Self-medication with antibiotics and analgesics among undergraduate medical students in a tertiary care teaching hospital

Background: Self-medication is to obtain and consume the drugs without the advice of a physician about the diagnosis and treatment. Medical students are different from the general population because of their exposure to numerous clinical cases and also the knowledge about diseases, diagnosis and drugs. Aim and Objectives: The objective of the study was to evaluate the self-medication practices among undergraduate medical students in a tertiary care teaching hospital. Materials and Methods: This study was conducted on 150 undergraduate medical students at Rajiv Gandhi Institute of Medical Sciences, Adilabad from September 2021 to November 2021 after obtaining approval from Institutional Ethics Committee. A structured and validated questionnaire was used to collect information regarding self-medication practices. The study was based on their knowledge and attitude about the practice of self-medication. Results: 150 students participated in the study. Out of 150 students, 136 practiced self-medication. Of them 86 were female and 50 were male. The most common reason which lead to the practice of self-medication was their convenience. Fever was the most common indication for self-medication. Paracetamol was the most common analgesic and Azithromycin was the most common antibiotic used for self-medication. Nausea was the most common among adverse drug reactions experienced by the students. Conclusion: This practice of self-medication masks the sign and symptoms of underlying pathology, and thus complicates and delays the diagnosis. It also creates drug resistance. The practice of self-medication assumes a special significance among the medical students as they will be the future medical practitioners and play a crucial role in counseling the patients about the practice and adverse effects associated with self-medication.

Comparison of efficacy of adapalene 0.1% with benzoyl peroxide 2.5% in mild-to-moderate acne vulgaris

Background: Acne is a chronic inflammatory disease of the pilosebaceous units. It is characterized by seborrhea, the formation of open and closed comedones, erythematous papules, and pustules and in more severe cases nodules, deep pustules, and pseudocysts. In many cases, a degree of scarring will ensues. Four major factors involved in pathogenesis are as follows: (i) Increased sebum production, (ii) hypercornification of the pilosebaceous duct, (iii) abnormality of the microbial flora, especially colonization of the duct with propionibacterium acnes, and (iv) inflammation. Aim and Objectives: The aims of the study were as follows: (1). Comparison of success rate among the patients receiving benzoyl peroxide 2.5% and adapalene 0.1% in patients diagnosed with mild-to-moderate acne vulgaris. (2). To compare the decrease lesion count. Materials and Methods: After obtaining approval from the Institutional Ethics Committee, the patients for the study were enrolled from the Department of Dermatology Venereology and Leprosy, Osmania General Hospital, Hyderabad. Patients diagnosed with mild-to-moderate acne vulgaris according to Global Acne Grading system were included in the study. A total of 100 patients were divided into two groups (Group A and Group B). Each group consists of 50 patients each. Group A received: Topical benzoyl peroxide 2.5% gel for 12 weeks. Group B received: Topical adapalene 0.1% gel for 12 weeks. Follow-up was done at 3, 6, 9, and 12 weeks of treatment. Acne scores were recorded at baseline and at, 3, 6, 9, and 12 weeks of treatment. The global acne grading score (GAGS) was used for assessing the severity of acne at each visit. Results: All the data were entered in a Microsoft Excel sheet and analysis was done using Graph prism version 7. Continuous data were expressed in terms of mean and standard deviation. Comparison of acne scores in each group before and after treatment at each follow-up visit was performed using Student t-test. Comparison of acne scores among the two groups was performed at baseline and at the end of 12 weeks by unpaired t-test. A detailed history was recorded and clinical examination was done. Acne grading was done using the GAGS. Conclusion: There was significant decrease in mean acne scores. Decrease in mean acne scores of Group A (benzoyl peroxide 2.5% gel) was compared with that of Group B (adapalene 0.1% gel) using unpaired t-test. There was no significant difference in between benzoyl peroxide and adapalene on mean acne scores. It was found that both the treatment groups were effective in reducing acne score.

