between group) and decreased number of abdominal writhing in comparison with the control group (p value <0.0001).Conclusions: Extract of T. cordifolia was found to possess analgesic activity and also exhibited dose and time dependant increase involving central and peripheral mechanisms. The analgesic activity of T. cordifolia found to be comparable to standard drug used.
ABSTRACT
Background: The practice and teaching in the MBBS curriculum has changed over the last few decades and most of it caters to the making of the Indian Medical Graduate (IMG) and the first contact physician of the community. The most notable change in pharmacy in modern times has been the virtual disappearance of the preparation and compounding of medicines. Pharmacy practical classes still form a part of the MCI curriculum in Pharmacology undergraduate teaching in many states of India including West Bengal. This study was undertaken to assess the attitude of students as well as teachers towards continuation of these practical classes in the curriculum and possible alternatives.Methods: Second year pharmacology students were included in the study (n=143). Along with this 10 faculty members were provided a structured and pre-tested questionnaire to be answered anonymously.Results: It was seen that 89 percent students and 100 percent faculty members wanted these practical classes to be discontinued. The most popular alternative to these classes were ADR reporting from the faculty members (90%) and demonstration of clinical effects of drugs and dosage calculation (86%) among the students.Conclusions: Given the lessening importance and relevance of the pharmacy practical classes in today’s day to day practice, a change in curriculum and examination system in Pharmacology must be considered.
ABSTRACT
Background: Use of fixed dose combination (FDCs) is a double edged sword with scope for irrational prescribing on one hand and improved pharmacotherapy and patient compliance on the other hand. Irrational FDCs are being marketed aggressively and often young prescribers including Post Graduate Trainees fall prey to the lure of FDCs. This was a Knowledge-Attitude-Practice study regarding of FDC use among the resident doctors working at a tertiary care medical college of rural Bengal.Methods: This was a cross-sectional, questionnaire based study including 50 resident doctors who were asked to fill a 10-question questionnaire on FDCs anonymously.Results: Ninety two percent of the study participants were aware of the FDCs. The most commonly perceived advantages were better patient compliance and synergistic effects. Most (96%) cited problems of titrating dosages and problems of more side effects. Only 37.6% knew about the banned FDCs. Preferred FDCs among them were antibiotics (94%), cough syrups (80%) and NSAIDs (68%). Residents of dermatology, orthopaedics, surgery and medicine most commonly prescribed FDCs. Sources of knowledge regarding FDCs were CME (92%), medical representative (76%), colleagues (72%), internet (68%), journals (48%) and textbooks (36%).Conclusions: The study showed that most participants were aware of the FDCs and also aware of the problems with irrational FDC use. Knowledge regarding banned drugs was poor as was the rationality of such combinations. More CMEs and inter department group discussions could be conducted to improve awareness and FDC prescribing practice among young prescribers.
ABSTRACT
Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases.
ABSTRACT
Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment of symptomatic cholelithiasis. The need of the hour is to understand the fact that PSI is a totally different subset of infection and antibiotics are not a solution to this problem. The core issue of “prevention” is the principal solution. The study was undertaken to revalidate these well known facts with an effort to bring about a radical reform to this “social” rather than clinical problem. Material and Methods: The study comprised of 60 patients admitted for elective LC. The first thirty patients undergoing elective LC were given single dose (SD) ciprofloxacin (500 mg) within an hour between the induction and making of the first port. While the control group received ciprofloxacin (500mg) post-operatively in the ward from ward nurses (MD). Operation-room anesthetic assistant administered prophylactic antibiotics at induction of anaesthesia to all the patients. Results: Of the 30 cases that received single dose prophylactic antibiotic pre-operatively, 16.67% were males and 83.3% were females. And, of the 30 cases that received multiple dose prophylactic antibiotic pre as well as post-operatively, 10% were males and 90% were females. Analysis showed that there was no statistically significant difference across the groups in regard to the duration of preoperative hospital stay. Of the 30 cases that received single dose prophylactic antibiotic preoperatively, only one patient suffered gross contamination during the surgery. Conclusion: The rate of early PSI after administration of single dose ciprofloxacin (500 mg) intravenously at induction of anesthesia and multiple dose ciprofloxacin (500 mg given thrice or four times) intravenously post-operatively for two or three days in addition to peri-operative dose is comparable in elective laparoscopic cholecystectomy. Furthermore, hospital cost can be reduced with single dose antibiotic regimen. So single dose of ciprofloxacin 500 mg can be used safely in elective cases of laparoscopic cholecystectomy to avoid infection at port site.
