Assessment of knowledge, attitude, and practice of self-medication among undergraduate medical students in a tertiary care teaching hospital

Background: Self-medication (SM) is defined as the use of medication by a patient on his own inventiveness or on the suggestion of a pharmacist or a untrained person instead of consulting a medical practitioner (WHO guidelines, 2000). Being future medical practitioners, SM has a special influence in medical students and they inevitably urge SM practice themselves and also for others as they are perusing professional course and will be learning different drugs and their proper use. Aim and Objectives: We had undertaken this study to estimate the prevalence of SM and also to find out the factors that influence SM practices in the second, third, and final year undergraduate medical students. Materials and Methods: The prospective and questionnaire-based study was undertaken among undergraduate medical students in a tertiary care hospital, after getting approval from the Institutional Ethics Committee to obtain information on SM practices. Descriptive statistics were used for analysis of data. Results: In our study, 58% were females and 42% were males. About 81.5% of the students were aware about Over the Counter drugs. About 97% of students had no knowledge on safety of SM, 69.5% did not prefer taking SM, and 92% do not want to prefer SM for non-medical persons. Medical stores were the major (81%) of SM and fever was the major symptoms for which students took SM. Commonly used drug for SM was Paracetamol. Conclusion: Conscientious SM can be promoted in both the medical students and the general public. From the present study, we conclude that SM is quite common in undergraduate medical students that may be because of easy accessibility of drugs and information from text books and classroom teaching.

A prospective, questionnaire-based study to evaluate the knowledge, attitude, and practice of rational use of antibiotics among clinical practitioners in a tertiary care hospital

Background: Irrational antibacterial usage leads to emergence of antibiotic resistance. Hence, to ensure rational prescription regular clinical audits are essential in tertiary care hospitals. Aim and Objective: To assess the knowledge, attitude, and perception of clinician抯 on rational use of antibiotics in a tertiary care hospital. Materials and Methods: The prospective, questionnaire-based study was conducted on clinicians in a tertiary care hospital, after getting approval of the Institutional Ethics Committee to obtain information on rational antibiotic usage and was analyzed using descriptive statistics. Results: The study included 100 clinicians. 95% were aware about Rational antibiotic usage, the ingredients, adverse effects, interactions, contraindications, and cost of the drugs they prescribe and they were also analyzing the culture and sensitivity report before prescription of antibiotics, but only 48% of them were prescribing antibiotics from National List of Essential Medicines, 35% were influenced by patient demands. Around 80% agreed with the usefulness of the feedback given by fellow colleagues on antibiotic decisions. Though 98% of them were aware of the hazards of antibiotic resistance only 68% knew about antibiogram and having antibiotic policy at the workplace. In practice, 95% were showing special interest in proper antibiotic usage, 82% knew the new antibiotics available and 91% were providing proper counseling to patients. 95% suggested the need for training on rational use of medicines and antibiotic policy post MBBS. Conclusion: The clinicians recognized the importance of rational antibiotic use in preventing its resistance thus reducing health care burden on the patients.

Gross Morphological and Morphometrical Developmental Studies on Harderian Gland in Chicken

The present gross morphological and morphometrical study was conducted on the Harderian gland of chicken. A total of 32 numbers of healthy birds were procured from the Poultry Farm of Nagpur Veterinary College, MAFSU, Nagpur. The chicks were divided into 4 groups viz. 3, 10, 17, and 24 days of age with 8 chicks in each group. It was seen that the Harderian gland was found directed towards ventro-medial aspect of the eyeball in chicks and loosely attached by periorbital fascia to the underlying muscle. The average biometrical observations of left and right Harderian gland in respect of weight, length, width and area of gland were found increased with the advancement of age. Area of the gland increased on its length from 17th day to 24th day of age which resulted into more elongated glands

Protective Effect Of Diosgenin On Streptozotocin Induced Diabetic Nephropathy In Experimental Rats