Coordinating a Postgraduate Orthopaedic Exam During the COVID-19 Pandemic

@#The Coronavirus (COVID-19) pandemic and institution of the Movement Control Order (MCO) had resulted in the cancellation of a major orthopaedic exam in April 2020. The exam is known as the Malaysian Orthopaedic Specialist Committee (OSC) Part I Examinations. It is similar to the British Royal Colleges of Surgeons Membership (MRCS) exams and held twice annually in April and October. There are up to 200 candidates involved. With implementation of new guidelines and standard operating procedures (SOP), the OSC Part I exam was successfully held by Universiti Kebangsaan Malaysia (UKM) from 5th-9th October 2020. Here we highlight the challenges we faced whilst coordinating a major exam at a national level during the COVID-19 pandemic with recommendations for future exams.

Prescribing pattern of antibiotics and susceptibility of pathogens in upper respiratory tract infections: a study from a tertiary care hospital

Background: Upper respiratory tract infections are mostly caused by viruses and are self-limiting. But it is seen that drug therapy is restored to many of them without adequate justifications. Sometimes multiple drug therapy imposes high cost burden on patients. Use of antibiotics in URTI patients have led to rise in bacterial resistance. So, this study was aimed to analyse the prescription pattern in upper respiratory tract infections and the antibiotic susceptibility of the isolated organisms.Methods: An observational cross-sectional study was conducted in a tertiary care hospital for a period of three months. Based on the inclusion and exclusion criteria sixty patients were selected. Prescriptions of these patients were collected and analysed for the various WHO prescription indicators like average number of drugs per encounter, percentage of drugs prescribed by generic names, percentage of drugs prescribed as injection, drugs form the essential drug list etc. The swabs were collected from the site of infections and were analysed for the bacterial growth. Also, the antibiotic susceptibility of these organisms was tested.Results: A total of sixty prescriptions were collected and analysed. The average number of drugs per prescription was 2.21. Antimicrobials were prescribed in 90% of cases. Approximately 50% cases the combination of amoxicillin and clavulanic acid was prescribed. The percentage of drugs prescribed by generic names was 87% and 68% drugs were form the essential drug list. The culture report of the specimen collected from the swabs showed that only 50% of cases were of some bacterial origin. And the organisms isolated were less susceptible to the antibiotics that were prescribed.Conclusions: This study of prescribing patterns in patients gives appropriate feedback and awareness among health care providers. Rationale prescribing practice will prevent antibiotic resistance and reduction in the adverse drug reactions.

Hypolipidemic effect of sitagliptin, voglibose and glimepiride in combination with metformin in patients with type 2 diabetes mellitus at a tertiary care teaching hospital: a comparative study

Background: The prevalence of coronary artery disease has been increased in diabetic dyslipidemia; hence the present study would like to compare the dyslipidemic effects of Sitagliptin, Voglibose, and Glimepiride in combination with Metformin in type 2 diabetes mellitus patients.Methods: This study was a Prospective, Randomized Clinical trial conducted at SRM medical College Hospital and Research centre. Potheri, Kancheepuram District in diabetic outpatient department after obtaining approval from Institutional Ethics Committee. The patients receiving antidiabetic drugs were divided into three groups. Patients received Metformin with Sitagliptin were grouped as I, Metformin with Voglibose were named as Group II and Metformin with Glimepiride were marked as Group III. Based on the inclusion and exclusion criteria, in each group, 40 patients were assigned as per simple randomization method. The level of lipid profile and BMI was evaluated at the end of 6 months.Results: There was a significant reduction of Total Cholesterol (TC) in Group II and Group III (p value- <0.001, <0.006). Group I showed significant elevation of HDL-C level with the p value of <0.03. Group III showed significant reduction of Triglyceride (TG) level with the p value of <0.04, significant reduction of Low Density Lipoprotein Cholesterol (LDL-C) level with the p value of <0.02 and significant reduction in Very Low Density Lipoprotein Cholesterol (VLDL-C) level with the p value of <0.05. There was no significant reduction in Body Mass Index (BMI) among the groups. On multiple comparisons, Group III showed higher efficacy in reducing TC, TG, LDL-C and VLDL-C levels.Conclusions: The results of this study were analysed and it could be concluded as Metformin with Glimepiride combination (Group III) showed significant reduction of TC, TG, LDL-C and VLDL-C levels.