ABSTRACT
Background: Emotional exhaustion, and reduced perception of personal accomplishment is commonly defined as burn out syndrome. This may develop when there is significant stress without adequate support and resources in the face of work overload, as commonly happens with physicians and undergraduate medical students.Methods: This work attempted to study the level of burn out among all the second professional medical students in two different medical colleges and compare the trends of an urban medical college with a college in the outskirts of the city. 278 students from two medical colleges participated in the study wherein they were given standard questionnaires for assessment of stress, support, satisfaction and control parameters.Results: Overall 169 students of the 278 (60.79%) interviewed had scores correlating with burn out. Both college students showed burnout in the various parameters individually like stress, lack of support, dissatisfaction, lack of control and perception of success. There was a significantly greater prevalence of burn out scores among students in the city college (123 students or 60.84%) compared to those studying in the rural medical college (46 students or 41.07%) (p ?0.05)Conclusions: Burn out syndrome was more prevalent among city students compared to rural students. Individual as well as organizational interventions need to be targeted to prevent burnout among medical students.
ABSTRACT
Background: Antimicrobial sensitivity pattern from clinical isolates can reveal important information that can help in drafting the hospital antibiotic policy as well as help improve prescribing patterns and patient outcome in a particular region.Methods: Data from the results of the antimicrobial sensitivity pattern of clinical isolates of the patients between 1stJuly and 31st December 2018 were collected on a pre-designed and pre tested case study form and analysed with the help of descriptive statistics.Results: A total of 75 blood culture reports were obtained which showed 58 gram positive cultures. Further 46 of the gram positive samples were positive for Coagulase negative Staphylococcus. A total of 305 urine samples were obtained for culture which showed gram negative cultures. Paediatric and medicine wards were the common yielding sites. A total of 242 pus reports were obtained which showed 47 gram positive cultures. A total of 154 wound swab samples were obtained which showed 47 gram positive cultures. For pus and wound swab samples, surgery wards were the common yielding sites. Common gram negative organisms seen were Klebsiella sp., E. coli, Citrobacter sp., Pseudomonas, Proteus and Enterobacter. Gram positive organisms were commonly resistant to Erythromycin, orally active Penicillins, Vancomycin and Teicoplanin and gram negative organisms were commonly resistant to Cephalosporins, Aminoglycosides, Colistin, Fluroquinolones and Meropenem.Conclusions: This study showed that over six months samples of body pus, wound swab, blood culture and urine showed high levels of resistance to commonly used antibiotics. This would provide an outline for development of an effective hospital Infection Control Policy.
ABSTRACT
Background: Rural Bengal has one of the highest snakebite prevalence in India. This prospective observational study was initiated with the motive to analyse the effects and adherence to implementation of the new national snakebite protocol 2016.Methods: Data were collected from the patients admitted with snake bite on a pre-designed and pre tested case study form and analysed with the help of descriptive statistics.Results: A total of 75 patients arrived in the hospital during the study period out which 53 were male (most in the age group of 31-40 years) and majority of them were farmers (26.6%) or housewives (25%). Maximum of them were bitten in the lower limbs (54.6%) and peak time of bite was between 6 am-12 pm (40%). Most of them reached the hospital late, i.e., beyond 2 hours (70.6%). It was found that there were 26 neurotoxic, 16 hemotoxic and 1 neuro-hemotoxic cases and the rest were non-venomous cases. Fifty-one of them received ASV and 4 died. There was 80% adherence in the indication of ASV administration, 73.3% in the ASV dose, 32% in the monitoring after ASV administration, 94.66% in the monitoring 20 WBCT, 100% in adherence to haemodialysis as indicated.Conclusions: The results showed good adherence in all the parameters. Protocol guided treatment has also resulted in rational use of ASV. So, from this study, it was concluded that protocol guided treatment is effective in snakebite management, but its continuous revision and amendments should be considered in future.