Diabetes mellitus is a multifactorial metabolic disorder associated with the diabetes related vascular diseases. Oxidative stress along with inflammation is the Key factor leading to diabetic complications. Present study was designed to investigate the protective role of diosgenin, a steroidal saponin, in diabetes induced early kidney injury and oxidative stress markers and histopathological changes in kidney of diabetic rats, induced by single intra-peritoneal injection of streptozotocin (55 mg/kg weight (b.w.). After 72 hrs, experimental rats received diosgenin at different doses (10, 20 and 40 mg/kg b.w.) once daily for four weeks. At the end of the experiment, diabetic rats showed a significant increase in the levels of plasma glucose, glycosylated hemoglobin with a significant decrease in insulin and total hemoglobin. The activities of antioxidant enzymes such as superoxide dismutase, catalase, reduced glutathione, and the levels of reduced glutathione were decreased while increases in the levels of lipid peroxidation markers were observed in kidney tissues of diabetic rats. Oral administration of diosgenin to diabetic rats considerably shrivelled the plasma glucose and exaggerated the endocrine level supported a dose dependent manner. Diosgenin at a dose of 40 mg/kg b.w. was more pronounced effect than the other two doses and used for further studies. All the manifestations observed in diabetic rats were significantly reversed to near normal at a dose of 40 mg/kg b.w. of diosgenin. These findings recommend that diosgenin may have a helpful role against excretory organ harm evoked by aerobic stress within the diabetic state.

Laboratory surveillance of chikungunya in Madhya Pradesh, India (2016-2017)

Background & objectives: Chikungunya (CHIK) is a neglected, re-emerging arboviral disease. Limited information on CHIK-confirmed cases during interepidemic period is available from India. This surveillance study was conducted in Madhya Pradesh (MP), India, during the years 2016-2017, to provide information about CHIK cases. Methods: Blood samples collected from patients suspected having CHIK were tested by immunoglobulin (Ig) IgM ELISA or real time reverse transcription-polymerase chain reaction (rRT-PCR) for the detection of CHIK virus (CHIKV)-specific IgM antibodies or viral RNA, respectively. Partial envelope-1 gene sequencing was done. Clinical and demographic data were collected and analyzed. Results: Of the 4019 samples tested, 494 (12.2%) were found positive for CHIKV infection. The positivity was detected in both rural and urban areas. The mean age of CHIK-positive cases was 33.12�.25 yr. Headache and joint pain were the most prominent symptoms, 34.6 per cent (171/494) of the CHIK cases required hospitalization and six patients with CHIKV infection died. The East/Central/South African genotype of CHIKV was found to be circulating in the study area. Interpretation & conclusions: Our study recorded a higher CHIK positivity during 2016-2017 in comparison to earlier reports from MP, India. A high proportion of CHIK cases required hospitalization and deaths were also reported, which indicated the severity of the disease in the study area. In-depth molecular analysis of the virus and other risk factors is essential to understand the trends in disease severity.

Trend of human brucellosis over a decade at tertiary care centre in North Karnataka.

Background: Brucellosis is an important zoonotic disease. India having a major agrarian population is expected to have a higher prevalence. However, due to lack of laboratory facility or awareness among clinicians, the disease is largely underreported. The aim of this study was to know the prevalence and trend of human brucellosis over a decade, in patients attending a teaching hospital in North Karnataka, and to understand their geographical distribution. Materials and Methods: The study was conducted from January 2006 to December 2015 at a tertiary care teaching hospital in North Karnataka. A total of 3610 serum samples were evaluated from suspected cases of brucellosis. All serum samples were initially screened by Rose Bengal plate test, and positive samples were further analysed by Serum agglutination test (SAT) using standard Brucella abortus antigen from Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India. A titre above or equal to 1:80 IU/ml was considered as positive. Demographic data such as age, sex and native place of these patients were also analysed. Results: We observed that human brucellosis is present in North Karnataka. The overall seropositivity of brucellosis in suspected cases was 5.1%. The positive titres ranged from 1:80 to 163,840 IU/ml. The majority of the patients were from Gadag, Koppal and Haveri districts of North Karnataka. Conclusion: Our study confirms the presence of human brucellosis in the northern part of Karnataka. Further studies to understand the prevalence of animal brucellosis in these areas will help in implementing prevention measures.

A preliminary study of recombinant human interferon-α-2a activity against rabies virus in murine model.