Adverse drug reactions in hospitalized patients in a tertiary care teaching hospital: analysis of the reported cases

Background: Adverse Drug Reactions (ADR’s) contributes to the burden of drug-related morbidity and mortality. ADRs are seen frequently in hospitals due to a variety of factors like complexity of diseases, drug interactions, polypharmacy, and possible negligence. The purpose of the study was to identify and assess ADR in various departments of a tertiary care teaching hospital.Methods: A prospective spontaneous reporting was carried out in a tertiary care teaching hospital during a period of four months from November 2016 to February 2017. All suspected spontaneous ADRs were assessed and the information was collected and analyzed by the pharmacologists for causality assessment using the Naranjo’s causality assessment scale.Results: A total of 30 ADRs were reported with female preponderance (70%). Majority of ADRs were from General Medicine and Oncology departments. The most affected organ systems were skin (80%) followed by the gastrointestinal system (13.3%). The most frequent drugs causing ADRs were antibiotics (56.3%) in which type B reactions were more compared to type A and followed by anticancer drugs (10%). The severity assessment showed that most of them were mild reactions (76.6%). Causality assessment revealed that 90% of the reactions were probable, 10% were possible and no reactions were unlikely.Conclusions: The study accomplished that ADRs are widespread and a few of them raised the healthcare expenditure due to increased hospital stay. The reporting of the ADRs to regional Pharmacovigilance centers should be encouraged to ensure drug safety.

Spectrum of adverse drug reactions and implicated drugs in a tertiary care centre: a prospective study

Background: Adverse Drug Reaction(ADR) is the major limitation in providing health care to patients at a global level. It affects patient’s recovery and is an important cause of mortality and morbidity in both hospitalized and ambulatory patients. ADR can occur with any class of drugs. Early detection and evaluation of ADR is essential to reduce harm to the patients. Thus, the present study was aimed to estimate the number of ADR’s reported, analyze its spectrum and the drugs attributed to it.Methods: This was a prospective study conducted in a tertiary care teaching hospital for a period of 3 months from March 2016 to May 2016 in SRM Medical College and Hospital, Potheri. Adverse drug reactions were collected by spontaneous reporting by active and passive methods. The causality assessment of the reported ADR’s was done using Naranjo causality assessment scale.Results: A total of 38 ADR’s were reported during the study period with male predominance (58%). Most of the ADR’s (42%) were common in patients in the age group 19-39 years. More number of ADR’s were from Medicine (29%) followed by Surgery (16%) and OG (16%) departments. Most commonly affected organ systems were skin (45%) followed by GIT (24%). The drugs mostly accounted were antibiotics (55%) especially Cephalosporins (33%). Most of the reactions were type A (68%) rather than type B (32%) and thus predictable. According to Naranjo’s causality assessment, 63% of reactions were probable, 26% were possible and 11% were definite. No reactions were unlikely. Severity assessment by Modified Hartwig and Seigel scale revealed 45% ADRs to be moderate, 42% were mild and 13% were severe and life threatening.Conclusions: The study concluded that Adverse Drug Reactions are common and some of them resulted in increased healthcare cost due to need of some interventions and increased length of hospital stay. As majority of ADR is predictable (Type A), so preventable. The health system should promote the spontaneous reporting of Adverse Drug Reactions (May be done mandatory). The proper documentation and periodic reporting to regional pharmacovigilance centres to ensure drug safety.

Comparative Study on Cartilage Tissue Collected From Less- and Severely-Affected Region of Osteoarthritic Knee

Culture expanded chondrocytes isolated from non-load bearing region of osteoarthritic (OA) joint has been used to construct tissue engineered cartilage for treatment purposes. The aim of the study was to compare the histological properties of the cartilage tissue and morphological properties of the chondrocytes isolated from less and severely affected OA knee. Human articular cartilage was obtained as redundant tissue from consented patients with late-stage OA undergoing total knee replacement surgery at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Articular cartilage was graded according to Dougados and Osteoarthritis Research Society International (OARSI) classification. Articular cartilage was classified into less affected (LA; Grade 0-1) and severely affected (SA; Grade 2-3). Cartilage tissue from less and severely affected region was stained with Safranin O staining. Isolated chondrocytes from each group were cultured until passage 4 (P4). Their growth patterns, cell areas, and circularity were compared. LA-cartilage tissue shows uniform spread of safranin O staining indicating intact extracellular matrix (ECM) component. However, SA-cartilage shows significant reduction and unstable staining due to its degraded ECM. LA-chondrocytes showed an aggregated growth compared to SA-chondrocyte that remains monolayer. Moreover, LA-chondrocytes have significantly higher cell area with wider spreading at passage 0 and 4 compared to SA-chondrocytes. It was also found that chondrocyte circularity increased with passage, and circularity of LA-chondrocytes was significantly higher than that of the SA-chondrocytes at passage 3. This study demonstrated the considerable difference in the cellular properties for less and severely affected chondrocytes and implication of these differences in cell-based therapy needed to be explored.

