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Background: Self-prescribing among doctors is common. But the General Medical Council (GMC) and American Medical Council recommend that doctors should avoid prescribing for themselves, and close family members. Self-prescribing can lead to serious consequences. The present study reports the prevalence and pattern of self-prescribing among doctors working in various healthcare facilities of Kashmir Valley.Methods: Pre-validated questionnaires were sent to 200 doctors selected by convenience sampling. Only 184 returned the completely filled questionnaires.Results: At which 95.7% male doctors and 97.8% female doctors were self-prescribing. 100% doctors above the age of 40 years were self-prescribing. 100% post graduate students and consultants were practicing self-prescribing. 98.0% of those active as doctors for 1-5 years and 95.1% of those active for more than five years were self-prescribing. 60.7% doctors cited convenience, 40.4% time saving, 27.0% quick relief, 60.7% confidence, 14.6% low cost of treatment, and 15.7% crowd avoidance as a reason for self-prescribing. Major diseases self-treated were: headache (78.7%), respiratory symptoms (79.8%), fever (53.9%) and pain syndromes (31.5%). Major drugs used were: analgesics (80.9%), antipyretics (68.5%), antibiotics (58.4%), decongestants (49.4%) and antispasmodics (33.7%).Conclusions: The observed prevalence of self-prescribing was very high in this study. The issue of self-prescribing is common and requires attention.
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Background: Self-medication with antibiotics is a global problem and increases the risk of antibiotic resistance which impacts morbidity and mortality.Methods: A total of 180 Medical students and the same number of people from general population were given a pre-validated questionnaire. The total respondents were 168 among general population and 173 among medical students. Results: 21.42% respondents from general population and 82.08% medical students practiced antibiotic self-medication. 66.66% respondents from general population practiced antibiotic self- medication to save time and money. 57.04% medical students had previous experience of treating similar symptoms.83.33% respondents from general population and 89.43% medical students used antibiotics to treat fever, cough, cold, sore throat and similar symptoms. 50.00% respondents from general population consulted the chemist/pharmacist before using the antibiotics.38.02% students consulted their textbooks for drug information. Only 16.66% respondents from general population and 24.64% students continued the antibiotics till full recovery.Conclusions: Antibiotic self- medication is more prevalent among medical students as compared to general population. Medical students need to be targeted repeatedly during their education and be taught the value of using antibiotics with caution. Public awareness and strict enforcement of law to control the sale of antibiotics without a valid prescription are needed to minimize antibiotic self- medication and associated risks.
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Background: Phenytoin is a widely prescribed anticonvulsant drug. There is a wide interpatient as well as intrapatient variability in serum phenytoin levels despite standard doses. Phenytoin dosing is challenging because the drug exhibits nonlinear kinetics and interacts with a number of drugs. Children metabolize the drug faster as compared to adults. Ageing is also associated with progressive decline in phenytoin clearance. Many CYP450 enzymes show a sex-dependent difference in activity. The objective for this study was to find the effects of sex and ageing on serum phenytoin levels.Methods: The influence of sex and ageing on the serum phenytoin levels was evaluated retrospectively in 96 anonymized epileptic patients who had received phenytoin alone for more than four weeks. These patients were divided into three age groups, up to 18 years (children), 19-60 years (adults) and more than 60 years (elderly).Results: There were 6.25% children, 84.37% adults and 9.37% elderly. The majority (71.87%) of patients were males. Children achieved a mean phenytoin level of 15.71±4.85 µg/ml after a daily dose of 225.00±75.82 mg. Adults attained a mean serum phenytoin level of 16.12±3.90 µg/ml with a mean daily dose of 282.72±69.44 mg. The elderly achieved a mean serum phenytoin level of 15.85±2.19µg/ml after a mean daily dose of 266.67±70.71 mg. As compared to 77.77% females, 84.05% males had phenytoin levels in therapeutic range. 50.00% children, 82.71% adults, and 100.00% elderly had phenytoin levels in therapeutic range. There was a correlation between sex, age and serum phenytoin levels (r = 0.003 to 0.762).Conclusions: There was a correlation between sex, age and serum phenytoin levels in this study. A better understanding of the effects of sex and age on the clinical pharmacology of phenytoin would enhance the quality of prescribing.