Rabies remains an important public health problem in the world due to uncontrolled enzootic rabies. Although rabies associated fatalities may be prevented with timely immunoprophylaxis, but till date a therapeutic molecule has remained elusive. We investigated the role of rhuIFN α-2a in murine model challenged with rabies virus. Titre of 104.25 LD50/0.03 ml of 10% w/v RV CVS stock suspension were obtained. Based on 1LD50 titre, challenge dose of 50 LD50 was administered along with rhuIFN α-2a with pre-exposure (primed) and post-exposure with the rabies virus. Both showed increased survival time as compared with the virus controls. These fi ndings suggest that the rhuIFN α-2a might have some anti-viral activity, which can be used for the treatment of rabies infection. Further research on the effi cacy of interferon along with anti-viral drugs for the treatment will be helpful in designing combination therapy against the disease.

Prevalence of leptospirosis among dogs and rodents and their possible role in human leptospirosis from Mumbai, India.

A total of 100 blood and 18 urine samples of rodents and suspected dogs were collected from Mumbai, India during 2006-2008. In order to determine the role of animals in transmission of the disease to humans, all the samples were screened retrospectively by real-time polymerase chain reaction for leptospiral DNA and antibodies were detected using microscopic agglutination test. Leptopsiral DNA was detected from two blood and fi ve urine samples from rodents. Of a total of 71 rodent and dog samples investigated for anti-Leptospira antibodies, 14 (19.7%) were positive. Pyrogenes was the predominant serovar found in 100.0% (7/7) and 85.7% (6/7) from suspected canine cases and rodents, respectively; followed by Icterohemorrhagiae, which was found in one rodent sample 14.28% (1/7). The study proves that there is high prevalence of leptospirosis in rodents and dogs in this region, which proves possible role of these animals in transmission of leptospires to humans. Hence it is imperative to necessary control measures to prevent human leptospirosis.

Carbon isotope fractionation studies of bacterial strain Rhodococcus rhodochrous MTCC 291.

Carbon isotope fractionation associated with the aerobic consumption of propane (C3) were determined using Rhodococcus rhodochrous MTCC 291 bacterial strain to estimate the amount of hydrocarbon oxidized using GC, fractionation of δ13C carbon isotopes of propane and CO2 using GC-C-IRMS and growth of bacteria by UV-Visible Spectrophotometer. The initial δ13C isotopic value of propane was -34 ‰ and after incubation the changes of the isotopic values have been determined on 6th, 10th, 14th, and 17th days. The propane isotopic fractionation value was found to be maximum of -38.0 ‰ with an average value of -36.5 ‰ and a standard deviation of -1.22 ‰. The initial δ13C isotopic value of CO2 was -19.601 ‰. The CO2 isotopic fractionation value was found to be maximum of -29.153 ‰ with an average value of -26.859 ‰ and a standard deviation of -28.338 ‰. The consumption of propane gas was estimated using Gas Chromatograph. The initial concentration of propane in control was found to be 53 ppm. On incubation, the consumption of the propane gas was observed to be of 26 ppm. The carbon isotope fractionation presented here may be applied to estimate the extent of C1-C4 oxidation in natural gas samples, and should prove useful in further studying the microbial oxidation of these compounds in the natural environment.

Interactive effect of boron and NaCl on germinatinion performance in soybean.

The present work was carried out to study the individual and combined effects of boron and salinity on soybean seed germination. The results revealed that all the treatments of both NaCl and boron (5 ppm) delayed the germination. However higher concentrations (50 and 100 ppm) of boron was found to be enhanced germination percentage over control by 10 %. The combinations of boron with NaCl (especially 5 and 100 ppm Boron with 200 mM NaCl and 50 ppm boron with 100 mM NaCl) effectively mitigate the adverse effects of NaCl on germination of soybean seeds. In addition to it 50 mM NaCl concentration was found to be reduced the delayed effects of 5 ppm boron on germination.

Prevalence of influenza virus among the paediatric population in Mumbai during 2007-2009.