Does the presence of Klebsiella pneumoniae carbapenemase and New Delhi metallo‑β‑lactamase‑1 genes in pathogens lead to fatal outcome.

Introduction: Infections due to multidrug‑resistant (MDR) pathogens are a medical challenge. There is considerable apprehension among clinicians regarding pathogens reported as carrying New Delhi metallo‑β‑lactamase‑1 (NDM) and Klebsiella pneumoniae carbapenemase (KPC) genes from their patients. In the face of extremely high rates of antimicrobial resistance, it is essential to gauge the clinical significance of isolation of pathogens carrying these genes from clinical samples. This study compares the outcome of patients infected with pathogens carrying NDM/KPC genes versus those without these genes. Methods: The study was conducted over a 1‑year period at a Level‑1 trauma centre. Hospital‑acquired infections were diagnosed on the basis of CDC’s criteria. The correlation of isolation of a multi‑resistant pathogen carrying KPC or NDM genes with the clinical outcome was ascertained. Results: A total of 276 consecutive patients admitted to the Intensive Care Units/wards of the JPNA Trauma Centre were included in this study. Of the 371 isolates recovered from these patients, 116 were from patients who had a fatal outcome. The difference in prevalence of blaNDM and blaKPC was not significant in any genera of Gram‑negative pathogens isolated from patients who survived versus those who had a fatal outcome. Conclusion: Isolation of MDR pathogens carrying NDM/KPC genes from clinical samples is not always a harbinger of a fatal outcome. Efforts should be made to prevent cross‑transmission of these pathogens.

A comparative study of Conventional and CT based planning of Target volumes and organs at risk in Intra cavitary brachytherapy for Carcinoma of cervix

Introduction: Cervical cancer is the third most common malignancy in women worldwide, and it remains the leading cause of cancer related deaths in women in developing countries. In the management of cervical cancer, both intracavitary brachytherapy (ICBT) and external radiotherapy (ERT) are essential as they deliver a high dose to the primary tumor and low doses to adjacent organ. The dose can be delivered either by conventional orthogonal radiograph mapping or by the 3- dimensional computed tomography mapping. In the present study, we have compared both the techniques. Aim and objectives: To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer based on orthogonal radiographs (conventional plan) and computed tomography sections (CT plan). Materials and methods: This was a prospective study, conducted in the department of Radiotherapy, MNJ Institute of Oncology and Regional Cancer Centre, over a period of two years from November 2012 to November 2014. The study consisted of total 25 registered patients having confirmed diagnosis of Squamous cell carcinoma of cervix. All the patients underwent conventional and CT planning for brachytherapy. One arm received the conventional plan of radiotherapy while the other arm received computed tomography (CT) based plan. Radhika Rani, R. Srikanth. A comparative study of Conventional and CT based planning of Target volumes and organs at risk in Intra cavitary brachytherapy for Carcinoma of cervix. IAIM, 2016; 3(9): 200-209. Page 201 Results: The patient age ranged from 35 to 65 years. The mean age was 47 years. The results of the study demonstrates that CT-guided brachytherapy planning is superior in terms of both conformity of target coverage and evaluation of OARs .Although this superiority was clear for small GTVs, for large GTVs both the conventional and CT-Plans had the drawbacks of inadequate target coverage and /or excessive radiation doses to normal organs. Conclusions: The conventional plan with the point A calculation relies on reference points on orthogonal films ,not tumor volumes defined on CT, which may cause underestimation of tumor doses. Likewise, the calculation of rectum and bladder doses made with ICRU reference points, not with bladder and rectal volumes may not reflect the actual organ doses. To overcome such problems, 3D CT-guided brachytherapy treatment planning is recommended.