ABSTRACT
Background: Snake envenomation is a common life-threatening problem encountered all-over West Bengal particularly in the rural areas. There are a large number of patients attending the Emergency unit and being admitted to the Medicine ward, some in the intensive care unit (ICU) and intensive therapy unit (ITU) of the tertiary health care facilities. The objective of this study was to assess rationality and effectiveness of management of venomous snake bite following standard protocol – Standard treatment guidelines of Government of West Bengal and National snakebite management protocol of Government of India.Methods: This was a retrospective observational study of six months (May - October 2017) duration. Data were collected from the treatment records of patients admitted with history of snake bite in the Medicine ward, ICU and ITU of tertiary care teaching hospital of rural Bengal.Results: Of the 63 venomous bite patients, most (82.5 %) were diagnosed to have features of neurotoxic envenomation. All of them (100%) received anti-snake venom (ASV). There was no incidence of anaphylactic reaction as well as any serious adverse drug reaction following ASV administration. Two patients developed acute renal failure, needed haemodialysis. Overall percentage of mortality was 3.2%.Conclusions: The survival rate in venomous snake bite is found to be high in this institution. The practice of snake bite management is found to be adherent with standard protocol. A multicentric study of longer duration is suggested to draw a firm conclusion.
ABSTRACT
Background: Individuals with epilepsy have a higher incidence of psychiatric disorders than person without epilepsy. Epidemiological studies have shown that the co-morbidity of epilepsy and depression to be high as 50%. The conventional anti-depressants are believed to lower the seizure threshold making it difficult to treat the co-morbid depression, but animal studies have shown SSRIs, a common anti-depressant, to have anti-convulsant properties. So, we propose to study the anticonvulsant effects of fluoxetine, a SSRI, in albino rats against maximal electroshock seizure and to compare against a standard antiepileptic drug phenytoin.Methods: The anticonvulsant effect of fluoxetine was observed in model of maximal electroconvulsive seizure threshold in albino rats. The animals were divided into 3 groups having 6 animals each, receiving distilled water, fluoxetine and phenytoin respectively. The drugs were given orally, and the effect was observed on day 7, 14 and 21. Tonic hind-limb extension was taken as the parameter of electroshock seizure. The effects were compared against a standard anti-seizure drug phenytoin.Results: Fluoxetine showed significant elevation of the seizure threshold following 14 days of administration (P value 0.031). The effect was comparable to phenytoin with no significant difference after 7, 14 and 21 days of treatment (P-value 0.485, 0.699 and 0.818 respectively) though phenytoin showed significant anti-seizure effect since day 7 of treatment.Conclusions: Fluoxetine showed significant anti-seizure activity against electroconvulsive seizure in albino rats.
ABSTRACT
Burnout is described as a syndrome of emotional exhaustion, and reduced personal accomplishment that may develop when there is significant stress without adequate support and resources in the face of work overload, as commonly happens with physicians and undergraduate medical students. Materials and Methods : This work attempted to study the level of burn out among all the third and fifth semester medical students in three different medical colleges. 596 students from three medical colleges participated in the study wherein they were given standard questionnaires for assessment of stress, support, satisfaction and control parameters. Results : Overall 310 students of the 596 (52.01%) interviewed had scores correlating with burn out. All the colleges across semesters showed burnout in the various parameters individually like stress, lack of support, dissatisfaction, lack of control and perception of success. Conclusions : Individual as well as organizational interventions need to be targeted to prevent burnout among medical students.