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Background: Information and Communication Technology (ICT) has a potential to improve teaching and learning process. There are conflicting reports on the effect of ICT on student`s outcome. Though there is an early indication of positive impact, but the technology has a potential to have a detrimental effect. The present study was taken up to explore the effects of ICT on medical student’s academic performance.Methods: All the second professional students were given the questionnaire. Only 75 students had filled up the questionnaires completely.Results: The study population consisted of 48.00% males and 52.00% females. 97.33% students had smart phones, 44.00% had a laptop too. 10.66% students got less than 50% marks in the second professional examination, 14.66% got 50-59% marks, 62.66% got 60-69% marks and 12.00% got 70% or more marks. A low negative correlation was found between academic performance and possession of a smart phone (r= -0.062), and between academic performance and possession of a laptop (r= -0.029). A moderate negative correlation was found between academic performance and the time spent on a smart phone or laptop (r = -0.309). The correlations between academic performance and gender, and academic performance and the time spent on mobile phones or laptops were found statistically significant (p=0.000 and 0.007 respectively).Conclusions: Though ICT has capabilities of improving student`s academic performance, but it has a potential to have a negative effect if not used rationally. There is a vital need to sensitize the students about the potential academic risks associated with improper use of ICT. Students should be assisted and guided on how to use it judiciously.
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Background: Adherence is a key factor associated with effectiveness of all pharmacological therapies. Medication non-adherence is a significant barrier to achieve positive health outcomes especially for patients suffering from chronic diseases. Improving medication adherence is a public health priority and could reduce economic and health burdens. The aim of the present study was to assess medication adherence to some common chronic ailments.Methods: Pre-validated questionnaires were distributed among 300 patients suffering from chronic illnesses, by simple randomization out of which 240 patients returned completely filled questionnaires. The analysis was done by manual calculators, VassarStats, and SPSS V20. Results were calculated using univariate linear regression, with each patient’s adherence score as the dependent variable and each predictor as the independent variable. Results are expressed in frequencies and percentages.Results: In this study, 46.66% patients were males and 53.33% females. The mean age was 56.69 years ranging from 24 to 90 years.65.00% patients were uneducated.40.00% were taking one drug, 53.33% two to four drugs and 6.66% more than four drugs. 63.33% had low medication adherence, 35.00% medium and only 1.66% had high adherence. Compared to 14.28% men, 43.75% women were moderately adherent to medications. 41.02% uneducated patients had medium adherence as compared to 14.28% educated patients. 92.30% young patients had low adherence as compared to 53.25% in adults. 44.79% of patients receiving a single drug had medium adherence as compared to 25.00% in those receiving multiple drugs. Linear regression analysis demonstrated that the level of medication adherence was associated with patient gender, age, educational level, and number of prescribed drugs.Conclusions: There are many challenges in understanding the reasons for non-adherence. In this study medication adherence in chronic diseases was found suboptimal and associated with patient`s socio-demographic characteristics. Patient-tailored interventions are required to achieve sufficient adherence to therapeutic drug regimens.