Cost analysis of different brands of antianginal drugs available in India.

Background: Ischemic heart disease is the most common cardiovascular disease in developed countries such as United States and Angina pectoris is the most frequent among them. If not managed adequately angina results in significant morbidity and mortality too due to the complications. Antianginal therapy is lifelong. Therefore, analysis of the price of drugs used in ischemic heart disease will help to improve patient compliance. Methods: Prices of various antianginal drugs of different strengths and combinations marketed by different companies was obtained from current index of medical stores. The variation between highest and lowest price of the same medication manufactured by various pharma companies and percentage variation in price for ten tablets was calculated. Results: In India, percentage variation in price for antianginal drugs was found to be: tablet isosorbide dinitrate (5 mg) 250%, glyceryltrinitrate (6.4 mg) 24.44%. In calcium channel blockers group, tablet amlodipine 10 mg shows maximum price variation of 1045%, closely followed by 5 mg of amlodipine with a variation of 1040%, while 120 mg of diltiazem shows the least variation of 262%. In betaadrenergic receptor blockers group, tablet atenolol 50 mg shows maximum price variation of 563%, whereas 100 mg of extended release metoprolol shows the least variation of 42%. Conclusions: To increase the benefit to the patient and reduce drug in compliance, doctors should be trained to be familiar from internship period itself about the brand names of cost-effective drugs with good safety profile for a long period.

Prescribing pattern of antimicrobial agents in pediatrics department of a teaching hospital.

Background: Antibiotics are commonly used in pediatric illness and irrational use of antibiotics can lead to bacterial resistance. Appropriate studies should be done to frame proper guidelines for the use of antibiotics in pediatric population. The objective of the study was to determine the prescribing pattern of antibiotics and to analyze the rational use of antibiotics in pediatric department. Methods: An observational prospective study was carried out for a period of 3 months in the Department of Pediatrics. The data were recorded in the specific format, and the result was analyzed by descriptive statistics. Results: In this study, 347 prescriptions containing antibiotics were analyzed, out of which 54.6% were of male child and 45.4% were of female child. About 40.6% of the patients were in the age group of 1-5 years. A single antibiotic was prescribed in 78% of patients. Respiratory tract infections were the most common disease (68.2%), followed by skin infections (12.3%), gastrointestinal diseases (9.5%), and fever without focus (6.5%). Cephalosporins were the most commonly prescribed antibiotic group (35%). Conclusion: Irrational use of antibiotics can lead to bacterial resistance and can worsen the existing disease conditions. So, antibiotics should be prescribed according to the WHO guidelines or other rational strategy, especially in the pediatric age group.

Serum 25-Hydroxy Vitamin D, Calcium,Phosphorus and Alkaline Phosphatase Levels In Healthy Adults Above the age of 20 Living in Potheri Village of Kancheepuram District , Tamilnadu.

Medical fraternity believed that Vitamin D deficiency is rare in southern part of tropical country like India. This study is aimed to determine the serum vitamin D, calcium, phosphorus and alkaline phosphatase levels in healthy subjects around Potheri, kancheepuram district of Tamilnadu. Total of 81 subjects above the age of 20, out of which 50 males and 31 females were recruited for the study. Institutional ethical committee clearance was obtained. After getting informed consent from each subject, a preformed questionnaire containing the details about socioeconomic status, religion, dietary habits , sun light exposure and skin color were filled. Venous blood was drawn to test vitamin D, calcium, phosphorus and alkaline phosphatase levels in the serum. Among 81 subjects, 73.91% had Vitamin D deficiency. Serum Vitamin D was not significantly correlated with serum phosphorus, serum alkaline phosphatase, skin color and living condition. But there exists positive correlation between serum calcium, sun light exposure with Vitamin D levels whereas socio economic status had a negative correlation. Adequate sun light exposure, fortification of food and oral intake of 800IU-1000IU Vitamin D daily are the best options to combat the Vitamin D deficiency.

Screening of cetirizine for analgesic activity in mice.