Purpose: Influenza has a major impact on public heath, annually affecting 15-20% of the global population. Information on the activity of influenza virus in Mumbai is limited. The present study was carried out to determine the prevalence of influenza viruses causing acute respiratory infections in children by molecular methods. Objective: To study the prevalence of influenza viruses among the paediatric population in Mumbai by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). Materials and Methods: From July 2007 to July 2009, 100 respiratory samples (nasal and throat swabs) were collected from paediatric patients with acute respiratory symptoms. attending out patients department, and admitted to the paediatric wards of B. J. Wadia Hospital for Children, Mumbai. The samples were collected and processed as per World Health Organization (WHO) guidelines. Viral RNA was extracted and one-step rRT-PCR was performed to detect influenza type A (H1 and H3) and influenza type B virus. Results: Out of 100 samples processed by rRT-PCR, a total of 11 samples (11%) were positive for influenza virus. The typing for influenza A subtypes showed 1% (1) positivity for H1 and 5% (5) positivity for H3 subtypes and 5% (5) samples tested positive for influenza type B virus. Conclusion: It was observed that both influenza type A and B viruses were prevalent in Mumbai during the study period. Such surveillance data are important in the early detection of any antigenic variants that may be helpful in global influenza vaccine preparation and for any pandemic preparedness activity.

Characterization of light gaseous hydrocarbons of the surface soils of Krishna-Godavari basin, India.

Several techniques are used for the exploration of hydrocarbons, of which; the geochemical techniques involving the microbiological technique use the principle of detecting the light hydrocarbon seepage activities for indication of sub-surface petroleum accumulations. A survey was carried out to characterize the light gaseous hydrocarbons seeping in oil and gas fields of Krishna-Godavari basin of Andhra Pradesh. A set of 50 sub-soil samples were collected at depths of about 3 m for geochemical analyses and 1m for microbiological analysis. The microbial prospecting studies showed the presence of high bacterial population for methane 2.5 x 102 to 6.0 x 106 cfu g-1, propane 1x102 to 8.0 x 106 cfu g-1 in soil samples. The adsorbed soil gas analysis showed the presence of moderate to low concentrations of methane (26 to 139 ppb), ethane (0 to 17 ppb), propane (0 to 8 ppb), butane (0 to 5 ppb) and pentane (0 to 2 ppb) in the soil samples of the study area. Carbon isotope analysis for methane (´13C1) ranging from -36.6 to -22.7‰ Pee Dee Belemnite (PDB) suggests these gases are of thermogenic origin. Geo-microbial prospecting method coupled with adsorbed soil gas and carbon isotope ratio analysis have thus shown good correlation with existing oil/ gas fields of Krishna-Godavari basin.

Targeting CYP450 modulation to decrease the risk of induced cataract in the experimental model.

Background: Diabetes is one of the major causes of cataract. Some drugs prescribed for the treatment of diabetes are the modulators of CYP450, which may alter the risk of cataract. Objective: To study the effect of CYP450 modulation in galactosemic cataract. Materials and Methods: Male Sprague-Dawley suckling rats were allotted to four groups (n = 6), as follows: Group 1: Normal control, Group 2: Galactose control, Group 3: CYP450 inhibitor pretreated and Group 4: CYP450 inducer pretreated. Cataract was induced in animals of all groups except group 1 by feeding them galactose (50%), 21 days after parturition. From the eighteenth day of life, CYP450 inhibitor (nifedipine; 8.1 mg/kg) and CYP450 inducer (pioglitazone; 3.8 mg/kg) were given orally to groups 3 and 4, respectively. The maturation pattern of the cataract was observed by an operating microscope, every third day. Biochemical changes in the lenses of all groups, for example, CYP450 activity expressed as µM NADPH oxidized / unit time, alterations in the levels of total proteins, soluble proteins, and reduced glutathione (GSH) following the induction of cataract, were estimated. Results: The microscopic examination of the lenses indicated that CYP450 inhibitor pre-treatment delayed (fourteenth day) the occurrence of cataract, while CYP450 inducer pretreatment demonstrated an early (ninth day) cataract as compared to galactose control rats (twelfth day). A significant decrease and increase in CYP450 activity was observed with the CYP450 inhibitor and inducer pre-treatment, respectively. There was no alteration in the GSH level, but a significant increase in total and soluble protein was found in groups 3 and 4 as compared to group 2. Conclusion: CYP450 may have a role in the initiation of cataract without any effect on the maturation pattern, as revealed by the delayed occurrence of cataract with the CYP450 inhibitor and an early onset of cataract with the CYP450 inducer.

Fracture of hyoid bone in cases of asphyxial deaths resulting from constricting force round the neck.