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Background: Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. Globally, the overall prevalence of hypertension in adults aged 25 and over was around 40% in 2008.Despite its benefits, treatment of hypertension is costly. Direct medical spending to treat hypertension totalled $42.9 billion in 2010, with almost half ($20.4 billion) in the form of prescription medications. Being, a silent disease, adherence to antihypertensive drugs is poor. One of the important factors of poor adherence to antihypertensives is the cost of the drugs. There is wide cost variation among different brands of the same antihypertensive drug. Clinician’s awareness of cost of therapeutics is poor. The costly brand of same generic drug is proved to be in no way superior to its economically cheaper counterpart.Methods: The minimum and the maximum cost in Rupees (INR) of a particular antihypertensive agent manufactured by various pharmaceutical companies in the same strength were noted. The cost of 10 tablets/capsules was calculated. The cost ratio and percent cost variation were calculated for each brand.Results: The cost variation observed in the present study was as high as 2337.50 % for Hydralazine. Other significantly high cost variations found in the present study were: 1315.25% (Telmisartan+Hydrochlorthiazide), 870.58% (Amlopdipine), 558.34% (Amlodipine+Atenolol), 537.68% (Valsartan), 394.44% (Metoprolol), 344.44% (Enalapril), 316.22% (Propranolol), 300% (Lisinopril), 290.90% (Carvedilol), 289% (Cilnidipine), 271.99% ( Labetolol), 268.04% (Indapamide), 256.31% (Losartan), 255.19% (Irbesartan), 226% (Methyldopa), 223.04% (Frusemide), 209.78% (Nitrendepine), 192.08% (Terazosin), 189.25% (Atenolol), 142.42% (Bisoprolol) and 120.51% (Felodipine).Conclusions: Financial constraints are a reality in almost all aspects of medicine. Doctors must consider drug costs to their patients. Increasing pharmaceutical costs negatively impacts patients. Given the increasing healthcare costs, there is growing interest in rational prescribing, which takes costs of medication into account.
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Aim: To ascertain the common causes of LGIB in the elderly and to evaluate sigmoidoscopy and colonoscopy as the initial investigation for diagnosing LGIB in the elderly in the developing world. Materials and Methods: The study was conducted over a period of two years at SMHS Hospital and Government Medical College Srinagar, a tertiary care centre, Jammu & Kashmir. All the patients above the age of 60 years, presenting with symptoms or complaints of LGIB to the OPD’s and casualty services of the said hospital were enrolled in the study. Exclusion Criteria: Cases presenting with LGIB which were proved by any diagnostic procedures or during laparotomy to originate from any source proximal to ligament of Treitz. Results: The commonest cause of LGIB in our study was local anal disease [haemorrhoids and anal fissures] followed by carcinoma colorectum, inflammatory bowel disease [IBD], solitary rectal ulcers [SRUS] and colonic polyps, in the order of decreasing frequency. Colonoscopy was able to detect the cause of LGIB in all our study subjects. Conclusion: Despite the small number of patients in our study group, it can be concluded that the cause of LGIB in the elderly in our part of the world differs from that of the developed world, although the reasons for this remain unexplained and require more research. As such, elderly patients with complaints of LGIB should be offered the benefits of colonoscopy unless contraindicated by their co-morbidities because of the fact that they may be harbouring a sinister cause of LGIB, i.e., colorectal malignancy.
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A randomized, open labeled comparative analysis for 2-week therapy of inhaled Tiotropium (T) (n=30) and Tiotropium plus Formoterol (TF) (n=30) once daily was carried in stable COPD patients. Objective parameters like lung functions (FEV1 and FVC), SBP, DBP, pulse and subjective parameters like improvement in respiratory symptoms & safety were assessed at baseline and after 2 weeks of treatment. Mean FEV1 was 1.0963±0.3826 & 1.1657±0.3701 as well as 1.1227±0.4129 & 1.2260±0.3830 before & after treatment with inhaled T & TF respectively. A statistically significant p<0.05 and p<0.001 improvement was only observed for FEV1 without significantly affecting other study parameters with two treatment modalities respectively when analyzed from respective base lines. However, on comparing the post drug improvement in objective & subjective parameters among T & TF treatment arms showed statistically insignificant p>0.05 variation. Both the regimens were well tolerated and no case warranted withdrawal of treatment. The present study suggests that in the treatment of COPD, inhaled long acting bronchodilators (T & TF) on comparison appear equally effective & safe.