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Background : Anticholinergic burden in Geriatric population is of great concern throughout the Globe, yet often neglected. There are previous studies to assess the Anticholinergic burden, carried out in specific population, though its prevalence in general population is difficult to interpret. Polypharmacy remains one of the major causes contributing to the increased burden in Anticholinergic score among Geriatrics. Multiple co-morbidities and the prevalence of Multiple Chronic Diseases are the responsible factors which imbibe Multiple Drug Therapy in Geriatric population. Anticholinergic burden in older adults has been associated with Cognitive impairment, Delirium, Dizziness and Confusion, Falls and increased hospitalizations. However, Anticholinergic-acting drugs are often advised in Geriatric population. In this study an attempt was made to understand the Anticholinergic burden score among Geriatric population. Methods : This study is a descriptive cross-sectional study, which was done, in a period of six months among 62 Geriatric patients attending a therapeutics clinic of a private clinical pharmacology OPD for first time. Patients were noted for their comorbidities and anticholinergic burden was calculated, based on the Anticholinergic Cognitive Burden scale. Results were statistically analyzed. Results : Clinically significant anticholinergic burden was observed in 22.58% population. The most frequently prescribed drug was found to be alprazolam followed by amitriptyline and theophylline. Among the comorbidities hypertension and diabetes was commonly seen in majority of the population. Conclusion : Co-professional care at clinical pharmacology OPD with assessment of anticholinergic burden of geriatric prescriptions and advices on rational de-prescribing with suggestions on safer alternatives would be beneficial for treating physicians to optimize therapy.
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An Online survey was conducted by sending a ten-point questionnaire to about 200 Doctors in India, using the Survey Monkey App. A total of 146 responses were received, out of which 132 were complete. Majority of the Doctors had more than 20 years of experience in the Medical Profession and 80% of the respondents were males. Surprisingly, majority of the Doctors were happy with their income and though the prevalence of smoking and alcohol intakes was low, almost 60% had High Stress Levels. Professional Stress was almost twice that of Domestic Stress. The causes and solutions for these high levels of stress in the Indian Doctors needs to be explored further.
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Introduction: Worldwide Human Immunodeficiency Virus (HIV) Infection is a Public Health Problem. Adolescents and young people are inclined to experiment with sex and prone to have HIV infection. Interventional Education Program on HIV/AIDS may prevent spread of the infection. Materials and Methods : Knowledge and attitude of students (N=2373) of 10th to 12th grade from 38 schools of Kolkata about HIV/AIDS was assessed based on a questionnaire. Subsequently an interventional educational program was conducted for them. A follow-up study with the same questionnaire after 6-8 weeks of the interventional program was performed among the students (N=811) of 11th and 12th standard. Knowledge and attitude towards HIV/AIDS was evaluated by defining a ‘Knowledge’ and ‘Attitude’ score from responses of the students to relevant questions. Data was analyzed using SPSS, version 17 software. Observations : Interventional Program improved student’s (a) responses to more questions, (b) knowledge level and (c) positive attitude towards HIV/AIDS. Significant improvement occurred in the association of knowledge score with respect to the male students after the Intervention Program but not much with respect to girls. Association of the attitude score with respect to gender and three streams (Arts, Science, Commerce) of study were significantly enhanced after the program. Discussion : Several studies around the world indicate that Interventional Educational Programs almost certainly improve knowledge and attitude of the school students about HIV/AIDS. Some differences in findings may be due to qualitative differences of the study participants. Our observations may not be extrapolated to other Indian Student Groups who may differ in awareness and cultural status
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Background: In patients with frequently relapsing nephrotic syndrome (FRNS), steroid-dependent nephrotic syndrome (SDNS) and steroid resistant nephrotic syndrome (SRNS) steroids are either used for prolonged period of time or ineffective. To reduce the degree of steroid dependency and avoid steroid toxicity, several immunosuppressive steroid sparing agents (SPAs) have been proposed to treat these children. The present study tried to study the relative safety of most commonly steroid sparing agent in such children.Methods: A multi-centred, prospective observational study was conducted in paediatric nephrology OPD of two tertiary care hospitals in Kolkata over a period of 24 months. All consecutive children with diagnosed FRNS, SDNS and SRNS who were started on steroid sparing agents were enrolled and followed up for at least 6 months. Records of clinical examination, laboratory tests were collected and measured at the baseline and regular intervals. Safety parameters were noted and statistically analysed.Results: A total 110 patients were screened, examined and enrolled. Levamisole, cyclophosphamide and MMF were commonly used SPAs. Of the two tertiary care hospitals, all the patients of FRNS and SDNS were started with levamisole and SRNS with cyclophosphamide in one set-up, while in the other hospital some SDNS patients were started with cyclophosphamide and SRNS with MMF but without clinically significant outcomes. In comparison with few minor adverse events in MMF group, some serious adverse events were documented in the both cyclophosphamide and levamisole groups.Conclusions: Levamisole being a very efficacious, safe and easily affordable drug, should be used as an initial first line SPA in treating FRNS and SDNS children. The side effect profiles of levamisole and MMF are much more patient friendly.
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Background: Respiratory tract infections have been one of the commonest types of infections affecting the Indian population. With antibiotic resistance being a global threat and challenge to healthcare, concerns over skilful and judicious use of existing antibiotics have been on rise. Update on region specific bacterial susceptibility pattern is thus a need. The present study was planned to identify the common pathogens responsible for the respiratory tract infection and their antibiotic susceptibility patterns.Methods: A prospective study was carried out, where subjects with lower respiratory tract (LRT) infection admitted in the Intensive Care Unit in the tertiary care centre in Eastern India during the one-year period were enrolled in the study. Samples such as sputum, suction tip, endotracheal aspirate, bronchial aspirate and pleural fluid were obtained under aseptic precautions and were processed. The bacterial isolates were subjected to susceptibility testing by standard Kirby Bauer disc diffusion methods. The susceptibility patterns of the bacterial pathogens were determined.Results: Out of 234 processed samples, klebsiella (33.44%) was found to be commonest pathogen isolated from all the sites followed by Pseudomonas, staphylococcus and others. Amongst the penicillin group of antibiotics, ampicillin showed highest activity against pseudomonas and E. coli respectively. Antibiotics like penicillin G, ampicillin/sulbactam and amoxicillin/clavulanic acid combination showed lower susceptibility towards most pathogens. Amongst broad spectrum antibiotics, amikacin showed high susceptibility towards pseudomonas species followed by chloramphenicol and tetracycline.Conclusions: With changing trends in microbiological patterns of responsible organisms, knowledge regarding antibiotic susceptibility pattern needs to be regularly revised, thus ensuring prompt initiation of adequate and appropriate antibiotic treatment with better patient outcomes.
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report describes a patient suffering from somatoform disorder that developed suicidal ideation specifically due to the treatment with sertraline. After 6-7 months on the regimen, she presented slight suicidal ideations. However, with gradual progress of time and continuation of the therapy, the ideation became intense. She complained of intense restlessness and anxiety. She presented with fresh cuts and bruises on her left arm and neck. On reporting the problem, the drug was withdrawn. Patient experienced gradual improvement in her state. The case report underlines the importance of onset of suicide risk in panic disorders due to specific antidepressants, selective serotonin reuptake inhibitors (SSRIs). The exact neurobiological basis of depression though being uncertain, the role of serotonin has been mostly implicated. Hypothetically, biological alterations in the serotonergic system might have contributed to the suicidal ideation/attempt in the presence of an SSRI. The present case attempts to highlight an incidence of development of suicidal ideation in a patient who is on chronic SSRI therapy.