When any case of hanging, strangulation or throttling comes to the Department of Forensic Medicine for Post-mortem examination, the hyoid bone becomes the most integral part of internal examination at the autopsy table. Many authors and workers in this field have seriously highlighted fracture of hyoid bone. Some have claimed hyoid bone fracture in about 20% cases of hanging. Some have claimed hyoid bone fracture in about 68% cases of hanging. They also claimed that hyoid bone fracture increases with age above 40 years due to calcification and immobilization of joints. Some also claimed that hyoid bone fracture increases with using hard ligature for hanging and strangulation. Fracture of hyoid bone has been ascribed to many factors like manners of constriction, level of application of ligature or force of constriction, long drop or short drop suspension, age of victim, sex of victim etc. Besides getting hyoid bone fracture at autopsy table, it is also very important to check whether it is ante-mortem or post-mortem in nature or just an artifact. For this difficulty some have even advised preautopsy X-ray of the neck structures to detect ante-mortem hyoid bone fracture. Observing the importance given to hyoid bone fracture in hanging, ligature strangulation and throttling cases by many authors at the past and present days, the present authors have taken up the study in 257 cases of hanging, 7 cases of ligature strangulation and 5 cases of throttling to notice that hyoid bone fracture is nil or very rare in hanging where as it is very common in both forms of strangulation.

A comparative clinical study of sisomicin cream versus mupirocin ointment in pyodermas.

This study was designed to compare the efficacy and safety of sisomicin cream (0.1%) or mupirocin ointment (2%) in the treatment of primary or secondary pyodermas requiring topical antibiotic therapy alone. In the evaluable patients (n=290), impetigo was the commonest clinical condition reported. Staphylococcus aureus was the commonest pathogen isolated from the lesions. Both sisomicin and mupirocin treatments produced a steady improvement in the scores of erythema, oedema, vesiculation, pustulation, crusting and scaling but the improvement produced by sisomicin was quicker and more pronounced. The percentage of patients with complete clearing of all lesions was also higher with sisomicin than with mupirocin on days 4, 8 and 14. Patients subjectively rated the sisomicin formulation as excellent in 75% of cases as against 59% with mupirocin. Sisomicin and mupirocin are effective and safe in the management of pyodermas; however sisomicin therapy resulted in faster and greater relief of signs and symptoms.

Capillary refill time in term neonates: bedside assessment.

Capillary refill time (CRT) is yet to be established as a specific clinical sign of peripheral circulation in neonates. This study was conducted to assess the influence of four body sites used for measurement, interobserver variability, sex, birth weight, age at assessment and room temperature on CRT recorded in healthy term neonates, at bedside. Two observers measured CRT in four different body sites (forehead, chest, palm and heel) of each of 155 healthy term neonates. Significant differences occurred between the mean CRT recorded by the two observers in forehead (mean +/- SD: 2.62 +/- 0.8 s and 1.88 +/- 0.57 s; p < 0.001), palm (2.99 +/- 0.61 s and 2.75 +/- 1.12 s; p < 0.05) and heel (3.08 +/- 0.79 s and 4.24 +/- 1.84 s; p < 0.001). Only CRT in chest (2.7 +/- 0.42 s and 2.62 +/- 0.74 s) produced no significant differences in the means with a statistically significant and clinically fair, but not strong, interobserver agreement (r = 0.4; p < 0.001). No significant associations occurred between CRT and sex or birth weight. The associations of chest CRT with age at assessment (r = -0.23; p < 0.01) and room temperature (r = 0.27; p < 0.01) were clinically not important. In conclusion, CRT in neonates needs to be validated further before it can be useful as a specific clinical sign of peripheral circulation.

Pancreatic juice and duodenal fluid flow rate in cow calves from birth to early ruminant state.

The present investigation on pancreatic juice (PJ) and duodenal fluid (DF) was carried out in 10 crossbred (Jersey x Kankrej) male cow calves from birth to early ruminant state (15 week). The respective samples were measured in situ by cannulating the pancreatic duct and duodenal lumen, 30 minutes before feeding (BF) and 30 minutes after feeding (AF) both during morning (MH) and evening (EH). The results revealed significant increase in PJ and DF flow rate with age. Diurnal effect was nonsignificant except a significant increase recorded during EH on 4 d for PJ and 3 d for DF.