Background: Pain is the most common symptom for which patients approach doctors. We have multitude of drugs for pain relief, but they have serious side effects ranging from peptic ulcer (e.g. NSAIDs) to renal failure. The other group, opioids have well known side effects ranging from sedation to drug dependence. So a search for a drug for analgesia with high therapeutic effect and fewer side effects will be a boon for the patients. The objective of this study was to find whether cetirizine, a second generation antihistaminic drug, has got any analgesic activity in mice. Methods: Ten adult albino mice weighing 20-30 grams of either sex were randomized to two groups (n=5). Group I: control group (Treated with solvent 0.1 ml/kg), Group II: Test group (Cetirizine 1mg/kg). All drugs were given orally. The analgesic activity was evaluated by using tail flick, tail immersion and tail clip methods. Reaction time of animals to pain sensation before and after Cetirizine administration were noted at 0, 15, 30, 60 and 90 minutes time intervals respectively on Day 1, 3, 5, 7, 10. Results: Mean reaction time was expressed as Mean±SEM, and one way ANOVA was used to assess statistical significance. Cetirizine was found to have statistically significant analgesic effect in mice and time dependent increase in analgesic effect were observed in all three pain models and maximum analgesic activity was observed at 60 minutes (p<0.001) after drug administration. Conclusions: Through this study, Cetirizine, a second generation antihistamine, is found to have significant analgesic activity in mice. This effect has to be studied further elaborately in animals as well as in humans.

Salt stress tolerance and stress proteins in pearl millet (Pennisetum glaucum (L.) R. Br.).

Salt stress as a major adverse factor can lower leaf water potential, leading to reduced torgor and some other responses, and ultimately lower crop productivity in arid and semi arid zone. Plant responses to salt stress have much in common. Salt stress reduces the ability of plants to take up water and this quickly causes reductions in growth rate. The initial reduction in shoot growth is probably due to salt effects. If excessive amounts of salt enter into the plant, salt will eventually rise to toxic levels and reduce the photosynthetic leaf area of the plant that cannot sustain growth. In order to understand the processes that give rise to tolerance of salt and to identify the salt stress proteins in the salt stress effect of on plant growth was studied using different salt solutions like Copper sulphate, Cadmium chloride and zinc sulphate with different concentrations like 200μM, 150μM, 100μM.

Periodontal infections: A risk factor for various systemic diseases.

A healthy periodontium is vital for the general well-being of an individual. However, periodontal diseases are common and periodontal infections are increasingly associated with systemic diseases. We aimed to critically evaluate the literature on the association between periodontal infections and systemic diseases. We searched the PubMed database over a 20-year period for literature on periodontal diseases and their links to various systemic diseases, and examined the strength of association between periodontal disease and each systemic disease, the dose–response relationship, and the biological plausibility. We found that individuals with periodontal disease may be at higher risk for adverse medical outcomes including cardiovascular diseases, respiratory infections, adverse pregnancy outcomes, rheumatoid arthritis and diabetes mellitus. Many cohort, in vitro and animal studies suggest that systemic inflammation due to pathogens associated with periodontal disease may play a role in the initiation and progression of some systemic diseases. Periodontal infections should therefore be considered as a risk factor for various systemic diseases.

Changing trends of candida species in neonatal septicaemia in a tertiary North Indian hospital.

Four hundred and fifty four blood samples of clinically diagnosed septicemic neonates were collected over a period of six months from the neonatal ICU of Kalawati Saran Children Hospital, New Delhi. 144 samples were culture positive; out of which 50 (34.7%) were Candida isolates. 92% isolates were Candida tropicalis, 4% were C. albicans and C. kefyr each. The study emphasises the changing pattern of Candida species and their importance in blood stream infections in neonates.

Anti-keratin antibodies in patients with rheumatoid arthritis.

As the proportion of patients with rheumatoid arthritis (RA) who have anti-keratin antibodies (AKA) varies in different ethnic groups, we studied its occurrence in a hospital populations with RA and its association with different disease variables. Sera from 84 consecutive patients with RA, 100 healthy controls and 85 disease controls (polyarticular juvenile rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis) were tested for AKA by an indirect immunofluorescence assay that used rat esophagus as substrate. The proportion of patients with RA who had AKA (47/84) was higher than in healthy controls (2/100; P < 0.001) and in disease controls (2/85; P < 0.001). The frequency of AKA positivity was higher among patients who had severe disease (P < 0.05) and rheumatoid factor. Anti-keratin antibody is present in 56 per cent of our patients with RA and is associated with severe disease.